The professor of rheumatology and immunology created an early computer database to follow rheumatology patients. The knowledge he gained from it precipitated his “compression of morbidity” hypothesis.
December 6, 2021 - By Bruce Goldman
James Fries, MD, professor emeritus of immunology and rheumatology, died Nov. 7 at a nursing home in Boulder, Colorado, after a lengthy convalescence from a stroke. He was 83.
Fries advanced, validated and promoted the “compression of morbidity” hypothesis: While a healthy lifestyle modestly extends longevity, it more effectively staves off the chronic diseases of aging, reducing the number of years of disability, dependency and pain.
His books on healthy aging sold millions of copies.
“Jim Fries was a giant in his field,” said Lloyd Minor, MD, dean of the School of Medicine. “His explorations of health-extending behaviors and interventions gave rise to strategies that are now common practice. He developed the conceptual component for healthy-aging programs used at Stanford and around the world.”
Fries will also be remembered as a pioneer in using computer databases to conduct epidemiological studies and for developing a monitoring tool that’s still widely used.
“He was a rainmaker — engaged, focused and fierce, always busy making things happen,” said Bill Robinson, MD, PhD, professor and chief of immunology and rheumatology. “He designed tools that formed the basis for understanding rheumatic disease and developing new drugs.”
Kate Lorig, DrPH, professor emerita of immunology and rheumatology, arrived at Stanford in 1978 and worked closely with Fries during a productive stage of his career. “My office was across the hall from his,” Lorig said. “He was brilliant. He did things nobody was doing before. To name just one example, he created the most valuable and first international database on arthritis in the world.”
James Franklin Fries was born Aug. 25, 1938, in Normal, Illinois, the son of Albert and Orpha Fries.
Fries attended Stanford University, where he met Sarah Tilden, who later became his wife, in a history class during his first year. They married in the summer of 1960, shortly after he earned a bachelor’s degree in philosophy, and immediately drove east to Baltimore, where he began medical school at Johns Hopkins. Earning an MD in 1964, he completed his residency in medicine and a rheumatology fellowship at Johns Hopkins.
In 1968, he returned to the West Coast to begin another residency at Stanford . A year later, he joined the faculty as an assistant professor, eventually becoming a full professor of immunology and rheumatology in 1993.
“He was a different type of faculty member from most of my peers,” recalled Sam Strober, MD, professor of immunology and rheumatology and division chief from 1978 to 1997. “He was doing ‘dry lab’ research — data-driven, computational epidemiology — at a time when very few people in the Department of Medicine were doing this. Most of our work was almost entirely clinical or laboratory-based. This was a different genre.”
Fries received funding in 1975 from the National Institutes of Health to establish a multi-center data-collection effort: the Arthritis, Rheumatism and Aging Medical Information System, or ARAMIS, which followed about 1,000 arthritis patients, assessing their quality of life, disability, mortality and other outcomes.
“He built a computer database to follow the patients,” Strober said. “That really marked the advent of using computer databases to follow the patients we had in the clinic.”
ARAMIS, which Fries directed for 35 years, was the first international study of its kind, involving centers in the United States and Canada. Reports of side effects from ARAMIS patients tied one arthritis drug to heart disease. The drug was eventually taken off the market, Lorig said.
Also in the 1970s, Fries developed a now widely used means of monitoring patients’ progress. Called the Health Assessment Questionnaire, or HAQ, the eight-section, self-reporting tool included questions such as, “Can you climb a flight of stairs?” and “Can you open a car door?”
“He didn’t care at all about stairs or car doors; he cared about knees and fingers,” Lorig said. “HAQ has been used in thousands of studies to gauge how well patients’ drugs are working and to determine which behaviors make a difference in their outcomes.”
Compression of morbidity
The data gathered through ARAMIS and HAQ suggested to Fries that lifestyle might more profoundly extend people’s healthy years than it would their age at death.
He formulated his groundbreaking “compression of morbidity” hypothesis during a sabbatical in 1978-79 at the Center for Advanced Studies and Behavioral Sciences at Stanford University. At the time, “healthy aging” was considered an oxymoron. Health promotion for seniors was generally viewed as contributing too little, too late — or merely adding extra feeble years of life.
But in a seminal article in The New England Journal of Medicine in 1980, Fries theorized that healthy behaviors — exercising, eating well, quitting smoking, getting regular medical checkups and receiving early treatment — could shift an individual’s health trajectory from poor health for many years to good health until close to the end.
A study Fries initiated at Stanford in 1984 tracked 538 people older than 50 until they were well into their 70s and 80s. Elderly runners wound up with fewer disabilities, longer active lives and half the likelihood of dying a premature death than aging nonrunners. While both groups became more disabled over the study’s course, the onset of disability started 16 years later for runners, on average.
That and other studies have confirmed Fries’ hypothesis, and compression of morbidity has become widely recognized as the dominant paradigm for healthy aging, at both individual and policy levels.
Fries published 11 books on wellness. One book he co-authored, Take Care of Yourself, now in its 10th edition, has sold 20 million copies in 20 languages. Others, including The Arthritis Self-Help Book, co-written with Lorig, were also bestsellers.
“He was the opposite of a self-help quack author,” Robinson said. “Far from promising eternal life or even substantially prolonged life spans, he drew on findings from his own studies to encourage people to live better by delaying the onset of chronic diseases.”
Fries practiced what he preached. He ran or jogged at least 500 miles a year for most of his adult life and climbed the highest mountain on six of the world’s continents, including Antarctica. (He failed to climb the seventh, Mount Everest, because a snowstorm forced him to turn back.)
Along with his wife, Fries founded a company, Healthtrac Inc., in 1985 to advise companies on healthy aging for their employees. In 1992, the couple established the James F. and Sarah T. Fries Foundation to award annual prizes for significant accomplishments in improving public health and health education. When, in 2005, their 42-year-old daughter, Elizabeth Fries, died of complications from breast cancer chemotherapy, the foundation renamed its health education prize the Elizabeth Ann Fries Award for Health Education.
About a decade ago, Sarah Fries developed advanced melanoma, leaving her permanently disabled and wheelchair-bound.
“He was absolutely, totally devoted to his wife,” Lorig said. “He fed her, bathed her, brought her to conferences and to our division meetings, and took her all over the world with him” — often to exotic locations such as Antarctica and even the Himalayas, where he carried her across a bridge.
On May 12, 2017, James Fries suffered a massive, debilitating stroke and was taken to Stanford Hospital, where his wife lay critically ill. She died at their Woodside, California, home two weeks later. Fries’ stroke caused severe and lasting damage, ending his career.
Fries published more than 450 scientific papers and received numerous awards and honors, including the C. Everett Koop National Health Award in 1994, the Arthritis Foundation Research Hero award in 2001, the American College of Rheumatology Master of Rheumatology in 2003, and the ACR’s Clinical Research Award in 2005.
He was a founding member of the American College of Informatics and an honorary fellow of the Society for Public Health Education. He was also a fellow of the American College of Rheumatology and American College of Physicians. He served on the editorial boards of The Journal of Rheumatology, the American Journal of Health Promotion and the Journal of Clinical Rheumatology.
Fries is survived by a son, Greg Fries of Longmont, Colorado; his brother, Ken Fries of Kuna, Idaho; and five grandchildren.
A memorial event in honor of Fries is planned for California in the summer of 2022.
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