Parkinsons - A simple mathematical cure?

I recently watched a TED video featuring Max Little (mathematician) on how math may be the cure for Parkinsons disease. It was a really interesting video -the primary focus being on how voice changes in an individual developing PD- long before any overt symptoms develop-can be captured utilizing mathematical algorithms to provide early diagnosis and trigger preventative treatment.

It is quite leading edge and lends hope to the thought that if you can identify disease processes before overt progression there can be treatment that stops a disease in it's track. Unlike DNA which only reflects the propensity for development-this focus' on clear early symptoms that signal a problem. The goal of Mr. Little's work is to eventually have a test that can literally be administered within minutes over a simple phone line-AMAZING! For insurance carriers that rely upon telephone interviews as a part of their process this really increases potential benefits.

PD is a progressive neurological disorder that affects between 4-6 million individuals worldwide and carries a median survival of 15.8 years from the onset of motor changes.

Max Little; A test for Parkinson's with a phone call; (link)

http://www.huffingtonpost.com/max-little/parkinsons-diagnosis-test_b_2545128.html

Mathematics are well and good but nature keeps dragging us around by the nose. ~Albert Einstein

MD Anderson "Moon Shots Program"-2013 Launch

The University of Texas MD Anderson Cancer Center in Houston is on the verge of making history in how clinical medicine and research approaches cancer cures and increasing life expectancy of survivors. In February they will "launch" the "Moon Shot" program - a concentrated and focused effort to harness the expertise of researchers and tecnnicians supported by very specific platforms to create the infrastructure needed to make tremendous strides in cancer treatment and therapy.

The program was aptly inspired after the 1962 speech that then President Kennedy gave at Rice University in regard to the nations focus on sending men to the moon, "We choose to go to the moon in this decade ... because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win," Kennedy said. On the verge of this remarkable and bold project MD Andersons president, Ronald DePinho M.D.  encapsulated the drive behind the program when he said,  "Humanity urgently needs bold action to defeat cancer. I believe that we have many of the tools we need to pick the fight of the 21st century. Let's focus our energies on approaching cancer comprehensively and systematically, with the precision of an engineer, always asking ... 'What can we do to directly impact patients?'".



The inaugural program will focus on; acute myeloid leukemia/myelodysplastic syndrome, chronic lymphocytic leukemia, melanoma, lung cancer, prostate cancer, and triple negative breast and ovarian cancers - two cancers linked at the molecular level. It is expected to span ten years with an estimated cost of $3 billion dollars. More importantly it holds the key to a new approach to chronic disease diagnosis, treatment, and therapy.  

"That's one small step for man, a giant leap for mankind"

Neil Armstrong, July 20, 1969

 

Options for "Super Seniors"

Interesting article on the need for consumer awareness on life settlement options. Those over the age of sixty are the fastest growing segment of the U.S. population, with needs and expectations much greater than those of the prior generations. Clearly life settlements and other similarly focused services to provide for the expanding needs of today's "super seniors" are going to continue to be sought after by this subset U.S. consumers. Those companies that understand those needs, develop longevity data and tools to manage these unique risks, and have the vision to develop products for this expanding market will lead the charge.

On November 7 through 9, LISA, the Life Insurance Settlement Association, held its annual fall meeting in Orlando. Many topics of interest to life insurance producers, life settlement brokers, and life settlement investors were covered, but two key items stood out.
        
I. The biggest obstacle facing the life settlement industry today is the lack of consumer awareness.

Each day, elderly policyholders, ignorant of the option of a life settlement, are surrendering policies that might bring them significantly more value as a life settlement. Although a relatively new financial option, knowledge of life settlements has not filtered through to consumers the way you would expect. Producers, who traditionally look out for their clients’ best interests (and their own wallets, too) should be happy to spread the word. Yet many find themselves afraid to even mention life settlements to their clients as a result of rules handed down by their primary company or broker-dealer. That’s the bad news.

There is good news, however. Regulators are becoming aware of how senior citizens are being shortchanged by these practices and have passed or are considering legislation or regulation that would mandate the disclosure of the life settlement option to a policyholder considering the lapse or surrender of a policy. Disclosure has already been mandated in six states — Kentucky, Maine, New Hampshire, Oregon, Washington and Wisconsin — with more on the way.

