By Brett Kelman, KFF Health News

NASHVILLE, Tenn. — Federal prosecutors sought a maximum prison sentence of nearly 20 years for the CEO of Pain MD, a company found to have given hundreds of thousands of questionable injections to patients, many reliant on opioids. It would have been among the longest sentences for a health care executive convicted of fraud in recent years.

Instead, he got 18 months.

Michael Kestner, 73, who was convicted of 13 fraud felonies last year, faced at least a decade behind bars based on federal sentencing guidelines. He was granted the substantially lightened sentence due to his age and health Wednesday during a federal court hearing in Nashville.

U.S. District Judge Aleta Trauger described Kestner as a “ruthless businessman” who funded a “lavish lifestyle” by turning medical professionals into “puppets” who pressured patients into injections that did not help their pain and sometimes made it worse.

“In the court’s eyes, he knew it was wrong, and he didn’t really care if it was doing anyone any good,” Trauger said.

But Trauger also said she was swayed by defense arguments that Kestner would struggle in federal prison due to his age and medical conditions, including the blood disorder hemochromatosis. Trauger said she had concerns about prison health care after considering about 200 requests for compassionate release in other court cases.

“The medical care at these facilities,” defense attorney Peter Strianse said, “has always been dodgy and suspect.”

Kestner did not speak at the court hearing, other than to detail his medical conditions. He did not respond to questions as he left the courthouse.

Pain MD CEO Michael Kestner leaves a federal courthouse in Nashville, Tennessee, followed by one of his lawyers, after being sentenced to 18 months in federal prison on May 14, 2025. ((Brett Kelman/KFF Health News)/KFF Health News/TNS)

Pain MD ran as many as 20 clinics in Tennessee, Virginia, and North Carolina throughout much of the 2010s. While many doctors were scaling back their use of prescription painkillers due to the opioid crisis, Pain MD paired opioids with monthly injections into patients’ backs, claiming the shots could ease pain and potentially lessen reliance on pills, according to federal court documents.

During Kestner’s October trial, the Department of Justice proved that the injections were part of a decade-long scheme that defrauded Medicare and other insurance programs of millions of dollars by capitalizing on patients’ dependence on opioids.

The DOJ successfully argued at trial that Pain MD’s “unnecessary and expensive injections” were largely ineffective because they targeted the wrong body part, contained short-lived numbing medications but no steroids, and appeared to be based on test shots given to cadavers — people who felt neither pain nor relief because they were dead. During closing arguments, the DOJ argued Pain MD had turned some patients into “human pin cushions.”

“They were leaned over a table and repeatedly injected in their spine,” federal prosecutor Katherine Payerle said during the May 14 sentencing hearing. “Over and over, month after month, at the direction of Mr. Kestner.”

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At last year’s trial, witnesses testified that Kestner was the driving force behind the injections, which amounted to roughly 700,000 shots over about eight years, with some patients receiving up to 24 at once.

Four former patients testified that they tolerated the shots out of fear that Pain MD otherwise would have cut off their painkiller prescriptions, without which they might have spiraled into withdrawal.

One of those patients, Michelle Shaw, told KFF Health News that the injections sometimes left her in so much pain she had to use a wheelchair. She was outraged by Kestner’s sentence.

“I’m disgusted that all they got was a slap on the wrist as far as I’m concerned,” Shaw said May 14. “I hope karma comes back to him. That he suffers to his last breath.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

This past week, the U.S. and China reached an initial trade agreement that will, in theory, halt the countries’ slide toward a full-blown trade war.

Yet the dynamics that fueled President Donald Trump’s attempt to single-handedly decouple the world’s two largest economies persist. Absent more vigorous efforts to limit misunderstandings and miscalculations between Washington and Beijing, the two countries could easily re-enter the escalatory spiral they’re trying to escape — not only threatening Americans’ pocketbooks, but risking disastrous military conflict.

History is full of examples where trade wars, boycotts, and competition over trade routes and markets led to military-political crises and conflict — just look at the Anglo-Dutch Wars of the 17th century, the Opium War between Great Britain and China in the 19th century, or the run-up to the U.S.-Japan conflict during World War II. During the Cold War, confrontation over trade and economic issues between Washington and Moscow contributed to the exacerbation of their military and overall strategic animosity.

