• Provide agents with the most current medical information they need to package and present their cases

• Provide agents with the most current medical information that will be of interest to their clients

• Provide agents with the most current medical information to improve their own health awareness

All baby boomers need to read this book!
Robert W. Griffith, MD
Editor, HealthandAge.com 

This book is a great gift for a financial advisor to give to all clients with senior parents.
Dick Bell, CLU, ChFC, President 2004 Society of Financial Service Professionals

Underwriting prostate cancer requires a predictable list of medical information.  The stage of the tumor tells the underwriter how far it has advanced at the time of diagnosis.  There are two systems for staging, the Whitmore-Jewett system and the TNM system.  In both systems an underwriter can determine the tumor’s size and degree of invasion. The most important question about staging is has the tumor spread beyond the prostate capsule.  Once the tumor has spread outside of the capsule, the client’s insurability is greatly reduced.  In the Whitmore-Jewett system this is a Stage C tumor or higher.  In the TNM system this is a T3 tumor or higher. (See this link for an overview of staging for prostate cancer)

Staging indicates how far the prostate cancer has advanced.  The Gleason score tells the underwriter how aggressive the tumor is.  It is determined by looking at tumor samples under a microscope and identifying one of five patterns numbered 1 through 5.  Taking the “sum” of the two most common patterns is how you get the score (e.g. 3+3=6).  The first number is the most common pattern, and the second number is the second most common pattern.  The rule in medicine and underwriting is higher the Gleason score the less favorable the prognosis.  

Below is a quick summary of what the different Gleason scores represent:

Gleason score 2, 3 and 4

These are well-differentiated tumors and are the least aggressive and least likely to metastasize.

Gleason score 5 and 6

These are moderately well-differentiated tumors and are the most common score.

Gleason score 7

These tumors have a “mixed” presentation and range from moderately to poorly-differentiated. 

Gleason score 8, 9, and 10

These are poorly-differentiated tumors and are the most aggressive form of prostate cancer.

Bottom Line: The tumor’s staging and Gleason score are essential items in underwriting prostate cancer.  Even with tumors that are confined to the capsule, a high Gleason score can result in a client being assessed as uninsurable.

Male 65
T2 tumor (inside of capsule)
Gleason score 6

Male 65
T2 tumor (inside of capsule)
Gleason score 8

Inflammation is the “hot” topic in cardiac disease. The inflammatory marker C-reactive protein (CRP) is being seen as a new tool to for “risk prediction” in patients not previously deemed at high risk. 

This a major step forward in risk management.  Strong evidence exists that CRP predicts future cardiac events and may be a better predictor of risk that LDL levels.  

For cardiac risk assessment, CRP is measured using a high-sensitivity assay and called hsCRP.

One hsCRP is generally enough and is not a fasting blood test.

Cardiovascular risk based on hsCRP is as follows:

Low risk: below 1 mg/L

Moderate risk: 1-3 mg/L

High risk: above 3 mg/L

Bottom Line: Expect to see hsCRP become a part of underwriting in the future.  This will impact clients who have normal or low LDLs but are discovered to have high hsCRP (higher than 3 mg/L). 

Baraclude (entecavir) was approved in March 2005 for the treatment of chronic hepatitis B.

RiskTutor classification is Yellow (underwriting concerns).

Bottom Line: If an applicant is taking Baraclude, you need to gather additional information to determine the degree and the severity of the chronic hepatitis.

This will include the date when the diagnosis was made, whether or not a liver biopsy was done, the type and length of other treatments, and the name of the primary physician who has all the records.

Clients with hepatitis B are insurable based on the impact of the virus on their liver function.  Some applicants will be issued standard policies.  Other applicants will have abnormal liver function studies that preclude any offers.

Female, 55, Non-smoker, $2,000,000 Individual Coverage
Height 5’ 6”, Weight 134 lbs
Current Medications: Zoloft, lithium

The applicant was declined for life insurance based on the use of two mental health medications, one indicated for depression and one indicated for bipolar disease.  The applicant only admitted to a history of depression on her application.

Discussion: Heath care providers realize that many times when a medication for depression is not working as well as they had hoped, it may be prudent to add what is known as a “booster drug.”  Booster medications can include Cytemol (a thyroid stimulator), lithium (historically used for bipolar disease), or Ritalin (historically used for ADD).  This is why the above applicant was taking lithium.  She did not have bipolar disease but this fact was not clear in her medical file.  Her file simply stated that her doctor was “starting her on lithium.”  The underwriter concluded it signaled a new diagnosis.  Once these issues were brought to her doctor’s attention, he wrote a letter that outlined his decision to use a booster drug and the positive impact it had on the applicant.  The client’s case was presented to a number of carriers and she was issued a policy at standard rates.