HotNotesTM

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Yes, You Can!A growing number of accomplished underwriting professionals are segueing from corporate careers to self-employment. Their new ventures range from contract underwriting and consulting practices, to creating larger business entities.

This trend has accelerated during our current “hard times” and it will continue unabated in post-Baby Boomer generations of underwriters.

Undoubtedly, many of you have mused about taking this step, sooner or later.

Toward this end, Hot Notes will be profiling some success stories where our peers have sallied forth into new, successful entrepreneurial ventures.

After a distinguished underwriting career at Travelers Insurance Company and decades of service to our profession – including President of the HOLUA in 1990-91 – Jerry Holmes, FALU, FLMI, CLU, launched a new company in late 2005.

Known as Hovin Partners, Inc. this firm offers a broad menu of services including outsourced

underwriting, audits, teleinterviews and APS summaries (www.hovinpartners.com).

Today, Jerry and Executive VP Jan Vincent provide employment for 21 underwriters averaging 25 years of risk assessment experience. This alone testifies to what Hovin Partners brings to the table!

Vol 9 No 11November 2010

Yes, You Can! . . . . . . . . . . . 1Conference . . . . . . . . . . . . . 2Engine Survey . . . . . . . . . . 4Ancient Wisdom . . . . . . . . 5Financial Advisors . . . . . . . 6“Light” Smoking . . . . . . . . 6ALT in Elderly . . . . . . . . . . 8Stable CVD . . . . . . . . . . . . 9T2DM Hypoglycemia . . . . 10Rx Update . . . . . . . . . . . . . 12Sleep and Risk . . . . . . . . . . 17Girth vs. BMI . . . . . . . . . . . 18Childhood Cancer . . . . . . . 20Weight Loss Patterns . . . . . 22GERD + Depression . . . . . 23BRCA Prophylaxis . . . . . . . 23Reiki . . . . . . . . . . . . . . . . . . 24Depression . . . . . . . . . . . . . 25Low Carb Diets . . . . . . . . . 25Viagra Coffee . . . . . . . . . . . 26Mutant food . . . . . . . . . . . . 26Hank’s Method . . . . . . . . . . 27Chaos . . . . . . . . . . . . . . . . . 28

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Jerry Holmes and Jan Vincent, Hovin Partners, Inc.

If you nurture an ambition to one day strike out on your own, pave your road now by:

• Relentlessly accumulating knowledge – in the absence of expertise, everything else is just so much hot air!

• Volunteering for opportunities to contribute to our professional community at the local/state, regional and national levels…then, accomplishing something people will remember.

• Networking ferociously – face-to-face as often as possible.• Learning from (ideally, being mentored by) persons whose

accomplishments you admire. • Holding yourself to the highest ethical standard you can imagine.

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At this historic event, executives from major reinsurers along, with others, shared experiences and insights into how teleunderwriting was profoundly impacting current risk assessment in Germany.

Symposium Organizer Sabine Muller-Gora (Versicherungsforen Leipzig) and Expert Presenter Susie Cour-Palais (SelectX)

So much for “assurances” from clueless opponents of progress!

We also need to hold teleunderwriting conferences in other global venues, especially in Asia and Latin America…

…where teleunderwriting offers so many dramatic advantages over traditional modes of risk appraisal.

2011 Underwriting Engine Survey

My company and our UK colleagues, SelectX, will be launching the most comprehensive survey ever undertaken on this important topic.

We have expanded the list of countries to be included, adding India and the People’s Republic of China to the original list consisting of the USA, Canada, Ireland, the UK, Australia, New Zealand and South Africa.

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If you are a chief life underwriting officer in any of these countries…

…and you DO NOT receive an invitation to participate in this survey by November 30, please let me know at once.

The survey consists of over 80 questions related to insurers’ experience with engine-driven “straight through processing” of new business. It also asks for the insights, opinions and concerns of chief underwriters about all aspects of engine deployment.

