It would seem that persistence would be tonic over the long haul; hanging tough should increase the odds that you'll succeed, and personal success is closely linked to well-being. But what if the goal is extremely unlikely? When does an admirable trait like perseverance start to look more like beating your head against the wall?

To test this in the laboratory, psychologists Gregory Miller and Carsten Wrosch developed a psychological instrument that can reliably distinguish between people who when faced with a difficult goal either persist or let go of it. In a series of experiments, the psychologists exhaustively studied these two personality types to see how healthy and well adjusted they are.

In their most recent study, published in the September issue of Psychological Science, a journal of the Association for Psychological Science, the psychologists followed teenagers for a full year. Over that time, individuals who did not persist obtaining hard to reach goals had much lower levels of a protein called CRP, an indicator of bodily inflammation. Inflammation has recently been linked to several serious diseases, including diabetes and heart disease, suggesting that healthy but overly tenacious teens may already be on the road toward chronic illness later in life.

Accordingly, Miller and Wrosch suggest it may be more prudent to cut one's losses in the face of an insurmountable obstacle. When people are faced with situations in which they cannot realize a key life goal, the most adaptive response for physical and mental health may be to disengage from this goal, write the authors.

But all is not lost for go-getters. The psychologists also sorted both groups by their willingness to re-engage and set new goals after they gave up on something important. While they did not find a direct link between re-engagement and physical health, they did find that people who readily jumped back into life had a greater sense of purpose and mastery and were less likely to ruminate about the past. Setting these new goals appears to buffer the emotional consequences of failure, especially for those who have the hardest time letting go.

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The medical community should insist that we invest the resources needed to do trials that ascertain the effect of interventions on patient-important outcomes, the authors state. This policy will prevent the premature dissemination of therapies that ultimately prove harmful, facilitate patients' participation in decision making, and speed the day when we can confidently offer safe treatments that can provide important benefit to patients with diabetes.

In summary, the authors say:

Diabetes medications have been approved without requiring proof of reducing the risk of complications associated with diabetes, such as heart attack, stroke, amputation, blindness and kidney dialysis. The majority of diabetes trials focus on the ability of medications to reduce blood sugar, not on outcomes that matter to patients. Diabetes medications may reduce the risk of complications, but we do not know this with confidence. The focus should shift from getting new drugs to market to testing the effect of diabetes medications against outcomes important to patients.

Dr. Montori is a lead investigator with the Knowledge and Encounter Research Unit at Mayo Clinic. His research team seeks to improve the care and outcomes of patients with diabetes by studying ways to promote health care decisions that are more consistent with research findings and the values and preferences of informed patients.

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