And after months of blustery talk from President Donald Trump about lowering drug prices and cracking down on Big Pharma, his plans are finally starting to take shape, beginning with pacts with manufacturers.

But before we get too excited, consumers should demand more transparency about what they’re getting from his dealmaking — and ask who is truly benefiting from the sum of his health care actions.

Trump wisely put the issue of drug costs front and center, promising consumers a better deal than what his predecessors could extract from companies. His main strategy has been to threaten pharma companies with outlandishly high tariffs if they didn’t comply with his demands, which included reshoring manufacturing, bringing U.S. drug prices in line with those in Europe, and expanding direct-to-consumer sales.

The deal with Pfizer announced last week seemed to check all the president’s boxes by offering most-favored-nation prices to Medicaid, a commitment to invest in U.S. production, and an agreement to feature some of its branded drugs on a TrumpRx portal. In exchange, the company is exempt from tariffs for the next three years. Other companies appear to be negotiating their own deals, fueling a sense that months of uncertainty and anxiety may soon be in Big Pharma’s rear window.

All of that sounds promising — until you look at the details, which remain murky.

When weighing the merits of the deal for consumers, it’s worth noting the differences in language between Trump’s press conferences, the White House fact sheet, and Pfizer’s press release, says Stacie Dusetzina, who studies drug policy and prices at Vanderbilt University.

A few words in the Pfizer release stand out. “Voluntary,” for example, and “confidential.” The careful language and lack of real details about the arrangement suggest that, despite the fanfare, “Pfizer got a really good PR deal out of it,” Dusetzina says.

It’s far less clear if American health care consumers got a good deal.

For starters, few people are likely to benefit from Trump’s direct-to-consumer website. Yes, Pfizer has agreed to sell drugs there at discounts as high as 85%, and an average of about 50%, but people with insurance usually pay only a fraction of list prices or a small copay. That significantly narrows the site’s appeal mainly to people without insurance, or to those whose insurance no longer covers a brand-name drug they prefer.

But even that group might not find it helpful. Discounting a wildly expensive drug can still leave patients with a crushing bill. Take, for example, the 40% price cut for Pfizer’s arthritis treatment Xeljanz that the White House touted in its fact sheet. With a list price of more than $6,000 per month, patients would still be on the hook for about $3,600 per month. (That same drug, notably, can easily be found for a lower price through GoodRx.)

Many pharma companies were already setting up their own direct-to-consumer websites, and Trump’s demands seem to be simply accelerating that move. Amgen, for example, announced Monday it would sell its cholesterol-lowering treatment Repatha at a 60% discount on a newly established site and eventually offer it through TrumpRx. (Like Xeljanz, the drug can be found at the same discounted price on GoodRx.) And Mark Cuban’s Cost Plus Drugs offers a transparent pricing model, raising the question of whether TrumpRx will offer consumers anything new or better.

Meanwhile, Medicaid’s most-favored-nation pricing approach also sounds promising, but it’s nearly impossible to gauge savings. Dusetzina points out that it’s unclear how Medicaid’s current payments compare to international prices. And because legislation that went into effect last year discourages price hikes and incentivizes cuts, it’s possible that Medicaid may already pay less than other countries for older brand-name drugs.

“The details really matter, and I don’t think we’re ever going to get the details to be able to understand if this was a good deal or not for the American public,” Dusetzina says.

Amid all the bluster, it would be easy for the public to overlook the other, more substantive health policy changes the Trump administration is making — unfortunately, some to consumers’ detriment.

The biggest are deep cuts to Medicaid and the likely expiration of subsidies used by most people with Affordable Care Act health plans. Combined with smaller policy shifts, these changes will result in an estimated 15 million more uninsured Americans by 2034, according to Congressional Budget Office estimates. For them, drugs will be far more expensive without insurance coverage — and studies show that cost is a major factor in whether people stick to their medications.

And while health policy experts are relieved that the Trump administration isn’t completely scrapping Medicare’s new drug-price negotiation powers, the president’s One Big Beautiful Bill significantly watered them down.