Even if your company does not as yet use one of these engines, we want you to participate…and all companies that participate will receive the report of the survey in the 1st quarter of 2011…for FREE.

We have invited reinsurers, software providers and other service firms to step up and assist us with the huge labor costs of undertaking this project. To date, we have had an encouraging response. We will let you know which of these companies chose to support this effort on behalf of their clients. They deserve your thanks for doing this on your behalf.

More details to follow.

“Ancient” Wisdom

Following our last look at the “clean case” underwriting dilemma, we got an e-mail from Tony O’Leary (G & T Management Pty Ltd.) in Sydney.

Tony tells us that while preparing his presentation for the 2010 ALUCA Conference, he came across the following admonition appearing in a British Medical Journal article published 102 years ago:

“Be cautious of the individual who tells you he has never been ill a day in his life…”

No doubt our professional forbears faced the same dilemma in this regard as we do now!

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“Light” Smoking

There is no consensus definition of “light” cigarette smoking.

However, there is a growing consensus among experts regarding the disturbing tendency of those who consider themselves light smokers to “self-classify as nonsmokers.”

This is particularly true among those who smoke intermittently, such as so-called “social smokers” and “chippers” (the latter being people who do not buy their own fags, preferring to mooch them from friends!).

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A new report summarized disease risks attributable to self-described “light smokers” in high-quality clinical studies:

Relative Risk: Light Smokers vs. Nonsmokers

Coronary Artery Disease 2.7-fold (men); 3-fold (women)

Lung Cancer 2.8-fold (men); 5-fold (women)

Pancreatic Cancer 1.8-fold (both genders)

Cardiovascular Mortality 1.5-fold (men)

All-Cause Mortality 1.6-fold (men)

Anyone think it makes sense to extend “nonsmoker” status to even the lightest of cigarette users?

Schane. Circulation. 121(2010):1518

ALT in the Elderly

We think of ALT’s relationship to risk as based solely on elevated readings.

A new Australian study reveals that, at older ages, low ALT also has insurability implications.

University of Sydney investigators followed 1673 community-dwelling persons age 70 and over for almost 5 years. Those with ALT below the median level had over twice the mortality as subjects having higher readings within the “normal” range.

Similar findings were reported in a smaller (but longer) 2006 study.

The risk significance of low ALT disappeared after controlling for the absence vs. presence of frailty. Indeed, physical frailty was the leading factor associated with excess 5-year mortality.

Subjects considered “frail” by study criteria were 9 times more likely to succumb than those regarded as “robust” and 3 times more so than

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“intermediate” (pre-frail) persons.

Several other findings are worth noting:

• Mortality was 38% lower in drinkers vs. alcohol abstainers.• Mortality was 50% lower in obese vs. normal weight subjects.• Mortality was nearly 2-fold higher in underweight vs. normal weight

subjects.

Our November Frailty CE course sets a new standard for addressing all aspects of physical decline in underwriting-focused depth.

Le Couteur. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences. 65(2010):712

Stable CVD – “Worst Case” Defined

We try to make competitive offers in “best cases” of stable circulatory disease.

This 4-year prospective assessment of over 45,000 patients (mean age 68) is especially important in this regard.

These study subjects either had proven stable atherosclerotic disease or were deemed at high risk by virtue of accumulating multiple factors.

The greatest risk of early death or new CV events was conferred by having documented stable disease at 2 or more sites (coronary, cerebrovascular and/or peripheral arteries).

Other findings of underwriting interest include:

• Being diabetic increased the mortality risk 44%.• Using statin Rx reduced the risk 27%.• Being a current smoker raised it 30%.• Having a BMI < 20 (underweight) did likewise.

Given that each of these factors is independently significant after controlling for the others, one could reasonably infer that an underweight diabetic

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smoker who does not take a statin is – figuratively speaking – a “claim waiting to happen”!

Furthermore, this inference seems to be valid whether or not stable circulatory disease is present.