In most such cases, conflicts or crises arose from efforts by one or more parties to use military violence to block trade routes, force open — or monopolize — a market, or apply decisive economic pressure to achieve political concessions or block technology acquisitions.

Often, those countries employing military force were acting out of a sense of desperation, or because of a false belief that they enjoyed a lasting level of military superiority. Regardless, misperceptions and miscalculations abounded, resulting from hubris, deep-rooted historical or cultural biases, poor diplomatic signaling, or poor intelligence regarding capabilities and intentions. And regular people paid the price for these mistakes.

America’s relationship with China today exhibits many similar characteristics — parallels which should chasten those in Washington who see the forced decoupling of the world’s two largest economies as more promising than dangerous.

For example, in prosecuting the trade war, Trump operates based on a wide range of largely false assumptions and images about global trade, Chinese attitudes and behavior, and U.S. strategic advantages over China. He views trade surpluses with the United States as a form of theft, tariffs as a source of painless revenue, and China as an unqualified economic predator. He also apparently believes that a tariff-generated trade war will greatly boost U.S. manufacturing, lower prices, and increase overall living standards for Americans.

And the actions he takes, based on these false views, appear to be driven by overconfidence that America enjoys a clear economic superiority in any contest with China. Finally, reinforcing Trump’s perception of Beijing as an economic predator is a broader popular image of China as a democracy-destroying, norm-busting, communist nation bent on replacing the United States as the dominant global power.

Likewise, for its part, Beijing’s confrontational response to Trump’s tariff war, although justified in some ways, incorporates a slew of equally deep-seated images and distortions about the U.S. and the West in general — some of which may be accurate, while many are not.

On the broadest level, many Chinese harbor a deep historical sense of suspicion and resentment toward the United States and other Western powers, originating from their so-called Century of Humiliation at the hands of the imperialist West and Japan.

Reinforcing this historical Chinese pessimism toward the United States is an increasingly widespread and firm belief sustained by the Chinese Communist Party that Washington is committed to containing and weakening China as a nation in order to sustain its own global hegemonic power.

In fact, Trump’s tariff attack on China is viewed by many Chinese as a weapon in that containment effort. In response, Beijing has adopted a predictably vigorous “tit-for-tat” stance, willing to meet every U.S. escalation with an equal or even greater escalation, secure in the rather arrogant belief that China is acting out of moral principle against an unjust opponent.

All of these dynamics combine to produce a volatile mix that could turn an escalating trade war into something more dangerous, with each side acting out of a sense of distrust, hostility, and resentment. Given the recent agreement, we may still be far from seeing U.S.-China trade disputes transform into any sort of military confrontation; the stakes are simply not high enough to justify the risks involved in two nuclear powers resorting to military force to resolve economic disputes.

Nevertheless, worsening conflict over trade, driven by hardening negative assessments of each side’s overall strategic intentions, could lower the threshold for smaller crises over Taiwan or disputes in the South China Sea or cause one or both sides to resort to severe, non-trade-related punishments — outcomes that could fuel dangerous political-military escalations and lead to the worst case scenario: a direct U.S.-China military confrontation.

Unfortunately, Beijing and Washington lack reliable and effective means of averting and successfully managing any such crises. A physical hotline of sorts exists, but it does not function effectively for several reasons, including the lack of a clear protocol for establishing communication as early as possible in a crisis.

In addition, the two sides no longer have mutually trusted interlocutors with deep experience in the relationship who can share views in an unofficial manner, thus reducing misperceptions. Moreover, crisis management is incorrectly treated by both sides as largely a military-to-military issue. In fact, any serious Sino-American crisis will be managed by senior civilian officials.

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Yet there is little evidence that such officials are briefed on the specific pitfalls involved in accurately assessing and responding to the crisis behavior of the other side. And yet such guidelines exist. And this is all made worse by the significant uncertainties presented by a U.S. president who does not seem to value expert advice, preferring instead to govern based on his instincts.

Persistent U.S.-China trade conflict doesn’t just pose massive risks to U.S. companies and consumers — it could help fuel dynamics on both sides that could lead to a mutually destructive conflict.

Beijing and Washington should build on the welcome progress they’ve made in defusing this trade war and urgently work to establish mechanisms to mitigate the risk that such disputes will spiral into military confrontation.

