This article is an edited version of extemporaneous remarks invited by the organizers of the National Heart, Lung, and Blood Institute-sponsored conference "Maintenance of Behavior Change in Cardiorespiratory Risk Reduction" (July 1998). The request for this author was an "outside-the-box" reaction from a clinical perspective to the working groups on the reports presented at the conference. The specific clinical perspective is one gained from 15 years of experience in the Ornish Heart Disease Reversal Program. The Ornish Program was of interest to conference organizers because of its success in reducing cardiac risk factors, altering the progression of coronary artery disease, and maintaining long-term adherence to lifestyle change (K. L. Gould et al., 1992, 1995; D. M. Ornish et al., 1979, 1983, 1990, 1998; D. Ornish & Multicenter Lifestyle Demonstration Project Study Group, 1998).