Change or die

Change or Die by Alan Deutschman is a thought-provoking book on a question of huge  importance.

The author makes excellent use of case studies and of his personal experience in permanent weight loss. Based on his observations and analysis, he proposes an approach to change when it really matters.

Genesis of the book

Inspiration for this book came from a conference which Alan Deutschman attended in 2004. Its purpose, he says, was “nothing less than proposing solutions to the biggest problems in the world.”

First on the agenda was the crisis in health care, and Alan sat back, expecting to hear about breathtaking advances in science and technology. That did not happen. What he heard instead stunned him.

Focus on health care crisis

One doctor gave a high-level view of the health care crisis, saying that 

A relatively small percentage of the population consumes the vast majority of the health care budget for diseases that are very well known and are by and large behavioral.

Next the dean of the medical school at Johns Hopkins University described heart patients whose arteries are so clogged that any kind of exertion is terribly painful.  Any exertion, even having sex. Surgeons can treat these patients by putting in stents to prop open blocked arteries (that’s called angioplasty) or bypassing the clogged arteries altogether, using veins taken from the patient’s leg.

Doctors tell some heart patients to “Change or Die”

These procedures, however, are very traumatic, enormously expensive, and worst of all, only temporary fixes. So doctors tell their patients: If you want to stop the course of your heart disease before it kills you, then you have to stop smoking, drinking too much, and eating too much.  You have to start exercising and reduce your stress. Essentially, the doctors say “Change or die!”

But the patients don’t change

And here’s the part that really got Alan Deutschman’s attention.  The heart patients don’t change, even when their very lives depend on it.  As a man whose work involves writing about change and innovation, he just couldn’t accept that.  And he began to research change in heart patients and several other groups.

Three basic questions about change:

1. How do doctors and others, such as family members) try to get heart patients to change? 

Typically, they use what the author calls the 3 F’s: they state facts, they instill fear (specifically, the fear of death), and they try force (i.e., nagging).

2.  Why don’t the 3 F’s work? 

Based on his research, Alan Deutschman suggests that they don’t work because they’re not compatible with the way our minds work.  He illustrates this with several key psychological concepts, such as the following:

  • Psych Concept 1. We are all guided by conceptual frameworks (or belief systems) about all kinds of matters—political matters, spiritual matters, financial matters.  Therefore, simply providing facts doesn’t sway how we think and feel.
  • Psych Concept 2 When a situation seems intolerable and our conscious minds feel overwhelmed by anxiety and a sense of powerlessness—our unconscious minds come to the rescue by activating coping strategies.  One of the most common of these is denial, that is, denying that a problem exists.

 3. What does work to get heart patients to change? 

The author describes a very successful program developed by Dr. Dean Ornish . It uses an unconventional combination of a very low-fat diet, meditation, yoga and other exercise, and extensive support for the patients.

A  three-year long study of the program included 333 patients whose insurance programs were willing to pay for them to have surgery—either a coronary bypass or an angioplasty.  The experimental group of 194 volunteered to try Dr. Ornish’s regime, while the control group of 139 underwent heart surgery, as needed.

In Year 1, for the first 3 months the team (consisting of a cardiologist, psychologist, nurse, personal trainer, dietician, teacher of yoga and meditation, and a chef) met with the experimental group 3 times a week for 4 hours each time.

For the rest of Year 1, the team and patients met together only once a week for 4 hours.

For years 2 and 3, the patients were back home on their own

The study was a spectacular success.  In the experimental group, 77% of the patients had changed so completely that they avoided the need for heart surgery.  The cost for this group was only $7,000 per patient. In the control group, bypass surgeries cost an average of $46,000 apiece and angioplasties cost $31,000.

The bottom line was that the Ornish program saved $30,000 per patient.

Three keys to change

Based on these results and others discussed in his book, Alan Deutschman proposed three R’s of change:


Heart patients who go through the program form new, emotional relationships with one another and with a team of professionals who fervently believe that the patients can change. 


The team helps heart patients learn, practice, and master new habits and skills—pertaining to diet, exercise, yoga, meditation, and social connectedness.


From the beginning Dr. Ornish catalyzes the process of re-framing their situation for heart patients.  Instead of summoning up “the fear of death,” he speaks of “the joy of living.”

The three R’s  help heart patients learn new ways of thinking.  They take responsibility for their own health.  They use their new habits to get better and stay better instead of relying on doctors to fix them.  They re-frame how they think about their health and their lives.

Photo by wlscience

Comments on this entry are closed.

  • Madeleine Kolb 03/10/2010, 8:21 am

    Kelly, Thank you for your comment. You really would think that making some changes in diet and level of physical actvity would be far preferable to undergoing an operation which entails sawing through your breastbone, spreading the halves to expose your heart, operating on the heart itself, and putting you back together. Just thinking about the pain, the cost, and the risk is enough to get me out the door for some exercise.

  • Kelly 03/10/2010, 12:54 am

    It sounds like a great book. Lifestyle changes should always be considered before surgical options. The three keys to change could be applied to a variety of situations.