Additionally, the legal profession is becoming aware of this malfeasance as well. Lawyers are starting to initiate lawsuits against producers who have failed to disclose the life settlement option to their customers and insurance companies that are uncooperative with policyholders who are trying to settle their policies.
The life settlement industry is trying to educate consumers of this valuable option through awareness campaigns and by supporting legislation intended to apprise consumers of their right to investigate the life settlement value of a policy about to be lapsed or surrendered.

II. Investment money continues to find its way back into the industry.

It is no secret that in the past few years, the combination of a poor economy and changes to life expectancy methodology drastically decreased the amount of investment money making its way into life settlements. Since bottoming out about four years ago, investor interest has slowly, but steadily, increased, with the realization that life settlement investments offer the potential for very attractive returns in this low interest rate environment and are relatively uncorrelated to the stock market.

Interestingly, pension plans have shown the greatest increase in interest in investing in life settlements. Their long-term view, combined with the attractive uncorrelated returns, make life settlements a good fit. Even more interesting are reports that some insurance companies are quietly investing in life settlements not only to reap good returns, but also to hedge against the mortality risks inherent in their life insurance business.

There’s no doubt that once a decision has been made to lapse or surrender a policy, investigating the option of a life settlement can only be a good thing for the policyholder. As we’ve said before, if it was your grandparent, parent, etc., and the choice was to surrender a policy for $91,120 or to settle it for $330,000 (a recent case that we did), what would you want for them?

Overall, as always, attendees of the LISA conference were well rewarded with an informative meeting. LISA's spring meeting will be held May 21-23 in Las Vegas.

by Robin S. Weinberger and Peter N. Katz, Life Health Pro journal, Nov. 26, 2012

Always do right. This will gratify some people and astonish the rest.

Mark Twain

 

Life Settlements-Consumers vs. Investors

Life Insurance Settlement Association (LISA) published it's weekly newsletter. I thought this was an interesting article!

Life Settlements: Weak Investor Supply Despite Growing Consumer Demand-11/15/2012

“The life settlement market volumes remained low in 2011, reflecting weak capital inflows continuing as in the past few years. This in part due to investor concerns with standards of underwriting and pricing accuracy,” said Scott Hawkins, analyst at Conning. “In fact, because of fewer new policies settled, we estimate that the amount of in-force life settlements actually declined for the first time in 2011 based on death claims and lapses on previously settled policies. While consumer demand for this product remains strong, the asset class has so far been unable to attract sufficient capital to meet that demand. Activity in the market has mainly centered on acquiring distressed portfolios rather than funding new policy purchases. But we may be seeing early signs of change”...READ MORE. Also see LifeHealthPro's article on the Conning report.

Wishing you all a Wonderful Thanksgiving Holiday!

Gratitude is not only the greatest of virtues, but the parent of all others.

Cicero (106 BC - 43 BC), 'Pro Plancio,' 54 B.C.

Interesting article on STOLI vs Life Settlements

I came across this article from Michael Kreiter of the Life Insurance Settlement Association on the clear distinction between a life settlement transaction vs. stranger owned life insurance (STOLI). There continues to be an ongoing "myth" in the life insurance industry that these transactions are the "same" and that perception could not be further from the truth. Those that support life settlement (and actively work in that market) have as much heartburn over STOLI as carriers do and do not want any part of those transactions-STOLI is bad for carriers, both the life and life settlement industries, and most importantly they are bad for the consumer.

     

Never hold discussions with the monkey when the organ grinder is in the room.

Sir Winston Churchill (1874 - 1965)

--Want to find STOLI? Ask the carriers!
The rhetoric, day in and day out, is always the same from insurance carriers…”all you have to do to find how much STOLI exists is ask the life settlement providers.” Time and time again, carriers and their trade organizations incessantly utter their bleat: STOLI/Life Settlements, STOLI/Life Settlements, STOLI/Life Settlements.

First and foremost, it is important to discern what IS – and IS NOT – STOLI before one can cast a stone. Stranger-originated life insurance is exactly what the term describes – life insurance originated by a stranger. These schemes are typically initiated by a third party looking to own and control a policy from its inception in violation of insurable interest laws.

Importantly, life insurance policies are not sold in a vacuum – there is a licensed insurance producer who has been appointed as an agent of the insurer. Carriers are responsible for performing underwriting and due diligence to seek out fraud and illegal activities in applications for new insurance.

