Holy smoke – the im­pact of e- cig­a­rettes on life in­sur­ance

– the im­pact of e- cig­a­rettes on life in­sur­ance

RISKSA Magazine - - CONTENTS - An­ton Pre­to­rius

E- cig­a­rettes don’t pro­duce real smoke, yet they’ve ig­nited a firestorm of con­tro­versy. If your client thinks that smok­ing the pop­u­lar and al­leged ‘ health­ier’ e- cig­a­rette might re­duce their life in­sur­ance pre­mi­ums, then you, as a bro­ker, need to nip that no­tion in the butt.

No con­clu­sive ev­i­dence ex­ists that val­i­dates e- cig­a­rettes as the health­ier al­ter­na­tive and as a re­sult, in­sur­ers are in no rush to re­duce life in­sur­ance pre­mi­ums for smok­ers – whether the cig­a­rette is elec­tronic or not. Glob­ally, smok­ing is on the de­cline. The Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion ( JAMA) states that, over­all, age- stan­dard­ised smok­ing preva­lence de­creased by 42 per cent for women and 25 per cent for men be­tween 1980 and 2012. Yet, 1.1 bil­lion smok­ers world­wide still find it hard to quit smok­ing. The South African Govern­ment’s tobacco con­trol pol­icy has halved adult smok­ing over the past 20 years, ac­cord­ing to the Hu­man Sci­ences Re­search Coun­cil ( HRSC). Ac­cord­ing to the lat­est na­tional sta­tis­tics in the South African Na­tional Health and Nu­tri­tion Ex­am­i­na­tion Sur­vey, smok­ing has de­creased by 15.6 per cent ( from 32 per cent in 1993 to 16.4 per cent in 2012). The study also found that ap­prox­i­mately 30 per cent of South Africans are clas­si­fied as smok­ers. While the sig­nif­i­cant drop in smok­ing fig­ures can be largely at­trib­uted to stricter smok­ing leg­is­la­tion, ad­ver­tis­ing lim­i­ta­tions and steeper tobacco prices, many smok­ers are still look­ing for al­ter­na­tive ways to fi­nally kick the habit. The use of elec­tronic cig­a­rettes is on the rise world­wide and con­sid­ered a $ 1 bil­lion rev­enue ser­vice in the United States. Elec­tronic cig­a­rettes have been lauded, al­beit con­tro­ver­sially, as a health­ier al­ter­na­tive to nor­mal cig­a­rettes, which could help to lessen the bur­den of dis­ease caused by con­ven­tional tobacco smoke. How­ever, many ask whether the health­ier la­bel is merely ‘ smoke- and- mir­rors’ and a ploy to help grow sales num­bers. E- cig­a­rettes are of­ten seen as a safe sub­sti­tute for reg­u­lar cig­a­rettes, and many smok­ers are us­ing them as a step­ping stone to quit­ting, once and for all. Ni­cholas van der Nest, di­vi­sional di­rec­tor for risk prod­ucts at Lib­erty Re­tail, says that they do not be­lieve e- cig­a­rettes are nec­es­sar­ily any health­ier than nor­mal cig­a­rettes, “The key dif­fer­ence be­tween a con­ven­tional cig­a­rette and an e- cig­a­rette is that an e- cig­a­rette does not con­tain tobacco. But, it isn’t just the tobacco in cig­a­rettes that cause cancer or car­dio­vas­cu­lar dis­eases.” For pri­mary school teacher Ri­aan Bailie ( 30), e- cig­a­rettes seem like a favourable al­ter­na­tive. A pack- a- day smoker since the age of 18, the Cape Town res­i­dent first learnt about e- cig­a­rettes from a friend, and has since built them into his daily rou­tine. “At work, there is hardly any time to go out­side and take a smoke break,” he says, “So I’ll take a puff of an e- cig­a­rette to take the edge off, be­cause they don’t smell and you can smoke them in­side.”

Ac­cord­ing to a new SA study, a team of doc­tors sup­plied 349 pa­tients with e- cig­a­rettes over a pe­riod of eight weeks, and found that 45 per cent of South African smok­ers who use e- cig­a­rettes were able to quit tobacco smok­ing within two months. De­spite pos­i­tive re­views from e- cig­a­rette users, very lit­tle is cur­rently known about their safety and po­ten­tial long- term health ef­fects. For this rea­son, most in­sur­ance providers in South Africa will not re­gard you as a non- smoker if you use e- cig­a­rettes and you will still be charged smoker’s rates, says Dr Pi­eter Coet­zer, chief med­i­cal ad­viser at Sanlam. “The only thing that dis­tin­guishes e- cig­a­rettes from tra­di­tional cig­a­rettes is that they do not con­tain tar. In most cases, they still con­tain nico­tine in liq­uid form, along with var­i­ous other chem­i­cals, some of which are used to va­por­ise the liq­uid. In fact, e- cig­a­rettes may even con­tain more toxic chem­i­cals than reg­u­lar cig­a­rettes. So, even though the vapour is tobacco free, it is prob­a­ble that us­ing e- cig­a­rettes can still in­crease a user’s risk of cancer and other se­ri­ous ill­nesses such as heart dis­ease and stroke,” he says.

