The Trump administration pledged Wednesday to reduce end stage kidney disease by 25 percent by 2030, proposing to provide better care earlier in the disease’s progression and double the number of kidney transplants performed in the United States.

President Trump signed an executive order Wednesday morning that is also designed to move many of the more than 500,000 people receiving kidney dialysis away from commercial centers to less expensive in-home care.

Trump said the order delivers “ground-breaking action to millions of Americans suffering from kidney disease. It’s a big deal.”

In a briefing for reporters before Trump’s speech, Joe Grogan, head of the White House Domestic Policy Council, described the package of initiatives as the biggest improvement in kidney care since the government extended coverage of kidney failure under Medicare in 1973.

Medicare spends more than $110 billion on kidney care, about 20 percent of all fee-for-service dollars paid out by the giant government health insurance program.

“The focus has been on paying for procedures rather than paying for good outcomes,” Secretary of Health and Human Services Alex Azar said in the telephone briefing. “Under the president’s leadership, we’re going to flip that around.”

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A career as a physician has traditionally been considered to be among the best vocations that talented students can pursue. That may no longer be the case. All too many doctors report that they are unhappy, frustrated and even prepared to leave the profession. That should worry all of us. The physician burnout crisis is likely to affect our quality of care and our access to health care providers.

According to a recent study, 44% of U.S. doctors suffered at least one symptom of burnout, and some studies have identified even higher burnout rates. By contrast, researchers have found only a 28% burnout rate in the general working population.

In a forthcoming academic article, I argue that physician burnout is as much a legal problem as it is a medical one. Many laws and regulations protect the health and welfare of American workers. This is particularly true when public safety depends on those jobs. Regulations limit the work hours of air traffic controllers, pilots, flight attendants and other transportation workers so they are well rested on the job.

Likewise, physicians have safety-critical jobs because patients routinely put their lives in doctors’ hands. That’s why I believe policymakers must turn their attention to the needs of doctors.

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A state inspector in Missouri documented the grim details: a deep, poorly treated pressure wound on the patient’s tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where the feeding tube entered his abdomen.

The official cited Vitas Healthcare, the nation’s largest hospice chain, for putting the patient in “immediate jeopardy,” the most severe category of violation. The inspector found that Vitas staffers had skipped home visits and failed to assess the amount of pain the patient endured.

The case is among the most severe of a dozen examples of patient suffering cited in a strongly worded inspector-general report on the hospice industry released Tuesday. The report takes Medicare to task for what it describes as weak oversight and enforcement of the growing ranks of hospice providers and recommends stronger safeguards “to protect Medicare hospice beneficiaries from harm.’’

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In 2015, Travis Rieder, a medical bioethicist with Johns Hopkins University’s Berman Institute of Bioethics, was involved in a motorcycle accident that crushed his left foot. In the months that followed, he underwent six different surgeries as doctors struggled first to save his foot and then to reconstruct it.

Rieder says that each surgery brought a new wave of pain, sometimes “searing and electrical,” other times “fiery and shocking.” Doctors tried to mitigate the pain by prescribing large doses of opioids, including morphine, fentanyl, Dilaudid, oxycodone and OxyContin. But when it came time to taper off the drugs, Rieder found it nearly impossible to get good advice from any of the clinicians who had treated him.

Rieder likens his experiences trying to get off prescription pain meds to a game of hot potato. “The patient is the potato,” he says. “Everybody had a reason to send me to somebody else.”

Eventually Rieder was able to wean himself off the drugs, but not before receiving bad advice and going through intense periods of withdrawal. He shares his insights as both a patient and a bioethicist in a new book, In Pain: A Bioethicist’s Personal Struggle With Opioids.

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The US Senate Finance Committee is demanding that pain societies and advocacy groups disclose any and all payments received from opioid manufacturers.

Sen. Chuck Grassley (R-IA), who heads the committee, and Sen. Ron Wyden (D-OR), the minority leader, sent letters to 10 organizations asking about their financial relationships with opioid makers and other medical entities that manufacture products to treat pain.

