Reflection on ICLAM 2025 – Navigating Risks in Insurance Medicine

The International Committee For Insurance Medicine (ICLAM) conference for 2025 was held in Estoril, Portugal from 11 – 14 May 2025. The itinerary over these days was jam-packed with experts from across the global medical and insurance market, each offering insights from their field of expertise. Presenting attendees also included our very own experts:

• John Schoonbee – Panel discussion: Ageing, anti-ageing and implications on the insurance industry
• Tobias Schiergens - Common Cancers at Uncommon Age: What is Early-onset Cancer?
• John Turner - Law and regulation: Cancer Survivors "Right to be Forgotten"
• David Lu - Weight loss without exercise? What are the facts about anti-obesity medication?
• Elyssa Del Valle - Cocktails and Covid 19 Pounds: The Essential Ingredients for Early Liver Cirrhosis

In addition to speaking, each of our medical officers also met some clients and took away some key messages from other experts.

Day 1 started with two keynote addresses on a trending topic, ageing and longevity. The first being on The Future of Long Lives. David Sinclair spoke to the aging population. The key takeaway being that the declining birth rates and increasing life expectancy has resulted in a gap between frailty and healthy aging. The second keynote addressed Geroscience and Implications for Ageing and Longevity. Jay Olshansky spoke to his research on rise in life expectancy.  Following thirty years of research, he believes that ageing and longevity has reached the red zone, in which there is very little that can be done for biological forces that remain a block for expanding life expectancy further. Going forward, in order to shrink the gap between health span and life span, research will need to be heavily focused on finding drugs that can increase healthy life span.

A panel discussion comprised of D Sinclair, J Schoonbee and C Bark spoke on Ageing, anti-ageing and implications on the insurance industry. Charles Bark spoke about his app, Hinounou, which can assist aged individuals with optimising their health and preventing disease. It prevents frailty, rather than focusing on reactive measures to chronic disease. The rest of the discussion focused on factors which influence ageing and the extent to which these are potentially modifiable to have an impact on reducing the gap between ageing and healthy ageing. Metabolic health especially is one such parameter .

The plenary sessions focused on Cancer topics. Miguel Barbosa, an oncologist, provided a cancer update specifically for didactics on staging, grading and treatments that have lower adverse effects. He leaned into the care of breast cancer patients. Adela Osman spoke about navigating cancer and insurance implications with the ICD-O revisions. She addressed the changes in ICD 10 to ICD 11, and behavioural codes in ICD-O.  She went through several changed definitions in cancer that impact the CI definitions and emphasized that the challenges when one does not see a diagnosis as impacting a person, as the intention of the product was intended. 

As part of the itinerary, the attendees were offered breakout sessions to choose from for attendance. These breakouts consisted of various insurance topics. Michael Lo covered Challenges in Juvenile Insurance, specifically on autism, and the challenges of inaccurate or over diagnosed juvenile conditions. Bill Bosany spoke about the Future of Health Insurance – AI and Digital Platforms – still need the Human Touch. The session focused on how insurers use risk scores and outcomes to personalize underwriting decisions, and this spans the entire insurance underwriting cycle including but not limited to deciding on thresholds for risk appetite for disease states and adjust these to product, specific geographies and cohorts.

Matthew Proctor spoke to understanding the role of critical illness products in 2025 and beyond. The session started with discussing fundamentals of protection gap and the fact that we only know the shortfall once the medical event has already occurred. These shortfalls change with medical advances increasing in some cases and decreasing in in other scenarios.  The need for CI products to be rationalized with focus on less is more and what is the actual need which would allow insurance industry to offer more in that space , allow for embedded upgrades and guaranteed insurability.

The day ended with a second plenary session on Cancer. Our very own Tobias Schiergens, addressed the topic of Common Cancers at Uncommon Age: What is Early-onset Cancer? The talk focused on cancers that were common in the elderly, now rising in those younger than 50 years old. After providing insights into the latest epidemiological data, potential underlying causes were discussed. The thought is that some of these cancers are driven by certain early life exposures (exposome). In other cancers, there is a strong link to metabolic risks. The need for regional consideration and critical appraisal of the data was emphasised. Finally, the insurance implications were illustrated. The second presentation was by Eric Raymond covering Personalised Therapies. He spoke about the increasing incidence of breast cancer in younger ages but reduction in mortality. And the impact of early diagnosis and advanced therapies which have improved outcomes. He also, made projections on potential trends in 2060. Aging population, changing risk profile patterns (obesity, alcohol consumption, reproductive factors etc) in different regions will drive the incidence with estimated 4.4 million new cases globally by 2070. This was followed by a review of factors that impact relapse, and right to be forgotten on the above numbers.