In a gift to pharma, the bill broadened reprieves to drugs that treat rare conditions. Under the original law, a medication treating a so-called orphan disease was exempt from Medicare negotiations. Trump’s bill expanded the scope, allowing drugs treating multiple rare conditions to be excluded altogether, and delaying the negotiations for drugs that first came onto the market as rare treatments but later gained approval for common conditions.

That shift could potentially delay Medicare’s ability to negotiate key drug prices, eating into projected savings — and ultimately costing seniors more. The CBO initially projected the change would sacrifice some $5 billion in savings, but that calculation is  viewed as a gross underestimate because it excluded the impact of several blockbuster drugs.

Merck & Co. and Bristol Myers Squibb, which market lucrative cancer immunotherapies that are expected to get a year’s reprieve, are among the biggest winners. Medicare accounts for a substantial portion of Merck’s revenue from Keytruda, which is projected to top $31 billion this year. In 2023, the government program spent some $5.4 billion on the cancer treatment — about a fifth of its total sales.

Trump’s focus on lowering drug prices targets a critical issue for Americans. But without far greater transparency, it’s impossible to assess whether his wheeling and dealing benefits consumers as much as it does Big Pharma. Until then, it’s hard not to worry that he’s creating the illusion of big savings, while behind the scenes making consequential decisions that could cost patients and the government dearly.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

In a world that often seems to be teetering on the edge of chaos, what hope is there for defenseless fish?

The Atlantic cod off the eastern coast of Canada were once such an abundant resource that their dried flesh helped drive the colonization of the Americas, spawning local delicacies from Spanish bacalao to Jamaican ackee and saltfish. Industrialized harvesting caused a collapse in populations in the 1980s and 1990s, leading many diners to switch to monkfish instead — until that species, too, went into decline.

It can feel like an inevitable cycle. Humans seem incapable of carrying out the most basic measures to protect common resources from over-exploitation — whether it’s the carbon that we spew into the atmosphere, the plastics that we scatter through the environment, or wild animals that we’ve been hunting to extinction since the paleolithic era. And yet on the high seas, there are encouraging signs that concerted efforts can reverse the process.

Take tuna. Like cod and monkfish, the most prized species once seemed to be on the verge of disappearance, thanks largely to our insatiable hunger for sushi. The skipjack tuna that you’ll typically find in cans is super-abundant, but the three main species of bluefin tuna were in a much more precarious state. Bluefins are  rarer, slow-growing and can be as long as a small car. Diners, particularly in Japan, prize their flesh for its complex, buttery taste, and fish sometimes sell for millions of dollars apiece.

The global catch fell by half between 2005 and 2011 as years of overfishing left populations too small to rebuild themselves. In 2010, a proposal to ban commerce in Atlantic bluefin came close to passing at the United Nations Convention on International Trade in Endangered Species, a move that would have given it similar levels of protection to the rhinoceros and elephant. The following year, the International Union for Conservation of Nature warned that more than half of tuna species were facing extinction. There was “little hope of recovery” for the southern bluefin, one of the IUCN’s authors was quoted as saying.

That’s not what happened. The same year, the countries fishing the southern bluefin’s habitat in the Indian and Southern Oceans for the first time agreed to joint limits on how much they could catch. Monitoring of fish stocks could provide a decent estimate of how many animals were out there, and how fast they were reproducing. By keeping the catch within reasonable bounds, the fishery could gradually rebuild to the point where populations were sustainable and exploitation was profitable.

The policy, along with similar measures to preserve other tuna species, was a remarkable success.

A revision to the IUCN’s endangered list in 2021 took the Atlantic bluefin from “endangered” to “least concern;” albacore and yellowfin, both seen as “near threatened” in 2011, were also moved to “least concern.” Southern bluefin, which had been seen as “critically endangered” since the 1990s, was lifted to merely “endangered.” As populations recovered, catches of the southern species nearly doubled, from 9,400 tons in 2011 to 17,000 in 2021.

Right now, tuna is probably one of the most sustainable wild fish you can eat. Some 99.3% now comes from sustainable stocks, according to a report released by the Food and Agriculture Organization recently, with 87% of stocks now being fished sustainably. That’s far better than the average 64.5% of stocks across all fish species.

