Kathryn Knowles  00:04

Hi, everybody, we are on Season Eight, Episode 12. And today I’ve met Ron, back with me. Hi, Matt. Hi, how’s it going? Everything is going very, very well. Thank you. I am currently wrapped up in a massive dressing gown. I think I’m looking forward to it. Well, obviously, we always record slightly our sequence. So there’s work beyond tonight. So I’m very happy. And I think Alan’s can be cooking as a burger dinner, as well. So I know I’m completely, completely happy for tonight. Very, very looking forward to the day coming to an end so I can switch off how are you? How are you, Matt? being looked after wouldn’t truly Well, I’m not too bad, but a

 

Matt Rann  00:44

bit of a problem with the osteoarthritis of the feet this week, which is kind of laid me like we literally immobile for a few days and very, very painful. But it’s over it. So you know, onwards and upwards. It’s rare, I get attacks, but occasionally, and then they come along and yeah, hats off to all of those people, especially ex sports, sports men and women. Who never told when Oh, it’s great to get on the park and the playing fields and play play sport. Seven, seven. Yeah. But you know, 3040 years later, my goodness, do you pay for it?

 

Kathryn Knowles  01:26

So I was gonna say you’ve just completely encouraged a nation of people to stop trying. Absolutely. But But what’s really good,

 

Kathryn Knowles  01:33

I mean, I’m really sorry that you’ve been uncomfortable. What’s really good, is that the subject today is arthritis.

 

Matt Rann  01:39

That was very strange. When when the subject came up, I thought, oh, goodness, here we go.

 

Kathryn Knowles  01:44

Okay, somehow psychically and be triggered with some salt. So I do apologise, so we won’t, we won’t list anything else. I’ll hide all future subjects so that you don’t have

 

Kathryn Knowles  01:57

a target of everything. But so yeah, today we’re gonna be talking about arthritis, everybody, we are probably gonna be focusing more on rheumatoid arthritis, because there’s so much to learn is so different and outcome for each type of arthritis that it is really important to take one as, as its own. And but this is the practical protection podcasts.

 

Kathryn Knowles  02:22

So everybody, just to go through a little bit of a background in terms of arthritis. So not all of the things not every stat out there, because there’s a significant amount of there. But I say we’re going to be focusing really upon the rheumatoid arthritis, which tends to be one of the ones where, you know, it is a, it affects the body more than some of the other arthritis is now that is obviously individual to each person as well, I must say that, but, and it’s got more kind of going on across the whole body generally. And so Matt will explain that. So osteoarthritis and rheumatoid arthritis are the most common forms of arthritis. So in the UK, we will probably have about 10 million people in the UK with arthritis. And it’s about 8 million of those have osteoarthritis, so about, you know, even though rheumatoid arthritis, you know, you can’t, they’re not necessarily 2 million people with that, because there are other ones as well that we need to be sort of like keeping eye on and sometimes data when people classify different conditions, sometimes it found the arthritis thing, sometimes the kind of slip out of it, depending upon who’s looking at it. And but the majority of people with arthritis tend to be in their late 40s or older, but it can be any age, as Matt was saying, some of the arthritis is more linked to how physically active you’ve been. That could be through sports, it could be through work. It could be some of like, if you’ve been someone who’s a stay at home parents that are just women who stay at home and our relationships and maybe some certain tasks that have caused certain

 

Kathryn Knowles  03:53

I want to say pressures in different parts of the body. And can can start to get a little bit uncomfy as we get older. Now rheumatoid arthritis is three times say that right? I don’t know why I said the word time so strangely, three times more likely in women than men. And it’s very, very off side tangent thing here, Nikki Ray, who’s the chief underwriter at zero, but she shared a post recently. So we started beginning of 2020, fall on the shared on social media about an autoimmune disease, which is rheumatoid arthritis is an autoimmune disease and how it’s potentially linked to the X chromosome, which is something on the X chromosome tends to have some kind of connection to it, which is really very, very interesting. And obviously insights like that can really help the medical profession and obviously the insurance world all work together to try and make improvements and understand the condition more. So me saying that arthritis there is a lot of different variations. I’m going to list some here. I’m sure there’s quite a few more. But just some of the ones that we might have heard of are things like gout, somatic arthritis, ankylosing spondylitis, to cervical spondylitis, fibromyalgia, lupus enteropathy, arthritis, reactive arthritis, secondary arthritis and polymyalgia rheumatica. And so they’re sort of like the main ones that tend to be looked at. I say there will be more than that. But they’re the ones that have probably the the most people diagnosed with them. And some of them do. We do have podcast episodes from them in the past. So do feel free to have a look through previous ones, if you yourself have one of these conditions. Or if you’ve maybe if you’re an advisor world, you have a client, and you want to have a bit of insight into what they can mean, when it comes to insurance. So to start off, Matt, I know we haven’t been focusing on the rheumatoid side of things. Tell us what set with rheumatoid arthritis is and what it’s what it’s doing to the body, please.

 

Matt Rann  05:44

Okay, thank you, you’ve certainly covered some of the highlights there. So I’ve been repeating a little bit, but I’ll go for it anyway, and see where it where we get to. So as you’ve already mentioned, rheumatoid arthritis is an autoimmune disease. And for those who haven’t heard some of the previous podcasts, this is where your immune system attacks the cells that line your joints by mistake. That’s, it seems by mistake seems a little bit Whoa, what does that really mean? But unfortunately, the why is still not clear. Taking Nicky brace, research paper to one side, but it’s still not clear why the immune system actually attacks your joints in this particular way. What it actually does is to attack the thin layer of cells, the covers your joints, and for those who like complicated medical terms, it’s called a cyno view. I’ve certainly had on the continuing theme of matter, this osteoarthritis condition called synovitis, which again, itis think inflammation. And what that does is turn it whilst that thing, no layer of cells covers the joints themselves, the joints become sore and inflamed. And that releases chemicals into the blood, that can damage nearby bones, cartilages, tendons, and ligaments. And if it’s not treated relatively early on, and what I mean by that is years and weeks or days, you can get damage to the bones or get bone erosion and joint deformity. Certainly, I haven’t come across cases, as bad as that, that have hit my desk for a very, very long time. What sort of what I mean, but as bad as that. Weather is obvious bone erosion and junk deformity. Catherine, have you had any cases that has come your way that way? severe cases of rheumatoid?

