Fred E. Wernette

The pancreas is both a digestive organ and an endocrine gland. As a digestive organ it supplies enzymes used in the digestion of food. As an endocrine gland it produces insulin (produced by beta cells of the pancreas to regulate metabolism) and glucogan (produced by alpha cells of the pancreas to regulate hypoglycemia or low blood sugar).

If the endocrine process becomes impaired the result is a low production of insulin, at which point diabetes sets in.  Conversely, if the production of insulin is higher than usual, hypoglycemia (low blood sugar) sets in. The pancreas is subject to many ills such as inflammation, atrophy (shrinkage), tumors, fatty necrosis (wasting away), cysts, sclerosis (hardening), and abscesses. Inflammation of the pancreas or pancreatitis is a severe abdominal disease and is one of the most common reasons to have an endoscopy. It can be acute (short lived) or chronic. In fact, 5 percent or so of the cases are chronic.

Causes:
Some 80 percent of pancreatitis cases are due to alcohol and gallstones. The remaining 20 percent are secondary to some other disease or the cause is unknown. Pancreatitis can be hereditary, although rarely, and as in many diseases, once contracted pancreatitis can re-occur.  

The severity of pancreatitis is dramatically clear in that any combination of pancreatitis with liver, cardiovascular or kidney disorders has a high mortality rate. Chronic cases are very susceptible to diabetes, liver disease, peptic ulcers and malnutrition. The incidence is higher among women and older individuals.

Treatment of chronic pancreatitis can be surgical. Generally the pancreas is removed, or the cause of the problem is removed. Acute pancreatitis is usually medically treated and surgery is elected only after all else fails. 

Pancreatic cancer has a very high mortality rate and recovery from the diagnosis is rare.

Ratings:
Acute pancreatitis:  Will normally rate for cause. If the cause is not discovered, then standard to low substandard is available after a minimum of 1 year with no symptoms.

Chronic pancreatitis:  After a minimum of 1 year with no symptoms, Table 4 to 6 depending on the severity and likelihood of future surgery as long as there are no complications

Alcohol induced pancreatitis:  This will usually result in a declination.

 Commentary on Communication:
Communication is a term that reflects a company’s desire to “keep the line open” between its agents and itself. Many companies claim to achieve communication to some degree of effectiveness. The depth of effectiveness is always relative to who is being asked the question. The company will claim a high degree of communication and can show you proof, while the recipient of all this communication may paint a somewhat different picture. The “proof” is somewhat easy to come by, although expensive. Any company can flood its agents with communication, (computer print-outs, memos, faxes, emails, and phone calls). However the key to the problem is making sure that all this expensive communication is reliable and understood by the agent. In other words, it is possible to communicate but not be heard. I fear that this happens all too often. 

The thyroid is a gland that is primarily concerned with the production of iodine-containing hormones. These hormones are a controlling influence on metabolism and growth of the body. Over and under production of the gland will cause most of the common thyroid disorders. Thyroid diseases are generally limited to goiter, hypothyroidism, hyperthyroidism, thyroid cancer, and thyroiditis. Thyroid disorders are more common in women than in men.

A brief explanation for each disorder is as follows:

• Goiter.  This condition is caused by a deficiency in iodine and is characterized by enlargement of the gland itself. This deficiency is less of a problem since the introduction of iodized salt.
   
• Hyperthyroidism.  This condition is caused by an excessive amount of hormones produced by the thyroid gland. It is also called Grave’s Disease, Toxic Diffuse Goiter, or Toxic Nodular Goiter. Hyperthyroidism is the most common of glandular disorders and occurs more frequently in women ages 20 to 40. This condition can be stress induced and may subside spontaneously.
   
• Hypothyroidism.  This condition is caused by the lack of hormone production by the thyroid gland. In children it is usually known as Cretinism if the deficiency occurs during the fetal stage or early life. Later development is Juvenile Hypothyroidism. In adults it is called Myxedema. This lack of production of the hormone effects virtually all body functions. In children, this is a major problem since seldom is full mental or physical development attained. In the case of the adult, there are a number of complications that occur which make the condition a bit difficult to handle.
   
