<International Circulation>:  You are no stranger to expressing your opinion about outside influences in medicine and I am thinking both governmental and perhaps insurance companies. In the second quarter of 2013 with Obamacare on the horizon， what are your thoughts about it?

 

　　Prof. Bakris:  I think a lot of people have not understood this. It is going to be the socialization of medicine. What’s socialized medicine? If they don’t know what socialized medicine is， they are going to figure it out real fast in the next couple of years， because if the government is paying the bills， the analogy I have given from the podium is that if it is socialized， it is as if Dad’s playing all the bills. Dad now realizes he doesn’t have this money， so he has to tighten his belt and the family is told they have to tighten their belts and all payments have to go through his hands and nothing is paid unless he says it is justified or not. So physicians will be stripped of their power more-or-less because they cannot make a decision on the appropriate medications can be used unless they are generic. If they are not generic， then forget it because the government is not paying for it. Politicians need to understand that generic and brand goods are not the same. There are a lot of them who are under the impression that they are the same， but not even close. There is no way that there is the same scrutiny for generics as there is for trade names. I am not pushing trade names but I am saying that assuming that brand names and generic products are the same is absolutely not true. There are definitely some similarities but it is not true. The plan is going to be making administrative decisions and taking a lot of the decision-making out of the hands of physicians and operating based on cost. No government official is going to agree with me and would rebut what I have just said because it is not politically wise but the reality is if there isn’t any money， who is going to pay for it? Nobody is willing to say that because it is not politically correct. Innovation in research in medicine is already going down the toilet. Europeans used to call me to find out what is going on. I am now calling them. There is no innovation in medicine anything near what it used to be， even five or six years ago let alone a decade ago. There are problems that this whole policy is going to bring but we can afford to have things going on the way they were and I am not saying the way things were is the way to do it， but there was definitely a lot more freedom in medicine. Of course， if you don’t have the money， you lose your freedom with it. I think people don’t want to admit that. I think there are going to be restrictions; there are going to be limitations. Physicians are already frustrated; a lot of them are dropping out of medicine way before they planned to. The government either doesn’t care or figures they will deal with it when they can. The reality is that the patients are not going to get the care they were getting previously. Some of them have already realized it and more are going to realize it.

 

 

　　<International Circulation>:  You are the Director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine that is becoming recognized both nationally and internationally as the place to go if you are having trouble controlling your hypertension. Can you tell us about this organization that you direct and who are the kinds of patients that you see there?

 

　　Prof. Bakris: Firstly， the whole concept of hypertension centers was championed under my leadership and commenced with the notion that there should be centers of excellence around the country that meet certain criteria. The review process is very much like the NIH. There is an application process which is reviewed by an independent group of hypertension specialists and then there is a site visit by a group of this committee and then the decision is made as to what level the center will be at. There are two levels: the comprehensive centers and then designated centers. The difference is that a comprehensive center is a university-based clinic or a very large center that has the ability to perform research and clinical care and the designated centers are going to be large office practices or large community hospitals that don’t necessarily do research but will certainly have the capability to take care of the difficult-to-treat hypertension patient. Our center is one of four approved centers in the country: University of Rochester is one， University of Michigan， University of Pennsylvania and us. There are three hypertension specialists in our center， two others and myself. One is senior faculty who is a cardiologist and the other is one of my former Fellows who is a board-certified endocrinologist， so we have a nephrologist， an endocrinologist and a cardiologist as specialists in the clinic. There is a small research unit. We were doing NIH studies but now we are conducting industry-sponsored studies headed by myself or one of the other faculty members. We have two research nurses that run these trials and we have an IRB support team that works with us to facilitate protocols going through. There is space allocated to us in the hypertension unit where we see patients two days per week. They are all referrals; there is no primary care. The referrals are usually from a cardiologist or a nephrologist or primary care physicians who have had difficulty in treating these patients. Many of them have secondary hypertension but a lot of them have resistant hypertension and we have clinical trials going on examining devices such as the renal sympathetic denervation and the baroreceptor activation therapy. So these therapies are available at the center for those in whom pharmacological therapy is not effective.