Bhatt. Journal of the American Medical Association. 304(2010):1350

Hypoglycemic Events in Treated Diabetics

Severe attacks of hypoglycemia in diabetics can be life-threatening.

Are there longer-term implications associated with having these episodes in terms of the risks of diabetic complications and mortality?

A new multinational study shows us that the answer is a robust YES!

Zoungas and 11 colleagues in the ADVANCE Collaborative Group followed 11,140 T2DM patients for 5 years. Just over 2% suffered at least one severe hypoglycemic episode during the 60-month follow-up interval.

Severe hypoglycemia in this setting was defined as: blood glucose < 2.8 mmol/L (< 50 mg/dL), occurring with symptoms and requiring intervention by someone other than the patient himself.

Subjects who had one or more such episodes experienced markedly unfavorable outcomes (when compared to those who did not):

Event Relative Risk

Major Microvascular Complications 2.19

Major Macrovascular Events 3.53

Death from Any Cause 3.27

Cardiovascular Mortality 3.79

Non-CV Mortality 2.80

Severe hypoglycemic attacks are a major mortality and morbidity RED FLAG

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in type 2 diabetics.

Zoungas. The New England Journal of Medicine. 363(2010):1410

Rx Update

As loyal HN readers know, we do 2 or 3 updates every year on new developments in pharmacology which have insurability implications.

We do not include citations for these brief reports. If you wish to get one of them, please contact me by December 15.

We use generic drug names in this report, adding the proprietary (brand) name used in the USA where appropriate.

Psychiatric Rx

A new Korean study has found that the widely used antidepressant venlafaxine (Effexor) is effective to some degree in managing patients with “functional chest pain.” However, it did not have any effect on the patients’ depression scores, suggesting that its impact was solely analgesic. Add “functional chest pain” to the growing list of off-label (unapproved) uses of venlafaxine.

Venlafaxine’s sister drug, duloxetine (Cymbalta) is roughly twice as effective as placebo in relieving symptoms of social anxiety disorder (formerly called “social phobia”). Duloxetine is already used in generalized anxiety disorder and likely is prescribed “off-label” for other anxiety states. Like venlafaxine, duloxetine is a potent neuropathic pain reliever, widely used to treat diabetic neuropathy. Be alert to the use of either drug in long-time diabetics.

Sertraline (Zoloft) failed to ameliorate depression or exert any other beneficial effects in a group of heart failure cases. This is yet another example of where antidepressant therapy has been found to be ineffective (despite its wide use).

Another selective serotonin reuptake inhibitor, paroxetine (Paxil), has come up short in a treatment context. In this investigation, use with tamoxifen

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increased the risk of death from breast cancer.

Does paroxetine negate the benefits of tamoxifen therapy? If so, its use in this context is a RED FLAG.

Antiseizure (also called “anticonvulsant”) drugs used in both epilepsy and bipolar disorder significantly increase suicide risk. Patients using these drugs for bipolar disorder (BPD) had > 2 times the risk of taking their own lives as patients with BPD who did not use antiseizure drugs. There was a similar increased risk in patients who had epilepsy with comorbid BPD or major depressive disorder. This is an especially significant revelation because both BPD and MDD are associated with a substantially elevated suicide risk, independent of any added risk conferred by specific drugs.

Antipsychotics are now used more often in America than lipid-reducing drugs…which gets our attention because there are far fewer psychotics than persons with hyperlipidemia!

You will see the newer generation of antipsychotics doled out in a wide range of nonpsychotic contexts, mainly “off-label.” Be alert to their use in all scenarios because they have serious adverse side effects. Their use should always be presumptively considered a RED FLAG, subject to further careful underwriting.

Bupropion (Wellbutrin, etc.) is primarily used as an antidepressant. Naltrexone (Vivitrol) is approved for use in alcohol and opiate addiction, and also given “off-label” for nicotine addiction. Now, a study reveals that combining both in a sustained-release pill “could be a useful therapeutic option for treatment of obesity.”

