Preston Buzz

ASSOCIATION BETWEEN INCOME

AND LIFE EXPECTANCY IN THE

UNITED STATES

Source:
Video 4 min 53 sec
Jama
April 10, 2016

AMERICANS ARE DYING YOUNGER, SAVING CORPORATIONS BILLIONS
LIFE EXPECTANCY GAINS HAVE STALLED. THE GRIM SILVER LINING? LOWER PENSION COSTS
by JOHN TOZZI, BLOOMBERG
AUGUST 8, 2017, 4:00 AM

Steady improvements in American life expectancy have stalled, and more Americans are dying at younger ages. But for companies straining under the burden of their pension obligations, the distressing trend could have a grim upside: If people don’t end up living as long as they were projected to just a few years ago, their employers ultimately won’t have to pay them as much in pension and other lifelong retirement benefits.

In 2015, the American death rate—the age-adjusted share of Americans dying—rose slightly for the first time since 1999. And over the last two years, at least 12 large companies, from Verizon to General Motors, have said recent slips in mortality improvement have led them to reduce their estimates for how much they could owe retirees by upward of a combined $9.7 billion, according to a Bloomberg analysis of company filings. “Revised assumptions indicating a shortened longevity,” for instance, led Lockheed Martin to adjust its estimated retirement obligations downward by a total of about $1.6 billion for 2015 and 2016, it said in its most recent annual report.

Mortality trends are only a small piece of the calculation companies make when estimating what they’ll owe retirees, and indeed, other factors actually led Lockheed’s pension obligations to rise last year. Variables such as asset returns, salary levels, and health care costs can cause big swings in what companies expect to pay retirees. The fact that people are dying slightly younger won't cure corporate America’s pension woes—but the fact that companies are taking it into account shows just how serious the shift in America’s mortality trends is.

It's not just corporate pensions, either; the shift also affects Social Security, the government’s program for retirees. The most recent data available “show continued mortality reductions that are generally smaller than those projected,” according to a July report from the program’s chief actuary. Longevity gains fell short of what was projected in last year’s report, leading to a slight improvement in the program’s financial outlook.

“Historically, mortality rates annually have tended to come down year-over-year,” says R. Dale Hall, managing director of research at the Society of Actuaries. The professional association compiles mortality data that many private pension plans use in their projections. “There really has been a little bit of slowdown in mortality improvement in the United States,” Hall says.

Absent a war or an epidemic, it's unusual and alarming for life expectancies in developed countries to stop improving, let alone to worsen. “Mortality is sort of the tip of the iceberg,” says Laudan Aron, a demographer and senior fellow at the Urban Institute. “It really is a reflection of a lot of underlying conditions of life.” The falling trajectory of American life expectancies, especially when compared to those in some other wealthy countries, should be “as urgent a national issue as any other that’s on our national agenda,” she says.

Actuaries use two main factors to project death rates into the future: They start with current mortality levels—the percentages of people who die at a given age—and then make predictions about how those percentages might change with developments such as new medical treatments or changes to smoking or obesity rates. For instance, the widespread prescribing of cholesterol-lowering statins in the 1990s was “a huge driver of mortality improvement,” says Eric Keener, senior partner and chief actuary at Aon’s U.S. retirement practice. If medical science produces new treatments for Alzheimer’s disease or cancer, they could have similar effects.

Death rates for Americans over the age of 50 have improved, on average, by 1 percent each year since 1950, according to an analysis by the Society of Actuaries, though there’s a lot of variation in any given year. From 2000 to 2009, that long-term trend seemed to be accelerating, with annual improvements of 1.5 to 2 percent—but then those gains stalled. From 2010 to 2014, death rates were only improving by about half a percent per year.

In 1970, a 65-year-old American could expect to live another 15.2 years on average, until just past their 80th birthday. By 2010, a 65-year-old could expect to live to 84.

But the increases have slowed down since then. Life expectancy at 65 rose by just about four months between 2010 and 2015—half the improvement recorded between 2005 and 2010.

