Deep insights

Robot nurses, drugs that enhance brain power, high-tech devices that can read minds – is this really all about to come true? It is beyond dispute that the sharp increase in mental and psychiatric disorders plaguing our ageing society and the growing use of psychotropic drugs in everyday life will pose challenges – challenges which will also impact the insurance industry. And breakthroughs in neuroscience and brain research will influence these trends: the earlier detection of dementia disorders could increase the claims burden in LTC insurance, for example, while new and better treatments for the more effective rehabilitation of stroke victims could affect health and disability insurance. Meanwhile, more widespread pill-popping in the workplace will raise new liability issues. Insurers must heed this early warning and brace themselves for these developments.

With this in mind, Munich Re has been keeping a watchful eye on medical trends and the advances made in pure research, maintaining close contacts with scientific experts – for instance with Professor John-Dylan Haynes from the Bernstein Center for Computational Neuroscience at the Charité Hospital in Berlin, who is conducting intensive studies into functional magnetic resonance imaging (fMRI). This is a further development of structural MRI and measures changes in blood flow in the various regions of the brain. This method allows functional brain processes to be represented in the form of cross-sectional image series and has the potential to improve the diagnosis, prognosis and treatment of disorders of the central nervous system.

Despite the great technical advances made in the imaging of brain structures, the use of this technology for diagnostic purposes is still in its infancy, and fMRI is not set to become a routine clinical procedure any time soon. One factor here is that with some diseases, such as multiple sclerosis, characteristic activity patterns in the brain cannot always be recognised conclusively. There have also been insufficient large-scale studies to exclude incidental fMRI findings which require checking and sometimes treatment. In the medium term, however, progress is primarily expected in the field of automated diagnostics, where computer analyses assist the radiologist’s trained eye in the assessment of digitised cross-sectional images. But much more extensive databases and prediction algorithms must be developed for different brain diseases before this becomes possible.

Evaluating chronic pain on the basis of brain activity measurements is problematic for another reason: a subject need only imagine the feeling of pain in order to produce the same brain activity as someone genuinely experiencing it. Even the symptoms of such fashionable mental disorders as burnout syndrome can be produced through autosuggestion alone. No studies have yet been conducted to investigate this phenomenon based on fMRI data.

The link between advanced technology and human behaviour is certainly an interesting topic for insurers, as numerous major catastrophes are unleashed as the result of human error. The reasons for this are manifold: loss of concentration, incomprehension of a system, operational errors, the human tendency to overcontrol. But the brain activities of people who are monitoring control units for industrial facilities are so complex that there is no specific brain signature which could be usefully measured by fMRI.

In this domain, neuroscience research findings are more likely to help us gain a better understanding of the processes in the brain – a knowledge which could, for example, be used to optimise working environments so as to prevent loss of concentration in the first place.

Neuroenhancers could become an important issue for insurers. These “brain-boosters” were originally developed for the treatment of various mental and neurological disorders but are increasingly being taken by the healthy to boost brain performance, increase concentration or brighten the mood. The long-term side effects involved are as yet unknown. Because numerous new substances are likely to enter the market in future, liability issues involving altered states of consciousness pose a potential risk in product liability insurance.

Neuroprostheses operate via interfaces set up between the nervous system and electronic components. In most cases, electrodes transfer impulses from the nerve tissue to a chip, where they are processed and fed back to the nerve tissue. The aim is to restore the function of damaged regions of the brain, for instance following a stroke. One sensory neuroprosthesis successfully being used in the medical sector is the cochlea implant, which restores the hearing of deaf patients. Motor neuroprostheses have so far been confined to animal experiments. They could, however be used to help people suffering from paralysis to relearn certain movement sequences, for instance. For the insurance industry, this will above all have an impact on product liability and health insurance business.

The latest findings in brain research have so far had little lasting impact on insurance. But they will be of relevance to us just as soon as the pure research stage has been concluded and innovations begin to find their way into medical applications. The initial effects will most probably make themselves felt in the non-life sector, particularly in product liability and product recall liability insurance for high-tech medical equipment. As far as health and long term care insurance is concerned, risk exposure is likely in the medium term if degenerative conditions such as Parkinson’s, dementia or stroke can be identified earlier and treated more effectively. However, exposure in life business is not likely to emerge in the next ten years, apart from an increase in incidental findings due to magnetic resonance imaging of the brain. In the long term, the advances in diagnosing and treating neurodegenerative diseases should improve insurability.

You can find a detailed version of this article and extensive background information in TOPICS magazine.