 

Kathryn Knowles  08:02

I think, I think we possibly have done, but I’m not I can’t remember any of the top of my head. And I think what’s really interesting about rheumatoid is that when, you know, when we’re looking at arthritis is that, you know, obviously, if you had like osteoarthritis versus rheumatoid arthritis, I think what can be quite surprising I was hinting at before is that it’s such a spectrum. And but even though I think if you were given if you if you would ask sort of like which ones in a sense worse to have, you know, in terms of which one’s going to be more likely to be more painful effects in the body the most you would tend to go rheumatoid arthritis, I think out with the two of you could correct me if I’m wrong, Matt. But then obviously, you can have some of them had arthritis, you know, where it’s affecting maybe one knuckle in pans, and but then you could have some with osteoarthritis, where it’s, it’s affecting them significantly, they’re having to have operations to try and support the joints, you know, that they might not be able to walk without some kind of mobility aids. So it’s so strange in in terms of when we are looking at things, but you know, we, you know, we’ve certainly had very strong cases, but we, in terms of a lot of the strong cases, we don’t, in a sense, just classify that as

 

Kathryn Knowles  09:17

what’s going on with the joints. But a lot of the time we’re quite led by the medication that’s in use in for our company and what we’re doing to sort of establish how strong we think the condition is presenting itself. But does that does that make sense what you’re saying? Oh,

 

Matt Rann  09:34

absolutely. I mean, I think when you hit on it in your in your introduction, when you said the rheumatoid arthritis, people often or people often think bones, joints and so on and so forth. But of course, it it the the problems that rheumatoid arthritis can cause are far I can be far beyond that. Just just in inverted commas, I have to say not not belittling we were talking about problems with joints, if they can be found in other parts of the body. So, in terms of seriousness, and what I mean by seriousness is how it impacts your mortality. Yes.

 

Kathryn Knowles  10:23

So for anybody who isn’t in the insurance space for mortality, unfortunately, it does mean that the rent something affects your mortality, it’s the likelihood that is, you’re having a reduced chance of living in a sense for a very long time. This is reduced lifespan, essentially, yeah,

 

Matt Rann  10:42

yeah. No, absolutely. Thank you for that. And rheumatoid is much more serious in that with that in mind, than say, osteoarthritis, which by definition, osteo is much more bone related. Okay, which is certainly joint as well, but won’t go into that too much at this particular point in time. You’ve already mentioned some that in terms of increased risks, sadly, if you’re a woman, there is, it seems that the studies do show an increased risk their family history, history of rheumatoid arthritis. Some studies say think that that will say suggest that that’s the family history is some very low risk. And really that proven however, it’s in another study, which says, If you smoke, and you have a positive family history, then you’re more likely to suffer from rheumatoid arthritis. Katherine, as you’ve already said, age, much more common, middle aged people, which is an interesting one, because arthritis, you tend, if sorry, osteoarthritis, you tend to think of folk who are a little older, maybe, middle age, middle age, what does that mean, by the way? I’m not I’m not entirely sure what middle aged mean,

 

Kathryn Knowles  12:02

I don’t know. I was gonna say I wouldn’t want to, I wouldn’t want to guess either, because you could massively insult any site if

 

Matt Rann  12:08

that’s true. Well, I rag on your eye with me cutting because you know, I’m old age. So you’re okay. We certainly wouldn’t. Yeah, get into the middle aged debate, and also overweight. She risk of rheumatoid symptoms, some very obvious ones that have come up will be of no surprise to anybody. Bear in mind what you and I have just said. So it could be rheumatoid can cause pain and swelling, stiffness in the joints. It usually affects the hands, feet, feet and wrists. But it can, as you said, cause problems in other parts of the body. And even very general symptoms. And then we get back into this debate. Well, goodness, it can be one over 1000 different issues, medical issues, but the old issues that come up time and time again, such as tiredness can show that you have you’re suffering from these early stages of Ri.

 

Kathryn Knowles  13:12

Far Right, so just as we’ll check our VI

 

Matt Rann  13:16

was a very good one. What can I pass on that one? Just for a second, okay. Now 40% of rheumatoid arthritis sufferers may have symptoms that do not even involve the joints. Oh, that’s very joints. Scary, is what I think I might say when I when I came across that stat. So this this disease doesn’t necessarily manifest itself to the start as a joint problem. But you might have a joint problem at all. But if you think of the itis and the inflammation, and because going back a little bit when I was saying that the medical disorder damages us because it releases chemicals into the into the body. Other areas, which I think you touched on a little bit yourself who’s been the skin itself? Yes, eyes, the eyes. Chest pain. So what we’re looking at there is a heart and lungs can be impacted. Yeah, kidneys, saliva, glands, nerve tissue, bone marrow. So there’s an awful lot of areas within the body that this, these chemicals can damage. So if you think yourself of osteoarthritis, most of those wouldn’t be impacted at all. But with rheumatoid, that’s the big difference. Some interesting complications, probably. People may occur Also maybe grandparents have complained about rheumatoid nodules? Crop those, those Yep. The customer

 

Kathryn Knowles  15:07

can’t off the top of my head, I’m not sure, but I know I’ve come across them.

 

Matt Rann  15:13

Okay. Well, certainly these these, these are hard lumps that that appear under the skin and usually around the joints. And certainly I, in my time with my family going back over generations, as they used to show me these things, they can be quite large, it has to be said, but some I do remember them certainly. And that is one of the complications that you again, impacting the joints themselves with these, these nodules. We’ve already talked about dry and mouth. Now infections is an interesting one, because infections, obviously if you’re going to, if you’re going to have problems with your, your, your skin, your eyes, you slavery, guns, and so on and so forth. You are likely to get infections, let’s be honest, but I think really, this comes more from the treatment that is used. And I’ll go on to some of the treatments a bit later on. And really, really methotrexate, which is kind of the go to first medicine, for the treatment of rheumatoid arthritis. It knows if you think that at the very beginning, I was saying about the immune system attacking the cells, methotrexate and the other treatments, calm down, we can use it, use that term, calm down your immune system, so it it is not as fierce and doesn’t attack everything. As, as it matches it was the problem with that is, with the immune system being compromised by treatment, you’re gonna get more infections, with attracts ages, that can be depending on how much you take it. Pretty powerful drug to say the least.