In 2014, the Society of Actuaries updated its baseline mortality tables for the first time since 2000 to reflect significant gains in life expectancies seen through 2008—a major revision that predicted future improvements based partly on that trend. That led many companies, expecting their retired employees to live longer and longer, to revise their estimates of pension obligations upward.

But as it turned out, those assumptions were too optimistic about how fast death rates would keep improving. Updates in the last two years, based on more recent mortality data, have pulled down companies’ estimates of what they’ll owe future retirees. The 2016 update would lower pension obligations by about 1.5 percent to 2 percent, all else being equal, according to the Society of Actuaries report. (The group draws on data from the Social Security Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services.)

And because accurate death records take a long time for the government to compile, the revised estimates published in 2016 incorporated mortality data only through 2014. The picture for 2015 looks bleaker still: The overall U.S. death rate increased that year, the CDC has since reported.

It’s still unclear exactly how Americans’ waning life-expectancy gains will mean for public-sector pension obligations, but the effect will likely be similar. The Society of Actuaries’ tables are designed for private-sector retirement plans; the group is still working on an update for public-employee pensions.

There’s no simple answer for why longevity gains are slowing. For years, economists and public health experts have been trying to ascertain what’s behind America’s troubling death trends, among them a rise in death rates for certain demographic groups. A much-discussed 2015 paper suggested that mortality was rising for middle-aged white Americans, citing suicides, drug overdoses, and alcohol, collectively sometimes referred to as “deaths of despair.” Women have been particularly affected.

While overall mortality rates are influenced by deaths from infancy to old age, pension payouts primarily reflect how long people survive after retirement. But looking just at people over 65, the death rate worsened in 2015 for that group as well, according to a July report published by the Society of Actuaries. That was the first reversal for retirement-age Americans since 1999.

“That’s actually rather remarkable,” says Keener, the Aon actuary. “Even in the previous years, you’ve seen a slower degree of improvement for the pensioners, but you haven’t seen a decline in life expectancy.”

The broader trend isn’t unique to the U.S. A July publication from the Institute and Faculty of Actuaries in the United Kingdom found that the U.S., Canada, and Britain have all experienced similarly slowing gains since 2011. That report suggested the combination of the recession and cuts to social safety-net programs may have played a role. “These signs should be taken as warnings that worsened health care, behaviour and environment can reverse decades of success in health and longevity,” wrote Joseph Lu, chair of the Institute’s mortality research committee.

Changes to life expectancy in the U.K. could cut 310 billion pounds from British private-sector pension obligations, or 15 percent of the total liability, PwC estimated in May, although other actuaries have called that figure “relatively extreme.”

The question actuaries can’t yet answer is whether the slowdown is a short-term blip or a more permanent shift. If mortality improved by 1 percent a year for most of the past 70 years, might the U.S. revert to that soon? Or, Keener asks, “is this really a new reality that we’re living in?”

LIFE EXPECTANCY DIFFERS BY 20 YEARS BETWEEN SOME US COUNTIES
by SUSAN SCUTTI, CNN
May 9, 2017

(CNN)Life expectancy at birth differs by as much as 20 years between the lowest and highest United States counties, according to new research published Monday in the medical journal JAMA Internal Medicine.
Dr. Christopher J.L. Murray, lead author of the study and director of the Institute for Health Metrics and Evaluation at the University of Washington, estimated life expectancy for each US county from 1980 through 2014. Murray and his colleagues analyzed county-level data and then applied a mathematical model to estimate the average length of lives.
Life expectancy at birth increased by 5.3 years for both men and women -- from 73.8 years to 79.1 years -- between 1980 and 2014, Murray and his colleagues wrote. During that time period, men gained 6.7 years, from 70 years on average to 76.7 years, while women gained four years, from 77.5 years to 81.5 years.

But the numbers aren't the same everywhere. Looking at the finer details, Murray and his colleagues calculated a gap of 20.1 years between US counties with the lowest and highest life expectancies.

The counties with lowest life expectancy are located in South and North Dakota, while counties along the lower half of Mississippi, in eastern Kentucky, and southwestern West Virginia also showed lower life expectancies compared to the rest of the nation. The North and South Dakota counties include Native American reservations.