A life settlement, on the other hand, is a lawful sale of a lawfully owned life insurance policy by a lawful owner. This transaction is highly regulated and transparent and, in all but a handful of states without settlement laws, is made to a licensed life settlement provider.

It would seem only natural when looking for STOLI to focus on circumstances surrounding the application and issuance of policies and NOT the sale of a lawfully owned policy. To find out how much STOLI exists, ask the insurers. Require them to report on how many policies they issued in violation of state anti-STOLI or insurable interest laws, or how often insurance companies issued policies where there was fraud or misrepresentations in the applications for the insurance.

Since STOLI involves the issuance of new policies in violation of state insurance laws, such an inquiry would also look at how many of the insurers’ appointed agents have been engaged in illegal activities and how many agents have been subject to termination, regulatory action or litigation for their involvement with STOLI.

And ask the insurers how many life settlement brokers and life settlement providers have been found by regulators or other law enforcement entities of illegally manufacturing policies. Of the more than 300 so-called lawsuits involving STOLI that the ACLI says are pending, how many are against life settlement companies? These are the questions that should be asked in an inquiry into STOLI.

Posted on August 29, 2012 by Michael Kreiter, Director of Legislative and Regulatory Affairs, LISA Written by: Michael Kreiter, Director of Legislative and Regulatory Affairs, LISA on August 29, 2012.

MIB-A Year in Review

Medical Information Bureau (MIB) just released Q4 and 2011 annual reports. Q4 proved to be a solid finish to a year that was stable across some age groups and quite active in others. To quote MIB directly, "The MIB Life Index showed marked resilience in 2011". Most age groups reflected an end of year increase in activity ( 45-59 year olds +0.1%, 60+ age groups +8.9% ). The only age group that reflected a slight downward trend was 0-44 (-2.2%). Application activity in total increased .2% compared to 2010 (which indicated that total activity for "individually underwritten life insurance applications fell 1.2%").

60+ age groups, continue their upward (YOY) trend (15.03% in 2010, 16.7% in 2011) which is consistent with development, and expanded, simplified issue programs along with a renewed carrier focus on middle market sales.

Age related distribution of activity noted 54.2% of all applications came from ages 0-44 (a slight drop from 2010 which reflected 55.6%); 29.1% ages 45-59 (unchanged from 2010); 16.7% 60+ age groups (increase from 15.3% in 2010).

Overall, these are encouraging year end results which , in this blogger's view, indicate some increased confidence on behalf of the consumers of insurance products. Certainly a more positive outlook than the prior years reports indicated!

As a tribute to a very young, but incredibly brilliant, young lady that recently succumbed to an untimely death, I wanted to take the opportunity to utilize one of her quotes-a wonderful reflection as we begin the new year;

"If you want to do something big in your life, you must remember that shyness is only the mind," she said. "If you think shy, you act shy. If you think confident you act confident. Therefore never let shyness conquer your mind."

Arfa Karim Randhawa, aged 10 (2005)

May all of my readers have a prosperous and blessed 2012!

Women and Increased Diabetic Risk from Statins

The LA times reported on a study just released from the Archives of Internal Medicine this week red-flagging increased risks related to statin (cholesterol lowering) therapies. The report indicates that post-menopausal women, taking statin therapy purely as "preventative" protection against development of heart disease in fact did not develop frank heart disease during the study period but developed a predecessor to heart disease, Type II diabetes!

Type II diabetes, known as "non insulin" or adult onset, is a lifelong chronic disease marked by increased levels of blood glucose. It is the most common form of diabetes, often a flagship risk factor associated with obesity. It is also a common predecessor to development of heart disease as it is more difficult to control blood pressure and cholesterol levels.

According to the study, over 153,000 post-menopausal women (aged 50-79) were studied and followed between 1993 and 2005. Statin usage was evaluated at baseline and year three. All women were encouraged to continue on therapy throughout the length of the study.

At the end of the study period, it was indicated that nearly 11,000. women had developed Type II diabetes. Increased incidences among women of Asian decent and those with normal BMI. The study indicated that further evaluation drilling down the statin drugs that were related with increased incidences would be a good next step.

As statins have become more prevalent, and often touted as the miracle drug of the century, it's reminders from important studies such as this that "one drug does not fit all".