The health la­bel myth

The de­vice it­self also falls un­der the Act, as it is con­sid­ered a de­liv­ery de­vice for a sched­uled drug. Ac­cord­ing to Van der Nest, the pro­posal from the Food and Drug Ad­min­is­tra­tion ( FDA) in the United States to clas­sify e- cig­a­rettes as tobacco prod­ucts, will tech­ni­cally cat­e­go­rize e- cig­a­rette users as smok­ers. “Even if they don’t get clas­si­fied as tobacco prod­ucts, they still con­tain nico­tine which most in­sur­ers will con­tinue to clas­sify as smok­ers,” he says. Ac­cord­ing to Van der Nest, con­ven­tional cig­a­rettes con­tain chem­i­cals that are harm­ful to your health, and e- cig­a­rettes still con­tain some of these chem­i­cals. “Nico­tine is one of the chem­i­cals found in both con­ven­tional and e- cig­a­rettes. It is highly ad­dic­tive and has been shown to re­duce bone health,” he says. New reg­u­la­tions on e- cig­a­rettes are set to take ef­fect in New York City as of May 2014. Leg­is­la­tion in the ‘ Big Ap­ple’ now sees e- cig­a­rettes fall un­der the same set of reg­u­la­tions as tobacco cig­a­rettes and other tobacco prod­ucts, which means they may not be used at bars, restaurants and sev­eral other pub­lic ar­eas, in­clud­ing city parks. The shift comes as the de­bate over the health ben­e­fits – or con­se­quences – of e- cig­a­rettes con­tinue to wage on, be­tween pub­lic health of­fi­cials and the e- cig­a­rette in­dus­try. In South Africa, the e- cig­a­rette is reg­u­lated un­der the Medicines and Re­lated Sub­stance Act, that clas­si­fies nico­tine as a sched­ule three drug, re­quir­ing it to be sold only at phar­ma­cies and with a doc­tor’s script. Ac­cord­ing to an anal­y­sis done by the Food and Drug Ad­min­is­tra­tion ( FDA) in the United States, e- cig­a­rettes con­tain de­tectable lev­els of known car­cino­gens and toxic chem­i­cals to which users could be ex­posed. Since e- cig­a­rettes also con­tain many of the same toxic chem­i­cals as nor­mal cig­a­rettes, there is no rea­son to be­lieve that they will sig­nif­i­cantly re­duce the risks of ex­po­sure. A study by the French Na­tional Con­sumers In­sti­tute, has also found harm­ful chem­i­cals in elec­tronic cig­a­rettes, spark­ing re­newed con­cerns about the prod­ucts that are of­ten hailed as a health­ier al­ter­na­tive for smok­ers. Af­ter test­ing for cancer- caus­ing mol­e­cules in the vapour from 10 e- cig­a­rettes, three types of e- cig­a­rettes tested pos­i­tive for the chemical formalde­hyde, at lev­els close to those of typ­i­cal cig­a­rettes. The toxic com­pound acrolein, which changes to vapour when heated, and which

has been shown to dam­age the lungs, was also found. For some e- cig­a­rettes, acrolein lev­els were higher than in nor­mal cig­a­rettes. Un­for­tu­nately, there are no long- term stud­ies to back up claims that the vapour from e- cig­a­rettes is less harm­ful than con­ven­tional smoke ei­ther. Cancer takes years to de­velop whereas e- cig­a­rettes are a rel­a­tively re­cent in­ven­tion. “It is al­most im­pos­si­ble to de­ter­mine if a prod­uct in­creases a per­son’s risk of cancer or not, un­til the prod­uct has been around for at least 15 to 20 years,” Van der Nest com­ments. In the South African Med­i­cal Jour­nal, Dr Brian All­wood from the Univer­sity of Cape Town’s ( UCT) Di­vi­sion of Pul­monology, ar­gues that these tiny ma­chines might be the lesser of two evils for those who strug­gle to kick the habit. “It is highly un­likely that e- cig­a­rettes are as toxic to hu­man tis­sue as con­ven­tional cig­a­rettes,” says All­wood. He adds that e- cig­a­rettes still al­low po­ten­tial quit­ters to par­tic­i­pate in the psy­cho­log­i­cal and so­cial rit­ual of smok­ing. But fel­low UCT Pul­mo­nolo­gist Dr Richard van Zyl- Smit dis­agrees. He states that cur­rent re­search has been limited to a few hun­dred people and also faults the de­sign of some stud­ies.“The ev­i­dence for there be­ing an ef­fec­tive method for smok­ing ces­sa­tion is un­con­vinc­ing,” he says. “Safety has not been proven in large stud­ies of long- term use. They may even en­cour­age more ha­bit­ual use of nico­tine, which, in time, might en­cour­age a switch to cig­a­rette smok­ing … or act as gate­way de­vices to cig­a­rette smok­ing,” writes Van Zyl- Smit. “E- cig­a­rettes may be less dan­ger­ous than tobacco, but given that tobacco kills 50 per cent of its users, what would not be safer?”