At the other extreme, residents of counties in central Colorado can expect to live longest, Murray and his colleagues said.

'Drastically different life expectancies'
While the study does not directly answer why we see low or high life expectancies in specific counties, it does look at what factors contribute to the overall gap between some counties, said Murray.
"We can see that many of the counties with very low life expectancies in the Dakotas, like Oglala Lakota County in South Dakota, overlap with large Native American reservations including the Pine Ridge and Rosebud reservations," said Murray.

Conversely, Summit County, Colorado, ranked as the county with highest life expectancy in 2014 at 86.8 years, is home to several ski resort towns.
"For both of these geographies, the drastically different life expectancies are likely the result of a combination of risk factors, socioeconomics, and access and quality of health care in those areas," said Murray.
Yet, socioeconomic factors are not everything, said Murray, explaining that "60% of the differences in life expectancy across counties can be explained by socioeconomic factors alone" yet that leaves a "substantial amount of unexplained differences."
"Behaviors like smoking and physical activity, along with risk factors like obesity and diabetes, are also very important," he said.
Still, almost all counties throughout the nation showed improvement over time, though the number of additional years varied across the nation. Counties in central Colorado, Alaska and along both coasts experienced larger increases than most other counties. Meanwhile some southern counties in states from Oklahoma to West Virginia experienced either no improvement or very little over time.
The most positive note is that, over the study period, all counties show declines in the risk of early death for children under the age of 5 years old, say the authors. And, nearly all counties (about 98%) show declines in the risk of early death for people between the ages of 5 and 25, as well as those between 45 and 85.
However, people between the ages of 25 and 45 show an increased risk of death in 11.5% of counties over the study period.

'A gap of 20 years ... is absurd'
For the first time since 1993, US life expectancy in 2015 dropped significantly for the entire population, not just certain groups, the Centers for Disease Control and Prevention reported in late 2016. CDC researchers warned that a one-year shift does not mark a trend.
Ellen Meara, a professor or health economist at the Dartmouth Institute for Health Policy and Clinical Practice, said many factors impact life expectancy. She was not involved in the new research.
"Socioeconomic factors like education and poverty can shorten lives of individuals, and it may be bad to live in areas with high rates of poverty and less educated adults," said Meara. "Similarly, sedentary lifestyles (which are reflected in obesity rates) and smoking are two of the biggest individual risks of poor health and premature death. For people who develop a disease like diabetes or hypertension, also measured in the study at the county level, risk of death is higher."

Meara noted that the authors used "rigorous methods" to gain a more "comprehensive look" at deaths by county and age group. "This research echoes what we have been learning from studies in other settings over the past decade," she said. "Disparities in mortality have widened over time."
Still, understanding differences across geographic areas can provide clues, said Meara, about what might contribute to improvements over time.

"To have a gap of 20 years in a country as wealthy as ours is absurd," she said.
Murray agrees. "The inequality in health in the United States -- a country that spends more on health care than any other -- is unacceptable," he said. "Every American, regardless of where they live or their background, deserves to live a long and healthy life."

CAN HUMAN MORTALITY REALLY BE HACKED?
by ELMO KEEP, SMITHSONIAN.COM
June 28, 2017

It’s just after 10:30 a.m. on a pleasant weekday morning at SENS, a biotech lab in Mountain View, California. I’ve come to speak to its chief science officer, Aubrey de Grey. I find him sitting in his office, cracking open a bottle of Stone pale ale. “Would you like one?” he offers hospitably. De Grey drinks three or four pints of ale a day, and swears it hasn’t kept him from maintaining the same vigor he felt as a teenager in London.