• Thyroid Cancer.  This is just as its name implies, a cancer. There are two basic types, papillary and follicular. Papillary tends to remain localized while follicular carcinoma tends to spread to the lungs and bone.
   
• Thyroiditis.  This condition is an inflammation of the thyroid gland and the acute form is caused by a viral germ. The chronic form is an auto-immune disorder. A type of chronic thyroiditis that is frequently encountered is Hashimoto’s Thyroiditis.

Treatment of various thyroid problems may range from medication for a short period of time or lifetime, treatment with radioactive iodine, or surgical removal of the gland. Underwriting actions on the above are rather simple in today’s environment. With the medical discoveries and the tremendous amount of advancement in the treatment of thyroid problems, the underwriting has become much simpler than it was back in 1977. Most of the above conditions can be accepted on a Standard basis with the possible exception of Cretinism, which could be postponed for a few years before an offer is possible. Even thyroid cancer once surgically removed with no metastasis and a favorable pathology report can be considered on a Standard basis.

One last thought–thyroid disease can manifest itself in everything from mental disorders to physical changes in body appearance. For this reason, it often remains undiagnosed and untreated. Like any hormone the body depends on, the thyroid hormone is essential to proper mental and physical heath.

What a nemesis chest pain is to everyone. To define “everyone” let’s take the various participants in proper order starting with the person most affected, the sufferer. They are frightened by the condition to say the least. Heaven knows there has been enough written, said, and propagated through the media to give a person some awareness of the possible seriousness of chest pain. In fact, the sufferer probably feels that they should do one of two things: 1) Remain perfectly still, or 2) run to the nearest doctor. 

The next person involved is the sufferer’s closest friend. This friend knows exactly what to do: boil some water and get some white sheets, or at least cover the person with a blanket and comfort them with religious words of wisdom. If the chest pain does not do the poor sufferer in, the tender loving care will. 

Next on the list is the doctor. Good ole Doc Christian, mom and dad’s old friend who delivered you and has been a friend of the family for the last 100 years or so it seems. He is such a comfort. For every disease you have ever had, he also has experienced exactly the same problem. Chest pain to him generates questions like: “Where does it hurt?”, “Did you eat beans last night?”, “Here, can you void in this bottle?”, “When did you have sex last?”, and the classic, “How is your mother?” (she died six years ago). Somehow or another you realize you have a problem even greater than your chest pain. But old Doc comes through and runs a number of tests and an EKG, which he interprets with a template. If you are fortunate enough, he may admit you to a hospital. With a little luck you may come out of it unscathed and with a hospital record showing the diagnosis as “chest pain of undetermined origin.” 

Next on our list of those involved is the inevitable insurance agent who, by some uncanny stroke of luck, blunders their way to the chest pain sufferer’s door step approximately three months from the date of the attack. The individual is obviously interested in purchasing life insurance. The agent produces an application out of his brief case and with delight begins to complete it. His delight turns to sour grapes when he asks the question, “To the best of your knowledge has any person to be covered every had or been diagnosed, or treated for chest pain, etc.?” And the applicant says, “Yeah, but don’t sweat it; old Doc Christian says I am in good shape.” The agent shudders; this is familiar ground for him and now the agent is having second thoughts about his “success.” 

Now enters the last participant, the underwriter. The agent has been kind enough to send a note along with the application. It reads, “Dear Will Ratem, here is another excellent risk. I need a real rush job on this one. Sincerely, C. L. Hugh, agent.”  

The underwriter pages through the application and comes upon the chest pain admission. AHA!  Bells begin to ring in the underwriter’s head as neon lights blink the words Table 4 and up, up, and away! 

It really does not work that way but you could not convince an agent otherwise. Chest pain can be serious business and the Table 4 may or may not be a good jumping off point for most cases. 

What are the causes of chest pain? There must be hundreds. To list a few: pleurisy, muscular disorders, gallbladder disorders, rib cage inflammations, pneumonia, angina pectoris, and of course the most important one, a heart attack. An underwriter’s main concern is the cause of the chest pain. Generally speaking, if the cause is non-coronary in origin, there will be no rating. If the cause is due to coronary problems the rating will be in relation to the severity of the cause. 