 

Kathryn Knowles  17:01

That’s really interesting. So it we’ve come across methotrexate quite a bit. And, you know, we know is sort of like that. And there’s some other there’s some biological ones as well, isn’t that the medications? And, and we know that if someone says to us one of these names, it’s the case of right. So actually, it is an advisor, it’s really, really good indication when you say to people, what medications do you have, you know, to get the names of it, and then they will do a quick Google and Google will say, Oh, well, this is a type of saw some sort of type of drug or this kind of drug. And it gives you a really good stuff like account from the start of how strong to how strongly medicated this person needs to be to be able to cope with the the condition which which then also then helps the underwriters to understand why if they’re needing that, then it probably means that you know, the there maybe there can be the the very unwell or maybe you know, they’re unwell. But the the the managing to cope without having to have that the really intense medication, which can then help to understand which insurer is going to be okay from the start. And you know, what the potential ratings might be in terms of the premium. So when we talk about ratings, we’re saying that, you know, with certain health conditions or other things as well, such as worked, sorry, the type of occupation someone has or a mood sometimes travellers do that, sometimes insurers will say, well, actually, we can offer you at this price, but if we were just gonna increase the price a bit, and we’ll be able to offer you the insurance. So that’s just what that means. But I’m really interested here but methotrexate not hearing that is to do with calming down the the system but as you say, it’s, it’s that’s obviously going to be, as you say, helping but at the same point, potentially making more subjected to I’ve seen other like maybe colds or things like that you also immune system isn’t kicking in as much. But I think it’s important for people when they think about it, it’s the fact that the body’s already because it’s already it’s like you’ve said it’s kind of attacking itself. So some of the fights that the body has to fight off infections is being diverted to sort of a counteracting the way that it’s attacking itself. So it’s already lower, because of the fact that it’s, it’s not it’s for systems, it’s something to defend itself against itself, in some ways. So that’s, that’s why the Yeah, it’s kind of like so so that’s why the chance of infections is, is potentially high. So I imagine maybe, possibly taken from a side tangent here, so I do apologise, but so I imagine if there was things like maybe like recurrence, bronchitis or like regular instances of pneumonia, that that could potentially influence I mean, for anybody that could influence obviously, the options, but I imagine, am I right in thinking that could be more of a concern in this kind of situation?

 

Matt Rann  19:46

Oh, yeah, certainly. I mean, I think anybody who is taking a strong drug, then, which impacts us system then any of the likely complications from that will be taken will be looked at by an underwriter. There’s no two ways about it. There are two ways an underwriter will look at that oneness, they will say, good, you know, good grief, they’re having to take so much methotrexate, that, you know, the complications are not that far off actually defeating the aim of the drug in the first place. So, yeah, it’s it’s important, I mean, methotrexate. If you are on methotrexate, then you, actually, I’ll take a step back, because it was something that you were saying that I just wanted to comment on, actually. And when when advisors do look up, or they ask their client, it could well be their clients. And it’s the same with every drug under the sun. I know we’ve talked about it for in the past, but maybe not for a long time. But you’ll often get a brand name, not the name of the call draw less. So you’ll find that when Catherine and I talk about methotrexate, it might actually be branded something else. So it is absolutely worth getting on to Google and trying to find out what the core drug is. And and Google will tell you that there’s no two ways about that. I think the other really important thing is with methotrexate steroids. In fact, I’ve you know, I personally as an underwriter would also, say, blood pressure, there’s one that comes out and stands out to me. But it’s not just the thing to do with Mr. trucksafe. But it’s to do with you get your name, but it’s also important to know what the dosage is. Yes, absolutely. So for instance, with steroids, methotrexate cetera, then you are looking in our underwriters won’t tend to worry about more than five milligrammes a day. Yeah. If it goes over that, then you starting at looking at additional ratings to the basic rate, the basic rate for rheumatoid arthritis talk about that a little bit later on. But with with blood pressure as well, I mean, often underwriters, in fact, you’ll sit on automated underwriting systems that will say do take more than one type of blood pressure treatment. Because it is thought that if you take more than one, then de hypertension is more difficult to control. And it might be something other than what is commonly known as essential hypertension might be something else within the body’s system that is, is causing you to actually have that, that high blood pressure. So so the, the dosage is important, you know, if you’re going to sort of talk about blood pressure just for a second, this business around dosages, if you see somebody on or instance, with a blood pressure tablet, and they are taking two and a half milligrammes a day, that is the smallest amount that you can, the doctor would prescribe. So, therefore, one could say that as long as the blood pressure has been stable, then this, this individual does not have a serious issue. When when you get much higher than when you get into the 10s and fifteens, then it’s more of a potentially more than worrying outcome that the, the underwriter will look at, it’s a little bit of a red flag, don’t call it that.

 

Kathryn Knowles  23:43

I think that makes sense. You know, I think that does make sense as well, like with any medication, yeah, the more the more you need it, you know, obviously, the more that the whatever it is that you have is affecting the body the way that they’re needing to try and change what’s happening to bring it back to what would be classed as more of a normal kind of level of functioning. And you know, that that would apply for the majority of things. It’s like, you know, if somebody, if you take aspects of two people generally think of asthma is quite, you know, straightforward and ascends with generally it is but you know, if you’ve had someone who’s needed just the regular blue and brown inhalers, you know, stuff, like just really standard inhalers, that’s probably not going to cause a concern. But if you have someone who’s needed a lot of oral steroids, or potentially recently as well to try and control the asthma, then that would be an indication that you know, obviously, so something’s changed, the symptoms have been quite strong. And so it would end up possibly being a different outcome in terms of these kinds of insurances what just you know, whilst things are just getting back into what we would expect it to sort of the normal way for being able to breathe but I think it’s interesting as well with like psych saying that as well as that it’s all to do with obviously at the time, that you when we’re looking at these insurances or time that we’re taking the insurance out. So it might be that something changed. I don’t know what the rheumatoid arthritis if it can. I’ve see I imagined it can I flab ups and everything like that. But it’s fine. That’s where, you know, obviously somebody, you know, rheumatoid arthritis, and I’m going to assume with it being an autoimmune condition isn’t something that can in a sense, completely disappear, that is probably going to be something that stays long term. Is that correct?