Now the 54-year-old’s long hair, tied back in a ponytail, is turning gray, a change that would be unremarkable if he weren’t one of the world’s most outspoken proponents of the idea that aging can be completely eradicated. De Grey first gained notoriety in 1999 for his book The Mitochondrial Free Radical Theory of Aging, in which he argued that immortality was theoretically possible. Since then, he’s been promoting his ideas from prominent platforms—the BBC, the pages of Wired, the TED stage. He delivers his message in seemingly unbroken paragraphs, stroking his dark brown wizard’s beard, which reaches below his navel. Unlike most scientists, he isn’t shy about making bold speculations. He believes, for example, that the first person who will live to be 1,000 years old has most likely already been born.

In 2009, de Grey founded the nonprofit SENS, the world’s first organization dedicated to “curing” human aging, not just age-related diseases. The organization, which conducts its own research and funds studies by other scientists, occupies an unassuming space in a small industrial park. Its walls are affixed with large, colorful posters illustrating human anatomy and the inner workings of cells.
The basic vision behind SENS is that aging isn’t an inevitable process by which your body just happens to wear out over time. Rather, it’s the result of specific biological mechanisms that damage molecules or cells. Some elements of this idea date back to 1972, when the biogerontologist Denham Harman noted that free radicals (atoms or molecules with a single unpaired electron) cause chemical reactions, and that these reactions can damage the mitochondria, the powerhouses within cells. Since then, studies have linked free radicals to all sorts of age-related ailments, from heart disease to Alzheimer’s.
De Grey takes this concept further than most scientists are willing to go. His 1999 book argued that there could be a way to obviate mitochondrial damage, slowing the process of aging itself. Now SENS is working to prove this. Its scientists are also studying other potential aging culprits, such as the cross-links that form between proteins and cause problems like arteriosclerosis. They’re looking at damage to chromosomal DNA, and at “junk” materials that accumulate inside and outside cells (such as the plaques found in the brains of Alzheimer’s patients).
The area of research that gives the organization its name has to do with senescent cells. (SENS stands for Strategies for Engineered Negligible Senescence.) These are cells that stop dividing but accumulate inside us, secreting proteins that contribute to inflammation. It’s widely accepted that inflammation is involved in arthritis, heart disease, cancer, dementia and any number of other conditions that define old age. As de Grey’s thinking goes, if we could figure out how to remove senescent cells using approaches like drugs or gene therapy, along with other types of repair, we could potentially keep our bodies vital forever.
This desire to eradicate aging has, in the last decade, inspired a mini-boom of private investment in Silicon Valley, where a handful of labs have sprung up in SENS’ shadow, funded most notably by tech magnates. The secretive Calico was established by Google, in collaboration with Apple chairman Arthur Levinson, to tackle the problem of aging. Facebook’s Mark Zuckerberg and his wife, Priscilla Chan, have invested $3 billion in the attempt to “cure all disease.” Amazon’s Jeff Bezos invested some of his fortune in South San Francisco–based Unity Biotechnology, which has been targeting cell senescence in animal trials and hopes to begin human drug trials next year.
It’s this influx of wealth that has brought novel anti-aging theories out of the scientific fringes and into gleaming Silicon Valley labs. De Grey notes that developing the means to make everyone live forever is not cheap. “This foundation has a budget of somewhere around $4 million a year, not $4 billion, which is what it should be,” de Grey says. He invested $13 million of his own money in SENS, the lion’s share of the $16.5 million he inherited when his mother died. (He says she earned her wealth through property investments.) SENS has also been the beneficiary of PayPal co-founder Peter Thiel, perhaps Silicon Valley’s best-known advocate for curing death. As Thiel told the Washington Post in 2015, “I’ve always had this really strong sense that death was a terrible, terrible thing....I prefer to fight it.”