Any person who has undergone significant chest pain usually has had a battery of tests performed. Sometimes these tests determine the cause and at other times they are inconclusive. This inconclusiveness leaves the doctor and the patient in a most distressing position. The doctor will instruct the patient to lose weight (if that is apparent), quit smoking (if that is present), and generally advise moderation in all activities. 

The underwriter must make a decision as to the effect the chest pain will have on the individual’s life expectancy. You can be certain that the decision gets and deserves a great amount of professional underwriting. The underwriter will do their absolute best to place the client in the best proper category. The process to do so will be frustrating for the agent and at times the client due to the time it may take to make a solid decision.  If that decision is a rating or a decline, then it can be even more frustrating.   

I hope all of the above enlightens you as to an underwriter’s feeling about “chest pain.” It is a tough problem to underwrite. But always remember, the individual who has suffered chest pain from whatever cause will tell you it is tougher to be on the receiving end of an attack. About the only pain an agent will be exposed to will be the pain in their southern part caused by an underwriter’s continuous never ending underwriting. 

To update the article above to the year 2003, there are many more tests available today that definitively will diagnose the various causes of chest pain, and the most common cause is a clogged artery. Once that is determined, then either a by-pass, an angioplasty or a medical regimen is given. If a by-pass or an angioplasty is performed, most underwriters will review the medical records after at least four to six months have passe.  Depending on the client’s age, if all looks acceptable and the individual is doing well, the offer may be as good as or better than standard.

Due to man’s habit of walking upright, varicose veins have been one of the many burdens suffered. Four-legged animals do not develop varicose veins. The blood is systematically pumped throughout the body by the heart. As blood is “used,” it is returned to the heart by the inhalation and exhalation of the chest and muscular contractions. The veins, unfortunately, are not like lead pipes, nice and rigid; they are pliable and soft. Therefore, the blood in the lower extremities has a hard time going uphill. There are two sets of veins in the legs, the deep (femoral) veins and superficial (close to the surface) veins. The superficial veins are the ones more affected by the varicose condition. In these veins are small traps or valves concentrated in the knee and groin areas. These valves do not allow the blood to flow backward. Prolonged pressure on these valves will tear them, making them inoperative. Once the valves become damaged (by infection or repeated stress), the blood pools and become stagnant. Incidentally, this system is called the venous system and is awkward at best. It is little wonder that there are so many breakdowns.

Varicose veins primarily can be painless or as the condition worsens, they will burn, become tense and itch. Many persons with advanced varicose veins complain that their legs feel so heavy that they cannot work. The veins can ulcerate, causing an intense burning sensation. Where there are varicose veins just under the surface of the skin there is a possibility that the veins may rupture. When this occurs the loss of blood is usually considerable.

Simple treatment of varicose veins entails the use of elastic stockings. There is an injection treatment that collapses the veins, which is often used in persons who cannot undergo surgery. The two operations available are ligation and stripping. Ligation is tying off of the vein and removing the damaged portion, while stripping takes the entire damaged vein out. Another simple way to try and reduce the appearance of varicose veins is to wear compression socks. This helps the blood circulate better around the legs and keep them from becoming tired and achy. It would be worth it to learn more here about the benefits of compression socks, especially if varicose veins is something you are currently suffering from.

Facts:

 • Phlebitis is one possible result of varicose veins. Phlebitis is a serious infection of the vein. It is very painful and can lead to possible amputation or a pulmonary embolism (blood clot) in the lung.

 • One out of every two women and one out of every four men over forty years of age will suffer from varicose veins.

 • Eighty-five to 90 percent of all cases are relieved by the operation procedures mentioned previously.

 • The varicose vein condition appears to be congenital, and if both parents have had the disease it will occur earlier in their children.

 • One strange fact is that there is no greater occurrence of varicose veins in persons who have jobs that require long hours of standing as opposed to those who have sedentary occupations.

 • Women who are pregnant will often develop varicose veins. Generally, the condition will reverse itself upon delivery.

Underwriting Action:

With mild varicose veins, or if they have been treated and there are no current residuals such as ulcers and swelling, there will be no rating applied and the client should be acceptable on a standard basis.