 

Matt Rann  25:19

I think there have been cases where I mean, I mean, flare ups of rheumatoid are well known, if you like, in terms of burning itself out, then if I can think of other autoimmune diseases, then I believe that I have seen cases where it’s burned out. But I have to say, you know, few and far between what I have seen, yeah, yeah, you know, certainly not every week, or every month that I see a case like that. But they they seem to the body somehow seems to sort it out. Or another, you know, the immune system calms down through just the body itself, sort of integrated with it.

 

Kathryn Knowles  26:05

So actually, I was just thinking now, in terms when we’re saying about potential premium increases, and, you know, I think it’s fair to say that, you know, it’s quite likely that there’d be some form of a premium increase within quite quite a lot of people with rheumatoid arthritis.

 

Matt Rann  26:19

But I can I can touch on that a little bit later. Yeah, I don’t think the, I don’t think the ratings are particularly that of a surprise to, to anybody. I mean, from a risk management framework, we can already we’re already starting to sift out those people with with kind of mild joint deformity or, and or pain. Those people who’ve got problems with their, with their heart and lungs, you know, completely different end games, if you like in terms of the disease itself. And it goes, the first one, the mild joint doesn’t really impact your life expectancy. Where the latter the heart and lungs certainly can, depending. So yeah, you know, it’s, it’s an interesting one. I ramble on. Yeah, got my good old rumble. Okay, so in terms of diagnosis is no surprises, really, that it’s important to have a quick diagnosis. So you can stop those those particularly on the joints, getting, making sure they don’t get damaged any any more than they already are. And also, in terms of if there, if you aren’t suddenly one of those 40% of rheumatoid sufferers who don’t have symptoms that involve the joints, then a treatment programme is put in place before again, those those organs aren’t damaged too much. So it is key. But unfortunately, there’s no one blood test or physical finding that can give you a an immediate diagnosis. So little thing, it’s, it’s a variety of things. But I know, Catherine, yourself is very interested in blood readings and results, and so forth, then there are two ones that we all tests and therefore the results that we see an awful lot in the laboratory analysis, and those are an ESR response, sedimentation rate. And a CRP which is the C protein reactive protein. It’s called. That’s a protein that’s made in the liver. And both the ESR and CRP increase with if there is information within the body. Again, in terms of automatic automatic medical evidence, so in other words, what I mean by that is pure evidence that is obtained purely because of age some assured and product, not because of a medical history, then I would say that raised the SR acrp are incredibly rare. I’ve seen them just kind of come up if you like, randomly in a in an audit with the automatic evidence. And also, let’s be fair, here raised ASR acrp when we’ve got this loose association with increases with inflation, inflation, sorry, inflammation, increases with inflammation. It can be done to an awful lot of things. Yeah, can any type of inflammation of the body in a in a body system can cause the so you know, it’s down to your doctor to work on exactly what is causing that problem. Once we don’t see from a from a on a routine basis of the rheumatoid factor, which you may see come up on reports, or indeed your client may mention it. And those again, those those are proteins made by your own immune system. That actually when they attack the healthy tissue, okay, so rheumatoid factor is much more of a poorly, you can guess that by the name and much more indicative of rheumatoid disease. I know I know you do like long technical names Katherine. So I fully find this one with you in mind especially fantastic.

 

Kathryn Knowles  30:42

As always pronounced myself do I have to

 

Matt Rann  30:45

be honest with you, I think I’ve had to practice for 10 minutes to either which way there is another blood test, kind of in the offices of rheumatoid factor is called anti cyclic citrullinated peptide antibody.

 

Kathryn Knowles  31:01

You know, I’m convinced Sorry, I’m convinced sometimes with scientists or medical people or anything like that, they’ve turned around and gone. Do you know what I’ve spent six years of my life making this in finding this and identifying this? I’m going to give it a name that is going to outdo all the other names? I don’t think that anybody genuinely wants to name something like that.

 

Matt Rann  31:23

What can I say? This I’m just gonna respond. And I’m not saying you’re being controversial by scientists, Catherine. But you know,

 

Kathryn Knowles  31:33

now I’m being controversial. Pick nicer names. None of us know what’s going on.

 

Matt Rann  31:39

Like a lot of scientists and probably more than doctors themselves, they it’s also known as an ant. hyphen, CCP. If

 

Kathryn Knowles  31:46

that’s fine. We can go Antifa and CCC. There we go.

 

Matt Rann  31:51

There you go. But I thought I’d have to have a bit of a laugh on that one. Absolutely. Right. And also is pretty no surprises with joints involved. X rays, MRIs and ultrasound tests are are apart from that diagnosis. Porton thing, though, is to get get to the disease quickly before it causes the damage that it can do. Going back to the okay for me to start on treatments. Yeah,

 

Kathryn Knowles  32:16

go for it.

 

Matt Rann  32:18

We can touch on those a little bit of ourselves already. Sadly, and it kind of hinges on a point that you make cancer, there is no cure. Yeah, okay. That doesn’t necessarily mean it needs to, in my opinion that the disease cannot burn itself out. But there is no man made, or woman made. Cure to be had. And it’s really the the all the treatments that we have at our disposal are all around slowing down the joint damage and the damage to other organs in the body. Now, I don’t think it’s quite as good as anti cyclic citrullinated peptide antibodies. I had been practising I didn’t warn you. But the there’s a group of treatments of which means the tricks he has one called disease modifying anti rheumatic drugs, which isn’t anywhere near as bad as ours.