Immortality, it turns out, is not such an easy sell: Most people don’t like the idea of living forever. In legends of old as well as in recent popular culture, eluding death typically comes at a terrible cost; like zombies or vampires, immortal beings must feast on the living. Besides, a large percentage of today’s population also subscribes to religious beliefs in which the afterlife is something to be welcomed. When the Pew Research Center asked Americans in 2013 whether they would use technologies that allowed them to live to 120 or beyond, 56 percent said no. Two-thirds of respondents believed that radically longer life spans would strain natural resources, and that these treatments would only ever be available to the wealthy.
I ask de Grey about how the world would change—socioeconomically especially—if no one ever died. Would people still have children? If they did, how long would the planet be able to sustain billions of immortals? Wouldn’t every norm predicated on our inevitable deaths break down, including all the world’s religions? What would replace them? At what point might you decide that, actually, this is enough life? After decades? Centuries? And once you made that decision, how would you make your exit?
“I find it frustrating that people are so fixated on the longevity side effects,” de Grey says, clearly irritated. “And they’re constantly thinking about how society would change in the context of everyone being 1,000 years old or whatever. The single thing that makes people’s lives most miserable is chronic disease, staying sick and being sick. And I’m about alleviating suffering.”
To explain his vision, de Grey uses the analogy of a car that has its parts continually repaired. People receiving cell regeneration therapies would be able to constantly add more time to their lives whenever their bodies began to break down. “We have a warranty period, it’s true,” he allows. “But cars also have warranty periods, and yet we still have vintage cars—because we know how to do comprehensive, regular, preventative maintenance.”
De Grey spent several years after college working as a computer scientist in the field of artificial intelligence, which might explain why he likes to compare human bodies to machines. He has a PhD in biology from Cambridge, but he received it for theoretical work rather than lab-based research. He often refers to himself as an engineer or a “technologically focused biologist.”
I ask de Grey how a planet full of immortals would support itself. Would people want to work for eternity? He answers that automation will take over most jobs. “We will be able to spend our lives doing things that we find fulfilling and we won’t have to worry about remuneration,” he says. De Grey has been closely associated with transhumanism, a movement that believes technology will help the human race evolve far beyond its current limitations, but he dislikes the term, noting that it “just scares people.”
De Grey has robust faith that humans will come up with “some new way to distribute wealth that doesn’t depend on being paid to do things we wouldn’t otherwise do.” The first step, he believes, is issuing a universal basic income. It’s an idea that’s shared by other Bay Area entrepreneurs, many of whom are in the business of developing automation technologies. Last year, Y Combinator, a highly successful start-up incubator, gave 100 Oakland families between $1,000 and $2,000 a month in unconditional free income to find out how they’d spend it. The city of San Francisco recently announced plans to launch a similar pilot program. But these are small-scale experiments, and if robots do take over more jobs, it isn’t clear whether our economic and political systems would reconfigure to support all unemployed people in time, least of all forever.
And that 1,000-year-old person: He or she has already been born?
“Oh absolutely, yeah,” de Grey assures me. “It’s highly likely.”
**********
In fact, the human body is not at all like a car, in the same way that the human brain is not like a computer. Such comparisons oversimplify the staggeringly complicated organic systems that researchers are only beginning to glimpse. The chaotic interactions between our trillions of cells and their enzymes are still poorly understood. We know almost nothing about why some people hit the genetic jackpot and live much longer and with much more vigor than others who have similar life circumstances. The question is all the more vexing because elderly humans are themselves an extremely recent phenomenon.
Judy Campisi is saying all this to me over coffee near her home in Berkeley. She works 45 minutes north in Novato at the Buck Institute for Research on Aging, a gleaming non-profit research institution. “For 99.9 percent of our human history as a species, there was no aging,” she says. Humans were very likely to die by our 30s from predation, starvation, disease, childbirth or any number of violent events.