"Wish not so much to live long as much as to live well"

Benjamin Franklin, Poor Richards Almanac, 1738

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The Truth about Statins and Seniors

I recently came across an editorial which reviewed the benefits of statin therapy in older aged individuals in the October 2011 Journal of the American Geriatrics Society. I wanted to provide some "highlights" from this enlightening review of several cholesterol studies which sought to shed some light on the value of lower cholesterol levels in the elderly. What was revealed in the study was that there is actually protective value in higher total cholesterol and non-high-density lipoprotein levels. Even more revealing, is that there have not been any studies to date displaying any benefits in persons over the age of 80 to utilize statin therapy unless they have documented coronary atherosclerosis.

Review of various studies indicated that there is strong association between higher cholesterol levels in the elderly with lower risk of non-cardiovascular disease and total mortality. Lower cholesterol levels have been strongly associated with higher all cause mortality and is utilized as a measure of "frailty" in the elderly. A large study of over 19,000 individuals, aged 65-82, found relative risk reduction of all cause mortality of 22% in statin therapy users vs. non-users. There was also associated protective value of statin therapy against dementia for the "middle aged" but on the flip side there was a notable increase in cognitive issues in the elderly utilizing this therapy. Additionally at older ages there are strong adverse issues related to individuals with fall histories, increased incidences of depression, symptoms of intolerance (muscle aches and gastric symptomology), and significant concerns related to poly-pharmacology.

As with most studies on the subject, there are pros/cons related to the use of this therapy. Not quite the "wonder drug" touted by some, especially in our aging population. As with any therapy, "one size does not fit all " and caution should be utilized when assessing mortality risk (or improvement) when it comes to statin therapy and the elderly!

"I find that a great part of the information I have was acquired by looking up something and finding something else on the way"

Franklin P. Adams (1181-1960)

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"Keys to Longevity" - The Adventist Advantage

I've been reading a fascinating book by Dan Buettner on "Blue Zones" in the world that boast higher than average pockets of individuals living well into their 90's and beyond (amazing Centenarians!). The book explores common lifestyle and genetic factors that contribute to longer than average life expectancies.

One U.S. demographic that was explored was the Loma Linda Blue Zone -specifically a concentrated area of 7th Day Adventists. In 2001 Loma Linda University released the results of a longevity study of SAD's in the Loma Linda area. It was a comprehensive study that followed 34,000 individuals over 12 years and focused on specific lifestyle factors based upon SAD practices-which indicated statistically significant increases in life expectancy. Compared to the average Californian, Adventist women exceeded the average life life expectancy by 6 years and Adventist men exceeded the average by nearly 10 years!

Dan Buettner and his National Geographic research team (funded by the National Institute of Health) completed additional focused longevity research on the phenomenon of the Loma Linda SAD group-the results further documented increased life expectancy (of 6-10 years) based upon an emphasis on health, diet, and sabbath observance.

Lifestyle benefits specifically uncovered by Buettner incorporated the following practices;

• Following a vegetarian lifestyle-on average a vegetarian status (specifically non-meat eater) will gain the average person 2 years of additional life expectancy


• Eating nuts-largely related to heart disease prevention, another 2 year gain


• Being a non-smoker-Even a past smoker is at moderate risk of lung cancer and heart disease


• Physical activity-mild amounts of daily activity provide another 2 years of average life expectancy with benefits directly related to heart disease and cancer prevention (specifically breast and colon). There is a wear-off point in activity where the benefits flatten out-such as for those marathoners (I always think of Jim Fixx as being a stand-out exception to the rule)


• Maintaining a healthy weight-increased weight is associated with obvious impacts on heart disease, diabetes, and respiratory issues. One area being further evaluated by the research community is an increase in active chemicals in the body which may increase cancer risk, chemicals that appear to come from excess fat cells. Vegetarians on average are 16 pounds lighter than their non-vegetarian friends.

It appears that there are clear longevity benefits to the Adventist lifestyle-many points which reflect similarities to other longevity studies I've followed over the years. Our individual genetic make-up only provides about a 20% benefit leaving a significant, and necessary, focus on our lifestyles.

"Most of the change we think we see in life is due to truths being in and out of our favor"

Robert Frost (1874-1963), The Black Cottage

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Living to 100-Revelations of the Longevity Project

So, like most Americans do you believe that "good genes" coupled with a healthy lifestyle-eating right, maintaining a healthy weight, refraining from "high risk" activities, and 30 minutes a day on a treadmill will equate to a long life expectancy? Well, that "myth" is being dispelled by several different researchers that have identified, in separate studies, that social activity has more impact in longevity than our genes for one thing!