Where naltrexone is concerned – whether or not it is bundled with bupropion –we should always underwrite cautiously. It is the drug of choice for many physicians in obese patients who have comorbid addictive disorders.

Two “drugs of abuse” are being evaluated for use in psychiatric disorders.

Ketamine infusion improved depression in bipolar patients and also reduced suicidal ideation in severe treatment-resistant depression.

MDMA (ecstasy) is in clinical trials as a remedy for posttraumatic stress disorder…which is a bit ironic considering that ecstasy was used medically

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prior to being classed as a “drug of abuse.”

SAMe is the acronym for s-adenosyl methionine. It is a potent nontraditional remedy for a variety of ills, including depression, liver disease and arthritis. A new study reveals that SAMe is an effective adjuvant Rx when major depression patients do not respond to SSRIs. In this setting SAMe nearly doubles the rate of remission induction when compared to placebo.

Every time you see SAMe mentioned, pay close attention to the context.

Liver Disease Rx Issues

Rifaximin 550 mg tablets are now approved as “Xifaxan 550” for managing hepatic encephalopathy in cirrhosis. At other doses, it is given for bacterial infections, traveler’s diarrhea, Crohn disease and diverticulitis. Be alert to the 550 mg dose and be mindful of the circumstances when this potent antiinfective is prescribed.

Methotrexate (MTX, Rheumatrex) is widely used as first-line therapy in rheumatoid arthritis and more severe cases of psoriasis. Underwriters know its (often-exaggerated) reputation for liver toxicity.

A new study reviewed MTX’s liver effects in patients with inflammatory bowel disease (IBD).

24% who had normal ALT and AST when starting MTX developed ≥ 3-fold elevations of one or both enzymes after starting treatment.

An even larger % who had pre-treatment liver enzyme elevations had their ALT and/or AST return to normal after starting MTX therapy.

Most of those who were biopsied for MTX-induced enzyme elevations showed little or no adverse effect on the liver.

Bottom line: be concerned about MTX use first and foremost if the applicant also has known or suspected liver disease. For the most part, these are the only cases where MTX exerts sufficient adverse hepatic effect to be of concern in underwriting.

What drugs have been found to be effective in treating nonalcoholic fatty

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liver disease?

A new meta-analysis reveals that the following may be prescribed in NAFLD cases:

• Metformin – predominantly used in diabetes/prediabetes• Orlistat – an obesity Rx• Rosiglitazone and pioglitazone – mainly used in more severe cases of

T2DM• Simvastatin and atorvastatin – lipid-lowering drugs• Fenofibrate – another lipid Rx• Ursodeoxycholic acid (URSO) – a potent drug with many uses• Pentoxifylline (Pentoxil, Trental) – originally used for peripheral

arterial disease; now widely used in numerous diseases• Telmisartan (Micardis) – used in hypertension and sometimes heart

failure

In addition to these prescription drugs, several A & C (alternative and complementary) remedies may be advised: L-carnitine, vitamin E and fish oil.

While each of these drugs is more likely to be prescribed for something other than NAFLD, any of them could be given for either simple steatosis or the more advanced form, NASH.

URSO – listed above – is given to IBD patients who develop primary sclerosing cholangitis (PSC). In this context, high dose use has now been linked to 4-fold increased risk of colorectal neoplasms. This is important for NAFLD cases because a new study shows that URSO – again, in high dosage – improves fatty liver/NASH more efficiently than placebo.

We consider the prescribing of ursodeoxycholic acid (URSO) to be a RED FLAG.

Rx in Other Impairments

We have ANOTHER statin drug – pitavastatin (Livalo) – approved here in the states. This brings us to 7 actively-used statins (not counting cerivastatin, which was discontinued due to muscle toxicity a few years ago). Will we eventually have as many hypolipidemic drugs as we do antidepressants? A recent case series shows that statin-induced myopathy symptoms do not

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always occur shortly after commencing use. Many patients suffered severe manifestations many months after starting atorvastatin…and in some cases, the advanced form of muscle damage –rhabdomyolysis – is fatal.