 

Kathryn Knowles  33:15

But that was a nice acronym, though. That one doesn’t so it’s got nice acronym is D

 

Matt Rann  33:19

mods. Yeah, that’s that’s the kind of the the acronym for it. And certainly, when talking about go to treatments, the often often the very first medicine that is is given is methotrexate itself. And if and I’m very surprised if the condition wasn’t painful if you’re going to start on muta trackside, but also, it’s often a short course of steroids, corticosteroids to relieve any pain is also given. Amongst the categories of these D mods are also ones that are often three that I’ve noted. I think I’ve heard of two of them. But again, Katherine, I know you do like coalface work. First one is that I haven’t heard of is called left lunar mide that lunar lunar mind. The third one noted down is hydro hydro crops hydroxychloroquine which I believe you take if you’re going to visit countries where there is a mosquito problem and sulphur salad zone, which again, I have heard, but I can’t quite put it into context, context. So those are your, your DMARDs. And as I say, methotrexate in particular would imagine any of those. Sorry, yeah, any of the other three you will see as well, or part of the very first drugs taken When you do have a diagnosis of rheumatoid, that obviously warrants quite a powerful job to, to help calm down the immune system. Yeah. methotrexate as we said already, it does. It’s a powerful drug and side effects can cause nausea, loss of appetite, sore mouth, diarrhoea, headache and hair loss. So, it can be pretty nasty, although I am assured by looking at things like the NHS site that that most people do tolerate it well. So it’s going to say Don’t, don’t be put off. If your doctor does in the future. You trek six is very, very important.

 

Kathryn Knowles  35:39

I was gonna say as well might have just suddenly something’s popped into my head and I think we’re having a Scotland a scone moment as well. It’s just going on that because you send me Thor trek sites and you send me yeah, you send me through trek sites and I say methotrexate, alright, okay, so I’m sort of like wondering, now we’re going to, we’re going to have a divide and we between like, maybe, I don’t know, maybe underwriters or Mito and advisory Metho. Or maybe that it may be it is just me. I’m gonna be the only one saying methotrexate?

 

Matt Rann  36:12

Oh, absolutely. It could, you know, as far if you weren’t mentioned your version, I know what we mean. Let me put it that way. So it’s something again, I always think that the most curious ones is urine and urine. Okay, just you mine. Yours are quite with respect. It I’ve heard that more in the north of England than I haven’t. No.

 

Kathryn Knowles  36:38

Absolutely not. I was thinking you’re gonna say it was like American or something.

 

Matt Rann  36:44

No, creating the barrier. So bear in mind, I am from the southwest. Oh,

 

Kathryn Knowles  36:50

I mean, originally, I just got you just gonna hear me every now and then in the podcast, can you by Just remain in the background? That’s apologies, anybody for little snippets of your writing, that’s gonna

 

Matt Rann  37:03

show that you just turned a bit American, doesn’t it? Let’s be honest.

 

Kathryn Knowles  37:05

It’s got that it sounds annoying. Yeah.

 

Matt Rann  37:10

What can I say? I was gonna make 2024. A little bit more. But bear in mind that subjects that we talk about a little bit more, yeah. So yeah, biting off on that. Absolutely. methotrexate. And also, it’s worse, if you do come across a client with who is taking me to trucksafe It’s also worth making sure or asking the question as best you can, in a very diplomatic way. Is that because the drug can impact on your on your blood cells in your liver, then that the client is attending for regular blood tests to monitor those. That’s important. Now, you then come to the second class of drugs, and as my understanding is it if the D mods are not working?

 

Kathryn Knowles  37:59

When you say D mods, is that also anti DNF?

 

Kathryn Knowles  38:08

Isn’t it anti? Anti I’m

 

Matt Rann  38:11

sorry, junk CCP mean, they’re not the one I was talking about?

 

Kathryn Knowles  38:14

No, what am I thinking of? I’m thinking anti DNF antibody products, TNF inhibitors and stuff like that. So I think sometimes we refer to some of the medication as anti so delta Nov Foxtrots. Yeah, the NF we sometimes refer to some like that. But that would be that’s is that something different? Obviously, it’s

 

Matt Rann  38:34

something different. It’s bringing it is bringing back memories. I think it’s something different. So these d mod ones have the disease modifying anti Yeah. Yeah. But they’re not fitting or specific to rheumatoid disease because I say hydroxychloroquine I’m sure I’ve taken that on foreign trips. So anyway, so as I say, if the DMARDs methotrexate group do not work, instead of satisfaction of the doctors, then they will start on biological treatments. Really, these are quite interesting to be honest with you, they are quite new, this this range of drugs is quite new. And again, I noticed that it advertised before. But it’s one of the reasons why it is so fascinating to be an underwriter as these new drugs come along and make differences not only to people’s lives, which is what it’s all about at the end of the day, but also could impact underwriters decisions as well. Which is which is which is fantastic news. But either way barge biological treatment really is literally is a biological substance that mate is made from proteins or other substances produced by your own body. And if you think of what they’re doing in cancer treatments, these substances that are natural to the body itself, are becoming more and more and more research has been put into them. And obviously, with rheumatoid arthritis, they’re into a scenario where these are already available to people. They’re being used animals and with success. So it is it is one of these kind of new drugs that says he’s made few concocted from your own body made.

 

Kathryn Knowles  40:22

Logical ones, isn’t it?

 

Matt Rann  40:23

That’s right. Yeah, make your own proteins and other substances from your own body. And what they do is absolutely really no surprise, given what we’ve talked about in the drugs, the DEA more types of drugs, blocks part of the immune system through reduced inflammation. So that’s a common outcome through all of these types of drugs. It’s just a different way of doing it. And these drugs, daily member Bob, say that,

 

Kathryn Knowles  40:53

ah, yeah, that one is always fun. Yeah, I’m really glad you’re saying it, not me.

 

Matt Rann  41:01

It kind of sapped infliximab. Yeah, I

 

Kathryn Knowles  41:04

was gonna say we usually say with a team, like, there’s certain things like, you know, if anybody tells you a medication error, it says statin, you know, whatever the name of basically, if it ends in statin, then you know, it’s something probably to do with cholesterol with a heart or something like that something’s going on. If it’s anything that’s a mob kind of thing at the end, then it’s probably we’re just gonna say generally, a stronger medication and some things.

