Kathryn:       Hi everybody, this is episode 10 of season four, we’re coming towards the end of season four right now, for the end of this year and today I have Matt Rann back with me.  Hi Matt!

Matt:            Hello Kathryn, how are you keeping?

Kathryn:       I’m really good thank you, really good.  I’m looking forward to the weekend, we’re recording on a Friday which is a little bit different to usual.  But it’s nice, just before – and how are you doing?

Matt:            I’m not too bad at all, although in saying that – given that I was in Cyprus last week with 25 degrees, coming home to the North of England in November has been a bit of a shock to the system to be honest with you.  Twenty-five down to five.

Kathryn:       You definitely know you’re home don’t you, when you start coming back in on the aeroplane and it’s just automatic rain and grey.  And you’re like, “Yeah –”

Matt:            Absolutely.

Kathryn:       “I’m back in the UK!”

Matt:            However, adding about three more layers of clothes has kind of solved the issue for at least a few days, so – I’m very, very good, thank you for asking.

Kathryn:       Absolutely all good.  Well I wish that you were still in the sunshine but then at the same point we wouldn’t be able to have a good chat, so –

Matt:            That’s true.

Kathryn:       So today everybody, we’re going to be talking about alcohol consumption and how it can influence insurance applications.  So, this is the Practical Protection Podcast.  So, to start things off as always, I am going to go through a little bit of statistics about alcohol and, you know, obviously there’s a complete range of situations where alcohol will come into certain question sets for some insurances and sometimes it won’t.  So, if we’re talking about the majority of insurances that people go for, which is known as personal insurances, so that’s ones that they take out for themselves and they pay for themselves, that will probably have a question somewhere in there saying how much alcohol do you drink in an average week?  Sometimes it might say in an average month and it can be a bit different the way that the questions are sort of like put forward, because you might get it where they say, “Well how many pints of beer and how many spirits are you having?”  Or it might ask you how many units.

It really depends upon the insurer.  And then you might have other policies where maybe they’re non-medically underwritten or maybe group insurance, which is something that’s arranged by employers for their employees.  They wouldn’t be going into the alcohol side of things.  But I think that people can be quite surprised at how much alcohol can influence insurance applications.  And obviously me and Matt will go through that a lot more and Matt will be able to give us a lot of the kind of medical background around it.  So, in general terms of like, from an advisor, if you’re wanting to help people, 24% of adults in the UK regularly drink.  I have to say, I actually was surprised at how little that percentage was, to say that there was only 24% of us regularly drink.  Because I think we are, kind of seen as a drinking nation.

So I was actually really surprised at that, you know, pleasantly surprised that we’re not seen as, you know, there’s not as many regular drinkers as I thought there might be.  But I think again, going back to the thing of people might think, “Oh why is it something that insurance really needs to know about?” and things like that well actually, alcohol is the biggest risk factor for death, ill-health and disability in people that are aged 15 to 49 years old.  Which is quite a – that’s quite a good age range and I found that quite surprising because I think if you automatically think of cancer as maybe the biggest risk factor but actually, you know, this is saying that alcohol can be quite a thing.  And I could be wrong Matt, but am I right in thinking that alcohol can actually sometimes increase the risk of some cancers as well?

Matt:            Oh yes, you’re absolutely right.  I mean, certainly the cancers of the throat, the mouth – the throat, stomach and it would be no surprise to you, the liver as well.  So yes absolutely, I mean alcohol is a toxin.

Kathryn:       Yeah.

Matt:            Or confused toxins.  And anything there that you’re pouring into your body that will damage organs and toxins do, then that is going to increase the risk of cancer.  So yeah, you’re absolutely right.

Kathryn:       Yeah.  So yeah, thank you for clarifying that, because when I was looking into it, it was saying that alcohol is the cause of over 60 known conditions.  And just sort of like going back over my notes, it’s also could potentially link to breast cancer as well.  And I think – I don’t want this podcast to come across as us saying, “All people shouldn’t be drinking and you shouldn’t do that,” but ultimately, as with anything, just as with smoking and maybe eating unhealthy foods, you know, if we’re putting stuff into our bodies that our bodies don’t necessarily naturally want to be having – and I’m not saying that everybody suddenly go off and rush and have like a paleo diet or anything, but our bodies are going to react to that in certain ways.  And obviously, with alcohol, I think many people would probably know that it does have that link to the liver and how the liver’s functioning, but they maybe wouldn’t know all the other areas that it can potentially come into.

So, if we go into sort of like the advisor space then and obviously if anyone else is generally listening, I think alcohol can sometimes be an area that some advisors might overlook when they’re doing sort of like their initial chats with people.  You know, especially if you know and you’re chatting with somebody and you’re doing the research, you know, you either – I think a lot of people tend to maybe either not really sort of like speak too in depth with people about their health or their risks before they go straight into applications.  You might get people that are a bit of a midway, just sort of like chat a little bit about it and then get straight stuck into things.  Or you have us at Cura who – we really go into all this information beforehand.  Almost a little bit like a tele-interview but not done in such a formal sense.