Life spans in the developed world have more than doubled over the past century or so, but this hasn’t happened through any interventions against aging itself. Rather, it’s a byproduct of innovations such as clean water, medication, vaccinations, surgery, dentistry, sanitation, shelter, a regular food supply and methods of defending against predators.
A biochemist and professor of biogerontology, Campisi has spent her career studying aging and cancer, and the role senescent cells play in both. She has researched these cells in her lab and published widely on the possible evolutionary reasons they remain in our bodies. She posits that for most of human history, natural selection didn’t favor living to old age. Evolution protected younger people so they could pass along their genes, and senescent cells play a very important role.
“One thing evolution had to select for was protection from cancer,” she says. “Because we are complex organisms, we have lots of cells in our body that divide, and cell division is a very risky time for a cell because it’s easy to pick up a mutation when you are replicating three billion base pairs of DNA.” If a cell doesn’t divide, there are fewer chances for such a mutation to creep in. “So evolution put into place these very powerful tumor suppressant mechanisms—senescent cells—but they only had to last for 40 years at the most.”
What serves as a preventive mechanism in early life later can become a cancer-causing agent of its own, Campisi says. Senescent cells contribute to inflammation, and “inflammation is the number one risk factor for all diseases of aging, including cancer.” Eliminating these cells might cut down on various ailments, but no one is yet sure what the side effects would be.
The idea that senescent cells contribute to aging was first postulated in the 1960s. Yet 50 years later, scientists still don’t entirely understand the role they play. All Campisi can say definitively is that, for most of human history, there was “no evolutionary pressure to make that system better because everybody died young.”
When I ask Campisi why some scientists talk about “curing” aging, she says it comes down to getting interventions approved. “There are people who want to consider aging a disease for the purposes of going to regulatory agencies and having a specific drug able to treat a specific symptom, which you can only do if it’s recognized as a disease.” But Campisi stresses that living forever is not the goal of most research on aging. Instead, she says it’s primarily aimed not at life span but “health span”—increasing the number of years that people can remain physically and mentally agile.
Campisi has known de Grey for years, collaborates with SENS and even serves on the organization’s advisory board. I ask what she makes of his assertion that someone alive today will reach the age of 1,000.
“I have to tell you Aubrey has two hats,” she says, smiling. “One he wears for the public when he’s raising funds. The other hat is when he talks to a scientist like me, where he doesn’t really believe that anyone will live to 1,000 years old. No.”