The antianginal drug ranolazine (Ranexa) appears to be beneficial when ischemic dysfunction accompanies heart failure. Therefore, we cannot assume chronic stable angina due to CAD is the diagnosis.

The anticoagulant dabigatran (Pradaxa) will soon be approved. This drug will be used like warfarin in chronic atrial fibrillation, so its used will be a RED FLAG obliging us to investigate further. Dabigatran is also destined to cost 2-5 times more than warfarin.

The diabetes drug rosiglitazone increases the risks of CV events and death. Despite this, the US FDA retains it, adding more label warnings. No doubt many doctors will continue using it if it effectively lowers HbA1-c in their patients.

We now have the improbable combination of an antiflux PPI (esomeprazole) and a prominent NSAID (Naprosyn). The combination – dubbed “Vimovo” – is indicated for osteoarthritis, rheumatoid arthritis and ankylosing spondylitis, plus to decrease the risk of NSAID-associated gastric ulceration. Naprosyn elevates ALT and, less often, AST; only 1% of patients experience 3-fold or higher levels.

A new osteoporosis drug is making its debut. Denosumab (Prolia) is a monoclonal antibody agent intended for postmenopausal women at high risk of osteoporotic fractures. Given by injection just twice a year, it may lead to high morbidity if osteonecrosis of the jaw ensues. Users must embrace thorough dental hygiene practices.

Isotretinoin (Accutane, Claravis, Sotret) is a potent anti-acne agent. It has just been shown to increase the risk of ulcerative colitis 5-fold. However, given the modest population prevalence of UC, the absolute risk to any given user is small (even lower if the patient smokes cigarettes). However, there is a link between severe acne and anabolic steroid abuse. Isotretinoin use deserves a closer look in both genders and at any age.

There have now been 48 cases of severe liver damage – including 14 deaths – tied to the pricey rheumatoid arthritis drug leflunomide (Arava). We are concerned when leflunomide is given for RA (or in any other context)

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to patients also using methotrexate with known liver pathology or if unexplained elevated liver tests are present.

Reports of violence and suicide associated with the “quit smoking” drug varenicline (Chantix, Champix) continue to pile up. Australian physicians alone have reported 1025 suspected adverse reactions. There is a high prevalence of smoking in psychiatric disorders having heightened risks of suicide and/or violent behavior. Use of varenicline in such cases cannot be taken lightly.

A review of over 400,000 subjects at ages 65+ discovered that > 50% had been prescribed one or more drugs with significant sedating effects. 15% got a prescription for an opioid; 1 in 5 received > 1 sedation inducer.

There are insidious risk issues related to opioids and benzodiazepines at older ages. We consider protracted use of either class of drug a YELLOW FLAG at older ages. The risk is greatest over age 75 and/or where evidence of frailty is present.

Did this overview of new underwriting-salient developments in Rx have any value for you?

Sleep Parameters and Insurability

We are seeing many studies now related to mortality and morbidity aspects of sleep duration and other characteristics of sleep patterns. This probably accounts for why some proactive insurers include sleep-related questions in their teleinterviews.

Cappuccio at the University of Warwick, UK, looked at data on over 1.3 million subjects in 16 studies. They found that sleep duration was a statistically significant mortality risk consideration:

Sleep Patten Extra Mortality

Too short (< 5-6 hours) 12%Too long (> 8-9 hours) 30%

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They also published data from their study in a second journal.

In that report, they found that excess sleep duration predicted significantly for developing type 2 diabetes.

In addition, both difficulty initiating and difficulty maintaining sleep were major risk factors for type 2 diabetes, raising the T2DM risk 57% and 84%, respectively.

Is it time to address sleep issues more often in teleinterviews?

Yes, it is.

