The Three Keys to Change

Change or die.

What if you were given that choice? For real. What if it weren't just the hyperbolic rhetoric that conflates corporate performance with life or death? Not the overblown exhortations of a rabid boss, or a maniacal coach, or a slick motivational speaker, or a self-dramatizing chief executive officer or political leader. We're talking actual life and death now. Your own life and death. What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think, feel, and act? If you didn't, your time would end soon--a lot sooner than it had to. Could you change when change really mattered? When it mattered most?

Yes, you say?
Try again.
Yes?
You're probably deluding yourself.
That's what the experts say.
They say that you wouldn't change.

Don't believe it? You want odds? Here are the odds that the experts are laying down, their scientifically studied odds: nine to one. That's nine to one against you. How do you like those odds?

This revelation unnerved me when I heard it in November 2004 at a private conference at Rockefeller University, an elite medical research center in New York City. The event was hosted by the top executives at IBM, who invited the most brilliant thinkers they knew from around the world to come together for a day and propose solutions to some of the world's biggest problems. Their first topic was the crisis in health care, an industry that consumes an astonishing $2.1 trillion a year in the United States alone--more than one seventh of the entire economy. Despite all that spending, we're not feeling healthier, and we aren't making enough progress toward preventing the illnesses that kill us, such as heart disease, stroke, and cancer.

A dream team of experts took the stage, and you might have expected them to proclaim that breathtaking advances in science and technology--mapping the human genome and all that--held the long- awaited answers.

That's not what they said.

Speaking to the small group of insiders, they were unsparingly candid. They said that the cause of the health care crisis hadn't changed for decades, and the medical establishment still couldn't figure out what to do about it.

Dr. Raphael "Ray" Levey, founder of the Global Medical Forum, an annual summit meeting of leaders from every part of the health care system, told the audience: "A relatively small percentage of the population consumes the vast majority of the health care budget for diseases that are very well known and by and large behavioral." That is, they're sick because of how they choose to lead their lives, not because of factors beyond their control, such as the genes they were born with. Levey continued: "Even as far back as when I was in medical school"--he enrolled at Harvard in 1955--"many articles demonstrated that eighty percent of the health care budget was consumed by five behavioral issues." He didn't bother to name them, but you don't need an MD to guess what he was talking about: Too much smoking, drinking, and eating. Too much stress. Not enough exercise.

Then the really shocking news was presented by Dr. Edward Miller, dean of the medical school and chief executive officer of the hospital at Johns Hopkins University. He talked about patients whose arteries are so clogged that any kind of exertion is terribly painful for them. It hurts too much to take a long walk. It hurts too much to make love. So surgeons have to implant pieces of plastic to prop open their arteries, or remove veins from their legs to stitch near the heart so the blood can bypass the blocked passages. The procedures are traumatic and expensive--they can cost more than $100,000. More than one and a half million people every year in the United States undergo coronary bypass graft or angioplasty surgery at a total price of around $60 billion. Although these surgeries are astonishing feats, they are no more than temporary fixes. The operations relieve the patients' pain, at least for a while, but only rarely--fewer than 3 percent of the cases--prevent the heart attacks they're heading toward or prolong their lives. The bypass grafts often clog up within a few years; the angioplasties, in only a few months.

Knowing these grim statistics, doctors tell their patients: If you want to keep the pain from coming back, and if you don't want to have to repeat the surgery, and if you want to stop the course of your heart disease before it kills you, then you have to switch to a healthier lifestyle. You have to stop smoking, stop drinking, stop overeating, start exercising, and relieve your stress.

But very few do.

"If you look at people after coronary- artery bypass grafting two years later, ninety percent of them have not changed their lifestyle," Miller said. "And that's been studied over and over and over again. And so we're missing some link in there. Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't."