 

Matt Rann  41:29

Absolutely, absolutely. It’s always best to leave it to the underwriter to try and say the whole thing. Yes. As opposed to map. Starting just about come COVID I think so. Either way, these are new, and they’re obviously working. And but I think one of the things as a advisor, for that matter, the underwriter as well to be aware that if they are used, generally, it means that the traditional DMARDs are not getting the results that the doctor wants. Yes. Okay. So, the threat is really as much as I really wanted to say about treatments. Was there anything that you wanted to add Catherine or otherwise, I’ve got some ratings if time? I

 

Kathryn Knowles  42:15

think that’s yeah, no, we’ve got time for that. I think probably the key thing is, is just to make sure that, you know, it’s from an advisor point of view that I, you know, have everything that I will potentially need to prepare myself. So just to same for you double check my checklist, in a sense. So obviously, we’ll be saying to people, when what were you diagnosed with when you’re diagnosed with it? What treatments have you had? What kind of medications? Are you using, you know, other things like any kind of mobility aids that are being in use? Is it? Is it affecting your ability to work? Your day to day living? Yeah, and things like that, you know, they’re all really useful. And obviously, as you were saying, in terms of medication, try your hardest to get the name of it. I always say, you know, sometimes people say these names, and you’re just like, listening and just hope really, I just, there’s no way I can get that sometimes, if you kind of take what you think they’ve said into Google, he’ll then find the right name for it. But you know, sometimes it’s just a case of saying somebody that I’m really sorry, I’m not familiar with the name of that medication after this after I’ve spoken. Do you mind? You know, if I send you an email and introduce myself? Do you mind just replying with the actual spelling a bit, obviously, that you can see on your medication box. And most people are absolutely fine doing that, because they want to make sure that they’re getting it right, you know, they don’t want to be getting anything wrong with the insurance, you know, they’re very much people who are very heightened and aware that, you know, they possibly do need insurance. And so they really, really do want to get it the right first time round. And, and obviously, you know, just just carve out but I think it’s really important as well to know and to establish for you as your own self and as your company. If you are an advisors to sort of what you will and won’t do in terms of sort of like the information you’ll get before you go and check things with an insurer because they’re like with this one, with rheumatoid arthritis, I would personally say that the medication name is something that I would really, really want to have before I did any pre sales research because, as with many many things, when you speak to an underwriter, I mean, again, correct me if I’m wrong that but when you speak to an underwriter, if you say some of them told arthritis, and they said, what medication is it? And you go, Well, I don’t know. It could be, you know, you know, it’s could be a small waiting, you know, a very small payment right field to a decline because we just, we don’t have that information in front of us, you know, some of the the medication for motor arthritis is significantly important to what that underwriting outcomes going to be into what insurances are available. Would you say that’s fair, Matt?

 

Matt Rann  44:37

I would, I would say so. I mean, I think you would expect me to do anything else but the underwriters, you’ve highlighted a really important thing to be honest considering underwriters like to look at cases in the round, which can often in other words, with all The information as well, I suppose I’m saying it in the round. And of course that that is it can lead to criticism from advisors because why is this underwriter going back to the GP for the third time type of comment. But underwriters like to look at in the round because they like to give the fairest outcome possible. Yeah, it’s reasonably music why? And certainly, treatment allows the underwriter to position the rating if indeed a rating is required on the case. And I think hopefully, one of the things I was saying there about a if you’re on methotrexate or a d mod anyway, that that, that that’s a red flag. And if you’re on one of the biological treatments as well, then that’s a red flag plus, yeah, yeah. So that those both of those do really help the underwriter. I think you’re absolutely classic one with rheumatoid is. You’ve got rheumatoid arthritis. Do you have how you put it on? You’re the you’re the expert in terms of talking to clients, but you’d want to know, is it confined to the joints? Or is it confined to it?

 

Kathryn Knowles  46:14

Absolutely. I missed that.

 

Matt Rann  46:17

Yeah. Because, you know, I hope it goes without saying to our listeners, that very different outcomes, we can be very different outcome. And just because to go back something which I know you’ve you’ve agreed with, and you do anyway, from previous conversations, it’s that dosage if you can, yes,

 