This article was originally written in February of 1977. I am going to leave it pretty much as it was written if for no other reason than to point out the changes that have occurred in the industry since 1977. This article also addresses the addition of the paramed to the insurance industry, and the results, both good and bad.

A few years back when the term paramed was mentioned, it was looked upon with disdain by the underwriting profession. At that time it was a logical and legitimate decision. Back then the medical profession decided to upgrade itself, and a good percentage of the insurance examining doctors opted out of the examining business. This, coupled with an increase in the number of exams needed by insurance companies, brought us to the age of the paramedical.

The paramed was the Messiah to the agent. To the home office underwriter, they were a pain in the gluteus maximus. The paramed was pictured as an extremely competent individual on the one hand, but on the other, they were bungling, ill-trained, transient types of individuals.

The Vietnam War and the emergency medical technician (EMT) program produced a great number of expert field parameds. Some of these individuals found their way into the paramed field and, generally speaking, did a fine job. The other type is what caused everyone the distrust that was prevalent in the past.

Anyone and everyone decided to get into the examining business. It was seen as an excellent way to make a fast buck. All you needed was a panel truck with a red cross on the side, a funny professional name like “Looks Standard To Me Medical Exams, Inc.,” and you were in business. I will admit that within the last year or so (mind you this was back in 1977), the paramed organizations are becoming more professional and the outfits that were less than perfect are going under.

By now you should be wondering why I am preaching. A day does not go by that we receive a questionable paramed exam. By questionable, I mean an exam that indicates an elevated blood pressure problem that is not backed up by any medical history, or an exam that is the reverse; that is, the client has a history of blood pressure problems but the exam does not reflect the slightest problem or any treatment. I am not saying that the above circumstances are impossible, I am saying that the underwriter has a very difficult time in trying to determine when his job is finished.

For example, we recently evaluated an exam in which the client exhibited a 136/110 blood pressure reading. This particular person had not one iota of family history or current medical history that indicated he was leading up to a  hypertensive problem. After writing all of the attending physicians and obtaining all the past EKGs plus a current resting EKG, we were able to determine that the exam blood pressure was in error due to the paramed being unable to correctly take blood pressure readings. We accepted the client on a standard basis. By the way, it was determined that this particular paramed had a track record of incorrect blood pressure readings that caused a huge problem for any number of clients and underwriters.

Another example is a client who has been previously rated. When this fact is known by the agent, the client should be examined by an MD and not a paramed. (My goodness, see how things have changed since 1977.) On an MD’s worst day they are still 100 times better than the best paramed. An MD’s knowledge, insight and diagnostic abilities are invaluable to the agent and the client.

Now let me back off a bit and say that there are excellent, very capable and very professional paramed examiners. (In this paragraph, circa 1977, I continued on to say how much time was taken to approve paramed companies to make sure that the quality of the exams was up to par and therefore would give the agent and his clients the best exams available.)

As stated in the first paragraph, and as you can see by my comments, the existence of the paramed in the late 1970s caused some rather significant problems for agents, their clients and underwriters. Again, for the older agents reading this, they will remember how it was. For the newer agents, you can be thankful that many of the problems that were so prevalent some 25–30 years ago are no longer even considered. 

This article was written because I was feeling lazy about 27 years ago and writing about goiters seemed to be the thing to do. As you’re probably aware, goiters are somewhat rare, and I will bet you a standard offer that most underwriters cannot remember the last time they even saw one unless it was included in the medical records having to do with thyroid condition.

There are two types of goiters—simple nontoxic and toxic. Simple goiters are usually smooth and symmetrical and are caused by an inadequate supply of iodine. Simple goiters occur in areas where iodine is lacking in the soil and water. A preponderance of cabbage in one’s diet can cause simple goiters. (Beware sauerkraut lovers). Treatment is usually the administration of iodine and surgical removal is rare—usually when the goiter has become so large that it causes pressure on the surrounding organs. Surgery is also performed for cosmetic reasons. Obviously, introduction of iodine is most valuable as a guardian against the disease.

