The Compression of Morbidity

in 1980, James Fries wrote an article that was decades ahead of its time.  Even today, this paper and his concept of The Compression of Morbidity has the power to change the lives of many and revolutionize healthcare.  His article, Aging, Natural Death, and the Compression of Morbidity has since been cited 4146 times. 

what is the compression of morbidity?

It comes from the idea (and literature) showing that improving lifespan, the amount of years one lives, is a futile goal.  Humans have a finite lifespan.  Sure, it can be improved a little (an increase of eleven months over the next forty years), but not much.

It is a better idea to focus on improving our quality of life.  This means delaying our morbidity (state of being unhealthy, diseased, ill, or symptomatic).  It means prolonging our healthspan.

"The compression of morbidity occurs if the age at first appearance of aging manifestations and chronic disease symptoms can increase more rapidly than life expectancy" -James Fries

(image source)

The average lifespan in the US is 78 years.  I can't speak for everyone, but I think we'd all much rather live a full 78 years and then die in our sleep without any morbidity.  Versus becoming sick or ill and struggling for the last 20 years of our life, but living to 82.

how to compress it

The problem isn't the acute illness that can be fixed with a simple perscription or surgery.  These don't lead to increased morbidity.  They're just small bumps in the road.  Once you get past it, you can often get back up to speed.

It's chronic illnesses that are the problem.  These are complex and require intervention from many different areas (sleep, diet, exercise, stress, etc.).  They are often the result of risk factors and lifestyle over time.  These can quickly lead to increased morbidity.  Like driving onto a sandy beach, they'll slow the car down until it can no longer go.

"The acute infectious diseases have ceased to be statistically major causes of mortality in the United States. Tuberculosis, small pox, diphtheria, tetanus, polio, typhoid fever, and others have declined by 99 percent to 100 percent in this century (Fries and Ehrlich 1980). In turn, the major medical problems are now well-known to be chronic illnesses: atherosclerosis in all of its guises, cancer in its many forms, emphysema, diabetes, cirrhosis, osteoarthritis. 

These illnesses are not well conceptualized under the medical model of diseases with single causes and specific cures. These present health problems are characterized by “risk factors” which accelerate their course or which increase the probability of their occurrence. Their “cause” is thus multifactorial, and no single cause is essential. "

As Fries mentions, these chronic illnesses are complex.  They're multifactorial.  It's often all connected.

If we want to be healthy, then we have to be healthy.  We need to do the best we can to live a healthy life, right now, so morbidity doesn't come sooner.

COVID-19: Stay Safe and Sane

These are scary times.  There is a lot of uncertainty.  A loss of control. A great worry for the current and potential future suffering.

Many of our lives are affected, or are going to be affected in the next few weeks as this progresses.  But keep in mind, this self-quarantine and social distancing we are doing will help save lives.  We will have to sacrifice some things we enjoy and need, so that someone else, who we likely won’t know, will have a better chance of living.  Social distancing accomplishes this by helping to flatten the curve (please read about this if you haven’t already).  

Another problem we have while we are practicing social distancing is managing information.  As we’ve seen in the past 4-5 years, misinformation can divide us, create panic, foster hate, and put others at risk.  The coronavirus is no different. We have a lot of stories coming from “my friend’s, friend said…”, social media coronavirus “experts”, and amature “science journalists”.  Plus, this is a novel virus and it seems everyday things change.

So how do you stay sane?

Here are a few things you can do:

1. Stick to Reputable News Sources

• The Centers for Disease Control and Prevention (CDC) is the #1 place you should be going for updates and information

• John Hopkins also has some great information

• You should also look up your state government’s COVID-19 information.  Here is North Carolina’s.  Our government shut down stores and our local government is shutting down all unnecessary business.  They are doing the right thing. But keep in mind your state may not be taking the necessary precautions, so always refer to #1.

• Avoid any website you don’t recognize or haven’t heard of.  Stick to reputable sources (Washington Post, BBC, The Economist, Wall Street Journal, etc.).  However, even with those sites, remember the coronavirus is getting clicks and helping their business.  There are a lot of amature science writers. Always go to the source (the study that the article is based off of).

• Follow smart people.  A few examples: Peter Attia, Rhonda Patrick, David Sinclair

• Avoid uninformed/dramatic people: your friend that thought it was a hoax, your coworker that loves telling the horror stories from other countries or the frontline, your family member that thinks it’s just a cold

2. Remember There Is A Lot of Bad Journalism Out There

For example a recent article circulating social media makes it seem like 1 in 5 young adults landing in the hospital with the coronavirus.  This is a scary number right?