Kathryn Knowles  46:37

yeah, absolutely. And I think, you know, we’re just gonna we’re going to start at the end of the podcast here. But just something that you said as well, I think it’s really important, like when you’re saying about, like going back to the GP for the third time, and I think there’s a bit of a mix there in terms of what’s happening. So, you know, I think some people automatically assume if underwriters are going back for further information, that they’re trying to find out ways to not insure someone? And I think, yeah, you know, I think a lot of people would think that, and you know, what it is, in some ways, you know, I certainly can’t say that, that doesn’t happen. But I think what happens quite a lot of the times when people don’t necessarily realise this, or maybe believe it is that a lot of the time the lender is they’re trying really hard to ensure the person. But and because the whole point of underwriters is to insure people, it’s, you know, people get it wrong way around, sometimes, yeah, the right mixture of people at the right price that’s fair to the person and to the insurer. And, you know, it isn’t, I would say that a sec can’t say everything, but you know, an underwriters job is to ensure it’s not to decline, you know, it’s, it’s, you know, they are trying to ensure the person. So when it is going to the GP for further information, sometimes it’s a case of them going, Look, we need this, because we don’t have the picture, you haven’t given us all the information. And it’s so so hard. I know, we were chatting about this before the podcast as well, Matt, about the amount of pressure on the NHS, it is incredibly hard the amount of pressure that’s on the NHS right now. And you know, and in terms of the GP, the first thing in the GPS mind isn’t completing an insurance form, it is serving the people that are going to see them. And when they’re filling out these forms, they are doing it, but you know, sometimes they’re trying to bundle it in with everything on top of everything else they’re doing. And you know, they might miss something out, that’s just a specific word that the underwriters need. And, and it can be quite hard, you know, sometimes what insurers will do in the underwriters, they will do targeted reports. So instead of asking the very generic set of questions, they’ll maybe say to the GP, right, we know that this person has this condition, can you tell us the deductor, which can sometimes be really, really useful, but they’re not always used? And obviously, it is very dependent. And I’m sure there’s very specific reasons as to why sometimes it’s a blanket document, rather than sometimes it’s a targeted one and things like that. And so when we are having that, and certainly in even my company, we have a lot of the time where they have to go back for further information. And, you know, sometimes you just they’re going, Oh, come on, you know, kind of thing, can we not just sort this out, but ultimately, you know, for the underwriter, you know, I think people sometimes forget as well, that they’re a person, they’ve got their job, and if they make a decision without all the information, you know, that could be their job at risk. And, you know, they certainly don’t want to risk their job, their, their income, their livelihood, they don’t want to put a person you know, so I have that awful situation with someone thinks they’re insured when they shouldn’t be insured, or the the policies revoked or anything like that, because there wasn’t the right information, you know, there’s potential for for non disclosure or anything like that. So, so yeah, I think it’s one of the things I just wanted to start like say with that, you know, that the further information thing it does happen, but it’s, you know, whilst it’s frustrating, whether or not you’re the applicant, or the advisor or the underwriter you know, it’s, it’s gonna have been needed. And ultimately, the way that I see it as well is that assuming that that happens, and assuming that we have to do the thing, obviously, I as everybody will know, I do have an issue with the transparency of decisions of underwriting at times. There’s a lot of development in this space, which has been fantastic but this Still a lot of way to go. And but ultimately, it does mean that when that person gets the insurance, the underwriter has had the GP report, they’ve had the private information of offer terms. The likelihood, if there’s ever a claim that there’s been a nondisclosure is incredibly low, because they’ve had everything in front of them. So I always say to people, that goes for medical postural canals is kind of a pain in the backside. But I actually quite like it because it means that no one can say you’ve not told us your exact medical history. And if there’s anything in there that you don’t remember, then it’s important that you know about it. Oh, sorry, my dog just barks and actually terrified me. And I was like, oh, there might be something in there. That’s not right. And we need to correct it. Because again, if there’s something in there, that isn’t correct, then if there’s a claim 20 years down the line, there’s no way we can refute the error that’s in your records. And so so they have a pain, there’s Method and Madness to them in many ways, but, you know, I was gonna say, I’ve certainly will say, at times, you know, stuff like, Oh, I wish the underwriters would do this and do that. But at the same point, you know, we do have to give underwriters some real real slack at times, because they they can only it’s their job, they can only work with the information that’s in front of them. And if it’s simply not there, then they can’t make a decision.

 

Matt Rann  51:17

Absolutely, I mean, you this particular sorry, this particular part of the world podcast, I tell you what, we could go for another hour on,

 

Kathryn Knowles  51:28

I was gonna say I was just trying to behave myself, I was thinking I’m going off on a bit of a preaching sermon here.

 

Matt Rann  51:35

I just think it’s very, very important. I mean, if I can absolutely assure you, underwriters don’t go back for information to decline a case? Yes. You know, people who think that I’m afraid I’m very, very wrong. I can assure you that if the underwriter could make a decision, which they think is fair and reasonable for the client, on the information that they have, they will. Information is asked for, because A, and generally, because the rating, or the terms that could be given would be so well, could be one and a half times the rate up to five times the rate, just, you know, it could be anywhere. And that is not fair. That’s not treating customers fairly. That’s not looking after the consumer whatsoever. I would say and again, customer, maybe this is we could put something on an on another podcast at some stage around this area. Insurers, some insurers, and you’ll know who they are, I’m absolutely sure. Will are much more amenable to taking information from the client? If it were others must have it from the doctor. Yes, absolutely. And, you know, that’s quite a wide, and there’s quite a wide difference in that practice in the marketplace. Personally, if the input I have always been, as an underwriter for many, many, many, many, many, many, many years, an advocate that if the client knows what you want, or not is likely to know, the answers to the questions that you want, ask them. Yeah, what’s good on the GP route one, it costs a lot of money to it costs delays, three, you know, it could well be the end of the day, the code, the client says I can’t be bothered with this can’t be more than waiting another, you know, two months, three months. I’m what I’m going to go elsewhere or not take out cover at all. So all I would say is if underwriters go back, they do it with the customer in mind not to be a pain in the ass. But also remember at the end of the day, if they you know, it costs money to go back to a GP. Yeah, because money in terms of the fee that the GPU requires it also costs money and underwriting time as well. And therefore from a business perspective, it makes no sense to go back, particularly if it’s going back to decline fine for some information to decline, because obviously the premium print no premiums are paid, and therefore there’s no money coming in to cover the costs of the underwriter and all the fees that they’ve racked up. Yeah, so let’s leave it blank. Let’s leave it at that just for the just for today. We’ve

 

Kathryn Knowles  54:42

got we’ve got about five minutes to go through your ratings and two case studies.

 

Matt Rann  54:48

So okay, we’re looking at rheumatoid arthritis. And writers tend to categorise it. And you’ll have heard this type of rating system before into mild, moderate and severe In terms of the mild category, the underwriter will look at whether the client gets minimal pain from the disease, slight pain or stiffness in the peripheral joints, whether there’s any swelling or deformity, and whether they’re able to carry carry out their activities of daily living, which of course, you touched on a few minutes ago customers. Yeah. So if you kind of answered no to that most of those are minimal pain, slight pain, stiffness, no, no or minimal swelling, no deformity, aim able to carry out your LDL, which follows on from the rest, then the rating gent for it from the most comprehensive manual in the marketplace. The rating is up to plus 50 For Life critical illness, and you’ll exclude it from income protection. Yep. So theoretically, you might get standard rates. Yeah, because it’s up to plus 50. In terms of the second category that is used is moderate. Again, the pain and stiffness is can be described as moderate. It’s more extensive joint involvement, slight deformity or limitation of movement, and the infected joints can carry out most ADLs or all of them, and then you’ve got a rating for life and kick of 75. If rheumatoid is an insured condition, then that may be excluded. And you may get if again, if loss of independence is in as part of the CLI package, then that may get excluded too. But unfortunately, IP is a decline. In terms of the severe and Android sort of categories, this is chronic active disease, no complete freedom from pain. Moderate are marked volunteers with serious restrictions of movement and impaired impairment of function and is able to form only a few ADLs with assistance, then the rating will be any guesses or informed educated guesses? are like you tell me, Rachel up to plus 150 So in other words, two and a half times the rate? Yeah, they are they are quotable is really what I was trying to get out there are quotable. You very much going to exclude an insurer condition of rheumatoid or loss of independent existence from critical illness and IP again, we’ll be in decline. We talked about steroids, and if you are taking more than five minutes a day, milligrammes a day, sorry, then the underwriter is, will be adding at least plus 25 to those decisions that I’ve already talked about for my friend kit, and if they’re on stories, then IP will be decline regardless of severity. Okay, that’s important thing with steroids. Now, if you do have some of those complications that we talked about, so the nodules are I symptoms, vasculitis, lung disease, you are going to increase any loans have normally spoke to by a minimum of plus 75 for life and kick and decline IP, anything else will be declined for all benefits to hope people can follow that. Basically, in terms of life insurance. When you have diseases that joints only then you are likely to get, you should be able to get cover up to a maximum of say two and a half times the rate. If you want kick, then you’re going to have some exclusions, potentially, depending on what the kick actually covers in terms of medical conditions, you may get some exclusions in there. But IP is generally unless you’ve got very mild disease is is a decline. Sadly, if you do have the disease that impacts other other areas of the body that we talked about earlier, if you remember, then it’s not very likely to be declined across the board. Unless they are unless the disease’s very minimal in those other parts of the body. Does that. Does that help into that? Does that sound reasonable to use an advisor Catherine?