Nodular goiters are more of a problem. They occur in single and multiple nodules. The danger in these nodules is that the single nodule can prove to be malignant. Surgery is the only option for a malignant nodule. Benign nodules are normally watched, and if the nodule becomes enlarged, hard or fixed, then a biopsy will be done. The benign nodule can be medicated for an indefinite length of time.

As far as rating is concerned, it only becomes a factor if the goiter takes a turn to malignancy. Otherwise, a standard offer can be made. If the goiter is malignant, then a cancer rating will be applied after surgery and all treatment is completed.

Now I must be humorous. This will be called my “Pet Peeve Department” or “Illnesses That Generate No Sympathy Department.” Some years back, I was diligently performing my weekend duties, which included manicuring the lawn. During the process of trimming, I very innocently bent over to pick up something (what it was escapes me at this time). As I was straightening up, something in my lower back went berserk.

After much deliberation I finally straightened myself into a more respectable position and actually was able to complete my tasks, with a considerable amount of pain. My children thought it was funny. “Look at Dad! He walks funny!” “What are you looking for in the grass?” These statements were the first of many that I would receive in the next few weeks. My condition worsened, and the worse I got, the less pity I received. Not that I wanted or needed pity; it is just that the comments did not assist my psyche whatsoever. In the confines of my home, the situation deteriorated.

Example: If you have ever had a muscle spasm of the lower back, you will be able to understand the following situation. Going to bed was a circus, at least up till the time I was finally prostrate. Let’s bypass the acrobatics necessary to get in bed and go on to later that night. I woke up at about 2:00 a.m. and realized that my intake of water the day before was surging forward. Generally, I would have stumbled out of bed and taken care of my pressing problem. However, with a bad back, the task is darn near impossible. You realize upon awakening that getting out of bed will be a monumental task. You cannot, I repeat, cannot sit up and swing your legs over the side of the bed. So I tried to ignore my pressing problem.

It soon became obvious that would not work. So after much groaning and extreme pain, I succeeded in rolling myself off the bed and onto the floor. From there I crawled to the bathroom. Upon reaching the commode, I realized that I could not succeed doing anything on all fours and level with the commode unless I was inclined to treat the commode like a fire hydrant, and if I did so, my mate of many years would give me more than a bad back. Therefore, I grabbed hold of the toilet paper holder first, almost wrenching it out of the wall, and then the towel holder and did eventually draw myself up to full height. Only upon looking down did I realize that the darn lid was closed. There was absolutely no way to bend over and open it. My problem had now enormously increased in size. After a quick evaluation, there was only one solution. I lowered myself to the floor again and opened the lid and crawled on the throne and realized immediate relief. Now I had another problem—getting off the throne and back into the sack.

By reversing methods, I inched my way back to bed, totally exhausted and unable to sleep. By morning the condition of my back was terrible. Still, doggedly, I decided to go to work. In retrospect, that was a real dumb decision. Putting on a shirt is simple, but pants are another story altogether unless you can suspend them in midair and slowly lower yourself into them. Socks and shoes appear impossible. If you bend over enough to reach your feet, you are in real danger of falling over on your face. Once the socks are on, the shoes can be slipped on unless they are tie shoes, which mine were.

I thought about it for a minute and decided the heck with the laces. I decided to just let them flop around. Of course, my problems were extended to the office. I winced and hobbled to work, and there I discovered that everyone gets a big charge out of someone who cannot sit down or get up from his desk without acting like he is climbing Mount Everest. Walking is pure torture and you appear to all watching to have a sky-hook attached to your rear end. Your gut hangs out and your face reflects the whole story.

In summary, beware of illnesses and/or medical problems that only you who are afflicted can appreciate. Your chance to laugh at others will come after you have recovered.

It looks and sounds bad and I assure you it lives up to its name. The name Lupus is derived from Latin and means wolf. According to what I have been able to research, the term is used because the disease eats away at the body in a gradual way, much as a wolf gnaws at a carcass. Systemic Lupus Erythematosus (SLE) is an inflammatory disease of the collagen group. Your body is held together by connective tissue much like glue. Any disease that attacks this tissue, such as SLE, is classified as a collagen disease. In a way, the body sort of becomes unglued. (Note, this ungluing is altogether different from the ritual of “coming apart at the seams” that occurs to some individuals we all know.)

