“He was a different type of faculty member from most of my peers,” recalls Sam strober, MD, professor of immunology and rheumatology and division head 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 did. Most of our work was almost entirely clinical or laboratory. It 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 approximately 1,000 patients with the disease. arthritis, assessing their quality of life, disability, mortality and other outcomes.
“He built a computer database to track patients,” Strober said. “It really marked the advent of the use of computer databases to track the patients we had in the clinic.”
ARAMIS, which Fries led 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 have linked an 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 way to monitor patient progress. Called the Health Assessment Questionnaire, or HAQ, the eight-section self-assessment tool included questions such as “Can you climb a staircase?” And “Can you open a car door?”
“He didn’t care at all about the stairs or the car doors; he cared about the knees and the fingers, ”Lorig said. “The HAQ has been used in thousands of studies to assess the effectiveness of patients’ medications and to determine which behaviors make a difference in their outcomes.”
Compression of morbidity
Data collected by ARAMIS and HAQ suggested to Fries that lifestyle may extend people’s healthy years more profoundly than their age at death.
He formulated his revolutionary hypothesis of “morbidity compression” during a sabbatical leave in 1978-79 at the Center for Advanced Studies and Behavioral Sciences at Stanford University. At the time, “healthy aging” was seen as an oxymoron. Promoting the health of the elderly was generally seen as contributing too little, too late – or simply adding years of less life.
But in a founding article of The New England Journal of Medicine in 1980, Fries hypothesized that healthy behaviors – exercising, eating right, quitting smoking, getting regular check-ups, and receiving early treatment – could shift an individual’s health trajectory from ‘poor health for many years to good health until the end.
A Fries study initiated at Stanford in 1984 followed 538 people over the age of 50 until they reached the ages of 70 and 80. Older runners ended up with fewer disabilities, longer active lives, and half the likelihood of dying an untimely death than aging non-runners. While both groups became more disabled over the course of the study, the onset of disability began 16 years later for runners, on average.
This study and others confirmed the Fries hypothesis, and morbidity compression has become widely recognized as the dominant paradigm of healthy aging, both at the individual and policy level.
Fries has published 11 wellness books. A book he co-wrote, Take care, 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,” said Robinson. “Far from promising eternal life or even substantially extended lifespans, he relied on the results of his own studies to encourage people to live better by delaying the onset of chronic disease.
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 of six of the world’s continents, including Antarctica. (He failed to climb the seventh, Mount Everest, because a snowstorm forced him to turn around.)
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 present annual awards for significant achievements in improving public health and health education. When their 42-year-old daughter, Elizabeth Fries, died in 2005 of complications from chemotherapy for breast cancer, the foundation renamed its health education award the Elizabeth Ann Fries Award for Health Education.
About a decade ago Sarah Fries developed advanced melanoma, leaving her permanently disabled and in a wheelchair.
“He was absolutely, totally devoted to his wife,” Lorig said. “He fed her, bathed her, took her to conferences and our division meetings, and took her all over the world with him” – often to exotic places such as Antarctica and even the Himalayas, where he carried her across a bridge.
On May 12, 2017, James Fries suffered a massive and debilitating stroke and was rushed to Stanford Hospital, where his wife was critically ill. She died at their home in Woodside, Calif., Two weeks later. Fries’ stroke caused severe and lasting damage, ending his career.
Fries has published over 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 Fellowship in 2005.
He was a founding member of the American College of Informatics and an honorary member of the Society for Public Health Education. He was also a fellow of the American College of Rheumatology and the American College of Physicians. He has 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 one son, Greg Fries of Longmont, Colorado; her brother, Ken Fries of Kuna, Idaho; and five grandchildren.
A commemorative event in honor of Fries is scheduled for California in the summer of 2022.