 

Kathryn Knowles  59:49

Okay, that sounds okay, you know, in terms of what we would be expecting. So the interest to a couple of case studies No. And so two case studies so And first one is that we had a couple, in their late 20s, they needed life insurance for a mortgage. So what I’ve been diagnosed with rheumatoid arthritis in their late teens, so they’ve had it for about 10 years or so and affected a couple of their joints, and they did have mild medication. And so I know just been talked about all the loadings and things like that. So just to give an idea, so I said these couple late 20s, the rise of rheumatoid arthritis, so as medication, so 435,000 pounds of joint decreasing life and insurance over 26 years, the premium was around 15 pounds per month. So we do talk about the fact that there’ll be increased premiums. And I think what’s really important is to say that, you know, obviously an increased premiums never nice, you know, obviously, we’d always love to like not have that. But it also doesn’t mean that it’s going to be silly amounts of money. I think that’s really key, especially talking life insurance, life insurance, at its basic points for the basic rates, in a sense that insurers will charge is incredibly low. In some cases, you know, it’s almost a bit like, how are they doing it that cheap? You know, and sometimes, you know, it is questionable, sometimes you think, how are you? But anyway, so, you know, it’s just to say that, you know, that’s 15 pounds per month for two people to be insured that way. So it’s not, it’s not, you know, it’s the, you know, this was somebody who had rheumatoid arthritis, but it was quite mild. So I’m going to do another example of someone where it was affecting them more. So the next case study is someone that was in their early 30s, they had rheumatoid arthritis, and they also had lupus. And they were taking strong medications for this. And in terms of where they were affected, it was their knees, feet, hips, shoulders, hands, and their skin. But the medications had meant that they’d become much, much better saucy, the body had reacted incredibly well, to having that medication. So again, we had a decreasing life insurance policy for mortgage, it was 290,000 pounds over 35 years. And the price was 30 pound a month. So I think, you know, I would hope that for a lot of people, if they were in that situation, if you’re an advisor with a client in that situation, it’s just sort of like trying to sort of share that it doesn’t, it’s not necessarily going to be ridiculous prices, there are times that prices will be silly, and it’s important to be transparent. And you know, I certainly say to people, sometimes you know, what, I think this is silly, this price, you know, and I’m not sure what to even suggests, in a sense, you know, but it’s up to you, ultimately, if you would want to have it or not. So, I think it’s really important to, to just always check, I think that’s the main thing is just like a summary, that’s just say, double check what you think is going to what is going to be, you know, there’s no hardship with a lot of advisors, there’s no fee for them doing the research for them try and you know, the only time that with a lot of advisors, that you would be paying anything would be actually, you know, once you start paying the premiums, in many ways. So once it’s already gone through all this medical stuffs, you already know the decision there. And then some advisors do have different situations where they will ask for like a fee. And you know, it’s in each advisor firm to themselves, there can be benefits to either which way pros and cons, as with anything in life, pros and cons to all different ways. So just reach out, find someone that I always say, Well, the key thing is to find someone you feel comfortable talking with. Because if you find an advisor firm, that you kind of think I’m not too sure, then you’re probably thinking not too sure the whole way along. So you might not feel confident in what they do at the end. But if you feel comfortable with them from the start, there’s somebody who’s really listening to you. And that just gives you that good feel, you know, a bit of a gut instinct, then it probably means that when you do get a decision through that, you’ll probably feel more confident that it’s the right one for you. So it’s just all about managing time and expectations and what you’re wanting to achieve. But I hope those case studies sound okay to you, Matt. Yeah,

 

Matt Rann  1:03:36

absolutely. Absolutely. Well done. Well done. You I think he’s finding a solution, which is, which works. So great. That’s what’s what’s needed. Absolutely.

 

Kathryn Knowles  1:03:50

Well, that’s what, that’s what we’re here for. So we are at the end. So thank you, everybody, for listening. And, as always, thank you for joining me. Next time, I’m going to be doing an overview of shareholder protection insurance. So I would say at the moment, I’m kind of alternating, I’ll chat with Matt and do a deep dive on a risk one, one time and then the next time for a little bit, I’m going to do some specific product, deep dives just to sort of like really highlight what they are some of the really key essential bits that you need to know there was going to be more than what I can put in a podcast, but you know, it’s just giving you those initial bits. So how things can work and how they can work well for people but also where they can go wrong and what we want to do to try and avoid the going wrong situation. As always, you can get a CPD certificate for having listen to this episode. Just visit the website practical hyphen, protection, Dakota, UK to get it and we can do the CPD certificates. Thanks to our sponsors, the ox members. So thank you very much, Matt. That’s been really interesting. And I will speak to you soon.

Matt Rann  1:04:45

Yep, take care. In the meantime, you too. Thank you. Bye