By definition, SLE is a disease of unknown cause with many manifestations. Discoid Lupus Erythematosus (DLE) is usually limited to a skin disorder. DLE is frequently related to exposure to sunlight, which initiates the appearance of lesions. For some unknown reason the discoid disease is more prevalent among young women. The recurring and persistent lesions usually appear on the scalp, nose and less commonly on the truck and extremities. Diagnosing DLE is through skin biopsies only. The treatment of DLE involves avoiding exposure to the ultraviolet rays of the sun. There are topical steroid medications that may be applied. A small percentage of DLE may turn into systemic cases.

SLE is a connective tissue disorder of unknown cause occurring, as in discoid, in women most commonly between the ages of 20 and 40 (in 85 percent of all cases symptoms are varied and may include painful joints, fever, fatigue and a rash on nose and cheeks resembling a butterfly).

The prognosis depends on which organs are involved and the degree of inflammatory reaction. The heart, lungs, central nervous system and kidney involvement are associated with a worse prognosis.

Lab tests are used in definitive diagnosis. However, at times, long term observation of the individual is involved. This observation is obviously important to carefully differentiate the two types of LE. The future of those individuals with SLE is guarded, particularly those with heart and renal involvement. Close observation, elimination of emotional problems and physical fatigue, and the avoidance of sunlight are all therapeutic treatment of SLE.

SLE Facts

 • If the renal system is involved, death may occur within three years.

 • SLE is often confused with many other diseases because of its multiple organ involvement.

 • Without renal or central nervous system involvement, the prognosis over 10 years is 95 percent.

 • There is no cure for SLE.

 • Lupus can go into periods when symptoms are not present, also called remission.

Underwriting Actions

DLE with certain diagnosis, no complications: offer is standard six months after diagnosis.

SLE with certain diagnosis: postpone for one year; 2nd to 3rd year = Table 8; 3rd/4th years = Table 6; 4th/5th years = Table 4; 5th year up = Table 2.

Now that all of you have lasted through the medical jargon, it is time to enlighten you on the item printed below. I am sure some of you have already guessed what it is. However, no one has fabricated a better explanation than one made by an agent who stated, “It looks like a method derived by an underwriting department to ascertain a standard rating for a case.” I realize that at times it does seem that way to most agents. However, I sincerely hope that obtaining a standard offer is not as bad as circumnavigating a complicated maze.

Point to ponder: A hen is merely an egg’s way of reproducing itself. 

Just as the name indicates, hypo means less than normal, glycemia means sugar, therefore hypoglycemia means low blood sugar. It is the opposite of diabetes. The symptoms (headaches, fatigue, weakness, marked perspiration and fainting) are all similar to diabetes. These attacks or symptoms usually occur when a person has gone several hours without food. It can be a very frightening and frustrating experience for the individual who does not recognize his symptoms. Some of us older folks usually chalk up the experience to oncoming senility. It is apparent, however, that the symptoms mentioned above are relative to any number of illnesses. Therefore, it is not recommended that anyone try for a self-diagnosis.

Seventy percent of all hypoglycemia is referred to as functional or reactive. There are other types, and some of them are quite serious. Organic hypoglycemia is caused by liver disease and possibly malignant tumors. However, as mentioned, 70 percent of all cases are the functional type of hypoglycemia. Generally speaking, this more common type is caused by an over production of insulin. The over production is usually caused by eating habits, excitement, excessive exercise and/or emotional problems. If a person were to ignore the symptoms mentioned and they were allowed to persist without some attempt to relieve them, psychological problems would begin to appear. These problems would mask the underlying condition. Severe reactions can lead to convulsions, coma and eventually death. However, most individuals seek medical care prior to experiencing a severe reaction.

The diagnostic test for hypoglycemia is a blood sugar test. If the test is taken during an attack and the reading is less than 50 mg of sugar or glucose, it is fairly certain that the person is hypoglycemic.

