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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