I recently read a book titled "Blue Zones-Live Longer, Better" by Dan Buettner. He focused on similarities in areas around the world which are "pockets of longevity"-higher than average populations of seniors living past 100. The primary message-living a happier and purposeful life is one of the secrets to a longer than average life. As an example, the average American could expect to live an additional (12) more years and increase their "happiness" by 40% with lifestyle optimization and making changes in their environment.

A new book coming on the heals of Blue Zones, but suggesting very similar findings, is "The Longevity Project". The researchers from Stanford University provide insight into study findings after following 1500 participants and compiling eight decades (yes-80 YEARS!) of data on older ages which suggests that the key to unlocking a long life are related to a life filled with purpose, not running on the track. Here are some of the key findings explored in living to 100;

• Set clear-sighted goals


• Work hard at ones job


• Worry in moderation


• Maintain strong and stable relationships

Oh, and as for relying on your perfect genetic baseline helping you out-the truth is that it only provides about a 20-30% impact. Environmental and social factors clearly have the upper hand in ones mortality.

"Here's to a long life and a merry one. A quick death and an easy one. A pretty girl and an honest one. A cold beer and another one!"

Old Irish Saying-and fitting at that!

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Ask the Underwriter: "Should I order paramedical exams on my life settlement applicant?"

Recently, I was asked about the value of life insurance paramedical exams and the potential value in life expectancy underwriting. It seemed like a good opportunity to explore the use of additional medical data sources in that process and focus on where the "protective value" truly lies.

Over the past six years I've had the opportunity to learn a lot about the secondary market -the interesting world of life settlements. In particular the medical information utilized to assess risks and assign the critical "life expectancy estimation" numbers stands out as an ongoing area of perplexity. By that I mean that in my two decades of underwriting life insurance risks, primarily focusing on affluent, senior market lives, it is confounding to me that with all of the "tools" available to carriers and reinsurers to properly vet mortality risk, only one tool has historically been utilized in the life settlement market, which is review of medical records. In a market where substantial financial risk is being undertaken by investors, they are skimming the surface of understanding the mortality impact of the policy (ies) they are vying for. I believe the reason for this is two-fold; (1) investors are not properly educated on the underwriting tools available and their "protective value", and (2) obtaining LE certificates has largely fallen on the shoulders of providers and brokers who absorb the cost of ordering medical records and LE's-hence the cost of additional underwriting requirements is not one that most want to take on.

So, what is "protective value" in the sense of underwriting assessments and of all the underwriting tools available which ones make the most sense in evaluating LS individuals? Protective value in underwriting relates to data gathered on an applicant that provides enough relative information to appropriately assess that individuals mortality risk that the carrier will be on the hook for at time of a claim. The goal is to obtain the right amount of information without incurring undue cost, not always an easy task as risk assessment tools available range from paramedical/MD exams to full medical records, from standard panel blood profiles to specific diagnostic tests, resting EKG's to treadmill testing, and from telephone interviews to extensive investigative reports including credit and background checks.

When it comes to life settlement risks, with a focus on affluent seniors, the following risk assessment tools will undoubtedly provide the best "protective value" for investors;

• Medical records; covering the past (5) years of history from the primary attending physician and specialists (i.e. cardiologist)


• Senior risk assessment (thorough on-site assessment) or senior risk questionnaire (telephone interview completed by an senior risk underwriting expert)


• Current blood profile with specific tests that reflect direct mortality impact

These specific underwriting tools will provide an additional layer of data that will enhance the underwriting assessment and provide a more robust LE certificate (i.e. the protective value that investors can be confident in). The average cost per life will be $1000.00 (exclusive of LE assessment) which is minimal given the financial risk investors are taking on.

I hope this brief overview will provide you with insight into options and opportunities to enhance the life expectancy process. This is the first of what I hope will be many "Ask the Underwriter" discussions-please continue to submit your questions about the largely misunderstood world of medical underwriting!

"Take calculated risks. That is quite different from being rash."

General George S. Patton (1885-1945)

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Statin Drugs- "Read the Fine Print"

Statin drug therapies have been touted as the most effective treatment for not only slowing the progression of atherosclerotic disease but also key in preventing development of disease by lowering the effects of increased levels of cholesterol. Cardiovascular disease still ranks as the #1 leading cause of death in the U.S. with strokes running a close 3rd-so it makes sense that from the time statin drug therapies were introduced (approximately 2003) there has been a continued rise in prescriptions and even insight into the broader uses of statins as a preventative therapy.

