Doctors, pharmaceuticals, medical procedures, hospitals, healthy diets, herbal supplements, regular physical activity and self-help books are used to stay alive and well. But something else is incredibly effective. Focus on this research finding for a few minutes: Women without close friends were four times as likely to die from breast cancer as women with 10 or more friends. A 2006 study of nearly 3,000 nurses with breast cancer found this to be true. And this too was true: Neither proximity or the amount of contact with a friend was associated with survival, nor was having a spouse. Only having friends was protective.

Similarly, a six-year study of 736 middle-age Swedish men found that not having friendships posed the same risk as smoking for heart attack and fatal coronary heart disease.

Need more evidence? A 10-year Australian study of 1,477 persons aged 70 years or more found that people with a large circle of friends were 22 percent less likely to die during the study period than those with fewer friends. Having relationships with children and relatives did not have this positive impact. The positive effects of friendships on longevity continued throughout the decade, regardless of other profound life changes such as the death of a spouse or other close family members.

The famed Nurses' Health Study from found that the more friends women had, the less likely they were to develop physical impairments as they aged, and the more likely they were to be leading a joyful life. Moreover, not having close friends or confidantes was as detrimental to their health as smoking or being overweight! And after the death of their spouse, those women who had a close friend were more likely to survive the experience without any new physical impairments or permanent loss of vitality. But those without friends were not always so fortunate.

Another Harvard study found that over a ninety-year period, seniors with the most social connection outlived their isolated peers. People without a lot of friends were between two and three times more likely to die.

Lesson to be learned from all this research: No matter what stresses, distractions and difficulties you face in life, make time to maintain friendships and put effort in forming new ones. True friends know all about us and still love us. But modern society makes it difficult to make and keep friends.

According to a 2006 study in the American Sociological Review, on average most Americans feel that they have two close friends, down from three friends two decades ago in 1985. During this same period, the percentage of people reporting no close confidantes rose from 10 percent to almost 25 percent, with 19 percent citing only one close relationship - often with a spouse. The Internet, cell phones, IPods, Blackberries, and all kinds of modern devices do not necessarily help us maintain solid friendships. All too often they eat up our time and foster social isolation. Keep in mind these words of Ralph Waldo Emerson: The only way to have a friend is to be one. That takes time. It requires intimacy that technological connectedness does not facilitate.

In fact, technology, money issues, work, family obligations and consumerism can combine to keep us time-poor and too busy to nurture friendships. Yet a long and high quality of life require that we make the time, sacrifices and investments necessary for keeping friends. Emotional friendship demands commitment. It is a choice we make, not an obligation like we feel for family. Best friends are always there for you as you are for them. Remember that friends are a matter of life or death, literally.

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