Michael Swaine is Senior Research Fellow for the Quincy Institute for Responsible Statecraft. He wrote this column for Tribune Content Agency.

On a Thursday morning in March, my family needed to accomplish three things at exactly the same time.

My husband had to board a plane to return from a business trip in London. I had agreed to moderate a panel discussion about how the cost of child care in New York City is harming the local economy. And someone had to sign our daughter up for a first-come-first-served preschool program that typically fills its seats within 90 to 120 seconds of their online release at 10 a.m.

We had not properly accounted for this overlap through our shared Google calendar.

Our snafu echoes across continents and generations, an age-old problem with a newish name: the mental load.

It’s the tedious, all-consuming work of planning our lives, made all the more tedious when young children are in the mix and free time seems to shrink to fleeting glances.

Enter the digital calendar, which aims to make invisible work very, very visible.

We received ours five to seven business days after our Thursday morning meltdown. We had identified our problem — essential information for our household was being shared only in snippets of conversation or haphazard Google calendar invites instead of one central place — and searched for a solution with a monthly installment payment.

The Skylight Calendar, which can cost $170 to $630, depending on size, all with an optional $79 annual subscription fee to unlock special features, would make our scheduling conflicts impossible to ignore. The company took $30 off some of its calendars for Mother’s Day.

Our various appointments, early-morning calls and evening drinks would be beamed 24 hours a day, in all their color-coded glory, from the Skylight’s commanding position in the middle of our hallway.

About 888,000 families own a Skylight, its co-founder Michael Segal, who has two children under 2, told me. The Hearth, one of the first entries into the category of supersize calendars that you can hang on a wall, was created by three working mothers and is itself a supersized version of the Skylight. It sells for $700, with a $9 monthly fee, though the company also ran a sale for Mother’s Day, offering 15% off for Mother’s Day.

The idea behind the product, said Susie Harrison, one of Hearth’s co-founders, was to “externalize the primary caregiver’s brain, and put that into a system that everyone could see.”

I wanted to know how other families used their calendars, and spent the next few weeks talking with the tools’ power users and skeptics: most partnered, all straight, with family budgets that could comfortably include a digital calendar. They were all ages 35 to 50, in the thick of raising young kids and juggling career demands.

I wanted to know if these families felt that the money had been worth it, if they had finally found a technological solution to an analog problem at the heart of human nature: that we cannot read our spouse’s minds, to know when they scheduled our kid’s next dental appointment or gymnastics class.

Or, I wondered, had the purported fix uncovered new friction points, hiding in familiar gendered expectations of who does what to keep a household running.

The ‘Calendar Partner’

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I reached Linda Caro on a Friday morning, as she was preparing for a transcontinental flight. Caro and her husband are both flight attendants, working opposite schedules, and they are both technically based in New York City despite living in Redlands, California, with their two children, 10 and 13, who attend different schools.

She unwrapped the Skylight last year on Christmas morning, a gift from her husband who had noticed that putting some of their events on a whiteboard calendar — and then taping their kids’ school calendars into a semicircle around it — wasn’t really working.

“It was my system; nobody else really understood it,” she said. But, she told me, she quickly became “obsessed” with her Skylight, and joined Facebook and Reddit groups for other die-hard users. “It’s like something we wish we could have invented ourselves,” she said. (Caro is such an enthusiastic user that she recently became an unpaid ambassador to the brand, allowing her to dispense 15% off discount codes to friends, for which she said she receives a small commission.)

She gave her two sisters, who live nearby, access so they could see when she would be flying and could help pitch in on child care. The kids can now check the calendar to track their parents’ flight numbers. Caro even created an alert on the calendar to remind her husband to do the laundry — a move that some husbands might see as overbearing but that Caro said hers was on board with.

Still, Caro is the only person in the family consistently adding events to the Skylight. “That’s something we can work on,” she admitted.

It is hard to avoid the dynamic of one spouse becoming the “calendar partner,” a phrase that sent a chill down my spine when Allison Daminger, a sociologist at the University of Wisconsin-Madison, explained it to me recently.

We talked about the remedy that many families land on when trying to redistribute household labor: using the skills they have learned at work to help run their family life.

