GLP-1 and Beyond: The Evolution of Incretin-Based Therapies for Obesity, Diabetes, and Cardiometabolic Health
written by Rahul Nawander, MD, FALU, FLMI Introduction Overweight and obesity-related medical costs are estimated at more than $92 billion annually in the U.S. Adults with obesity are associated with an additional $2,505 in annual medical costs that is largely associated with cardiovascular disease (CVD)-related morbidity and mortality. Obesity disproportionately affects minorities with the highest rates among non-Hispanic black and Hispanic adults. Daniel Drucker, a scientist and endocrinologist at the University of Toronto, Canada spent 10 years researching and experimenting with the venom of Gila monster lizard at his lab in Utah which laid the foundation for discovery of GLP-1 receptor agonist. Later, a biochemist from the United States Dr. John Eng harnessed and synthesized Exendin-4 (hormone) from the venom of Gila monster lizard which had [...]
Plasma Cell Disorders
written by Rahul Nawander, MD Plasma cell disorders are age-related hematologic conditions that present interpretive challenges for life expectancy underwriting. This article offers a thorough overview of plasma cell disorders, diagnostic criteria, prognostic indicators, treatment options, mortality, and most importantly, underwriting implications. Understanding Plasma Cell Disorders Plasma cells are antibody-producing white blood cells derived from B-lymphocytes, primarily residing in the bone marrow and lymphatic tissues. In plasma cell disorders, a single aberrant plasma cell proliferates clonally, generating large quantities of monoclonal antibodies, referred to as M-protein. Normally, antibodies consist of two pairs of protein chains: one heavy and one light. However, in monoclonal gammopathies, the produced antibody is often incomplete, consisting of only heavy or light chains, illustrated in Figure 1. These abnormal proteins suppress normal [...]
Advancing Frontiers in Metastatic Melanoma: Innovations, Treatments, and Improved Survival Outcomes
Research by Rahul Nawander, MD, Medical Director at Fasano Underwriting Melanoma of the skin (cutaneous melanoma) is a malignant tumor originating from melanocytes, the skin cells responsible for producing melanin. While primarily occurring in the skin, melanoma can also arise in the eyes, ears, meninges, gastrointestinal tract, and mucosal surfaces such as the oral, genital, nasal, and sinus membranes. Cutaneous melanoma accounts for over 90% of all melanomas and is commonly observed in White populations [1]. The incidence of all skin cancers, including melanoma and non-melanoma skin cancers (NMSCs), has increased significantly in recent decades, outpacing many other cancers. This rise may partly reflect overdiagnosis due to more frequent skin screenings, biopsies, and the histopathological overcalling of melanocytic lesions that might otherwise remain benign [2]. [...]
Life Expectancy in Breast Cancer
By Dr. Rahul Nawander, Fasano Underwriting Medical Director Introduction Breast cancer is a leading cause of morbidity and mortality among women worldwide. In the United States, the American Cancer Society estimates that 310,730 women will be newly diagnosed with breast cancer in 2024, with an estimated 42,250 deaths from the disease [2]. Studies indicate that countries with a higher Human Development Index (HDI) have higher breast cancer incidence rates, with more than 50% of cases occurring in developed and industrialized nations [4]. Risk Factors Risk factors related to increased incidence of breast cancer include use of oral contraception; hormone replacement therapy; family history of breast, ovarian, and endometrial cancer; exposure to radiation therapy, western-type diet, obesity, excessive consumption of animal fats, high alcohol consumption, and smoking. [...]
Falls: Significance in Life Expectancy Underwriting
Written by Scott McClure MD As our population ages, the significance and frequency of falls increases. This affects life expectancy as well as morbidity and mortality. It is important to remember this both when evaluating prospective clients in life underwriting and when considering life settlements. In order to begin to understand the significance of falls in the elderly, it is always helpful to start with a definition. What exactly constitutes a fall? The World Health Organization defines a fall as an event where a person comes to result inadvertently on the ground or other lower level. Falls in the elderly population are a common reason for emergency room visits and hospital admissions. According to the CDC, about 36 million falls are reported by older adults each [...]
A New Treatment Protocol for Chronic Pain
by Roger H. Coletti, MD, FACC, FASNC, FSCAI, Medical Director at Fasano Underwriting One of the most common ills of humankind is chronic pain. In some cases, the associated chronic muscle spasm is known to be the culprit. However, in some cases, there is not an obvious connection between the pain and the chronic muscle spasm that was responsible for the chronic pain. In any case, treatment of chronic pain requires knowledge of its source. If chronic muscle spasm is indeed the source, then it is necessary to have a diagnostic tool to identify the muscle or muscles in chronic spasm. Ultimately, a treatment that specifically targets chronic muscle spasms is then needed to successfully treat the chronic pain. What is not generally known is that [...]