Treatment of hypoglycemia is simply diet. Any individual with the condition should instruct those who live with them and close friends of their condition and give them instructions as to what to do when an attack occurs. Obviously a person with hypoglycemia should carry sugar or something similar with them in case of an attack. Again, as with some of the past articles, back in the 70s when this article was first written, a rating was applied. In today’s underwriting world, a person with diagnosed hypoglycemia should be acceptable on a standard basis, assuming he is following his attending physician’s guidance.

Since this article is short in nature I am going to plunge into something altogether unrelated to fill up a little space. Please permit me to expound on a pet peeve of mine—at least it was a pet peeve back some 27 years ago when I first wrote this account. Johnson & Johnson Band-Aids state the following very boldly in red lettering on the cover of every Band-Aid they sell: TEAR OFF END—PULL STRING DOWN. I, being the medical label follower I am, follow the directions and a very predictable thing happens. I end up holding a four-inch piece of red string that looks and feels more like thread and not in the least bit string. According to my upbringing, string (or strang, to those in West Texas) was something strong and big enough with which to fly a kite, and thread was something that moms used in sewing machines. String was also used to pull teeth, which is another story.

Well, this little piece of string irritates the heck out of me. First of all, it doesn’t do the job it was intended to do. The one and only big moment of its whole life is a complete flop. A bust. Secondly, the string seems to assume that since it didn’t do what it was made for, it must quickly change to the next thing it was made for, and that is to further irritate me. This “string” refuses to go into the garbage can. You can roll it, throw it, mix it with saliva, whatever, and it blatantly refuses to be thrown away. What it does is attach itself to the very Band-Aid it came from, somewhat like a “mother complex.” And then it becomes entangled along with the wrapper, which has been waiting in the wings for an opportunity to strike in cahoots with the string. If entanglement escapes it, the string effectively adheres itself to my wound or my fingers. Either way I am defeated in my feeble attempt to place a Band-Aid on the poor, little infected part of my body. What is the outcome of all this? I, out of desperation, open another Band-Aid and try again.

Just to see if Johnson & Johnson really cares, I wrote the company and very diplomatically pointed out my problem. They responded by asking me to send all my unused Band-Aids to their research department to determine the cause of the malfunction. They also sent me a coupon for a box of brand new Band-Aids. At that time, in the 70s, I decided to “string” along with them for the time being. Since then, Johnson & Johnson has corrected the problem. 

Most of you through the years have become fairly decent diagnosticians. This is due to experience with your clients and various home office underwriters. Let’s see if you can identify the following individual’s illness. He is a middle-aged male, but appears to be ten to fifteen years beyond his actual age. He is thin, almost gaunt, and his posture is stooped. His eyes are deep-set, aggravated possibly by his thinness. His energy level is very low, and physical exertion other than the basics seems to be out of the question. Generally speaking, he is a poor specimen of homo sapiens.

If you diagnosed our friend as a man with an alcohol problem, you were wrong, although some of the symptoms fit. If you said tuberculosis, you are correct. Let me state that my description is a true one; however, there may be no signs or symptoms present.

I described the individual as I believe most people would, and by most people I mean people of my generation, born in the late 1930s and 1940s, who were witnesses to actual TB patients and the devastation that TB had on their bodies. We were also aware of the various TB sanitariums that were located in the country. I remember my parents telling me to be careful around anyone who was very thin and coughed a lot. Those were the two signs that were most significant years ago. Then the cure rate went up significantly and for a time TB was really not a factor in our lives.

That is, until recently, when it was discovered that TB was again rearing its head in our society, especially among the less fortunate of the population. For example, in New York, among street people, the incidence of TB is rather alarming. The biggest problem is that although medication is available to stifle the disease and it is given to the afflicted, they elect not to take the entire regimen of the drug. From this event comes a more virulent strain of TB that is resistant to cure.

Going back to the description, TB is one of those diseases people would rather not identify with. It falls into the same category as leprosy or mongolism. If a member of a family has TB, the balance of the family politely, or not so politely, isolates all reference to the person from conversations. The individual is isolated until they are cured or die.

For some reason, people feel TB is a disease of low-income people, and that is certainly the situation today. However, the fact is, TB can strike anyone from the aforementioned alcoholic to the priest, policeman, corporate president or anyone in your immediate family.

