August 06, 2019 | By Annika Tiedemann
Earlier this year researchers at Heidelberg
University Hospital announced the development of a blood test that can detect
breast cancer cells in patients - with higher accuracy than mammography. Around
the same time it was reported that a second and third HIV-positive person had
been cured of the disease. Then in March 2019 the development of a new Ebola
vaccine, created from antibodies taken from a survivor, was announced.
Medical progress happens all the time - with
unprecedented speed in the 21st century. New approaches in the fields of
prevention, diagnostics and therapy suggest that the extinction of serious
diseases could become a reality. In any case, they offer the prospect of
earlier discovery or of a more precisely tailored therapy, and they give hope
for an improved chance of survival even in the case of hitherto lethal
diseases.
But how are these developments reflected in
medical underwriting? Does this rapid development mean that underwriting
guidelines can be updated frequently to reflect improved outcomes, resulting in
more and more cases of standard (medical) risk assessments?
First Priority - A
Fundamentally Sound Basis in Medical Research
Underwriting guidelines follow the principle of
evidence-based underwriting (EBU). EBU is inspired by (and builds on) the
concept of evidence-based medicine (EBM).
EBM has the goal of systematically evaluating
the published medical literature and thereby communicating scientifically
verified findings. It is important to emphasize that the hierarchical
classification by evidence type only reflects the structure of a medical study
and says nothing about its content.
The content or the research question of a study
can still be of only limited value, even if the study is ranked high according
to the grid. The subject-specific evaluation of scientific findings and their
consequences for diagnosis, therapy and prognosis requires a great deal of
clinical experience and broad coordination. A detailed knowledge of internal
and external validity is required to assess whether a clinical trial
is “good”.
Big questions have to be answered to evaluate
the value and usefulness of a clinical study, including:
·
Is the number of
subjects large enough?
·
Is the observation
period long enough?
·
How many subjects
dropped out?
·
Were the methods
suitable and targeted?
From Medical Research
to Underwriting - Taking Great Care to Get It Right
EBU developed on the basis of EBM in order to
ensure the best possible assessment, i.e., a non-discriminatory offer to the
customer, with a risk-adequate premium rate. It does so while taking advantage
of the latest valid findings on risk from the clinical field.
Basically, the same types of evidence are used
for EBU as in EBM. High demands are placed on the selection of suitable
information and the transfer of findings from the clinical context to the
context of insurance medicine.
Multiple factors include:
·
The population studied
and whether the findings are transferable to the target group of insurance
products
·
The reputation of the
researcher and the journal the study is published in
·
The main purpose of the
research and whether the study design is transferable to the insurance medicine
sector
·
The funder of the
research and whether the study was conducted with a specific objective that is
inconsistent with the objectives of the underwriting guideline
The interpretation of these (and other) factors
- as well as the transfer of clinical findings to the insurance context - is
the responsibility of relevant experts, most typically medical doctors. Their
expertise is also required when it comes to the completion of guidelines in
areas where clinical information is not available (e.g., rare diseases, certain
age ranges, combinations of diseases, etc.).
Danger of Skipping the
Validity Check - Too Quick on the Draw
It’s clear all these steps are important when
you look at the reality of medical progress.
·
Only days after the
recent announcement of the revolutionary breast cancer blood test by the
University of Heidelberg, the school apologized for the premature and
misleading marketing of its research results and the hopes that had been
prematurely raised.
·
Meanwhile, the
apparently cured HIV patients really do exist, but their cure came about in a
very specific and not easily replicable way.
·
As for Ebola, things
still look grim. Since the summer of 2018 the virus has been raging in the
Congo. As of March 2019, more than 1,000 people have been infected and
over 600 fatalities confirmed.
Medical progress observed these days (and
reflected almost daily in the headlines) is extraordinary. But, for the reasons
outlined above, it requires patience for spectacular advances to be reflected
in insurance underwriting guidelines that will stand the test of time.
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