Cappuccio. Sleep. 33(2010):585Cappuccio. Diabetes Care. 33(2010):414

Waist Circumference (WC) Trumps BMI

Insurers that have progressed from “build” (weight in relation to height) to BMI in weight underwriting have further to go if they seek to maximize the accuracy of their assessments.

Waist circumference (even more so, waist-to-hip ratio) is sorely needed to sort out BEST, AVERAGE and WORST overweight/obesity risks.

Why?

Because it is less a matter of how much weight you carry than it is where that adiposity is hanging!

Consider the findings of Jacobs et al. when they looked at WC and mortality in over 100,000 men and women, ages 50 and older.

There was a linear association between increasing waist circumference and all-cause mortality. This remained robustly significant after adjusting for BMI.

Once WC was considered, BMI was no longer a viable basis for determining

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mortality based on weight.

In their female subjects, BMI had no impact whatsoever on weight-related death risk within WC subsets.

In other words, an “obese” woman with a satisfactory waist circumference had no extra risk, whereas a “non-obese” female with an undesirable WC had the same overall risk as an “obese” peer with the identical undesirable WC.

We need to set criteria for adjusting build and/or BMI according to waist circumference. To be able to accomplish this, we need routine waist circumference measurements on paramedicals.

WC matters most at ages 40 and beyond, when people tend to maintain more or less the same bodily habitus in the absence of successful dieting, bariatric surgery or chronic disease.

Jacobs. Archives of Internal Medicine. 170(2010):1293

Long-Term Mortality inChildhood Cancer Survivors

We have already considered aspects of this subject in prior issues of Hot Notes and we did an entire course on childhood cancer survivors for our CE program this year.

Why do we seemingly belabor this point?

Because we believe many companies still do not have adequate guidelines addressing the imposing excess mortality (and even worse morbidity) in this group of risks.

Individuals, we hasten to add, who really covet life, health, disability, critical illness and long-term care coverage!

Thank you, Ken, for calling the following paper to our attention!

Investigators in the British Childhood Cancer Survivor Study followed

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17,981 childhood cancer patients diagnosed before age 15 and alive 5+ years following treatment.

Would you expect the standardized mortality ratio in this group to be unfavorable?

Indeed, it was.

Even after all deaths due to recurrence or progression of the cancer were excluded, the SMR was a gaudy 3.9.

1117 actual deaths balanced against just 285 expected deaths.

The SMR for CV disease mortality was 4.0. It was twice that high for respiratory disease.

Cardiovascular mortality steadily increased over time. While some of this was due to the effects of aging, CV mortality was notably 10-fold greater than expected 45 years after cancer diagnosis. A sizeable portion is attributable to delayed cardiotoxicity from chest-area radiation and anthracycline (doxorubicin, etc.) chemotherapy.

Half a century after cancer treatment, mortality in childhood cancer survivors was 3 times greater than one would have expected.

If you read our 2010 CE course on this high-priority subject, you would have all you need to fashion accurate guidelines addressing this oft-overlooked matter.

What’s in your manual?

Reulen. Journal of the American Medical Association. 304(2010):172

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Pathological Weight Loss Benchmarks

We all know that unintentional weight loss (and often “intentional” loss as well in elders) is highly significant to insurability at older ages.

Alley and her epidemiologist colleagues sought to determine whether there were stages of weight decline in elders which precede – and then accelerate toward – death.

They pointed out that prior investigations have shown that insidious weight loss may start as long as 15-20 years before death, saying that decades-early patterns of weight decline represent “altered physiology linked to the risk of death.”

They found that the pattern of weight loss leading to early death inches forward roughly 9 years prior to demise, averaging just 0.4 kg/year (roughly 1 pound annually).

In eventual cancer deaths, the amount of weight loss increases precipitously over the final 3 years.

Where death is attributable to progressive circulatory disease, the final phase of weight decline begins earlier: 5 years before death at ages 60-65 and 9-10 years preceding demise after age 80.

