When I started my training in 1980, we accepted an arithmetic that would now be indefensible. Central lines, the catheters we threaded into the great veins of the critically ill, became infected, and some of those patients died. We recorded the deaths as complications. Almost no one thought of them as preventable, because no one had yet done the slow work of proving they were.

That work got done, and federal money paid for it. Beginning in 2008, the Agency for Healthcare Research and Quality, a small arm of the health department, funded a national effort in more than a thousand adult intensive care units: a checklist, a sterile insertion protocol, and a unit culture in which a nurse could stop a surgeon. Central-line bloodstream infections fell by 41%, from 1.915 to 1.133 per 1,000 catheter days. The agency estimates that effort alone averted between 290 and 605 deaths. Across its wider work on hospital-acquired harm, AHRQ’s own accounting credits 20,500 deaths prevented and $7.7bn saved in the four years from 2014 to 2017. Hardly any of my patients have heard of the agency. That was always rather the point.

On 15 July, AHRQ sent researchers around the country nearly identical letters ending at least 104 grants, most of them aimed at making care safer. Congress appropriated $345m for the agency this fiscal year. It has spent under $15m on grants and has not issued a new one in more than a year. About three-quarters of the staff have been fired or have quit since Donald Trump took office, and the office that ran grant review was eliminated last summer. An agency with no grant managers cannot make grants, which tells you how long the closure........

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