JAMES F. FRIES, M.D. Advisory Committee

Dr. Fries is Professor of Medicine at Stanford University School of Medicine. He is nationally and internationally recognized as a leader in conceptualization of strategies to promote healthy aging, in behavioral approaches to decrease morbidity, in long-term outcome assessment, in self-management strategies, in improvement in chronic disease outcomes, in design of efficacious, effective, and cost-effective interventions, in evaluation of medium and long-term behavioral interventions by large randomized clinical trial, and in managing large scale patient data collection and analysis projects. He has published over 200 articles, 11 books, and numerous book chapters and invited papers, and is a frequent keynote speaker.

In 1980, he developed the Compression of Morbidity hypothesis, which has provided the conceptual foundation for health promotion and healthy aging programs. Prior to this landmark contribution, health promotion in seniors was generally viewed as (1) too little too late or (2) contributing extra feeble years to life. He postulated that primary prevention strategies would postpone the onset of morbidity and disability, ameliorate functional decline, and result in decreases in lifetime cumulative disability and morbidity. The Compression of Morbidity hypothesis holds that primary preventive factors have a greater effect upon morbidity than upon mortality and that chronic diseases with onset later in life will be present for a shorter length of time. The Compression of Morbidity hypothesis has been intensely discussed and argued for nearly two decades, with the recent data strongly confirmatory of the hypothesis and the framework for successful aging programs established. Recent work by Dr. Fries on this hypothesis include a major invited policy address at the Nobel Forum, an address to The Institute of Medicine, an editorial in The American Journal of Public Health, a major policy paper focused on Need and Demand Reduction in Health Affairs, and a recent Special Article in the New England Journal of Medicine.

Dr. Fries established ARAMIS (Arthritis, Rheumatism and Aging Medical Information System) in 1975 and has continued as Principal Investigator through its current 24th year. ARAMIS is funded by The National Institutes of Health as the National Arthritis Data Resource and includes two large longitudinal studies of aging directed at quantification of the Compression of Morbidity hypothesis, one study of approximately 500 vigorous exercisers and 500 community controls now in its 14th year and a second study following University of Pennsylvania alumni over the past 12 years. ARAMIS pioneered the concept of the chronic disease databank and remains the prime example of this investigative technique. ARAMIS subjects are followed for life with assessment of quality of life, disability, mortality and other outcomes at six-month intervals and have introduced many new statistical and econometric techniques.

Modern self-management techniques directed at empowering patients toward appropriate decision-making in their own best interest were pioneered by Dr. Fries and co-author Donald Vickery in 1976 with the book “Take Care of Yourself”, which has gone through 157 printings and 11 million copies through the present. Four separate randomized controlled trials established the efficacy of “Take Care of Yourself” in reducing physician visitation by approximately seven to seventeen percent. In 1989, Dr. Fries wrote “Living Well”, based upon “Take Care of Yourself” concepts and directed at the senior population, “The Arthritis Help Book” (co-authored) and “Arthritis: A Comprehensive Guide”.

Healthtrac, Inc. was established by Dr. Fries in 1984 and he serves as Program Director, with responsibility for design of interventions and for evaluation of these interventions. Healthtrac programs are mail and telephone delivered, low in cost, and are strongly effective. Healthtrac programs have been proven effective in four randomized controlled trials and have been extensively studied by a number of investigators. The programs are highly individualized to the specific problems and chronic illnesses of the individual senior and adapted culturally, by age, by gender, and by specific medical problems. Healthtrac is the only four-time winner of the renowned C. Everett Koop National Health Award. Dr. Fries was the first individual recipient of this award.

Dr. Fries has conducted clinical trials of behavioral interventions in a number of populations. A randomized controlled trial of retirees of the Bank of America was evaluated at one and two years, and a randomized trial of California Public Employee Retirement System members (CalPERS) was carried out over one year (n=57,000). The Propath program was evaluated by a small six-month randomized controlled trial in patients with Parkinson’s disease and the Arthritis Home Help program also evaluated in a small 400 person randomized controlled trial. Each of these studies yielded positive results with regard to improvement in health risk, reduction in disability and morbidity, and in reduction in need for medical services.

Dr. Fries plays a role in The Health Project, a private-public consortium of national leaders who seek solutions to health care crises through behavioral approaches in worksite, health plan, or community programs which are directed at reduction in the national illness burden and increases in patient autonomy.