It was an early start to day 2, with topics focused on blood screening, mental health, behavioural science and law and regulation.

The first topic was Blood screening: Transforming chronic disease prevention with advanced risk detection based on a single blood test. Jeffrey spoke on the Nightingale development of a finger prick blood test that predicts health and the development of chronic disease in the next decade. The work was based in part on the UK biobank data.

For mental health, the topic was Evolving perspective on neurodivergence – are ADHD and autism still a risk to consider in UW? A highly topical session where Karsten explored the risks associated with ADHD and autism, particularly for adult diagnoses, where there is an increased risk of associated mental health disorders and risk of burnout. Is it time to ask more comprehensive questions on the application form?

Will Trump covered Behavioural science: What Works and What Doesn't: Counter-intuitive Findings from 10 years of Applying Behavioural Science in Insurance. He gave a highly engaging talk, focused on how insurers often concentrate on outcomes at the cost of the consumer engagement process. He gave numerous examples of where tweaks to a question set, or process could reap considerable rewards in terms of disclosure or customer satisfaction and engagement.

Lastly, a panel discussion covered the topic of Law and regulation: Cancer Survivors Right to be Forgotten - State of Affairs and Future Directions.  A nice recap on the much-discussed topic of RTBF, with our very own John Turner highlighting the considerable work that he and the team have done in this space. There were comparisons of different approaches, from France, Belgium and of course the conference location of Portugal. It remains contentious that other diseases have not had equivalent attention. It was highlighted that our focus must be one of greater sharing of our considerable efforts to evolve our underwriting guidance to reflect improved cancer outcomes over time, as well as sharing data driven rebuttals to some of the statements made by stakeholders, albeit with the best of intentions for their patients.

The last day of ICLAM started with exciting insights into the opportunities and challenges of healthcare data, data analytics and artificial intelligence (AI). Dr. Paulo Pinho explored the challenges of connecting and leveraging electronic health data and what would be needed to unlock their full potential for healthcare and public health. Dr. Emoke Posan shared insights into the use of AI as predicting and screening tool in cardiology. It was fascinating to see how AI is advancing across a range of diagnostic modalities such as electrocardiograms (ECG, e.g., prediction of heart failure), echocardiograms, and wearables. Craig Rhodes shared first-hand experiences where AI in healthcare is in its evolution to support patient care and how it is received by clinical teams and patients. Craig addressed the question how the acceleration in developing these algorithms go alongside some of the biggest challenges we are seeing in healthcare such as waiting list, increasing cost and more complexity both in the data and the patients. He gave an overview on the promising opportunities to deploy AI to hospitals and support improvement in patient care (e.g., use cases in radiology) and care delivery. He also emphasised, however, the challenges and bottlenecks linked to this fast-developing trend such as technical infrastructure that is required to successfully deploy this technology.

In the next session on obesity treatments, Dr. Daniel Tong (Hong Kong University, HK) spoke about insurance coverage for metabolic surgery which was following by a discussion also addressing the relevance of bariatric surgery in the era of new weight loss medications (GLP-1 agonists). This was followed by Dr. David Lu providing a comprehensive overview on the current evidence and the insurance implications of GLP-1 agonists outlining Swiss Re’s extensive expertise in this area.

The afternoon sessions focused on infectious diseases and gastrointestinal disorders. In a “fireside chat”-style discussion, Dr. Michael Osterholm (University of Minnesota, US) shared his views and insights into the evolving area of infectious disease risks and their trends, public health aspects such as the challenges and barriers to public health officials in implementing preventative interventions and policies as well as future vaccine technologies. The interview was followed by a comprehensive overview on the current evidence and insurance implications of Long Covid by Dr. Tim Meagher. Tim covered important aspects of diagnostic challenges, long-term outcomes as well as impact on morbidity and mortality with respective impacts on life insurance claims.

Dr. Sandra Mitic’s presentation Go with Your Gut provided comprehensive insights on the importance of the role of the microbiome in the development of cancer and neurodegenerative disease. The last session by Dr. Elyssa Del Valle entitled Cocktails and Covid 19 Pounds: The Essential Ingredients for Early Liver Cirrhosis, Elyssa gave astonishing insights into the emerging trends of worsening liver health in young women. The increasing prevalence of metabolic associated liver disease along with increased trends on alcohol use is driving this. The session explored causes of liver disease in developing and developed countries and emphasised how to recognize the red flags at time of underwriting that should prompt high suspect for advanced liver fibrosis and thereby protect business from early claims.