One of the things I do when I start chatting with somebody is obviously, I get everything ready for the application.  So, you know, I’m saying like, “I’ve done the research, we’re good to go, we’re going to be having this, you know, I’ve already talked about the alcohol and everything,” but something that we make sure – well I make sure especially that I always ask, you know, if someone says to me, “Oh I’m drinking about two units a week or five units a week,” no matter how much they are drinking, I always say to them – and I’ll say, “This is something I ask everybody, have you ever been advised to reduce your alcohol consumption?” And the reason that I ask this is that I was caught out by this years ago when I was doing an application for somebody.

And I was doing this application, this person said, “Oh, you know, yeah –” at the time I think they were drinking about 18 units a week. And I was like, “Okay, so that’s not like near the flag level with insurers in terms of the amount of units per week, okay.”  And as we were doing the application I was just like, “Have you ever been told to reduce your alcohol consumption?”  And they suddenly said, “Yes.”  And I was like, “Okay.”  And it completely stumped me at the time and, you know, this was very early in my advising side of things.

Matt:            That’s absolutely fine, yeah.

Kathryn:       Yeah.  It completely stumped me and I was like – because I didn’t expect it because I thought well, “You’ve been told to reduce,” but in my mind I was thinking, “You’ve been told to reduce but you’re drinking 18 units.”  And it didn’t factor in my head that somebody would still drink 18 units if they’d been told to reduce their alcohol consumption. And so then it was straight away a case of like, “Well what were you drinking?  If this is reduced, what were you actually having?”  And I think we were up to sort of like 45 units a week that they had been having.  And obviously, there is a quite a knock-on effect from that.  You know, there are certain amounts of alcohol consumption which are sort of like the usual levels and – but, you know, if somebody has been drinking a higher amount and then they have reduced it, you know, the insurers might obviously want to know about that.  But I think a good thing to ask straight away Matt is, why is it so important for an underwriter – for an insurer – why is it so important to know about the amount of alcohol that’s being consumed?

Matt:            Absolutely, I can completely understand.  Well, as you’ve mentioned already, on the basis that statistics will tell you that more than 60 conditions are linked to excessive alcohol abuse, those are medical conditions obviously – then that can give you an immediate insight to the impacts that alcohol can have on the human body.  And we’ve talked about cancer in terms of liver and stomach, there are conditions within the liver called fatty liver, I’m sure that many of our listeners will have heard of that and effectively fatty liver can turn into a condition – it’s called NASH, or I always call it NASH because that’s a far easier way of remembering it.  NASH stands for non-alcoholic steatohepatitis.  That’s a mouthful to get out.

Kathryn:       It is, yeah.

Matt:            NASH.  And that really is a condition which can go on to cause scarring of the liver, otherwise known as cirrhosis and then can obviously lead to liver failure at the end of the day which is either terminal or of course if you’re lucky enough to have a transplant donor available, then it will end up in a transplant.  But really with fatty liver disease, I thought I’d talk a little bit about it, because I think it comes up certainly in the media an awful lot.  But there is also a condition under fatty liver called non-alcoholic fatty liver disease, NALFD.  Now, if you have that, then that’s 30% of people will end up with NASH, so that tends to be the more serious type of fatty disease – fatty liver disease and of those getting NASH, then about 20% of that 30% will end up getting end-stage cirrhosis.  So, fatty liver disease is something that may come up with advisors when you’re talking to clients and we know that the NASH can be serious – is serious, but non-alcoholic – interestingly, alcohol – non-alcoholic, you know, can lead on to more serious conditions as well.  So it’s important to get those conditions noted down.

It’s no surprise really that, you know, we’ve talked about 60-odd conditions.  Stomach ulcers often come with heavy alcohol abuse.  So liver and stomach, obviously not surprising because you’re putting toxins down your throat into your stomach and then it’ll go off and be broken down in the liver.  But brain and nervous systems can also – impacts on nervous system can also be an issue.  So memory problems and brain damage.

Kathryn:       Yeah.

Matt:            Nerve damage and obviously you’ve got – within the brain if you want, alcohol withdrawal symptoms and addiction as well.  And again, we’ve talked about this historically on previous podcasts, but unfortunately alcohol or excessive alcohol is also linked to mood and mental health.  So simply it can exacerbate depression and anxiety, paranoia, paranoid hallucinations as well.  Noting that alcohol is an anti- – is a depressant in its own right – a depressant in its own right so it’s not going to help if you are depressed.  Also, you’ll often see it with raised blood pressure as well.  Alcohol itself can exacerbate raised blood pressure and we all know that raised blood pressure can lead to strokes and heart attacks.  So you’ve got a whole raft of pretty serious disorders there which are in some areas life threatening and life limiting.  And that probably gives you, I hope, and our listeners an idea of why underwriters are very interested in current alcohol consumption as well as historical alcohol consumption as well.

Kathryn:       Absolutely and I think it’s really fascinating when ultimately like you say, you know, even if we ignore all the potential cancers in the sense of everything, you know, everywhere the alcohol’s touching from the mouth right down.  You know, if we’re talking about the liver – the liver is such an integral part of how the body functions, it’s – I’m going to go a little bit off for a minute – so when I did my doctorate, one of the things that I did was –it was all to do with, well part of it was to do with cybernetics and no not robots but the concept of systems and the interconnection of systems.  And one of the ones that I really focussed on was something called the bible systems model and it was done by a guy called Stafford Beer.  And it was fascinating because he was a businessman.  But what he did is, he used to – and it’s what I use a bit as well – he models businesses based upon the human body and the central nervous systems and everything.