In­sur­ers: there’s no smoke with­out fire

Coet­zer says that most in­sur­ers in South Africa, and in­deed, world­wide, have taken the view that the po­ten­tial im­pact on a client’s risk pro­file for longevity- re­lated prod­ucts such as life in­sur­ance, dread dis­ease and disability prod­ucts, is the same as that of a smoker. “At Sanlam, we have re­cently adapted the ap­pli­ca­tion ques­tion­naire we give to clients to in­clude a ques­tion on e- cig­a­rette use, along with tra­di­tional tobacco prod­ucts. You will only be deemed a smoker if you have not used any of these prod­ucts for longer than 12 months. This in­cludes smok­ing ces­sa­tion prod­ucts such

as nico­tine patches and chew­ing gum.” All clients who have in­di­cated that they are non- smok­ers un­dergo a rou­tine blood test to de­ter­mine the level of co­ti­nine ( a by- prod­uct of nico­tine) in the blood­stream. Coet­zer continues, “The pre­mium dif­fer­en­tial for smok­ers is sig­nif­i­cant and de­pends on fac­tors such as age and gen­der. The dif­fer­en­tial is based on our claims ex­pe­ri­ence that smok­ers have more or less dou­ble the mor­tal­ity rate than non- smok­ers, in­clud­ing causes of death not re­lated to smok­ing.” Van der Nest also says that smok­ing e- cig­a­rettes won’t al­low pol­i­cy­hold­ers to qual­ify for non- smoker rates or lower pre­mi­ums, “The price dif­fer­ence in pre­mium rates be­tween smok­ers and non- smok­ers can be as much as dou­ble, depend­ing on your age or gen­der. Nico­tine prod­ucts, such as cig­a­rettes, cigars, pipes, e- cig­a­rettes, snuff, hub­bly bub­bly ( hookah) and any other as­so­ci­ated prod­ucts, would qual­ify you as a smoker for life in­sur­ance pur­poses,” he says. “As e- cig­a­rettes con­tain nico­tine, their users will test pos­i­tive for co­ti­nine when the un­der­writ­ing tests are per­formed. This means that those who use e- cig­a­rettes will be clas­si­fied as smok­ers and pay a higher pre­mium than non- smok­ers,” says Van der Nest. He adds that it is not pos­si­ble to say defini­tively whether there has been a rise in claims for smok­ingre­lated dis­eases com­pared to pre­vi­ous years. “How­ever, Lib­erty’s claims ex­pe­ri­ence for 2013 shows that lung cancer was re­spon­si­ble for about one in six cancer claims for smok­ers but only one in 20 cancer claims for non- smok­ers. Smok­ing sig­nif­i­cantly in­creases the like­li­hood of be­ing di­ag­nosed and claim­ing, as a re­sult of cancer. Ex­perts say around 90 per cent of lung cancer cases are due to tobacco smok­ing.” Coet­zer says that much more work needs to be done to de­ter­mine the long- term ef­fects of us­ing e- cig­a­rettes. “Be­cause it is a rel­a­tively new prod­uct, there is no con­clu­sive ev­i­dence that e- cig­a­rettes are a safe al­ter­na­tive to reg­u­lar cig­a­rettes or, for that mat­ter, ef­fec­tive in as­sist­ing smok­ers to kick the habit. Most in­sur­ers there­fore pre­fer to err on the side of cau­tion. How­ever, none of our un­der­writ­ing poli­cies are cast in stone – if it is sci­en­tif­i­cally proven that e- cig­a­rettes do not in­crease users’ risk of con­tract­ing dread dis­ease such as cancer, we will cer­tainly relook our pol­icy and pric­ing model,” Coet­zer con­cludes.

Killing him­self with 30 a day.

Pays a packet for risk in­sur­ance as a smoker.

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