As He May Design

Cardiology is probably one of the most mature specialties in medicine. The field has dramatically improved lifespans around the world on the same footing as clean water, antibiotics and vaccines. In the world of cardiovascular medicine, few shine as radiantly as Dr. Deepak Lakshminarayana Bhatt. A physician-scientist of exceptionally rare depth and clarity, his contributions have shaped not only the field of cardiovascular medicine but also the way I think about rigor, mentorship, and purpose. On the same plane of excellence as some of the greatest classical Carnatic musicians whose equipoise and mastery transcends material concern and transient emotion. What strikes me most about Deepak is not just his extraordinary body of research and clinical acumen, but the way he embodies balance. Precision with warmth, selfless ambition with humility, and brilliance with generosity. As his mentee, I’ve spent many hours discussing all kinds of concepts with him. He is an inspiration, reminding me that excellence in medicine and science is as inseparable from compassion and humanity as Carnatic music is from philosophy and mathematics.

One of the earliest conceptualization of the heart and circulation are rooted in the Vedic age (c.1500–500 BCE), where the heart (hṛdaya) was recognized as a vital organ. Though not fully described in anatomical terms, multiple verses from Vedic chants venerate the heart as associated with life force and consciousness, an idea that persisted into later Ayurvedic theory. Early Vedic descriptions of the heartbeat or pulse are poetic; for instance, the heart’s activity was sometimes linked to the concept of prāṇa (breath or life-energy) moving through the body. While detailed physiology was not articulated in the mantras, there was an implicit gestalt that the chest was central to life and vitality. The Atharvaveda in particular even uses terms like hṛddyota or hṛddyotana; both suggestive of inner heat or energy of the heart, hinting at an intuitive grasp of the heart’s importance. Multiple treatises (commentaries on the Vedas, and commentaries on the commentaries) firmly establish the connection between the blood, heart and breath as a central pillar of the astonishing continuity and harmony of yogic practices (nutrition, exercise, philosophy, meditation, poetry, fine arts and classical music) in Indian philosophy. It is difficult to describe with precise articulation how deep-rooted this gestalt is for anyone born and raised in India. Over and over again, one is exposed to and encounters descriptions of the heartbeat or pulse in very poetic terms. The heart’s activity is repeatedly linked to the concept of prāṇa (breath or life-energy) moving through the body from classical Carnatic music lyrics, instructors expounding the benefits of proper yogāsana form to depictions of divine deities in ancient temple sculptures.

I distinctly remember stories narrated by my grandmother when I was a child on a series of experiments devised by the meditating sages on the trinity (Brahmā the creating energy, Viṣṇu the preserving and nurturing energy and Śiva the energy that dissolves the multiverse in emancipation and anticipation of a new cyclical epoch). It is said that when the meditating sages probed the heart and breath of each of the trinity, they inextricably found imprints of the consciousness of their respective loving consorts. I distinctly remember being told that the “life force” of each of the trinity stems from each imprint.

Deepak is probably one of the most prolific clinical trialists in medicine today. To design a clinical trial, implement it in practice and then communicate its import in a way that changes practice on the ground requires a staggering array of disparate and uncommon skills. Deep expertise spanning medicine, causal inference, social networks and an ability to work with every kind of personality type imaginable. Despite his background from being a valedictorian at Boston Latin High School to being a math major and National Merit Scholar at MIT to his training as a physician-scientist, the way in which he is able to surface the inner essence of causal inference, Bayesian statistics and medicine like cream emerging from whole milk; in the same way as the gifted musician whose practice and mastery allows them to transcend semi-tones and quarter tones into microtones. A kind of meta-awareness and meta-eloquence that is riveting to watch in action. Strikingly similar to a varṇam in Carnatic music.

Of the different types of compositions in Carnatic music, the varṇam is one of the most elaborate, intricate and technically challenging, both in structure and in mathematical complexity. A varṇam is divided into two main sections: pūrvaṅga (first half), containing paḷlavi, anupaḷlavi, and muktāyi svaram (also known as ettugāda or chittā svāram) and the uttarāṅga (second half), containing the caraṇam and the chittā-svarams (svarā passages alternating with the caraṇam). Each section is aesthetically crafted to explore different emotional registers and musical depths of the rāgam, but philosophically they map to a seeker’s inward progression from a seed of philosophy to transcendence.