So, you know, basically so like your sense, you know, your sight, your hearing, everything is your primary function.  So the primary functions of the business.  The spinal cord and all the nervous system and everything, that would be like your administration structure, that’s sort of like making everything co-ordinate.  And obviously then you’ve got your organs which are the really vital functions.  And the reason he did that was – it was along the lines of saying, “You can’t have, you know, there’s not one thing that working on its own is going to work – basically, if something’s affected in one place, there’s going to be knock-on effects everywhere else.”

Matt:            Yeah.

Kathryn:       It’s impossible to just think of things in a singular kind of way.  So as you say, with the liver, it is going to have a knock-on effect everywhere.  But it’s interesting what you were saying there as well about mental health because I think I – I’m not saying that obviously I have – my way is sort of like the ideal way to do it or anything, but it is something that I do and it’s something that I have said before on sort of like social media and stuff because I do have, obviously, anxiety.  But one thing I do is – I’m really big on I will never drink alcohol if I’m not feeling completely okay.  I know it sounds daft but like you were saying there about it being a depressant, you know, kind of thing it’s like for me is the case of, for me I just don’t want to risk it, I don’t want to feel – I don’t want to risk feeling yuk.  But not everybody’s in that mindset and as you say, you know, sometimes it can lead to more of like a negative cycle that people can get into with having it.

Matt:            Absolutely.  I think that’s an excellent way of looking at it Kathryn in terms of if you’re feeling a bit down.  I mean, how many people when they’re feeling a bit down, turn for a drink?

Kathryn:       Yeah.

Matt:            And you not doing it I think’s a fantastic way, so it must work for you as well, so I’m glad it helps.

Kathryn:       It does.  But, you know, even saying that’s my thing, sometimes if I’ve had a long day at work and it’s not that I’m feeling down or anything, but maybe I’m just tired, I’ll think, “Oh, I’ll maybe have a gin tonight,” and obviously it’s nice and I enjoy it.  I don’t drink often but, you know, every now and then I will do it.  But then there is obviously I’ll say, I’m still in an okay space when I’m doing that, but again if I wasn’t I just wouldn’t do.  But no, it’s very – I think it’s very easy for it to maybe become a situation where it’s not what people think.  You know, people maybe – it becomes maybe a bit easy to have that glass of wine or that gin or something at the end of the day if it’s been a bit of a tough day.  And then that kind of like to become the normal level.  So then –

Matt:            Yeah, yeah.

Kathryn:       But then, you know, I think it can probably quite easily escalate without really realising it until some day you look back and you think, “Hang on a minute,” you know, but that’s probably a completely different podcast.  But yes, if we focus back onto, sort of like the underwriting side of things.

Matt:            It does have a link Kathryn, believe me.  What you’ve just said there and went through, it does have a – it’s an important point, so thank you for sharing it.

Kathryn:       Yeah, no, of course, thank you.  So I mean another thing is obviously, you know, we know now why the underwriters really need to know about it, because it does have a knock-on effect to so many aspects of the body’s function and potentially what might develop.  Because, as you say, it is a bit of a toxin going into the body.  And one of the things that I seem to – obviously if someone says to me that they have had a lot of alcohol in the past or maybe they’re talking about cirrhosis or as you’ve said, the alcoholic fatty liver, I always ask people for what’s known as their latest LFT – so that is lima foxtrot tango, reading so that I can do the research for the cover.  And it’s one of those things for me that, if someone comes to me in that situation and they don’t have those readings, I will typically kind of say, “Look, I need you to go away and find those before I can do research and really prepare you for what’s gong to be available.”  So can you explain a little bit about what these liver function tests – what the readings mean and sort of – kind of like what would maybe be considered normal levels and not normal-ish levels?

Matt:            Yeah sure, it’s an interesting one.  I think some of the levels again is an interesting point and I’ll talk about those.  But really, liver function tests – there are a number and as we’re talking about alcohol, I’ll just stick to the ones that are relevant to alcohol.  Ones that are not – very, very quickly, include a total protein reading, a total albumen reading, total globulin reading and total bilirubin, which I’m sure people if they’re interested in their own medical results, are fairly standard when a GP asks for bloods, will have seen them.  The three – really the two – but the three that are most common in terms of looking at alcohol is something called ALP.  And the wonderful technical name is aspartate transaminase, ALT which is alanine transaminase and gamma GT, which is probably the most famous one, which is gamma-glutamyl transferase.

Now, the gamma GT is the reading that generally goes up first if you are drinking heavily.  The other two are more slow to react.  With gamma GT, it will come down relatively quickly if you don’t drink at all where the other two take a little bit of time.  Now in terms of readings, I must admit I always get – a little bit of a red flag comes up when I see – even our GP –reports from GPs, they will just give a single reading.  Let’s say, let’s take – I’ll give the reading – well, I will give some readings in a minute, the normal ranges, with a big caveat, I’ll go on.

Kathryn:       Yeah.

