Change or Die

Why is it so hard to change? The Buddha tells us that change is inevitable, that everything is always changing. We are always changing whether we like it or not, so why do we resist change for the better? Why do we allow entropy (laziness) to change us instead of changing ourselves?

Dr. Raphael Levey, founder of the Global Medical Forum, an annual summit of leaders in the health care, told a recent 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 live their lives, not because of environmental or genetic factors beyond their control. Levey didn't bother to name them, but you don't need an MD to guess what he was talking about: too much smoking, drinking, eating, and stress, and not enough exercise

Dr. Edward Miller, the dean of the medical school and CEO of the hospital at Johns Hopkins University was more explicit He turned the discussion to patients whose heart disease is so severe that they undergo bypass surgery, a traumatic and expensive procedure that can cost more than $100,000 if complications arise. About 600,000 people have bypasses every year in the United States, and 1.3 million heart patients have angioplasties -- all at a total cost of around $30 billion. The procedures temporarily relieve chest pains but rarely prevent heart attacks or prolong lives. Around half of the time, the bypass grafts clog up in a few years; the angioplasties, in a few months. The causes of this so-called restenosis are complex. It's sometimes a reaction to the trauma of the surgery itself. But many patients could avoid the return of pain and the need to repeat the surgery -- not to mention arrest the course of their disease before it kills them -- by switching to healthier lifestyles. Yet very few do. "If you look at people after coronary-artery bypass grafting two years later, 90% 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."



For the last two weeks, I've been shadowing a nutrition counselor. She sees patients who have been referred by their doc and most of her patients are overweight often with diabetes, heart disease and other related conditions. She is giving them advice for change that is cheap, simple, and has no negative side effects. She wants her patients to cut down on sugary treats and high fat foods; eat more fruits and vegetables; and get a little exercise. I'm shocked by the number of patients who refuse to use skim milk in their 20 oz Mocha Latte, or who can't give up their third dessert in the evening. These same patients are the ones who will insist that their doctor give them every last test, medication or procedure up until their last breath, but they won't put in a little effort to loose 10 pounds.

On a similar note, I was listening to a podcaster who I really enjoy (but don't always agree with) and he was discussing an article in his local paper. This article was written by a grad student who was studying climate change. This student's theory was that if we didn't cut our carbon emmisions by 96% in the next 20 years, climate change would become inevitable. Ninety six percent! The podcaster claimed that we couldn't change by that much if we were threatened with a nuclear bomb. He's probably right, but why not? Could you cut your emmisions by 96% if it was a choice between change or die? Could I?