With the exception of Mediterranean albacore (a favorite of Spanish canneries) and bigeye in the Indian Ocean, every population is now being fished within sustainable levels. Compare that to Atlantic cod, where just 21.7% of stocks are being fished sustainably, and the difference is stark.

There’s a lesson in this: Capitalist self-interest, combined with intensive regulation, can work — even when it’s being driven by our obsession with particular high-value foods. On land, we think of monocultures — the dominance of major food groups such as corn, apples and chickens — as a bad thing. In the ocean, where it’s inherently difficult to get a handle on just how many fish are lurking in the depths, monocultures can be beneficial. The fish that are most caught are, by and large, the ones that are best understood, and the easiest to manage sustainably.

Intensive management and catch quotas, like the rules helping the southern bluefin to recover, are also spreading beyond the richest countries to the likes of Thailand and Indonesia.

There’s no cause for complacency, however. Even fish being sustainably harvested could be just a few years away from an unexpected population collapse, and a growing human population with rising incomes and improving capture technology is inevitably going to maintain pressure on wild stocks for centuries to come.

Still, there’s nothing foreordained about our despoliation of the environment. In the seas, as on land and in the atmosphere, our efforts to rein in our over-exploitative tendencies can still find success.

David Fickling is a Bloomberg Opinion columnist covering climate change and energy. Previously, he worked for Bloomberg News, the Wall Street Journal and the Financial Times.

The U.S. Supreme Court has rejected the appeal of Anton “Tony” Lazzaro, the formerly well-connected Republican donor convicted of giving teenage girls gifts, alcohol and money in exchange for sex.

On Monday, the high court turned away Lazzaro with no comment. In February, the 8th U.S. Circuit Court of Appeals also denied his appeal.

Anton Lazzaro

In August 2023, Lazzaro was sentenced to 21 years in prison on federal sex trafficking convictions. He was convicted of seven counts involving “commercial sex acts” with five girls ages 15 and 16 in 2020, when Lazzaro was 30. The charges carried mandatory minimum sentences of 10 years with a maximum of life in prison.

Prosecutors had requested a 30-year sentence for Lazzaro. They likened Lazzaro to financier Jeffrey Epstein, who was arrested in 2019 on federal charges accusing him of paying underage girls for massages and then abusing them at his homes in Florida and New York. The defense asked for no more than 10 years.

Lazzaro, who has said the charges against him were politically motivated, maintained his innocence, denying that he paid any of the girls explicitly for sex.

Lazzaro’s indictment in 2021 touched off a political firestorm that led to the downfall of Jennifer Carnahan as chair of the Republican Party of Minnesota.

His co-defendant, Gisela Castro Medina, who was 19 at the time, formerly led the College Republicans chapter at the University of St. Thomas in St. Paul. She pleaded guilty to two counts last year. She testified against Lazzaro and was sentenced to three years in prison.

Prosecutors argued during his trial that Lazzaro enlisted Castro Medina, who he initially paid for sex, to recruit other teenagers — preferably minors — who were white, small, vulnerable or “broken.” He often sent cars to take the girls to his luxury penthouse condo at the Hotel Ivy in downtown Minneapolis, they said.

Pictures on Lazzaro’s social media accounts showed him with prominent Republicans, including President Donald Trump and former Vice President Mike Pence. He gave more than $270,000 to Republican campaigns and political committees over the years. Several recipients quickly donated those contributions to charity after the charges became public.

The sources of Lazzaro’s wealth have been murky. Defense filings called him “an up-and-coming real estate owner and entrepreneur.” Items seized from him included a 2010 Ferrari and more than $371,000 in cash.

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By STEPHEN GROVES and MARY CLARE JALONICK, Associated Press

WASHINGTON (AP) — The Senate was voting Wednesday on legislation to put a check on President Donald Trump’s ability to use deadly military force against drug cartels, as Democrats and at least one Republican tried to counter the administration’s extraordinary assertion of presidential war power to destroy vessels in the Caribbean.

