The Global Nature of Medicine
June  2015

​​​​​​​​​​In our jobs we usually must focus on mortality and morbidity risk, underwriting standards, products, governmental rules and regulations for our own regions. We assess risk based on our regional population rates for standard and excess risks, even though we know that pathogens can affect other regions of the world significantly differently than at home.

Consider the Epstein-Barr virus (EBV). Worldwide, 90%-95% of adults are seropositive for EBV. In the US it is primarily known as the causative agent for Infectious mononucleosis, a self-limited disease manifest primarily by sore throat and fatigue. EBV is rarely associated with malignancy in the West, outside of immunosuppressed individuals.

In contrast, 95% of children in equatorial Africa are infected with EBV. There the virus is associated with Burkitt’s lymphoma, the area’s most common childhood cancer. It is likely that Malaria/EBV co-infection plays a key role in this cancer’s development. Meanwhile, in southern China, where rates of nasopharyngeal carcinoma can reach 55 per 100,000, EBV is found in nearly all anaplastic nasopharyngeal carcinoma cells. This is likely due to a dietary/exposure trigger in this area. Most EBV-infected individuals fortunately do not develop malignancies, but hopefully an effective vaccine might reduce prevalence even further.

We see differences also in allocation of research monies around the world. North America, and the US especially, spent about $117 billion, or 44% of all medical research spending globally, in 2012. However, figures for 2009 show that the US published 122,659 medical research articles, while the EU published 120,421 and Asia contributed another 60,666 studies. The annual growth rate in medical publications from China is 18.7%, versus 0.6% in the US. A lot of medical research is going on half a world away.

In line with our global theme, we are pleased to have Dr. John Evans, Associate Medical Director for SCOR Global Life Paris, examine a case in this issue of Housecalls involving patent foramen ovale (PFO). Many of our readers may know Dr. Evans from his attendance at North American and international insurance medical meetings. I write about an interesting case involving spinal syrinx and present this issue’s Underwriting Puzzler. Rest assured that Dr. Rooney will return to this newsletter very soon. And remember to look up from your work occasionally to absorb some knowledge from other parts of the world.

References
Moses H, et al. “The Anatomy of Medical Research, US and International Comparisons” JAMA. 2015;313(2)174-189.