An article from the magazine Fast Company began with the following paragraph:

Change or Die. What if you were given that choice? What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think 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?

According to the article, the odds are nine to one that you will not change—even in the face of certain death. The author based that statistic on a well-known study by Dr. Edward Miller, the dean of the medical school and CEO of the hospital at Johns Hopkins University. Dr. Miller studied patients whose heart disease was so severe that they had to 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. 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 alter the course of their disease before it kills them—by switching to healthier lifestyles. Yet very few do. Dr. Miller summarized his research on patients' inability or unwillingness to change their lives:

If you look at people after coronary-artery bypass grafting two years later, 90 percent of them have not changed their lifestyle. 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.