Matt:            But GPs – or people would just say, “I’ve got a gamma GT of let’s say 60,” it’s not that helpful.  What you actually need is the range that the laboratory has used.

Kathryn:       Yeah.

Matt:            For instance and I’ll give you – here’s some examples – normal range from a couple of cases I’ve seen recently, these are laboratory ranges, so here they will dictate whether it’s up or down, I don’t think I’ve ever seen a very low gamma GT, but either which – sorry, one under the normal range.  The normal range is five to 60 units, whatever the unit is.  Now, I read this morning and others are saying six to 32.

Kathryn:       Oh right.

Matt:            I’ve seen others that actually have an upper limit of 80.

Kathryn:       Okay.

Matt:            So you have one of 32, you have one of 60 and you have one of 80.  Now, the reading and whether it’s up or not, really is – you need to look at the actual normal range.  Okay?  So for instance, if it was 40 on the six to 32, that would be up, okay?  But on the five to 60 and it was 40 then it wouldn’t be up.

Kathryn:       Yeah.

Matt:            That normal range is so, so important and whether the level is over above the range for that particular laboratory.  So as I say, single readings – what I mean by that is, a reading with no reference range – is not that helpful.

Kathryn:       Okay.

Matt:            Okay?  When you’ve got, obviously I’ve used references here for an upper range of say between 32 and 80 – if you have one of 120, you know that that is going to be raised.

Kathryn:       Yes.

Matt:            The key is, now is 120 50% higher than 80 or is it four times higher on the 32?

Kathryn:       Right, okay.

Matt:            I.e. if it’s four times higher then that person has got a problem, definite problem.  If it’s 50% higher, then maybe he’s been on holiday and drunk too much –

Kathryn:       Yeah.

Matt:            For a short period.  Does that make sense, Kathryn?

Kathryn:       Yeah, it does.

Matt:            Because it’s quite important I think for – if there are any underwriters out there, I’m sure that they will be trained on that type of thing.  But it also is important for people and, you know, if you have a blood pressure reading, so you’ve got 120/80, that kind of thing is fairly standard, depending on your age of course and whether it means anything from a clinical perspective.  But these – when you have blood tests and this doesn’t just apply to liver function, you really need to know the range so you can put that reading into perspective.

Kathryn:       Yeah.

Matt:            Okay?  So, sorry to repeat, does that make sense, do you think?

Kathryn:       Yeah, I think that does make sense because I think, you know, I’ve had that similarly with something else recently which for me, it was like, I got the readings but then – and obviously I sent it over but then it wasn’t to do with alcohol it was to do with cholesterol actually, which I thought was quite standard.  I could be wrong, but I thought they were quite a standard range and I sent the things off to the insurer and the underwriter said, “Well we need to know the reference range,” and I was thinking, for me I was like, “Really?”  Because I’ve never, ever been asked the reference range before for cholesterol.  But I have it, so I’m just going to make sure that obviously they get it over to them.  But no, so I do understand that, you know, it’s different areas will sometimes do them in slightly different ranges and we need to make sure that –

Matt:            It’s different laboratories, that’s right.  Different laboratories that can do them in different ranges.  With cholesterol, the differences between laboratories is much, much smaller.  We’re talking about you know, 0.5 – 0.5 for instance on the range.  But either which way.  So if liver function tests are available, we talked about the three that underwriters will look at, but I would say that the ALP – why I kind of focus more on ALT and gamma GT was really that ALP isn’t really specific to the liver at all.

Kathryn:       Okay.

Matt:            It can also be raised for a number of other factors such as bone disease, osteoporosis, Paget’s, things like that.

Kathryn:       Yeah.

Matt:            So again, it’s important to look at the picture, as all underwriters do, or should do – look at the whole picture here.  Other clinicians, GPs in other words, will also look at a blood test which is usually found in your full blood count called an MCV which stands for mean corpuscular volume.  And what happens there is, to see if there’s any increases in that range for instance and with that one, a normal range is 83 to 96.  Now what happens is that – and we talked about those 60-odd different areas Kathryn, the MCV gets raised where alcohol poisons the bone marrow.

Kathryn:       Oh right.

Matt:            So, we talk about alcohol impacting different parts of the body.

Kathryn:       Yeah.

Matt:            And it actually increases the size of the red blood cells and doesn’t allow them to function properly –

Kathryn:       Okay.

Matt:            At the end of the day.  And that causes an increase in your MCV.  So it basically poisons some of the red blood cells and they can increase – so MCV readings will increase within six to eight weeks of heavy drinking and you have to stay off for things return back to normal – stay off alcohol completely for about two to three months.

Kathryn:       Right.

Matt:            So, if they’re up, that’s a bit of a red flag.  The other thing that clinicians look at is triglycerides as well, which you’ll know from your cholesterol – your liver fraction triglycerides, which are fatty acids and effectively can be up because of the fat content of alcohol.

Kathryn:       Yeah.

Matt:            Okay, which we know all about, because it puts on weight, obviously.  So you do have the liver function test, but I thought I’d throw in, certainly MCVs as well and triglycerides, because again an experienced underwriter will look not just at the liver function tests but also they will look at those two areas as well.  And certainly clinicians do – doctors, GPs.  So, does that help in terms of – with your question –

Kathryn:       Yeah.