Do not underestimate the implications of a slow pattern of unintended weight loss at ages 60 and over.

Recognize that even if the pace of weight decline is sluggish, it still matters.

The key here is that the loss be progressive, as opposed to in a weight-cycling pattern (loss, then gain; another loss, another gain, and so on). While weight-cycling is not ideal, it does not have the implications associated with insidiously progressive loss, whether rapid or slow.

Alley. American Journal of Epidemiology. 172(2010):558

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Gastroesophageal Reflux and Depression

GERD (GORD) is one of the most prevalent impairments we see as underwriters. It is associated with a host of morbidity risks and also a manifestation of potentially premalignant Barrett esophagus.

A large primary care study in the UK found that GERD is more prevalent in depression victims than the general population.

Depression severity is not a factor in the degree of GERD risk. Antidepressant Rx does not reduce the likelihood of GERD in depression patients.

Indeed, when tricyclic (TCA) second-line antidepressant therapy is given, the incidence of GERD is even greater than in untreated depression cases.

Martin-Merino. Alimentary Pharmacology and Therapeutics. 31(2010):1132

Prophylactic Surgery in BRCA

Young women who carry one of the BRCA genes predisposing them to a high risk of early breast and/or ovarian cancer are being advised by some physicians to have preventive mastectomies or oophorectomies before it is “too late.”

Are at-risk patients taking this advice?

Apparently not in droves, based on a new study which showed that only 10% opted for mastectomy while 38% agreed to removal of their ovaries.

Those who chose against breast surgery are urged to have mammograms and breast magnetic imaging in alternating years, often starting as young as age 25.

Therefore, female applicants who acknowledge this regimen, or even have just mammograms under age 45, should raise our antennae.

Where BRCA-driven risk of ovarian malignancy is concerned, the encouraged approach to surveillance is both CA-125 tumor marker and vaginal ultrasound, as frequently as every 6 months!

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Another telltale RED FLAG to be aware of.

Esserman. Journal of the American Medical Association. 304(2010):1011[editorial]

Reiki

Reiki is a healing art which has gained many advocates in recent years. We know one licensed Reiki practitioner who is also a remarkably adept underwriter; likely, there are many more.

Normal heart rate variability (HRV) minimizes the risk of lethal arrhythmias in those with known coronary disease.

In a small study, Reiki therapy significantly increased HRV in patients who had survived an acute coronary syndrome event.

When matched to control patients who did not have Reiki performed, Reiki administered by nurses greatly improved autonomic function – the driver of heart rate variability – and in so doing likely reduced their risk of a fatal outcome.

Never heard of Reiki?

Check it out.

This underwriter visits a Reiki Master as often as he can coax himself into paying her fee! The therapy works wonders for putting one in a positive emotional state, not to mention the potential for even greater benefit if the subject is properly predisposed.

I might add that my therapist claims to have a 75%+ success rate in getting smokers to quit…permanently.

Those keen to deal with a nicotine narcosis might be well served to investigate Reiki.

Friedman. Journal of the American College of Cardiology. 56(2010):995[letter]

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Insight into Depression and its Treatment

“Most increases in depressive symptoms do not represent depressive disorders for which evidence based treatments exist. Moreover, most treatment for depression in the community is inadequate or inappropriate. Non-syndromal depressive symptoms are not appropriate targets for treatment with antidepressants, though initiating treatment in people with symptoms but who do not have major depression probably contributed to a twofold to fourfold increase in antidepressant use.”

James C. Coyne, MDProfessor of PsychiatryUniversity of Pennsylvania School of MedicineBritish Medical Journal 341(2010):519[letter]

How many readily acceptable “depression” cases do we rate up or turn away largely because some (likely useless) drug was prescribed?

Low Carbohydrate Diets

These diets have gained great favor amongst those who believe they can lose a significant amount of weight…and then sustain it (the hard part!) over time.

Fung and her Simmons College (Boston) colleagues reported a very modest excess all-cause mortality in subjects on these diets whose “low carb” scores are the highest.

