President Donald Trump named Robert Wilkie, a veteran GOP aide and acting secretary of the Veterans Affairs (VA), to lead the VA; with the power of a pen, HHS Secretary Alex Azar is eager to play the role of a “joyful regulator;” patients with amyotrophic lateral sclerosis (ALS) are finding they are caught between hope, expectations, and insurers that won’t pay for a $145,000 intravenous drug.