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Vikas Saini: a career protecting patients from the excesses of medicine

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4753 (Published 24 October 2017) Cite this as: BMJ 2017;359:j4753
  1. Jeanne Lenzer, freelance journalist
  1. New York, USA
  1. jeanne.lenzer{at}gmail.com

The campaigning US cardiologist once chose medicine over political activism, writes Jeanne Lenzer, now he works to combine them

Earlier this year the Boston cardiologist Vikas Saini, along with journalist Shannon Brownlee, led an international team of 27 co-authors to publish a series of articles for the Lancet about the global scourges of undertreatment and overtreatment. The series comprised a call to action against the physical, psychological, and social harms to patients, and wasteful misallocation of resources, caused by medical overuse and underuse and included a framework for addressing them”1

Saini and Brownlee began collaborating in 2011, after he read Brownlee’s book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. Together they organized the first Avoiding Avoidable Care Conference in April 2012, the first medical meeting devoted to the problem of overuse. This led to the formation of the Right Care Alliance, a US “partnership of providers, patients, and the general public,” which campaigns for an “affordable, effective, and accountable” healthcare system.2 But Saini has been trying to protect patients from the excesses of medicine for 30 years.

Not just a technocrat

At 16 years old Saini had rejected his father’s entreaties for him to become a doctor. He didn’t want to become a “technocrat,” he told himself, and began studying literature, politics, history, and philosophy at Princeton University. He wanted to do good, to help make the world a better place, and joining Princeton’s peace movement, led by Students for a Democratic Society, seemed a better way than practising medicine. But just two years later, Saini had a change of heart: neither medicine nor politics provided the vehicle for what he wanted to do.

Born in India in 1954, Saini’s path—from student rebel to cardiologist and faculty member at Harvard, to cofounding a medical device company, and then serving as president of the Lown Institute, a public policy think tank based in Brookline, Massachusetts—may seem meandering, but each role reflects his lifelong effort to reconcile the gap between social justice and medicine.

Saini came to the US aged 4, when his parents arrived to do their doctorate degrees at Ohio State University. He told The BMJ, “I sold apples out of my little red wagon at Buckeyes football games, had nightmares during the Cuban missile crisis, and watched Lee Harvey Oswald get shot on live TV.” Saini’s father returned to India and then emigrated to Canada, where the family settled when Saini was 10.

Protests against the Vietnam war

At Princeton, he participated in student protests against the Vietnam war. But he quickly grew disenchanted with the “simplistic solutions” and political infighting among student activist factions. He decided that although he wanted to be engaged in social change he was uncomfortable with the options available, and he took a year off to travel and think.

Saini went to Europe. He took the Orient Express from Venice to Istanbul then went on to Tehran and Afghanistan, ultimately crossing the Indian subcontinent. He read voraciously during his travels, engaging in a literary exploration that prompted him to “reimagine” becoming a doctor. Troubled by the “world of hurt” that he saw around him, he concluded that while political protests yielded uncertain benefits, by becoming a doctor he could help people in a concrete way. He says, “There’s a lot of uncertainty in working for social change, but there’s an incontrovertibility about doing good in the exam room.”

After he returned to North America, he earnt his doctor of medicine degree with distinction from Dalhousie University in Halifax, Canada, in 1980, and then served his residency at Baltimore City Hospitals and Johns Hopkins. Here he also served as the president of the Baltimore chapter of Physicians for Social Responsibility, and this was followed by a fellowship with the Lown Group in 1984, where he was mentored by the cardiologist and Nobel prize recipient Bernard Lown.

As part of his work researching mind-body interactions in causing sudden cardiac death, Saini helped to develop the bispectral index monitor, which is now in widespread use in operating rooms and critical care settings to monitor consciousness.

Extravagance in cardiology practice

After a stint with a private cardiovascular specialty group in Cape Cod, Massachusetts, Saini grew increasingly disturbed by the gap between the holistic and conservative approach of Bernard Lown and the seemingly extravagant use of non-invasive and invasive testing he saw in medical practice everywhere. He realised that the “incontrovertibility” of doing good in the exam room was not a given. In 2007 Saini returned to the Lown Institute and Lown cardiovascular group. Board certified in cardiovascular disease, internal medicine, and nuclear cardiology, he served on the faculty of Harvard Medical School.

Through his work with the Lown Institute and the Right Care Alliance, Saini says his interests in social justice and medicine have come together: “It’s clear that we’re at a big turning point in history that is easily comparable to the Flexner period [of US medical education reform] 100 years ago, and even potentially bigger than that because there are so many things that are existential threats to us on this planet.

“The Right Care series [recently published in the Lancet] is an attempt to put an intellectual framework on overuse and underuse. But stepping back, looking at the big picture, what we face in the coming decades and century is how we are going to survive and retain our essential humanness in the face of a tsunami of technology.”

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