The article discusses the shift of power in clinical trials from the US to China and India. The US, once a leader in medical research, is in decline. After recent funding cuts, 383 trials were stopped. Cuts to federal science funding combined with the political situation under the Donald Trump regime are creating a research ecosystem that is pulling funding. Politics cannot be separated from medicine, including medical research. The BMJ publishes articles on the political determinants of health and the geopolitics of global health. Medicine is one of the geopolitical "soccer balls".