Perspectives
Profile
Vikas Saini: leading activist in the Right Care Alliance
Without a clinic or a laboratory, Vikas Saini could feel out
of his comfort zone, but as President of the Lown Institute,
located in Brookline on the outskirts of Boston, USA, he does
not have much time to reflect on his previous life. Having
trained as a cardiologist under the great Bernard Lown, Saini
now heads up the non-profit organisation founded by his
mentor in the 1970s. “Bernard thought his vision for patient
care should become part of a national conversation within
the US. The work I do now is a natural extension of this,
which has led to a focus on medical overuse and underuse
within the US health system”, he says. One outcome of
Saini’s work in this field is the publication of the Lancet Right
Care Series, which Saini has led. Shannon Brownlee, a Series
co-author and colleague at the Lown Institute, comments
that “I’m still amazed by his ability to integrate disparate
fields of scholarship ranging from critical appraisal of clinical
research to the history of social movements. I think this
ability to surf multiple waves of thought makes him willing
to take on audacious projects, including our Lancet series.”
Part of Saini’s role at the Lown Institute is to grow a
grassroots movement, the Right Care Alliance, to become
a leading voice for change in the way US health care is
delivered. “The aim of the Alliance is to create public
demand for a health system that is universal, safe, and
effective, and that delivers the right care. One current
project is to motivate people to sign up and help define a
top ten priorities list: not only the five things we shouldn’t
do that we currently do, but also the things we should be
doing. The aim is to have local and national impact by
encouraging people to link up and exert pressure on what
an affordable, fair health system should be”, he says.
Born in the Punjab region of northern India, Saini’s scientist
parents moved to the USA when he was 4 years old, later
settling in Fredericton, New Brunswick, Canada. Saini took a
philosophy undergraduate degree at Princeton at the height
of US involvement in the Vietnam War. “My main passions
were in studying literature, history, politics—and, the most
important aspect of being a student, in thinking deeply
about the world around us”, Saini recalls. It was while taking
a year out from his studies, travelling overland from Europe
to India, that the idea of medicine gradually took hold. “It
was during that long journey that I first saw the deep ocean
of need in the world, and realised how politics could not help
with the same certainty that medicine could”, Saini says.
By 1980, Saini had qualified from Dalhousie Medical School
in Halifax, Canada, including a year out working at New York
City’s Montefiore hospital on a survey of toxic exposures
of chemical workers. He drove a cab to make ends meet;
his fares included Dan Aykroyd and Andy Warhol. “That
experience grew my understanding of American society, and
www.thelancet.com Vol 390 July 8, 2017 117
I found myself arguing with passengers, especially those I
picked up around Wall Street”, Saini recalls. During residency
at Hopkins Bayview Hospital, he became fascinated by
cardiology, and the coronary care unit. He became especially
interested in the psychosocial aspects of cardiovascular
disease, gaining a cardiology fellowship at Johns Hopkins,
and an epidemiology scholarship at the Johns Hopkins
Bloomberg School of Public Health. “It was at this time that
I first came into contact with Bernard”, Saini says. “I became
fascinated by his work on psychological stress on the heart.
I told him I was fully funded, and would love to spend some
time to come and work in his lab at Harvard. He said no.”
Published Online
The only condition that Lown would accept was for January 8, 2017
Saini to leave Johns Hopkins and become a Research http://dx.doi.org/10.1016/
S0140-6736(16)32622-8
Fellow under Lown at Harvard. Saini moved to Boston,
See Series pages 156, 169, 178,
relishing work in the laboratory, studying the effect of
and 191
neurotransmitters and endogenous opioids on cardiac
For the Lown Institute see
function. His clinical work opened his eyes, too: “It was http://lowninstitute.org/
during the mid-1980s when I truly discovered myself as For the Right Care Alliance see
a doctor. On the wards we took a very holistic approach http://rightcarealliance.org/
with patients, trying to understand the psychology that
often related to their health situation. Our focus then was
humanistic. We had deep contact with our patients, a
revelation to me about what doctoring could be like.”
A close collaboration with Nassib Chamoun, a graduate
student engineer in Lown’s research laboratory, led to a new
phase in Saini’s career, as he and Chamoun set up Aspect
Medical Systems in 1987. Originally intending to develop non-
invasive monitors for sudden cardiac death, the company
expanded by developing state-of-the-art technology for the
first widely used monitor to measure consciousness during
anaesthesia. “I felt odd, as a trained cardiologist, not seeing
patients, developing a business in anaesthesiology”, he says.
He left to reconnect with clinical work, establishing a busy
cardiology practice in New England.
Harvard became Saini’s professional home once again
in 2007, where he returned to lead the Lown Institute and
co-directed Bernard Lown’s practice group. Increasingly
concerned with the problems in the US health system, Saini
collaborated with Brownlee, author of the book Overtreated,
to organise a meeting in 2012 entitled Avoiding Avoidable
Care. “The 2012 gathering was the first academic meeting
to discuss the problem of overtreatment and triggered a
remarkable outpouring of interest and support; it catalysed
our current and future thinking and led to the creation of
the Right Care Alliance. There’s no going back. Right care
advocates are going to have increasing influence on the way
US health services are organised”, Saini says.
Richard Lane