Life underwriting is undergoing a profound transformation, shaped by advancements in medical research, evolving risk assessment strategies, and the growing complexities of chronic illnesses. As insurers navigate this shifting terrain, the need for informed discussions has never been more crucial. In Part Two of our Pacific Life 2025 Symposium Blog, we present a series of insightful sessions featuring industry experts, medical professionals, and underwriting specialists. They offer valuable perspectives on how insurers can balance risk with opportunity in a rapidly changing landscape. Read on as we explore the present, and the future, of medical life underwriting — one conversation at a time.

Alzheimer's disease is a complex and evolving challenge, with biomarkers shifting long before a diagnosis is made. Currently, 6.9 million people in the U.S. live with dementia, the vast majority being over 75. As lifespans continue to stretch, dementia's prevalence will only rise, cementing its place as the seventh leading cause of death—one that still has no cure. The likelihood of developing Alzheimer's varies, with 10-11% of men and 19-21% of women affected, while those with mild cognitive impairment (MCI) face a 4-25% chance of progressing to Alzheimer's.

However, dementia is not a uniform experience. Disparities in diagnosis and care arise due to race, education, socioeconomic status, and family dynamics. Not all forgetfulness signals cognitive decline; normal age-related memory lapses can stem from stress, fatigue, distractions, or even poor vision and hearing. Many aspects of aging, including cardiovascular disease, diabetes, depression, and medication effects, contribute to cognitive slowdowns without indicating progressive disorders. 

Metabolic health is at the core of many modern health challenges, yet it often takes a backseat to more superficial discussions about diet trends and weight loss strategies. The real issue isn't just losing pounds—it's whether our bodies are functioning optimally or slipping into a state of metabolic ill health. A significant indicator of this is metabolic syndrome, which is diagnosed based on a set of criteria, including low HDL cholesterol, elevated blood sugar, high blood pressure, excess abdominal weight, and high triglycerides. These markers paint a concerning picture of widespread health risks that can lead to diabetes, cardiovascular disease, and other chronic conditions.

One of the more surprising dietary truths is that a banana contains more sugar than a cookie. While that doesn't mean bananas should be vilified, it does highlight the importance of understanding the impact of food choices on blood sugar levels. Instead, opting for berries—especially blueberries—can provide valuable nutrients while keeping sugar intake in check.

For years, dietary guidelines emphasized reducing fat intake, but an unintended consequence has been a dramatic increase in carbohydrate consumption, fueling obesity rates. Paradoxically, while smoking rates have declined, which is undoubtedly positive for public health, the rise in obesity is offsetting some of those gains. It's a frustrating trade-off that illustrates how public health initiatives must consider the broader picture.

GLP-1 medications have entered the conversation as a tool for managing metabolic health. While they show promise in assisting behavior modification, they come with challenges—adherence, side effects, and unforeseen consequences. They may help individuals in their journey to better health, but they are not a magic solution. Instead, addressing the fundamental causes of metabolic ill health is where real change begins. Chronic stress, excessive sugar intake, lack of sleep, sedentary habits, and highly processed foods all contribute to the crisis. Tackling these issues requires a shift in mindset and lifestyle.

Ultimately, widespread behavior change toward healthier eating and more active lives is necessary. Resilience—both individual and collective—depends on prioritizing metabolic health. By making informed choices, embracing movement, and rejecting harmful dietary habits, we can transform lives not just in the U.S. but globally, paving the way for a healthier future. 

Coronary Artery Disease (CAD) remains a leading cause of health complications, making standardized reporting methods crucial for effective patient management. One such approach, Pi-Rads for Coronary CT Angiography (CCTA), uses a scoring system from 0 to 5 to help clinicians interpret results. This system provides valuable guidance on treatment pathways and gives insight into the percentage of coronary artery stenosis, helping doctors make informed decisions about the next steps.

When assessing heart disease risk, the Coronary Artery Calcium (CAC) test plays a significant role. While it offers 80% sensitivity in detecting obstructive CAD, its specificity is only 40%, meaning it may not always accurately predict disease severity. A score of 0 is the exception—this provides confidence that a patient is at lower risk for developing critical blockages.

The type of plaque within coronary arteries can be just as important as the presence of plaque itself. Low-density, non-calcified plaques pose the highest risk because of their unpredictability. These plaques are more vulnerable to rupture, potentially leading to heart attacks, making plaque composition an essential factor in cardiovascular risk assessment.

Artificial intelligence (AI) is increasingly being integrated into coronary diagnostics, particularly in CCTA testing. Companies such as Cleerly and Elucid utilize AI technology to measure both calcified and non-calcified plaques, enhancing precision in detection. However, interpreting the highly detailed findings these tests provide can be complex. In underwriting, the impact of these insights on risk ratings remains an area that requires further study.

Another advanced tool in coronary assessment is Fractional Flow Reserve (FFR), which helps determine whether an arterial narrowing (stenosis) is significant enough to require intervention. With a sensitivity of 88% and specificity of 89%, FFR provides valuable information for evaluating the necessity of procedures like stenting, ensuring treatment decisions are well-informed and tailored to individual patient needs.

These advancements are shaping the future of coronary health assessment, offering improved precision and deeper insights that help guide clinical decisions. As research and technology evolve, the ability to predict and manage CAD more effectively continues to expand, creating a promising outlook for patient outcomes. 

Reporting and Data Systems (RADs) play a crucial role in medical imaging and diagnostics, ensuring consistency in interpreting, reporting, and managing various conditions. These standardized frameworks, established by medical and technical organizations, help bridge the gap between radiologists and clinicians by reducing ambiguity and promoting clear communication. Additionally, they facilitate data collection, which is vital for monitoring patient outcomes and refining diagnostic practices.

RADs extend across multiple anatomical areas, covering everything from the thyroid and prostate to the lungs, liver, bone, colon, and even ovarian/adnexal regions. By providing structured guidance, these systems support accurate assessments, leading to better-informed clinical decisions. The American College of Radiology (ACR) has developed Reporting and RADs protocols that integrate standardized terminology, risk assessment algorithms, structured reporting techniques, and data collection recommendations—creating a comprehensive toolset for medical professionals.

Despite the technical complexity behind each RADs system, their value in both clinical and insurance medicine is undeniable. They serve as an essential framework for classifying and rating impairments, improving risk assessment, and streamlining healthcare evaluations. Familiarity with these systems is fundamental for professionals working in medical imaging, diagnostics, and insurance underwriting, as it ensures precision, consistency, and improved patient care.