Dr. Vikram .R. Lotwala

Here are excerpts from a fantastic article written by Dr. Ara Darzi in NEJM. There is a message in the article for all doctors and medical policy makers regarding medical insurance and policy making towards it. The message is very pertinent not only to western countries but India as well. "William Beveridge, the economist whose 1942 report led to the founding of Britain’s National Health Service (NHS), famously said that “a revolutionary moment in the world’s history is a time for revolutions, not for patching.” 1 Given the combination of the global downturn and the time bomb that is health insurance costs, there is no denying that health care in the United States has reached such a moment. This matter is too important to be left to the politicians and policymakers; there is an urgent requirement for professional clinicians to step up and lead the debate. Every country in the developed world confronts a similar challenge right now: finding a way to create a well-resourc...

Boston: Using an endoscope to remove leg veins for heart bypass surgery appears to damage the veins and makes patients 52% more likely to die within three years, doctors reported. Although the technique is meant to be less invasive and gentler, it may in fact damage the vein and lead to heart attacks, the researchers reported in the New England Journal of Medicine on Wednesday. About 70% of bypass patients now have their leg vein removed endoscopically, in part because it produces much less scarring and infection to the leg than the traditional method, known as “open harvesting”, in which the vein is taken by directly cutting along a stretch of the leg. Endoscopes are little cameras that can be inserted, sometimes with surgical instruments, via a small incision in the skin. They are widely used for a range of procedures and have been used for vein harvesting for 13 years. But the study of 3,000 patients found veins removed by the endoscopic technique were significantly more likel...