While there has been a focus on all of the positive aspects of statin use, often times the issues surrounding this therapy have been overlooked. There are a number of issues related to statin drug therapy that have prevented many individuals (especially seniors) from utilizing these drugs. Some of the minor issues, that do relate to lack of "tolerance" and use of the therapy long term include; muscle weakness, abdominal cramps, and general athralgias. More severe, and compromising issues include liver function abnormalities, acute renal failure, and heart muscle damage. A news release today indicated an FDA warning against increased uses of one particular statin drug (Simvastatin-sold under the brand name Zocor) at increased levels due to muscle (heart) damage.

There has been a trend by clinicians prescribing this drug therapy to prescribe amounts in excess of acceptable limits (if good is good, than more must be great!) with increased utilization in otherwise healthy individuals. Independent studies have shown that utilizing statin therapy as compared to a placebo show no statistically differences in reducing cardiovascular morbidity and mortality.

For underwriting risk assessment purposes, it does seem reasonable to apply "credits" to those heart patients that have been on long-term statin therapy that have notable stability and control of their lipid levels. It stands to reason that applying mortality improvement across the actuarial curve does not "make sense" given the broad based issues noted with current statin therapies and the lack of long-term mortality/morbidity data related to this therapy.

"A strong positive mental attitude will create more miracles than any wonder drug"

Patricia Neal

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Positive Movement in Life Insurance Activity

MIB-Medical Information Bureau posted their April index which indicates continued gains in individually underwritten life insurance applications. Typically a month that trends down due to normal seasonal fluctuations, this April posted gains for the first time in seven years!

Reflecting a +1.1 gain, older ages (60+) continue to lead the pack with a year-over-year gain of +8.4% but there is surprising increased activity in the middle group (ages 45-59) of +1.0% which has posted positive numbers four months straight.

This information comes on the heels of my travel to a major underwriting industry meeting (AHOU) where underwriting managers and executives seemed positive and upbeat about the increased business they were seeing on their end. Many attributed growth to a renewed marketing and product focus on middle-markets (average death benefits of $1MM) directed at Gen X'rs and continued expansion of simplified products pointed at the baby boomer market.

Trends that require continued monitoring for those active in secondary markets as this will undoubtedly change the future landscape of policy settlements.

"Spring is a true reconstructionist"

Henry Timrod

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It's All in the Genes!

I just read a fascinating article posted by Reuters this weekend about (13) new genes identified by English researches which have a direct correlation to increased risk of coronary artery disease. Researches feel these genes are the key to unlocking how the disease develops and preventative therapies that can be instituted early on in a high risk individuals life to stop the development of the disease.

Clinical researchers, although excited about the future prospects of identifying specific genetic patterns, are realistic about the fact that they are years off from truly pulling all of the pieces together that will be needed to put changes into preventative therapy into action and even longer before we start seeing decreases in cardiac related deaths-still the leading cause of death in the world according to statistics from the World Health Organization (WHO).

Often times I am asked what part genetic testing can, and will play in medical underwriting and longevity. I've watched the focus on DNA testing and followed clinical research studies over the past several years and see the impact to underwriting being years off. From a life insurance perspective stringent GINA (Genetic Information Nondiscrimination Act) regulations do not allow insurers to take negative action on a proposed insured based upon DNA results. For life settlement, where we look at longevity not issuance of a policy, we know that an individuals genetic predisposition accounts for less than a 20% mortality impact vs. lifestyle which accounts for over 80%! Where underwriters will first see the impact of DNA testing is in more individualized preventative and specific impairment treatment options for patients that will positively impact that individuals morbidity and mortality. To read this Reuters article follow me on twitter!

"As for me, except for an occasional heart attack, I feel as young as I ever did"

Robert Benchley, 1889-1945

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MIB Activity Index-Tick Up In Activity

Medical Information Bureau (MIB) recently reported it's life insurance activity index for December 2010 and summation of 4Q results. December, historically being a high volume month associated with "year end push" in life underwriting departments across the board noted that December 2010 -although reporting a shortfall-was still an improvement over notable market declines experienced over the past 4 years. December closed at -1.2%-all ages combined. Prior years have had an annual decline run rate of -3%, December 2009 -0.2%.

