Precision medicine: what life insurers need to know

Vol 46: Issue 4 | December 2023

In the 24 hours before he spoke to the Journal, paediatric oncologist Professor Nick Gottardo was beginning to decode three precision medicine puzzles. Their solutions will carry great weight in a life-or-death outcome for three children with brain tumours.

Each one is a real-world example of the potential of a personalised treatment, versus traditional protocols that take a one-size-fits-all approach. Precision medicine, as it’s known, typically relies on testing the genetic make-up of the patient. While it can offer tailored medical solutions, it also raises ethical dilemmas insurance professionals continue to wrestle with.

Brave new world

Precision medicine is a relatively new direction in therapy that promises better outcomes, fewer side effects and a much-improved quality of life for people who otherwise had little chance of survival, or who faced the prospect of ongoing medical issues resulting from their treatment.

While Gottardo specialises in the treatment of childhood cancers, precision medicine is also being used to treat adults with breast cancer, melanoma, colorectal cancer and many more life-threatening diseases. In some instances, tests establish if cancer cells exhibit a certain gene or protein changes that are being targeted in clinical trial by a new medicine.

This gives researchers better information on how a new treatment works, and it can get patients better outcomes.

“[Precision medicine] has become embedded in our day-to-day practice for making the diagnosis, assisting with the diagnosis or refining the diagnosis, and to find specific treatments that are more effective and less harmful,” says Gottardo, co-head of the Telethon Kids Institute’s Brain Tumour Research Team and head of the Department of Oncology and Haematology at Perth Children’s Hospital.

“It is most commonly used when you’re talking about cancer. In children, it helps rationalise how much therapy a specific child needs. If you undertreat a child with a specific tumour, their chance of relapse is higher. Conversely, if you overtreat them, you’re causing more side effects.”

What does precision medicine mean for insurers?

Insurers, particularly those in the life and health spaces, are watching the development of precision medicine with great interest. Giving people access to the most effective treatment with the fewest side effects is in everyone’s best interest. However, few insurers are willing to comment now on how it will affect their underwriting and their products.

In Australia, a moratorium is in place, preventing insurers using genetic test results to discriminate against customers who might apply for health insurance. Life insurers are permitted to use genetic test results in limited ways, and Treasury is currently reviewing regulations. In New Zealand, people have no protections in terms of how their genetic test results are used.

A white paper from RGA Reinsurance called Genetics and Insurance: Challenges and Opportunities III argues that genetic and genomic testing is playing a pivotal role in life and health insurance. While information from such tests can improve the population mortality and morbidity experience, the paper explains, it also creates challenges for insurers around the use of such information.

“Many countries continue to prohibit genetic test results for use in underwriting, even if the results have been shared with an insurer,” researchers say. “In addition, as more individuals order their own genetic tests, a growing asymmetry of information continues to emerge. This may create added challenges and could signal a significant shift in the information balance between proposed insured and insurer.”

Similarly, a 2019 report from the Swiss Re Institute called Can life insurance pass the genetic test? says if such information is not treated in “a careful, balanced way”, that information could provide enormous challenges for life insurers.

Regulation and innovation

Territories around the world are coming up with their own solutions. For example, in Singapore, the use of predictive tests in insurance underwriting is regulated. In the United States, significant legislative activity is currently underway at state level to limit the use of genetic testing data in life underwriting.

In Australia, the FSC Standard No 11: Moratorium on Genetic Tests in Life Insurance ensures individuals can access life insurance without having to disclose an adverse genetic test result.

Insurers can only request results of past tests if those tests are relevant and if lump sum death cover or TPD cover is over A$500,000, if trauma cover is over A$200,000 or if income protection cover is over A$4,000. The Financial Services Council is currently reviewing the moratorium, which is due to end on 30 June 2024.

Exploring the possibilities

Meanwhile, some insurers are dipping their toes into precision medicine to improve offerings to their clients.

For instance, Pru Life UK offers the myDNA Pro bundle in the Philippines, which “provides tailored diet and fitness recommendations on reducing health risks based on an individual’s DNA”. Essentially, the insurer is using precision medicine to advise clients and help prevent future health issues.

Canada Life health insurance customers have access to Pillcheck, a personalised DNA analysis tool that claims to help identify the right medication type for each customer’s genetic make-up.

The Atlanta, Georgia-based Centers for Disease Control and Prevention (CDC) explains that our DNA can influence how body tissues absorb certain drugs and how quickly our bodies remove them from the system. This can impact how effective medications — even relatively commonly used ones such as statins (cholesterol lowering drugs) — are for different people.

Other insurers, however, are taking a wait-and-see approach to precision medicine. While better data makes for greater efficiencies when assessing risk, there are social, legal and ethical issues to navigate.

This was highlighted by a 2023 report from the Australian Genetics and Life Insurance Moratorium, Monitoring the Effectiveness and Response, that recommended “the Australian Government amend the Disability Discrimination Act 1992 to prohibit insurers from using genetic or genomic test results to discriminate between applicants for risk-rated insurance, and consider amendments to the regulation of financial services to ensure insurers are subject to a positive duty to not discriminate”.

At the same time, precision medicine could also ensure people get the most effective solutions for their unique make-up: potentially leading to shorter and more cost-effective treatments — which benefit customers and insurers alike.

Despite the ethical challenges, precision medicine marches onwards.

“In the long run, it is going to be much better for the patient,” says Gottardo. “It will reduce side effects. It will be more specific and effective in the way we treat, so you will have better chances of success. And the patient will then have a more productive life because of the minimised side effects.”

3 branches of precision medicine

1. Pharmacogenomics — understanding how an individual’s body is going to react to certain therapeutic drugs.
2. Gene therapy — identifying a gene that is abnormal, missing or mutated in an individual, then modifying their genes to treat or cure the resulting issue.
3. Nutrigenomics — an individualised approach to diet and exercise that begins with an understanding of a person’s genetic make-up.

Precision medicine for the mind

At least one Australian health insurer is in discussions with inTruth Technologies, which will soon release a wearable in the form of a watch and wristband that measures, among other things, heart rate variability and electrodynamic activity in the skin to identify emotional states.

“Our approach is to train a machine learning model to enhance heart rate variability’s capacity to identify valence [whether an emotion is positive or negative]. By combining valence and arousal [the strength of an emotion], we capture emotional states through the PPG sensor in the heart rate variability, ensuring real-time, day-long monitoring,” says CEO Nicole Gibson.

This offers users a window into their own emotional wellbeing via an app to help them manage their emotions.

“Over 85 per cent of our decisions are influenced by emotions,” says Gibson. “As a result, mastering emotions is crucial for genuine life transformation. Many prioritise mental and physical health, but the emotional impulses often dictate choices, like unhealthy eating or avoiding exercise.

“I believe health insurers can understand the potential, and most practitioners recognise that emotional fluctuation and emotional health have been challenging to quantify… Our solution aims to be a key antidote, turning what has been ambiguous into something tangible, measurable and easier to address.”

The wearable will be available in the first quarter of 2024.

“It will reduce side effects. It will be more specific and effective in the way we treat, so you will have better chances of success. And the patient will then have a more productive life because of the minimised side effects," says Professor Nick Gottardo from the Telethon Kids Institute.

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