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Why do we do things we know are bad for us? This is a fascinating question, one that combines neuroscience with evolutionary psychology and philosophy. The question probably needs revision and explanation to be tackled in a coherent way. One thing, however, is certain. Americans struggle with this problem on a grand scale.

I was shocked to learn in medical school that the majority of patients in our hospital are there because
of decisions they made. A part of me had idealized medical care as a miraculous cure for people randomly stricken with rare diseases. While that certainly does occur, a more common situation is for patients to present with obesity and poorly controlled diabetes, substance abuse and trauma, or smoking-related lung diseases. Though the reasons for it can be many, our dangerous pattern is clear. Doing things we know are bad for us has become a lifestyle.

I do not mean to imply that all diabetics or victims of car crashes are responsible for their condition. It is absolutely not that simple. I also do not mean to place judgment or blame onto people who suffer from maladies that are “their own fault.” I have actually come to believe that patterns of behavior have very complicated roots, and sometimes defy being placed into simple categories such as right and wrong. But even if we remove labels and reserve judgment, I still believe that individuals are responsible for every single one of their choices and actions – no matter how subconscious our routines make them seem.

Given the epidemic of so-called lifestyle diseases, we would be mistaken to ignore the role of our own choices and routines. When Bill Parcells was asked if his 1996 Patriots were better than their record of 0-3, he answered: “You are what you are.” The great motivator himself understood that some problems require changes in habits, no matter how uncomfortable. We are now dealing with a social and economic problem far greater than can be solved by handing out nicotine patches and insulin.