Matt:            You know, what are these readings all about, actually?  What do the numbers mean?

Kathryn:       Yeah, it really helps as well because I think as I say for a lot of people I think, you know, would probably be thinking, you know, I know to sort of like – for me, my go to is probably to say to people, “Do you know what your latest liver function test is?”  And I think people do tend to sort of like generally know that and that would be the one that probably sticks in the mind.  But having all those extra ones as well, it’s just that extra bit of information that, if you can get it from the start, then it means that you and the underwriters are prepared for what’s going to come up in the application and the GP reports and then you can just manage expectations really early on, which is obviously what is the main thing.  I suppose something that sort of like stands out for me is sort of like when does it become a – so if somebody is applying for maybe life insurance, critical illness or income protection, what kind of amount of units or amount of beers would you maybe be expecting every week where an underwriter starts to think, “Hmm, I wonder if we maybe need to know a bit more about what’s going inside, here?”

Matt:            Yeah, it’s an interesting question and I would have said that from underwriting in the last few years, the underwriting fraternity have been probably a little bit more wary of units of alcohol consumed.  Now, I must admit, I didn’t realise that it was – when people – when clinicians introduced the idea of counting units of alcohol, that actually was introduced as recently, if I can call it recently, as 1987.

Kathryn:       Oh right.

Matt:            Which surprised me.  I would have thought that units had been going on forever.  But bear in mind I was a relatively – in 1987, I was a relatively older person in 1987.  I’m trying to be a bit careful here.  But it’s interesting – but to answer your question in terms of units, then it’s around 30.

Kathryn:       Yeah.

Matt:            If somebody discloses 30 and it certainly used to be more for life, so I’m probably thinking CIC an IP – critical illness and IP, it used to be more than that for life but with the advent of automated underwriting systems, I seem to come across cases being referred or even declined in some cases for life insurance with alcohol between 30 and 40.

Kathryn:       Yeah.

Matt:            So it’s a little bit different between different insurers, let’s put it that way.  Which is no surprise because a lot of these medical disorders are – but alcohol seems to be one that is not necessarily being treated in a way it should be by automated underwriting systems.  And what I mean by treated the way it should be, I think you need a darn sight bigger picture than, “I am drinking 31 units.”

Kathryn:       Yeah, I think it’s quite –

Matt:            There is a lot to it with alcohol that concerns me.

Kathryn:       I was going to say as well, I think, you know, it sounds, you know, 30 units sounds like a lot and it really does, but then I kind of think well I know it’s not necessarily the case now, but I think of the amount of people – I’m not saying it was always me, but whenever I – obviously it definitely wasn’t me when I was travelling to London, because I wasn’t drinking but when I travelled down to London and I’d be there and I’d maybe, you know, be going from meeting to meeting, the amount of people you would see kind of on their lunch breaks having a drink together and lunch and then you’d go into some meetings and you’d come out and then people would then be there having dinners and having drinks.  And it seemed to be – I’d look at it and I’d think, “I imagine there’s a lot of people here,” and it’s kind of – I’m not saying it’s a specific mentality but just that culture of getting together and seeing each other and the kind of like the informal networking with business and everything.  I imagine it’s quite easy for it to quickly add up without you realising it.

Matt:            I absolutely agree.  I mean, you know, with drinking socially, I mean you’ve got so many different ways that you can have alcohol.  You can have it in cans, as you know, cans, bottles, big bottles, small bottles, you can have the traditional pint pulled.  It’s quite difficult to really keep an eye on quite what you are drinking, there’s absolutely no two ways.  I mean restaurants – not restaurants so much if there’s just two of you, but if you’re at an industry event then you’re going to get people who keep on topping up your glass.

Kathryn:       Yes, I was going to say, Lindsay and Jay, they went down to the Money Marketing Awards and I have to say, the pictures of them coming back on the train the next day were not the jolly, smiley faces that had gone down the day before.  There were sunglasses on.  They’d had a very, very good night and the same with Alan, he was down at the Cover Awards and it surprised me the amount of messages – obviously people had started chatting to each other socially the next day and I think it’s because to be honest, I think in those situations it was just the case of really big get togethers, it’s been so long since people have seen each other, but there’s a lot of people again saying that they’ve had some sore heads.

But I think that in itself as well though, that can sometimes stand out and confuse people because, you know, some people might think, “Well I have a glass of wine every night, so that’s – it’s not like I’m going on and suddenly having a binge on the weekend,” but then other people might think, “Well, I don’t drink the majority of the month but then on a week, you know, there’ll be one weekend at the end of the month when I’ve had my pay packet come in and I’ve had a really nice weekend.  Two days just sort of like a nice time with my mates,” and they probably don’t see that as bad, so well like I’m not doing it for the majority of the time but then it’s so hard isn’t it, sort of like – in a sense, you can’t – I don’t even think there is a case of which one’s better, kind of a regular steady stream of alcohol or going on a real bender kind of thing, it’s difficult.

Matt:            Well I think it we look at clinicians and statistics, binge drinking is certainly not a good idea.

Kathryn:       No.

Matt:            Because, you know, in an extreme level, you can end up with alcoholic poisoning of course, but pretty rare I hope.  But the recommendation these days and you do see it on insurance applications, they ask you how many days a week you drink.

