Sunday, May 01, 2005

[Research] FastCompany: Change or Die

http://www.fastcompany.com/subscr/94/open_change-or-die.html


They started with the crisis in health care, an industry that consumes an astonishing $1.8 trillion a year in the United States alone, or 15% of gross domestic product. 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. They said that the root cause of the health crisis hasn't changed for decades, and the medical establishment still couldn't figure out what to do about it.

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"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. Continued Levey: "Even as far back as when I was in medical school" -- he enrolled at Harvard in 1955 -- "many articles demonstrated that 80% of the health-care budget was consumed by five behavioral issues." 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.

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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... 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"

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The conventional wisdom says that crisis is a powerful motivator for change. But severe heart disease is among the most serious of personal crises, and it doesn't motivate -- at least not nearly enough. Nor does giving people accurate analyses and factual information about their situations. What works? Why, in general, is change so incredibly difficult for people? What is it about how our brains are wired that resists change so tenaciously? Why do we fight even what we know to be in our own vital interests?

Kotter has hit on a crucial insight. "Behavior change happens mostly by speaking to people's feelings," he says. "This is true even in organizations that are very focused on analysis and quantitative measurement, even among people who think of themselves as smart in an MBA sense. In highly successful change efforts, people find ways to help others see the problems or solutions in ways that influence emotions, not just thought."

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"We also need to bring in the psychological, emotional, and spiritual dimensions that are so often ignored." Ornish published studies in leading peer-reviewed scientific journals, showing that his holistic program, focused around a vegetarian diet with less than 10% of the calories from fat, can actually reverse heart disease without surgery or drugs. Still, the medical establishment remained skeptical that people could sustain the lifestyle changes. In 1993, Ornish persuaded Mutual of Omaha to pay for a trial. Researchers took 333 patients with severely clogged arteries. They helped them quit smoking and go on Ornish's diet. The patients attended twice-weekly group support sessions led by a psychologist and took instruction in meditation, relaxation, yoga, and aerobic exercise. The program lasted for only a year. But after three years, the study found, 77% of the patients had stuck with their lifestyle changes -- and safely avoided the bypass or angioplasty surgeries that they were eligible for under their insurance coverage. And Mutual of Omaha saved around $30,000 per patient.


[JIH - Reminds me of my belief that insurance companies will be a primary lead in creating a ubicomp world...]


So instead of trying to motivate them with the "fear of dying," Ornish reframes the issue. He inspires a new vision of the "joy of living" -- convincing them they can feel better, not just live longer. That means enjoying the things that make daily life pleasurable, like making love or even taking long walks without the pain caused by their disease. "Joy is a more powerful motivator than fear," he says.


[JIH - Interesting, they successfully reframed the problem from an "aspirin" to a "vitamin" problem, and had people stick to the vitamin. ]


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Lakoff says: "Concepts are not things that can be changed just by someone telling us a fact. We may be presented with facts, but for us to make sense of them, they have to fit what is already in the synapses of the brain. Otherwise, facts go in and then they go right back out. They are not heard, or they are not accepted as facts, or they mystify us: Why would anyone have said that? Then we label the fact as irrational, crazy, or stupid." Lakoff says that's one reason why political conservatives and liberals each think that the other side is nuts. They don't understand each other because their brains are working within different frames.

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Reframing alone isn't enough, of course. That's where Dr. Ornish's other astonishing insight comes in. Paradoxically, he found that radical, sweeping, comprehensive changes are often easier for people than small, incremental ones. For example, he says that people who make moderate changes in their diets get the worst of both worlds: They feel deprived and hungry because they aren't eating everything they want, but they aren't making big enough changes to quickly see an improvement in how they feel, or in measurements such as weight, blood pressure, and cholesterol. But the heart patients who went on Ornish's tough, radical program saw quick, dramatic results, reporting a 91% decrease in frequency of chest pain in the first month. "These rapid improvements are a powerful motivator," he says. "When people who have had so much chest pain that they can't work, or make love, or even walk across the street without intense suffering find that they are able to do all of those things without pain in only a few weeks, then they often say, 'These are choices worth making.' "

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