MIB CEO, Lee B. Oliphant, provided further insight into the numbers indicating that 2010's "modest decline demonstrates resilience in the markets compared to the past".

4th Quarter results noted a surge in applicants aged 45-59 (a demographic that has suffered along with the economic decline over the past several years), seniors in the 60+ group continued to drive the market which has been a relatively consistent trend over the past several years.

What does this mean to this blogger? The increase in applicants 45-59 is a stand-out, it reflects that there is a feeling of increased market confidence -no matter how small-keeping in mind that for most individuals life insurance is still considered a "luxury" item, not a necessity.

"The most beautiful thing we can experience is the mysterious. It is the source of all true art and science" Albert Einstein

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Advances in Cardiovascular Treatment - "Silver Bullet" Cure?

Merck pharmaceutical has just released initial clinical trial study results for a new drug that is being touted as having the potential to stop progressive cardiovascular plaque in it's tracks. Associated with a new class of drugs-Anacetrapib is making some waves in the clinical science community. Unlike statin drug therapies, which increase HDL (good cholesterol) levels-assisting in slowing the progression of coronary plaque development, this new drug significantly reduces LDL (plaque causing cholesterol)-essentially removing the risk of plaque development.

The initial trial studied 1,623 heart patients (with known coronary heart disease) for a period of 18 months. The results noted a significant impact on lowering LDL (by 40%) as well as increasing HDL levels (by 138%!).

This all sounds very exciting, and lends to initial thoughts that this may be the "Silver Bullet" in cardiovascular disease that will bump this off the list as the number one (or even top 5) killers in the U.S. However, a number of cautionary notes should be made:

1) This is an extremely small study group over a short period of time. It will take at least another (5) years of study and thousands of trial participants (Merck indicates a pending study of 30,000 global participants) to support initial theory and determine overall efficacy.

2) During this small trial, 8 participants taking the drug required further cardiovascular intervention (bypass and/or angioplasty)

3) LDL levels dropped to extremely low and dangerous levels in 18% of the participants-so they were removed from the study prior to completion.

4) There were a reported 11 deaths for which it is unclear if it was related to abnormally low LDL levels.

5) This is in the same class of drugs which was previously studied- and withdrawn- by Pfizer due to high incidents of heart attacks and deaths.

Lastly, as this underwriter has seen with statin therapies (the wonder drugs of the Millennium) in elderly patients, due to the number of side effects experienced there is always a large percentage of the population that cannot tolerate these drugs. Just think of the most recent pharmaceutical ad you watched on t.v. which always wraps up with the list of potential side effects and it becomes very clear that anything too good to be true, often times comes at a price!

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Major Press Release from Life Expectancy Providers

October 14, 2010- Major Life Expectancy Providers (LEPr) have formed a focus group to provide best practices standards and transparency to the life settlement and longevity markets. Members of the newly formed LEPr focus group were participants in the "Best Practices" committee of the Life Insurance Settlement Association (LISA) and recognized the need to further expand the sope and definition of "best practices" by continuing this effort as an independent group. All major life expectancy providers were invited, and encouraged, to join in this important endeavor. The goal of the LEPr focus group is to provide a comprehensive and consistent set of best practices and performance standards to all longevity markets that may benefit from life expectancy and mortality information. It is also the intent that all major life expectancy providers participate and adhere to our best practices and professional standards.

Life Expectancy underwriting "Best Practices" are based on the principal of full disclosure and transparency in the information and performance results of LE underwriters, while protecting the integrity of their proprietary methodology and practices. Issues that the LEPr focus group are addressing include privacy, fraud, and confidentiality policies as well as comprehensive performance reporting and definitions common to life expectancy providers.

The founding members of the LEPr focus group are Advanced Underwriting Solutions, AVS Underwriting, Examination Management Services Inc., ISC Services, and 21st Services. Once a "Best Practices" document is completed by the LEPr focus group, the document will be presented to the Life Insurance Settlement Association (LISA), Institutional Life Markets Association (ILMA), European Life Insurance Settlement Associations (ELSA), and Bundesverband Vermogensanlagen im Zweitmarkt Lebensversicherungen (BVZL) for acceptatnce and adoption by those organizations. The LEPr focus group will continue to review and refine its best practices as well as provide education opportunities to the longevity and life settlement markets.