The paḷlavi (in pūrvaṅga) sets up the rāgam’s jīva-svaram (most characteristic note) and the grāha (starting note). Aesthetically, it is like a mantra or seed, bare-bones but potent, usually repeated at different speeds. Philosophically, it denotes a budding leaf (pallavam) or as was described to me growing up, like the stirring of divine longing or curiosity.
 The anupaḷlavi usually moves towards the upper octave, introducing lyrical expansions. It adds gentle ornamentation and deeper phraseology within the rāgam and symbolically this represents continual refinement as if two leaves sprouting as the philosophical impulse takes shape and turns upward towards the divine. This is followed by the muktāyi svara, which is composed of pure svaras often expansive and flowing. Sometimes with matching lyrical maneuvers in pada-variants. Aesthetically, it glides, like the rāgam taking flight. Philosophically, it represents a certain detachment from words, beginning to move past intellectuality, a transitional elevation.

The lyrical body of the varṇam is the caraṇam. It unifies the rāgam’s melodic ideas, often sung in vilamba-kāla (slow), then in madhyamakāla (fast), providing rhythmic and expressive range. Symbolically, caraṇam is the surrender at the lotus feet, reaching the divine that the music has gradually guided the listener to (saraṇam). Chittāsvarams (chittā svaras) are pure svara passages that punctuate or follow the caraṇam in structured stanzas. Aesthetically, these are like butterflies, flitting through the rāgam. They are ornamental, virtuosic, winged expansions where the artist sings a meticulous series of combinations and permutations of notes that obey both the grammar of the rāgam and the rhythmic tāḷam. Philosophically, they symbolize a complete release from lyrical constraints, basking in spiritual sweet nectar.

The parallels between the structure of a Carnatic varṇam and the design and journey of a clinical trial are striking in their similarity. I think they both embody and require a similar disposition of temperament and intellect. Each is a carefully composed progression, from hypothesis to realization, from yearning to understanding, seeking to reveal truth through structured exploration. It is almost as if the paḷlavi encapsulates a kernel of melodic truth, just as a trial’s hypothesis encapsulates a single question with vast ramifications. In both the varṇam and a clinical trial, everything that follows is informed by this root: a rāgam cannot contradict its paḷlavi; a trial cannot deviate from its core hypothesis. The anupaḷlavi is not embellishment for its own sake but a sort of a disciplined ascent, like the IRB protocol, where every detail (inclusion criteria, arms, timelines) is tuned for precision. Just as anupaḷlavi lifts the rāgam into a higher octave, this stage lifts the research from a question to a rigorously executable plan. The muktāyi svarams bring disciplined improvisation; one follows the rāgam’s rules but explores space and time. In clinical trials, this phase aligns with pilot studies or run-in periods, an experimental, yet rule-governed exploration that helps solidify the path forward. Philosophically, caraṇam represents offering oneself at the divine feet; methodologically, it represents full immersion and the heart of data collection, primary endpoint capture, patient impact. This is where all threads converge into meaning and measurable outcome.

Amongst a dizzying number of research projects he has dabbled in his career, Deepak is best known for leading several landmark cardiovascular trials that have shaped clinical practice. Among the most influential is REDUCE-IT, which showed that icosapent ethyl (a purified omega-3 fatty acid) significantly reduced cardiovascular events in high-risk patients with elevated triglycerides despite statin therapy. He also led the CHAMPION PHOENIX trial, which established the intravenous P2Y12 inhibitor cangrelor as a powerful option for reducing ischemic complications during percutaneous coronary intervention. He also led the THEMIS and THEMIS-PCI trials clarified the role of ticagrelor in patients with diabetes and stable coronary disease, while breakthrough studies such as SOLOIST and SCORED expanded understanding of SGLT inhibitors in diabetes and cardiorenal disease. Collectively, these trials underscore his impact on radically changing and  advancing prevention, interventional therapies, and pharmacologic strategies in cardiovascular medicine.

The suruṭī is one of the most auspicious rāgams whose versatility and compositionality lends itself explorations that induce an almost meditative energy. Perhaps it is fitting that it is this rāgam that reminds me so much about Deepak. 

Music credit: Anugrah Lakshmanan and M Shrikanth presenting the ragam Surutti. Listen here.