Except the study shows that of those hospitalized, 1 in 5 were young adults between 20-54 (34 year age span).  That’s a big difference.

Furthermore, the study they tried to write about found a mortality rate of “<1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years.”

This type of journalism is fear provoking.  Maybe it will keep some of those selfish spring breakers from putting our communities in danger?  But for the most part I think this will just scare a lot of people that are already struggling.

However, this does bring me to my next point...

3. Just because you're young doesn’t mean it doesn’t apply to you.  You can spread it and kill others. Don’t be an asshole.

4. Just because you’re older and have been through alot, doesn’t mean you know what the hell is going on.  If you’re over 60 or have any comorbidities (lung, heart, diabetes, etc.) stay home. Don’t be an idiot.

5. Maximize Actions, Minimize Things You Can’t Control

There’s a lot of scary news out there.  A lot of it we can’t control directly, such as ventilator supply, people suffering, economic recession, etc.  

By no means am I implying that these are not important.  I am merely saying that these are things we (as individuals) cannot control right now.

Instead, we need to focus on what we can do.  And this is practicing social distancing, good hand washing and hygiene, taking care of our health, and taking care of each other.

As Mother Teresa once said, “if you want to change the world, go home and love your family.”

6. Have Gratitude

Our healthcare workers are making great sacrifices to take care of us.  Our grocery store workers, supply chain workers, and law enforcement / firefighters are still out there working for us.  We need to appreciate these people for helping our country in a time of great need while putting themselves at risk.

We can show our appreciation by abiding to the social distancing and self-quarantine. Hoarding, panicking, and ignoring precautions only hurt these people who are making sacrifices for the better of our communities.

We also should try to focus on some of the things we have around us.  Gratitude has been proven to help mental health. It might be difficult to find things in times like these, but if we try hard enough I’m sure we can. 

7. Support the Community

Many small businesses, artists, and restaurants are in trouble.  Try to support them with gift cards, take out, or online purchases (not in person)

8. Try to Stay Positive and Healthy

Panicking and hoarding only hurts our community.  Furthermore, this accomplishes nothing to help the situation.

Try to stay positive.  Stay active both mentally and physically.  You can still go on hikes, walks outside, exercise, etc.  Pick up a hobby. Cook a healthy meal. Do a home project or knock off stuff on your to do list.  Play a board game or do a puzzle with the family.

It hasn’t peaked yet in the US, but it will get better.  This won’t last forever.  

Everyday more Americans are making the right decision to stay home and protect their community.  Our scientists and researchers are making progress everyday. And I am hopeful that our government will make the American people a priority and help us through this difficult time.

We will get through this.  Be smart. Be safe. Stay positive.  Love one another.

CPM & TKA

Continuous passive motion (CPM), a device that does exactly its name, has fallen out of popularity in the last few decades.  

Why? 

A study or two showed no long term benefits. And just like pop culture, a trend started and deeper research was overlooked.  

What is missed, besides an unbiased look at the research, is the view of short term. Almost all studies will show short term benefits.  

Does short term matter? 

Ask the person who is a week out of their knee replacement. As the person who has a stiff knee and has had to fight and struggle for every degree for the short term. Sure, maybe a year later they'll be fine. But these patients are suffering in the short term.  

Joints get their nutrition and fluid from movement. Movement is like WD-40 to joints. The CPM is like a IV of WD-40 to the joints. The best part is that there's no pain and it's not pharmaceutical, so your liver and gut won't get damaged in the process. 

CPM may never come back. Insurances won't pay for it. And surgeons can have a difficult time changing their mind.  

I've seen hundreds of knee replacements. I think there are definitely patients who could benefit from it. I think they would have less pain and greater ease getting their motion back.  

My criteria would be: 

• Less than 90 degrees of flexion
• Hypomobility of the patella
• Severe pain
• More than 10 degrees away from terminal knee extension

I think we should do a study on that specific population.  

There is this study from 2019:

"A total of 77 RCTs with PEDro scores ranging from 6/10 to 8/10 were included. Meta-analyses revealed an overall significant favorable effect of CPM on treatment success rates...Early CPM initiation with rapid progress over a long duration of CPM application predicts higher treatment effect on knee ROM and function."

Maybe things will change. Maybe we'll start considering the patients short term experience. Especially in the opiod age.