Kathryn:       Yes.

Matt:            I’m sure you’ve seen that.  And, you know, it’s known that to allow your liver to recuperate after being poisoned, let’s be frank about it, is a very good idea.  So somebody drinking once a month, potentially depending on how much, then rather than three or four units a day, is probably a better thing.

Kathryn:       Yeah, absolutely.

Matt:            So, you know, it’s different for different people.  I have to say – and I, once upon a time, in a previous life, I did some research for a Channel 5 programme.

Kathryn:       Okay.

Matt:            And it was all around what alcohol did to your body.  And they selected – I think I probably wrote – underwrote that is, not in the traditional sense, I just looked at them from a medical perspective, so I didn’t – these weren’t applications for insurance.

Kathryn:       Yeah.

Matt:            And there were probably about a dozen I think, that the TV programme came up with.  And these people were admitting to – they were partygoers basically, clubbers and they were admitting to something between 70 and 120 units a week.

Kathryn:       Right.

Matt:            And so not every day, but at the weekend when they went out.  And what happened was that full bloods were done on them all, some of those would have included your MCVs, your trigs and importantly liver function tests and it was a great surprise to me that none of them came up with raised liver function tests.

Kathryn:       Oh wow!

Matt:            Any of them.  Or MCV or trigs.  And call me a sceptic, but I wondered whether they’d over-exaggerated the amount of alcohol –

Kathryn:       Right.

Matt:            – they actually had.  Or it tells you –

Kathryn:       That some people’s bodies do different – some people’s bodies metabolise it in different ways.

Matt:            Absolutely.  Absolutely.  So again, this is what I mean about taking one element of alcohol as read, if you like, as a black mark against somebody.  We really do need to find out an awful lot more.  The challenge again that the whole industry has is partly because people don’t actually know what they drink.  Let’s be honest, if they are regular drinkers they don’t know what they drink.

Kathryn:       Yeah.

Matt:            But also of course because it’s self-reported.

Kathryn:       Yeah.

Matt:            And I think anybody who is going to go for life insurance, like critical illness, income protection, is likely – there is likely to be a bit of an underestimation than an absolute true estimation.  That’s just the way of the world, I think.  Because you can never ultimately prove it, unless –

Kathryn:       GP involvements and stuff.

Matt:            Absolutely and told them.

Kathryn:       Yeah.

Matt:            You know, it’s an interesting one, you know, we’ve talked about have you ever been asked to reduce alcohol, well I certainly have.  I drink about 25 units a week, I’m a member of CAMRA, Campaign for Real Ale, and I do love my beer.

Kathryn:       Okay.

Matt:            But I’m also hypertensive.

Kathryn:       Right.

Matt:            Which is one of those 60-odd conditions.

Kathryn:       Yeah.

Matt:            Anyway, to cut a long story short and not get personal about me, every time I see the hypertensive nurse, which is about every year, she tells me to reduce my alcohol.

Kathryn:       Yes.

Matt:            You know, and the reality is, am I drinking too much?  Well, according to the public guidelines of 14 for men and women now, which kind of came down in 2016, it felt as though it was the other year, but 2016, then certainly – certainly I am.  And another statement if you want, I’m not sure if it’s a fact or not, but I’ll throw it in that actually the NHS – no sorry, the GPs are actually paid to actually ask if somebody is drinking more than 14 units a week.

Kathryn:       Oh right!

Matt:            And advise – you know, part of that would obviously be if they have to advise to reduce.

Kathryn:       That was going to be something I was going to ask about, because –

Matt:            I don’t know whether that is fact or not, I have to say, for the sake of – bear in mind this is a podcast, a live podcast.  But it goes back to – well, I’m always a little bit skeptical about people who have been told to reduce their alcohol, you know, I think you mentioned that 18 to 40.  You know, from an underwriting perspective, that means absolutely nothing.

Kathryn:       Yeah.

Matt:            So you can detect the red flags flying all over the place for absolutely no reason at all.

Kathryn:       So I’ve had like – yeah a couple of people recently and that was one of the things I was going to ask you about, you know, I’ve had somebody not long ago who – they were type one diabetic, so I said, “Have you been advised to reduce?”  And they were like, “Well, yeah, I’ve been told that because I have type one diabetes that ideally I shouldn’t drink alcohol,” but it’s not that they’ve drunk – they weren’t drinking anywhere near and they never had been drinking anywhere near your flag levels of alcohol.  They just had, you know, the occasional social drink.  But it’s kind of like – but still on the application form, I’d probably need to tick yes and then follow it up with the underwriter to say, “It’s not really,” but, you know, but then that could end up then maybe triggering GP reports or something extra that we maybe didn’t need to have in the first place.

And then there was someone else not long ago, that they’re drinking about 20 units a week, it’s a gentleman I’ve spoken to and I said “Have you ever been advised?” and he was like, “Yeah,” and that kind of matches in with what you were just saying Matt, because he had joined a new GP surgery.  So he’d done his new GP form, he’d said, “I drink about 20 units a week,” so the GP had said, “You should probably not drink 20 units a week.”  And it’s a case of it is advice not to drink as much, but it’s not like – it’s not from a blood test, it’s not from, you know, and it’s just a general guidance of saying to – it’s kind of almost as well, a bit down to individual GP mindset, of “Well I’m going to say it to this person, or I’m not going to say it to that person,” you know, in some ways.  And then it’s like, how does that then kind of influence the application and the terms?