The LEPr focus group will initially host an "investors only" educational seminar on December 7, 2010 in New York. The day-long event is intended to open direct channels of dialog with investors to discuss the results of the LEPr's ongoing work. Seminars for providers, brokers and other interested parties will be scheduled in the near future. For further information regarding the Life Expectancy Provider group you are encouraged to contact any of the LE providers participating in this focus group.

Life Settlement Consumer Disclosure-NCOIL Holds the Line

In recent years, life settlement business transactions and ethics have been under intense scrutiny. Some of which has been well deserved, but largely LS was caught up in the failing economy and questionable wall street practices. Unfortunately, the value and intrinsic benefits of LS to seniors was lost in the turmoil. NCOIL may be the start of providing seniors with the ability to take control, once again, of their life insurance assets.

No matter which side of the argument you sit on, at the end of the day each individual should be provided full disclosure of their options so that they can make an informed financial decision. By withholding this information someone will lose, and it will most likely be the consumer.

In an climate that now requires full disclosure on all financial products and transactions, why should life insurance be the one product that is excluded from that? We will all be watching the status of the Consumer Disclosure Model Act in the coming weeks and months to see if NCOIL will ultimately side with consumers in their ability to have all options fully disclosed to them.

"If knowledge can create problems, it is not through ignorance that we can solve them"

Isaac Asimov, 1920-1992

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Mild Cognitive Impairment-Different than Dementia?

Mild cognitive impairment (MCI) has been on the rise as a "diagnosis" in the medical records being reviewed on senior market insurance applications and settlements. On the life side, this is causing increased challenges in getting policies approved by underwriting, and hence increased frustrations at the broker level. Brokers by and large are under the impression that these are merely typical, age related changes and underwriters have the belief that this is early stage dementia-They are both correct! On the settlement side, this is often the cause of unwarranted aggressive life expectancy estimations, a problem for the investor. Here are some insights to help both sides successfully navigate through this impairment.

According to the AGS (American Geriatrics Society); MCI is the intermediate stage between cognitive changes of normal aging and dementia. Although MCI typically shows up years prior to a formal diagnosis of dementia, and there is some increased risk of MCI progressing to dementia, it is not a definitive measure for development of dementia. Approximately 12% of those over the age of 70 that have MCI are3-4 times more likely to develop AD (Alzheimer's Disease).

Mayo clinic developed a general criteria utilized for the identification of MCI: 1) Self reported memory complaints, 2) Objective memory impairment, 3) Preserved general cognitive function, 4) Intact activities of daily living (ADL), 5) Not meeting criteria for dementia.

In the thousands of senior medical records reviews I have completed over the years, it is important to really evaluate the symptoms and patient presentation when the AP (attending physician) has indicated MCI. I have found a number of instances when all criteria have not been met yet the AP indicates this as a diagnosis-always troublesome for the underwriter to make the appropriate assessment yet retain case documentation that will not haunt them on future underwriting audits!

It is clear, based upon the research to date, that MCI is a risk factor for dementia, much the same as hyperlipidemia is a risk factor for coronary artery disease. As such, it would be reasonable to expect a mild rating, but declinations of insurance based upon this single factor would be unwarranted.

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Contact our Expert/Blogger:
Traci Davis, President/Chief Underwriter
tdavis@advanceduwsolutions.com
www.linkedin.com/in/tddavisaus


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Senior assessments require experienced medical underwriters that understand the differences in impairment mortality on applicants and insureds over the age of 65. AUS has that underwriting expertise-contact us today to find our more about our suite of underwriting services!

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Life Insurance vs. Settlement Indices-July 2010

Medical Information Bureau (MIB) released results of July 2010 activity reflecting life insurance applications entering the market. For a second month in a row, there was a notable decline in applications of -3.9%. It is important to note that although this is following declines in June, these declines are consistent with the cycle of business that is "historically" typical during the summer months.

Applications on Senior ages continues an upward tick. Ages 60+ noted a +7% increase , year-over-year.

Life settlement trends, provided by Amrita Financial noted a stable level compared to June 2010. The index posted 460 points for July.

As there continues to be a trend towards senior market applications and settlements, it's becoming even more critical that the underwriters utilized to evaluate the risks associated with seniors are specialized and experienced. AUS, Inc. -Founded and managed by Senior Market Underwriting Consultants

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Contact Traci Davis-Underwriting Expert!
tdavis@advanceduwsolutions.com
www.linkedin.com/in/tddavisaus