One thing we do know is that there are more elderly people alive now than there have ever been in the history of the planet. Even if today’s life-extension researchers made meaningful breakthroughs, the therapies wouldn’t be available for many years to come. That means we’re about to face a lot of death, says Rachel Maguire, a research director focusing on health care at the Institute for the Future, in Palo Alto. “By 2025 or 2030, there will be more of a culture of dying and lots of different ways of experiencing it. There are early signs of new types of funerals and spiritual formations around this.” Maguire foresees new end-of-life plans, including assisted dying. When it comes to aging, she points out that biological research is only one piece of a puzzle that must also include economics, politics and cultural change. “I don’t think we have answers yet for how we’d do the other pieces. And the financial piece alone is huge.”
There’s already a huge disparity between the life spans of rich and poor Americans, and critics of the new longevity research worry the gap may only grow wider. A 2016 report from the Brookings Institution found that, for men born in 1920, there was a six-year difference in life expectancy between men at the top 10 percent and bottom 10 percent of the earnings ladder. For men born in 1950, the difference was 14 years. For women, the gap grew from 4.7 to 13 years. In other words, advances in medicine haven’t helped low-income Americans nearly as much as their wealthier counterparts.
I had a glimpse of that discrepancy as I used ride-hail apps to get around the Bay Area. On my way to Mountain View, where the median household income is $103,488, my driver, a woman in her 50s, told me she had trouble paying for gas and was sleeping in the car between nights on relatives’ couches. Sometimes, she said, she was stricken by bouts of rheumatoid arthritis. If her joints seized up while she was driving, she had to pull over and wait until the episode passed, usually not working anymore that day. I did not want to ask how she would feel if she ended up living so long that her future included another two decades of driving.
Jake Dunagan, the director of design futures at the consulting firm Very Nice, studies the cognitive biases that make it difficult for people to plan ahead. “That’s one of the conundrums of futurist work: The future doesn’t exist,” Dunagan tells me. “It’s always a projection.” Our minds, he says, have not evolved to be very good at seeing our future as connected to our present, as we spent so much of our early existence concerned with outwitting immediate threats.
Dunagan has little patience for Silicon Valley’s longevity research; he says proponents are not sufficiently interested in the details. “The rich people are defining the terms of the longevity conversation and have enhanced access to these technologies,” he says. “Everyone wants to live longer, to some degree, but it’s also the sense of privilege, of selfishness to it that’s ‘I want mine. I always want mine.’ Well, what if everyone had this? What would be the long-term implications of that?”
**********
In 2006, the magazine MIT Technology Review published a paper called “Life Extension Pseudoscience and the SENS Plan.” The nine co-authors, all senior gerontologists, took stern issue with de Grey’s position. “He’s brilliant, but he had no experience in aging research,” says Heidi Tissenbaum, one of the paper’s signatories and a professor of molecular, cell and cancer biology at the University of Massachusetts Medical School. “We were alarmed, since he claimed to know how to prevent aging based on ideas, not on rigorous scientific experimental results.”
More than a decade later, Tissenbaum now sees SENS in a more positive light. “Kudos to Aubrey,” she says diplomatically. “The more people talking about aging research, the better. I give him a lot of credit for bringing attention and money to the field. When we wrote that paper, it was just him and his ideas, no research, nothing. But now they are doing a lot of basic, fundamental research, like any other lab.”
In marked contrast with de Grey, however, Tissenbaum doesn’t see aging itself as the problem. “I don’t think it’s a disease,” she says. “I think it’s a natural process. Life and death are a part of the same coin.”
Instead of seeking out a universal cure for aging, Tissenbaum finds it more useful to look at the genes involved in specific factors, such as good metabolic function and resistance to stress. For her own research, she has artificially extended the lives of C. elegans roundworms and mice, but she’s found that the creatures are sluggish and frail during that extra period of life. In other words, extending life through lab-based means doesn’t necessarily lead to good health. “If applied to humans, this would likely lead to unsustainable healthcare costs,” she and her co-authors concluded in a 2015 study published in the Proceedings of the National Academy of Sciences.
There are all kinds of theories about how to close the gap between life span and health span, and not all of them focus on senescent cells. Some scientists think taking aspirin and vitamin D could reduce inflammation throughout the body and lower the incidences of all kinds of diseases. Others believe the key is to repair telomeres, the sequences at the ends of each chromosome that unravel with stress and age. Research is still very much in progress on all of these ideas.
Meanwhile, scientists are trying to understand why the brain deteriorates over time, losing mass and neural circuitry. Tissenbaum and others are trying to understand these mechanisms, hoping to find new treatments for neurodegenerative diseases. But she doesn’t expect any intervention to keep humans healthy forever. “It may be that the brain has a finite life span,” she says.
For now, Tissenbaum recommends the usual methods of fending off frailty. Studies have shown that regular physical exercise can stimulate neural networks and keep connections alive. So can challenging mental activities. “If you always do crossword puzzles, try Sudoku,” she says. “Where we have really progressed is in our understanding of how keeping your mind and body active is fundamental to healthy aging.”
Many of the world’s oldest stories are quests for eternal life, from Herodotus’ fountain of youth to the medieval Holy Grail. There’s a great deal of money and brainpower invested in the hope that science will finally deliver on this promise. The research in these labs might yield more incremental breakthroughs, revealing the mechanisms behind Alzheimer’s or certain types of cancer. But for some true believers, that won’t be enough. De Grey, for one, dislikes the idea of seeking cures for individual age-related diseases. “I believe that the term ‘disease’ has become one that does far more harm than good, as has ‘cure,’” he says, “such that some aspects of aging are inappropriately described as curable diseases and others as ‘aging itself.’”
I asked Judy Campisi if she thought there was an upper limit to the human life span. “I suspect there is,” she said. “Like you’d say there’s a limit to running a marathon. You aren’t going to ever run one in 30 seconds.” When it comes to extending life, she says, “we think the upper limit we could get to is around 115 to 120 years old—if we don’t blow ourselves up before then, or the planet doesn’t melt down.”
If Campisi and others are right, we may come to accept that we’re profoundly mortal creatures after all. Still, we seem to be driven, as a species, to overcome every adversity we encounter. We may not live forever, or even to 1,000, but a more vibrant old age could yet be on the horizon for all of us.
Editor’s Note, May 25, 2017: An earlier version of this article erroneously called the Buck Institute a “gleaming profit institution”, as opposed to a non-profit, and described its distance from Berkeley as two hours instead of 45 minutes.