It was the first vote in Congress on Trump’s military campaign that has so far has destroyed four vessels in the Caribbean, killed at least 21 people and stopped narcotics from reaching the U.S., according to the White House. The war powers resolution would require the president to seek authorization from Congress before further military strikes on the cartels.

The Trump administration has asserted that drug traffickers are armed combatants threatening the United States, creating justification to use military force. But that assertion has been met with some unease on Capitol Hill.

Some Republicans are asking the White House for more clarification on its legal justification and specifics on how the strikes are conducted, while Democrats insist they are violations of U.S. and international law. It’s a clash that could redefine how the world’s most powerful military uses lethal force and set the tone for future global conflict.

The White House has already indicated Trump would veto the legislation, and the Senate vote Wednesday was not expected to succeed, but it provided lawmakers an opportunity to go on the record with their objections to Trump’s declaration that the U.S. is in “armed conflict” with drug cartels.

“It sends a message when a significant number of legislators say, ‘Hey, this is a bad idea,’” said Sen. Tim Kaine, a Virginia Democrat who pushed the resolution alongside Democratic Sen. Adam Schiff of California.

What is the War Powers Resolution?

Wednesday’s vote was being brought under the War Powers Resolution of 1973, which was intended to reassert congressional power over the declaration of war. The legislation would bar the Trump administration from using military strikes against vessels in the Caribbean Sea unless Congress specifically authorizes it.

Sen. Rand Paul of Kentucky, who has long advocated for greater congressional power over war powers, was the lone Republican to support the legislation ahead of the vote, though Schiff and Kaine said others had expressed interest. A number of GOP senators have questioned the strikes on vessels and said they are not receiving enough information from the administration.

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“Congress must not allow the executive branch to become judge, jury and executioner,” Paul said in a floor speech.

Sen. Kevin Cramer, a North Dakota Republican, acknowledged “there may be some concern” in the Republican conference about the strikes.

However, Sen. Mike Rounds, a South Dakota Republican who like Cramer is on the Senate Armed Services Committee, said he did not expect many Republicans to vote for the resolution.

“I’m going to vote no when the president is exercising his constitutional responsibility,” Rounds said.

What has the administration told Congress about the strikes?

Members of the Senate Armed Services Committee received a classified briefing last week on the strikes, and Cramer said he was “comfortable with at least the plausibility of their legal argument.” But he added that no one representing intelligence agencies or the military command structure for Central and South America was present for the briefing.

“I’d be more comfortable defending the administration if they shared the information,” he said.

Kaine also said the briefing did not include any information on why the military chose to destroy the vessels rather than interdict them or get into the specifics of how the military was so confident that the vessels were carrying drugs. The Democrats also said the administration has told them it is adding cartels to a list of organizations deemed “narco-terrorists” that are targets for military strikes, but it has not shown the lawmakers the full list.

“Maybe they were engaged in human trafficking, or maybe it was the wrong ship,” Schiff said. “We just have little or no information about who was onboard these ships or what intelligence was used or what the rationale was and how certain we could be that everyone on that ship deserved to die.”

A visit from Rubio

Secretary of State Marco Rubio visited the Republican Conference for lunch Wednesday to emphasize to senators that they should vote against the legislation. He told the senators that the administration was treating cartels like governmental entities because they have seized control of large portions of some Caribbean nations, according to Sen. John Hoeven of North Dakota.

“These drug trafficking organizations are a direct threat to the safety and security of the United States to unleash violence and criminality on our streets, fueled by the drugs and the drug profits that they make,” Rubio told reporters at the Capitol. “And the president is the commander in chief, has an obligation to keep our country safe.”

Still, Democrats said the recent buildup of U.S. maritime forces in the Caribbean was a sign of shifting U.S. priorities and tactics that could have grave repercussions. They worried that further military strikes could set off a conflict with Venezuela and argued that Congress should be actively deliberating whenever American troops are sent to war.

Schiff said, “This is the kind of thing that leads a country, unexpectedly and unintentionally, into war.”

Associated Press writer Lisa Mascaro contributed.