Excellent article on access to cancer drugs

The story of revolutionary immunotherapy drug Keytruda crystallised the debate over our access to high-priced cancer medicines. This article provides an excellent overview of a number of complex issues includeing: Pharmac funding, drug development, price negotiations, and treatment outcomes. Donna Chisholm reports in this article at Noted.co.nz. Well worth a read.

Cancer: out of control epidemic or evidence of human progress?

World cancer day on February the 4th brought a lot of writing about cancer to the web. Some of that is useful information for committed insurance professionals. It isn't all good news. For example, as some regions get wealthier they have increasing rates of cancer. That can be from a reduction in other causes of death that tend to occur earlier in life, but it can also come from a shift in lifestyle factors - such as eating more red meat. There is also plenty of good news there, and lots of potential for good news to come.

Much of the global increase in cancer arises from a reduction in other causes of death, and is simply a consequence of longer life. Much cancer could be avoided, for example, by increasing physical activity, eliminating tobacco, reducing alcohol consumption, and changing diet.

There are several good sources of more detailed information on global cancer trends. I found this report particularly useful. Also, Max Roser has several great data-visualisations on cancer and I reproduce two here to show both the increasing number of cases of cancer, and actual reduction in age-adjusted rates of cancer. (Do refer to his excellent blog post on the subject).

First, the number of cancer deaths by type:

 Contrast that with the age-standardised death rates from different forms of cancer over time and you get a more realistic picture, which also underlines the broad (albeit slow) progress that has been made on this terrible category of diseases:

Battle with AMP who Refuse to Pay Life Insurance

Andrew Porteous was made redundant shortly before being diagnosed with a rare form of terminal oesophageal cancer. Porteous had life insurance through his job and was not aware that the insurance would lapse once he was made redundant. Porteous is now in a legal battle with AMP who are refusing to pay out the $450,000 policy. Andrew's lawyer Barrister Sandra Grant says:

"I think that the contract - the way it's drafted - does cover Andrew's situation, which is that he has a terminal illness, while he was employed for the purposes of the policy,...he just didn't know that he had a terminal illness, he didn't find that out until afterwards."

I do not have a copy of the policy wording on which to make any sort of judgment about the merits of the arguments advanced by Mr Porteous' Barrister. It strikes me that this situation underlines the value of advice. The client had cover, but perhaps lacked good advice on how to use that cover. A good adviser may have been able to spot the potential claim and lodge it while the cover was in force. This is why advice, as distinct from product, is one of my key themes for 2018.

Whatever the outcome, however, my thoughts are with the family of Mr Porteous.

Click here to read more.

Summer - be sun-safe

As I get older I pay more attention to my health. I probably should have done so sooner, but hey, better late than never. Being interested in insurance, I follow all sorts of - literally - morbid blogs. So I know that skin cancer prevalence is on the rise. I have three children and two of them take after their mother with very pale skin and red hair, so we are pretty strong on the sunscreen message. They are always sunscreened in the morning and take sun-block to school. When schools leave our kids to toast in the sun all day at sports events without access to adequate cover, we're the parents that send a sharp message to the school. This video has a particularly convincing approach to educating about the dangers: 


Cancer Incidence and Survivability

The news on cancer is both good and bad. The long retreat of infectious disease as a cause of early death means that cancer is a far more likely disorder. Within that great trend there are other trends, national, and individual factors which affect risk. But this is the key from a recent article: 

"Given increasing incidence rates, the average lifetime risk of being diagnosed with cancer has increased from one in three to one in two. However, as incidence rates have increased, mortality rates have reduced, leading to better outcomes overall. The good news is that cancer survival rates are improving: for patients diagnosed during 2010-2011 in England and Wales, 46% of men and 54% of women are predicted to survive their cancer for 10 years or more. However, the cost challenge for critical illness insurers and reinsurers is likely to persist."

The article "Cancer and cost", by Aisling Kennedy, reports on the latest data on the incidence and risks of cancer, at The Actuary.com - and it is well worth a read. 

The implication for individual insurance programmes, I think, is that a good combination of trauma and income protection insurance is ideal. Trauma because it can deliver assistance even before the insured is too ill to work. Income protection because it can provide most of the funds to replace income for a long period of time. 

Causes of Death and Non-Underwritten Products

A little while ago we blogged about the causes of death, the main causes do not change a lot in short periods of time, so the table below, based on Ministry of Health data from 2011, is still a good views of the main causes. The reason for returning to this is to consider the causes of death in relation to the exclusions common in non-underwritten policies. 

Pre-existing conditions, whether with a blanket cut-off at application, or with the ability to include them after five years without recurrence or treatment, are most likely to affect the categories of cancers, heart attacks, strokes, and respiratory diseases. What proportion of these causes are likely to emerge from a pre-existing condition or pre-disposition?

Now look at some of the other categories - take accidents, at 15% of the causes of death, and recall the exclusions relating to heights, speeds, presence on a building site, and certain occupations. 

Lastly, look at the rate for suicide, which might also be considered a death from depression or mental illness, this is one of the top five causes of death at 8% of this group, exceeding the level for strokes. Many of the non-underwritten policies contain long suicide exclusion clauses (up to five years), and increasingly bank insurers are lengthening their exclusion clauses as well (up to three years). 

These are the factors behind the recent changes made by Quality Product Research to the increased penalty for pre-existing conditions exclusions in the product quality database for Momentum Life and ASB Easylife. Other non-underwritten products will be added to the database and scored along similar lines. 


Causes of death top five 30 to 54