Inside Salk; Salk Insitute

Insider's View

William Brody

Years ago, Stanford physician Dr. James Fries proposed an idea which has been deemed the "compression of illness" hypothesis. According to Fries, the best strategy both for healthy living and lowering medical costs is to delay the time of onset of chronic disease: in other words, slow down the appearance and progression of chronic illness.

When Fries proposed this idea, it was highly controversial. Critics of the strategy suggested that if chronic illness appeared early, longevity would be shortened and overall healthcare costs would be lower, even though the outcome would be worse for the individual patient. In other words, the healthcare costs of dying of a heart attack at age 40 might be lower than living to age 75 with heart failure that occurs at age 65.

Yogi Berra supposedly once said: "In theory there is no difference between theory and practice. In practice, there is!" In this case, subsequent studies appear to validate Fries's theory. Interventions that slow or delay the onset of a chronic illness appear to lead to lower overall healthcare costs incurred by that patient. Of course, addressing the costs of treating chronic illness is still an enormous challenge—one that has become a major concern in recent decades. Unfortunately, chronic illness requires chronic treatment.

Today, formerly acute illnesses, including infection, heart disease and many forms of cancer, have been transformed by medical science into chronic diseases. According to some estimates, Medicare patients with five or more chronic illnesses consume 75 percent of the costs of this important federal program. Common logic dictates that bending the cost curve requires more cost-efficient methods of care for arthritis, heart disease, cancer, stroke, depression, dementia, Parkinson's disease and other chronic illnesses.

The Salk Institute has a lot to offer in addressing this issue. As the feature article on the Campaign for Salk's Healthy Aging Initiative in this issue of Inside Salk explains, deciphering how cells change at the molecular level as we get older will help us bolster our ability to fend off age-related illnesses. Similarly, our Genomic Medicine Initiative was also designed to tackle chronic illnesses that undermine our health as we age. The Helmsley Center for Genomic Medicine, established by the largest gift in the Institute's history, has at its core the focus on understanding chronic inflammation and the role that our immune system plays in aging and the development of chronic disease.

Salk scientists believe that there is a common thread to chronic illness and the aging process: chronic, low-grade inflammation. When our body encounters something it considers 'foreign,' like a bacterium, it sends signals to the genome of immune cells that participate in fighting the foreign invader. Unfortunately, as Salk scientists are discovering, sometimes what gets turned on fails to get fully turned off, which can lead to so-called autoimmune diseases, like rheumatoid arthritis and type I diabetes. In addition, there may be other forms of chronic inflammation that keep the immune system activated, albeit at a lower level, and this form of chronic immune response may play a previously undiscovered role in chronic illness as well as the aging process.

Finding the keys to chronic illness will reduce the burden of healthcare costs and at the same time help us stay healthy longer. By 'compressing' illness, Salk science helps people live their lives to the fullest.