Then, they made a key distinction: animal-based vs. vegetable-based “low carb” diets.

This distinction resolved the mortality matter.

Animal-based diets led to > 20% increased mortality in those with the highest “low carb” scores.

Those who followed a vegetable-based diet approach, on the other hand, had significantly lowered mortality after adjustment for cofactors. Overall, their

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mortality sorted to 20% less than that of control subjects not on a “low carb” diet.

The authors rightly concluded that to gain survival advantage, “low carb” dieters must follow a vegetable-driven approach to ingesting proteins and fats.

Fung. Annals of Internal Medicine. 153(2010):289

Viagra Coffee

Our Food and Drug Administration – mindful, in equal measure, of the well-being of citizens and the success of pharmaceutical companies – has issued a somber warning regarding “Magic Power Coffee.”

Seems this sinister brew contains a substance which energizes males in a decidedly non-coffee-like manner.

The manufacturer of this organ-transforming elixir should be thankful to our bureaucracy for doing its “best” to transform a product hitherto unknown to most middle-aged men…

…into a potent weapon in the War on Flaccidity!

From an underground site disposed to fiercely following fondly forgettable fare.

Genetically Modified Food

A European research committee has now reported on its study of the merits of mankind’s future staple source of nutrition.

Genetically modified food

Other than:

“…adverse impacts on kidneys and liver…as well as different levels of damages to heart, adrenal glands, spleen and hematopoietic system…”

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…they could find basis for alarm over these mutant imitations of nature.

Bon appétit.

Hank’s Method

A friend from New York asked if I knew any surefire method of passing ALU exams to earn our FALU designation.

I confessed that I did not have any ALU-specific insights but do have my own battle-tested method of assuring success on examinations.

It works like this:

When you read assigned content in a textbook or review lecture notes, you disdain those ineffectual yellow highlighters.

Instead, you create a set of note cards where all text and lecture content you deem important enough to make its way on to an examination is recorded.

You frame it as a question on one side and then write the answer on the other side.

Once you have done this for all assigned textbook readings and lecture notes, you concentrate all of your study for the examination solely on these note cards.

Starting at least 2 weeks before the exam, you review each card by reading the question (ideally aloud), taking your best shot at the correct answer and then turning over the card to see if you were correct. This process is best done with an (extraordinarily patient) partner…and without alcohol (which comes later, after you pass!).

In the final week, you do this every morning and again before dinner, and start discarding those note cards when you have the answer locked in your short-term memory.

On the morning of the day before the exam, you review them one last time and then throw the remaining cards away. No further thought should be given

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to the exam until you commence taking it.

If you follow this precise – and, yes, quite labor-intensive – protocol, you will pass the exam for sure and likely with an outstanding score.

I dropped out of university with 15 credits remaining. I took them all – 5 courses – in one semester (while working full-time). Using this method I got an “A” in every course.

It works.

Chaos We know how “energetic” European football (soccer) fans get when their team wins! Fact is, matters can get rather “carried away” on this side of the pond as well. My friend Kurt Vlach, Underwriting Director at Catholic Financial Life (Milwaukee) and Webmaster of our state underwriting association’s website, sent us this photo of what took place after our University of Wisconsin Badgers football team beat the nationally #1 ranked Ohio State University Buckeyes just recently.

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Rumor has it Kurt and his teenage son were right in the thick of the mayhem!

Cheers and we’ll be back at you in December.

Peace,

Hank

DisclaimerHank’s HOT NOTES® is an independent publication designed to provide business information and opinion to life and health insurance underwriters. It is intended to encourage discussion and further research.

Hank’s HOT NOTES® does not recommend any specific action or risk appraisal in any individual life or health insurance application. All information and opinion published should undergo formal scrutiny by underwriting officers, medical directors, actuaries, legal counsel and other insurance professionals as appropriate. Copyright 2009 Hank George, Inc.