Matt:            Yeah.  It’s a difficult area I think, particularly when you’re dealing with automated underwriting systems.  Because there are so many if’s and buts to actually create a framework in order to get the information that actually helps, is not easy.  And it’s obviously very expensive as well to start messing around but –

Kathryn:       Yeah.

Matt:            Yeah, it’s one of those areas which, you know, I think for me and it’s such a subtle difference but, is have I been told to reduce my alcohol or have I been advised?

Kathryn:       Yeah.

Matt:            Told is much more sinister than advised.  You know, anybody who’s overweight is probably going to be advised to reduce, because you won’t take so many calories.  So, you know, that whole question is a very – it can create an awful lot of hassle, let me put it that way.

Kathryn:       It can do.

Matt:            And of course, underwriters don’t want to go around getting more information or delay cases or everything else, because it’s a waste of their time ultimately.

Kathryn:       Absolutely.

Matt:            So I think that the best thing to do is come up with another way of –

Kathryn:       Quantifying it, probably.

Matt:            Obtaining the information that you want, yeah.

Kathryn:       Absolutely.  Because I was going to say from an advisor point of view, it’s hard because, you know, if someone says to you, “Well I’ve kind of been told and not told,” as an advisor straight away, “Well I’m going to have to, you know, check it out,”  You know, even if it’s not specifically naming the client but as you’re doing research, you know, speaking to an underwriter and just saying, “Right, I have a situation, where this is what’s happened, what do I need to do?”  Because ultimately, as the advisor, you know, you don’t want to non-disclose, obviously you don’t want to over-disclose.  And I think generally the guidance is – that would usually come back is that, from an underwriter it would be a case of, “Well it depends on what the client’s been told.”  And so you kind of end up in a bit of a situation where you’re stuck and you just have to say it and then just live with what happens.  But I do have a case study, as we’re coming towards the end of our chat.

Matt:            Okay.

Kathryn:       So I have a case study of somebody and it was a lady who came to us a little while ago.  She’s in her mid-forties, so BMI absolutely fine, working full time, young children and wanted to make sure there was some family protection in place obviously.  Now, when I talk about the premiums on this one, they are going to seem higher and one of the reasons being is that she was a nicotine e-cigarette user.  So as with the majority of insurers, that meant that she was smoker rates, which obviously did bump the pricing up.  So, previously before coming to us, she had been diagnosed with alcohol dependency.  She’d been drinking generally a bottle of wine a night, but at times, she was on about something like at least 80 units a week and she’d been told by her GP obviously that she needed to stop drinking.  Obviously, she got the involvement, she’d seen a psychiatrist to help and everything as well.  And, you know, at one point, had to – obviously she’d had to stop driving and she’d had a seizure as well and ended up in hospital and was told obviously that she absolutely needed to go through a full detox.  And from the point of her kind of being told that she was alcohol dependent to her stopping, was about seven years before she properly stopped drinking.

And it meant that when she actually came to us, she’d actually been teetotal for about five years, which was obviously really good, a really big achievement for her and obviously she was really happy with where she was in life, compare do where she had been.  So for us obviously, we were looking at different options and in terms of the family protection, we were able to arrange her £500,000-worth of life insurance over 18 years and the premium came out at around about £188 per month.  Now for some people that might seem quite a large premium but as I say also we need to take into account that she was a smoker.  And, you know, to be quite transparent as well, the premiums were increased on the policy because of the – sort of like what had been going on in terms of the alcohol and the long-term effects that the insurer felt were possibly still there or potentially still a risk from what had been obviously the previous consumption and I think probably the amount of time it had taken to be able to do the full detox and to actually stop drinking.

So that’s an example of obviously it is possible to get cover, you know, this person obviously had had quite a large alcohol consumption and as I say, the time period of getting to a point where there was no alcohol was seven years, so if you are hearing that kind of a situation, it’s to sort of like say don’t assume that it’s a no.  Yes, we sort of like generally say 30 units is a flag for insurers, but for this person, it had been something where, you know, the alcohol hadn’t been there for quite a while.  But even if it hasn’t been there for a while, just bear in mind that it can potentially have an influence on the premiums and quite a good influence on the premiums.  I say good influence, I mean, that’s probably my Yorkshire way of saying it, but good actually probably means bad in the sense of it’s increasing.  But, I just mean there’s going to be an increase there.  And obviously we don’t want to see that, but it’s just an example to say that cover is possible and with anything like this as well, really important and I know we’ve had this debate in the industry about reviewing policies and not reviewing policies, but if you have had somebody in this kind of a situation and either they’ve not been able to get cover, obviously you can always signpost or if not, you know, keep them in the book, say let’s chat again in a certain period of time.

Just keep seeing what’s available in the market.  If you have arranged something, maybe go back and see if there’s maybe – they’re at a stage where the premium increases will be less and so all the premiums will be a lot better for the person.  And, you know, it can be really important to do that because obviously the longer we go since something’s happened or since some certain events or circumstances have stopped the more favourable the underwriting risks can become after a while.