“As Chairman and Ranking Member of the Senate Finance Committee, we have a responsibility to ensure transparency and accountability in matters that directly affect Federal healthcare programs and tax-exempt organizations. This responsibility includes examining the extent to which pharmaceutical manufacturers fund tax-exempt organizations and how these payments may influence pain treatment practices and policy,” the senators write.

The letters were sent to the American Chronic Pain Association, the American Pain Society, the American Society for Pain Management Nursing, the American Society of Pain Educators, the Center for Practical Bioethics, the Federation of State Medical Boards, the Joint Commission, the American Academy of Physical Medicine and Rehabilitation, the Alliance for Patient Access, and the International Association for the Study of Pain.

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There are a lot of news stories that the hard-working staff here at Spoiler Alerts have been following closely. These topics that warrant thoughtful columns that weave together current events, scholarly literature and hard-earned policy knowledge. The aim, as always, is to generate some useful scribblings that might help make the chaos of 2019 more recognizable to readers desperate for clarity. And I promise, those columns are coming.

First, however, I have to deal with the possibility of zombie pig brains and what that means for world politics.

If you have no idea what I am talking about, I would strongly suggest that you read Matthew Shaer’s New York Times Magazine cover story about the newfound ability to revive cellular activity in postmortem pig brains. Savvy readers will recall that this story first made waves three months ago when the research was published in a peer-reviewed Nature article and covered by NPR’s Nell Greenfieldboyce at the time. Here’s the paper abstract:

The brains of humans and other mammals are highly vulnerable to interruptions in blood flow and decreases in oxygen levels. Here we describe the restoration and maintenance of microcirculation and molecular and cellular functions of the intact pig brain under ex vivo normothermic conditions up to four hours post-mortem. We have developed an extracorporeal pulsatile-perfusion system and a haemoglobin-based, acellular, non-coagulative, echogenic, and cytoprotective perfusate that promotes recovery from anoxia, reduces reperfusion injury, prevents oedema, and metabolically supports the energy requirements of the brain. With this system, we observed preservation of cytoarchitecture; attenuation of cell death; and restoration of vascular dilatory and glial inflammatory responses, spontaneous synaptic activity, and active cerebral metabolism in the absence of global electrocorticographic activity. These findings demonstrate that under appropriate conditions the isolated, intact large mammalian brain possesses an underappreciated capacity for restoration of microcirculation and molecular and cellular activity after a prolonged post-mortem interval.

In English: It turns out that it is possible, with the right equipment, to revive some aspects of brain activity in large mammals — including human beings — after death.

Now there are a HECK of a lot of implications for this kind of research, and Shaer does an excellent job of describing both the science and the bioethics behind this paper. He focuses in particular on the lead author of the article, Yale neuroscience researcher Nenad Sestan.

Now as someone who has also published peer-reviewed research on the international implications of reanimating dead tissue, I can imagine all the questions you might have. Having read Shaer’s story carefully, I think there are a few important takeaways

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One of America’s leading medical organizations has filed a lawsuit to block a North Dakota abortion law requiring doctors to tell women that a medication-induced abortion can be “reversed,” an assertion medical experts say is scientifically unsound.

The American Medical Association has joined the Red River Women’s Clinic, the last abortion facility in the state, and its medical director, Kathryn Eggleston, to argue that the law violates doctors’ constitutional right to free speech by forcing them to lie to patients. The plaintiffs also contest an existing provision in North Dakota law that requires a doctor to tell a woman that the abortion will “terminate the life of a whole, separate, unique, living human being,” a statement they argue is ideologically biased and “forces physicians to act as the mouthpiece of the state.”

The AMA joined with the Center for Reproductive Rights to file the lawsuit.

AMA President Patrice A. Harris told The Washington Post that “we will oppose any law or regulation that restricts our ability to talk to our patients honestly about their health, health care, or treatment alternatives.”

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