“You don’t always want to go from a day of back-to-back Zoom meetings and then go home and have a check-in meeting with your partner,” said Daminger, the author of the forthcoming book “What’s on Her Mind: The Mental Workload of Family Life.”

But that’s exactly what several couples told me they do.

Who Knows When Trash Day Is?

The uncluttered calendar represents true logistical nirvana, said Eve Rodsky, who helped bring the idea of the mental load to the masses with her 2019 book, “Fair Play,” and accompanying deck of cards, each with its own task, used by couples around the country to divvy up their responsibilities.

Rodsky has put the system to work in her own home. Her husband is in charge of every aspect of the trash in their home — from noticing when the garbage bags are running low and restocking them to sorting the recycling to picking a cadence for when the trash is taken out.

Owning every aspect of a task, a practice Rodsky has coined CPE, for conception, planning and execution, is the only way to truly lighten the mental load, she says. And you can’t calendar your way out of that.

“My biggest fear is the disappointment people are going to have when they think this amazing new shiny app will solve their gender-equity issues,” she said.

Daminger said she had been approached by some entrepreneurial digital calendar founders who wanted her advice on how these tools might help moms in particular. “I often end up being a buzzkill,” she said, “where I say, ‘I’m not sure this is actually going to change the underlying dynamic.’”

Ruth de Castro, who has two teenagers and works in technology, understands that dynamic well. Her marriage had long felt unequal, but absorbing Rodsky’s work on the mental load was the final straw that led to her divorce, de Castro said.

“I didn’t have language for why keeping all those things in my brain was driving me crazy,” said de Castro, who lives in California’s East Bay and works in technology.

When she was still with her husband, she debated buying a Hearth — “I was like, Do I really need this thing? It’s 600 bucks,” she recalled — but took the plunge after she mixed up some dates and missed her daughter’s ballet recital.

She uses the Hearth to help ease the scheduling burden of co-parenting her two teenagers with her soon-to-be-ex-husband. It’s actually simpler now that she doesn’t have to hope that her partner will add important appointments to the calendar.

“You can buy something really aesthetic and nice,” she said. “But if you’re not consistent as a parent, it’s almost like another thing you have to micromanage.”

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Today is Saturday, May 17, the 137th day of 2025. There are 228 days left in the year.

Today in history:

On May 17, 1954, a unanimous U.S. Supreme Court handed down its Brown v. Board of Education of Topeka decision, which held that racially segregated public schools were inherently unequal and therefore unconstitutional.

Also on this date:

In 1792, the Buttonwood Agreement, a document codifying rules for securities trading, was signed by 24 New York stockbrokers, marking the formation of the New York Stock Exchange.

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Today in History: May 14, Jamestown becomes North America’s first English settlement

In 1875, the first Kentucky Derby was held; the race was won by Aristides, ridden by jockey Oliver Lewis.

In 1946, President Harry S. Truman seized control of the nation’s railroads, delaying — but not preventing — a threatened strike by engineers and trainmen.

In 1973, a special committee convened by the U.S. Senate began its televised hearings into the Watergate scandal.

In 1980, rioting that claimed 18 lives erupted in Miami after an all-white jury in Tampa acquitted four former Miami police officers of fatally beating Black insurance executive Arthur McDuffie.

In 1987, 37 American sailors were killed when an Iraqi warplane attacked the U.S. Navy frigate Stark in the Persian Gulf. (Iraq apologized for the attack, calling it a mistake, and paid more than $27 million in compensation.)

In 2004, Massachusetts became the first U.S. state to allow same-sex marriages.

In 2015, a shootout erupted between members of motorcycle clubs and police outside a restaurant in Waco, Texas, leaving nine of the bikers dead and 20 people injured.

Today’s Birthdays:

Musician Taj Mahal is 83.
Boxing Hall of Famer Sugar Ray Leonard is 69.
Sports announcer Jim Nantz is 66.
Singer-composer Enya is 64.
TV host-comedian Craig Ferguson is 63.
Musician Trent Reznor (Nine Inch Nails) is 60.
Actor Sasha Alexander is 52.
Basketball Hall of Famer Tony Parker is 43.
Screenwriter-actor-producer Lena Waithe is 41.
Dancer-choreographer Derek Hough is 40.
Former NFL quarterback Matt Ryan is 40.
Actor Nikki Reed is 37.