Matt:            And also underwriting philosophies change Kathryn, I would say, as well.

Kathryn:       Yes.

Matt:            You know, with the fantastic advances in medicine.  I’m talking across the piste here of course, there are cases now that can be written where five years ago – well maybe five or 10 years ago they couldn’t.

Kathryn:       Absolutely.

Matt:            So it’s always worth looking at those case where they’ve attracted an increased premium historically.  So now absolutely.  Can I throw something in?

Kathryn:       Ooh, go on then, yeah.

Matt:            It’s not particularly interesting I have to say –

Kathryn:       Ah.

Matt:            But it’s something that I know I kind of grew up with in my reinsurance days as something which sounds extremely strange, but we’ve talked about liver function tests, we’ve talked about readings, abnormal readings and so on and so forth and how we have to be careful in our interpretation of those readings.  Well, it’s not unheard of that people with liver cirrhosis have completely normal liver function tests.

Kathryn:       Oh, I wouldn’t have expected that.

Matt:            So there you go.  Well absolutely, I didn’t expect and all those years ago when I was growing up as an underwriter.  It always kind of fixated in my brain if you like and really it’s because of course, the ALP, AST, GGT are enzymes and effectively if someone’s got cirrhosis, the liver cells have died and of course they can’t give out enzymes because they’re too damaged.

Kathryn:       Oh.  So does that mean it’s kind of reached an even more serious level because if the enzymes are just dead, then –

Matt:            Very much so.  Well, the cell is dead, but it produces enzyme, yeah.  So, you know, again, it’s – why I raise it is we have to be careful in terms of their interpretation.  And I’ll also just throw in as well that I think it’s around 2.5% of people who have abnormal gamma GT – listeners might remember that I said that was the one that kind of reacts most quickly to alcohol, they will have abnormal gamma GT for no reason.

Kathryn:       Right.

Matt:            No underlying pathology at all.  It’s just their makeup.  The way that their liver works.

Kathryn:       Fair enough.

Matt:            And again, we just need to be careful how we – it’s not just one thing, it’s the whole picture and I think if anything, you know, they’ve been talking for a year now I think on these podcasts, is really that underwriters should and I’m sure do look at the big picture and take everything into account when assessing a case.  Because it is very, very important.

Kathryn:       Absolutely.

Matt:            And I think that is the only two things I was going to have.

Kathryn:       No, it’s brilliant and it’s reminded me as well, Alan, years ago – Alan, I don’t know why he had a blood test but he was having a blood test for something and they noticed that his liver function tests were a bit funny and I can’t say the name of what it was but basically he’d taken like a bit of a – he started taking a bit of a daily vitamin, like an energy booster type thing –

Matt:            Yeah, yeah.

Kathryn:       And it caused it.  Because his brother had had something – I think his brother had started taking them and he said, “Ooh, I feel brilliant on these,” so Alan had started taking them and he suddenly turned around afterwards, he was like turning to me and he was like, “You know what?  Apparently this has happened and they said it could be –” and he was just – and the brother said, “That’s happened to me as well but I just thought it must have been me.”  So, you know, anything, obviously we’re saying alcohol, but even that, something that’s penned as being something healthy, really good for the body, that can have an influence on the way that different things are working on the inside.

Matt:            It’s simply saying that the liver is working harder than it normally does.

Kathryn:       Yeah.

Matt:            Trying to metabolise the vitamins was causing it to work harder.  That’s all it is saying, ultimately at the end of the day.  And of course we shouldn’t – it’s a very last gasp from me, we shouldn’t forget that some medical treatments, some medical drugs, can cause increased LFTs as well.  Certainly, this is a bit from memory, but I certainly remember some of the epilepsy drugs, the LFTs need to be monitored to ensure that the liver isn’t being – is not working too hard.

Kathryn:       Yeah.

Matt:            Obviously the GP has to look at the balance between the drugs and the liver working hard against the control of the epilepsy.

Kathryn:       Absolutely.

Matt:            So there are an awful lot of things can cause these things, can raise LFTs and, you know, sometimes in a good percentage, it’s absolutely nothing to do with alcohol at all.  So, that’s what I mean about big picture.

Kathryn:       Yeah, absolutely it’s a bit of here, everything and anything.  So, well thank you Matt for going through all of that and as always sharing your insights.  It’s been really useful.

Matt:            My pleasure, my pleasure.

Kathryn:       Next time, I’m going to be back with Roy McLoughlin and we’re going to be chatting with Peter Hamilton and all the things that he’s been getting up to in the industry and beyond.  And I think that’s going to be really exciting to see all the different things, especially in his new disability role as well.  Be good to catch up with him.  If anybody would like a reminder of the next episode, please drop a message on social media to me or any of my colleagues and you can visit the website practical-protection.co.uk and please don’t forget if you’ve listened to this as part of your work, you can claim a CPD certificate on the website, thanks to our sponsors Octomembers.  So thank you again Matt and I’ll speak to you soon.

Matt:            Yes, take care everybody and yeah, hopefully before the end of the year.  That would be good.

Kathryn:       Brilliant.  Fantastic.  Thank you so much Matt.