Facts Regarding TB:

 • Streptomycin, discovered in 1944, was the most important therapeutic drug in the cure of TB. INH or isonizid was developed in 1952 and was also very effective in treating TB.

 • TB may attack the kidneys, bones, lymph nodes and, more commonly, the lungs.

 • Hands, dishes, glasses or utensils do not spread TB. Very minute droplets excreted by coughing, sneezing or speaking usually spread it.

 • In the early part of the 1900s, TB infected 80 percent of the United States population before the age of twenty. In contrast, in the 1970s only approximately 4 percent of the young adults tested had a positive reaction to the TB test. The reason for this great decline is education, the improved standard of living, and prompt recognition and treatment of the infectious cases.

 • TB can remain dormant for years.

 • In 1906 TB was the leading cause of death in the USA. In the 1970s TB caused only 2 to 3 percent of all deaths.

 • Caucasian and Mongolian races have a natural resistance to TB. American Indians and Eskimos have much less resistance.

 • TB can imitate nearly any pulmonary disease.

 • The TB cough usually passes off as a cigarette cough and generally occurs principally upon arising in the morning. Some blood may be produced with this cough.

 • The most diagnostic test available for establishing the presence of TB is a positive culture taken from the site in question. Chest x-rays are helpful, and a negative TB skin test makes the diagnosis of TB very unlikely.

There are other facts, but the most revealing one is the one I wrote in an article in July, 1976: “It is possible that someday TB will be eradicated entirely in the United States.” That reality is still a dream, but the possibility still exists.

As for underwriting actions, I cannot remember the last time I saw a client with TB, and if you talk with most life underwriters they will tell you the same thing. I would have to say that TB is not a factor in life underwriting at this time. The occasional client who is seen is so rare that younger underwriters have never had to underwrite a TB client. The reason could be that the occurrence of TB today is limited to those in lower income brackets who are therefore not in the market to purchase life insurance. With proper drug treatment and compliance with the attending physician’s instructions, a client with TB can be acceptable on a standard basis after treatment is completed and when there are no residuals of the disease.

This article is not expounding on any medical item. Maybe it is the season, or possibly laziness on my part. Anyway, no matter the reason, I have made it a point to never put out an article just for the sake of doing so. If I cannot keep interest in writing myself, I know good and well that you, the reader, are not going to be particularly eager to read anything I write. Heaven knows there is enough printed matter received daily by all of us. Some of it is good and the rest is bad. Unfortunately, there is no in-between. The “in-betweens” are usually those that bore you with the first sentence and it goes downhill from there.

Let me pose something to you, the agent and “super salesman.” With those qualifications, you also have to be a “super buyer,” scrutinizing everything you purchase. Consider someone offering you the following “good deal” for a nominal price. The specifications are the following:

 • Needs watering frequently.

 • Needs feeding frequently.

 • Needs cleaning frequently.

 • Needs occasional overhauls.

 • Needs programming of some type for daily operation.

Other features:

 • Cannot always be repaired if damaged.

 • One-third of every day, the product must be turned off.

 • It is very sensitive to heat, cold, dust, wetness, dryness—in other words, any extremes.

 • It cannot take falls from heights greater than itself without danger of extreme damage.

 • It can be punctured quite easily; repair kits must be continually handy for such emergencies.

 • It will, at time, completely fall apart due to an unknown cause.

Final feature:

 • There is no warranty whatsoever.

My question to you is, “How much are you willing to pay for this fine product?” Obviously, most of you know by now that I have described the human body. We all know that even with all the above-mentioned idiosyncrasies, the body seems to serve us excellently. Nader’s Raiders would probably go bananas, but so far,  no one has invented a better substitute.

The point of the aforementioned “Ramblin’s” is that most professional life underwriters evaluate a person—a being—not a case. Underwriters realize that they are looking not at a frail body, but at an individual. This individual is capable of making his body perform magnificently under all types of stress, whether it is sickness or trauma. Medical and physical science dictate certain limits of body capabilities; however, individuals continually upset scientists’ theories by out-performing the limits imposed.

That is very important! That is why underwriting and underwriters are unique. They realize that each body contains an individual, and they will underwrite the individual and not the body.