VCS LOVE INSURANCE, EVEN IF YOU DON’T
by JOANNA GLASNER, TECHCRUNCH
July 22, 2017

Most people hate shopping for insurance, and they don’t enjoy talking about it either. That’s probably why you’re unlikely to hear about the industry’s current transformation in conversation, even in startup circles.
But make no mistake, there are vast sums of venture dollars going into insurance deals. Investment has risen dramatically, with VCs betting that, in the coming years, we’ll see major shifts in both how we buy insurance and what types of items we insure with it.
So far this year, insurance-focused startups (excluding the Asian continent*) have raised more than $700 million, almost as much as they raised in all of 2016, which was itself an especially busy year for the space. Much of the funding boom comes from big insurers themselves, who are backing and leading more rounds for insurance startups, as well as companies in related areas like financial services. In the chart below, we look at funding growth over the past four years:
Insurance investment totals are heavily driven by a few large rounds. Over the past year, the two biggest funding recipients are tech-enabled health insurer Bright Health and pay-by-the-mile auto insurer Metromile, which raised $160 million and $153 million, respectively. In 2016, health insurance provider Oscar Health took in $400 million in growth funding, more than 40 percent of all insurance startup investment.

At first blush it may seem like insurance and venture capital make an odd couple.

 
There are plenty of smaller and mid-sized rounds getting done, too. Over the past year, at least 75 companies in the insurance space have raised rounds of $1 million or more, and about a quarter of those were for $20 million or more. They cover a big range of business models, as well, including new insurance categories, online platforms for comparing and purchasing coverage and tools for providers to better assess risk.
One might be inclined to call these startups industry disruptors — except that their biggest supporters seem to be long-established players in the space.

We hear you like insurance

As mentioned, a sizeable chunk of the financing comes from insurance companies themselves, many of whom have dedicated venture arms. The most active by round count looks to be AXA Strategic Ventures, the VC arm of French multinational insurer AXA. The two-year-old fund has invested in two dozen companies over the past two years, including a $6.5 million round it led this month for QLoo, a celebrity-backed developer of AI-powered tools for mapping cultural tastes. MassMutual Ventures, the VC arm of insurance giant MassMutual, has also been keeping busy, backing 16 companies over the past three years. In the chart below we look at a few:
Well-known venture firms are also leading significant rounds. New Enterprise Associates, for instance, backed both Metromile and Bright Health, along with Indio, a seed-stage commercial insurance startup. Accel and Bessemer have also each made three insurance-focused investments in the past couple of years. And over the years, most of the biggest Silicon Valley firms have at least one investment in the space.
But while it looks like large sums are going into insurance deals, the figures may underestimate the breadth of activity. One reason is that many fast-growing players in the insurance space operate in other industries too, such as financial services. A case in point is Credit Karma, the credit score unicorn that now offers auto insurance quotes alongside offers for credit cards and other financial products.

What next?

At first blush it may seem like insurance and venture capital make an odd couple. Venture capital is all about taking big risks for the potential of even bigger payouts down the road, while insurance is all about quantifying and mitigating risk.
In small allocations, however, venture can actually be a strategy for reducing risk, as it allows large, entrenched players to track and take stakes in the upstart ventures that could reshape their industries. It’s worth noting that many of today’s largest insurance companies have histories that date back a couple of centuries. They didn’t  last this long without some ability to adapt to changing times.
* Crunchbase’s tally of insurance investment totals excluded Asia, which sees fewer deals but some large ones. The biggest to date is Zhong An, a China-based online insurance company that raised more than $900 million two years ago.

Freediving Is the Lung-Crushing, Mind-Altering Path to Inner Peace
How the high-risk, high-reward extreme sport helps conquer your fear of the deep through meditation.
by PATRICK SCOTT, BLOOMBERG PURSUITS
June 14, 2017

The Guinness World Record for holding one’s breath underwater is 24 minutes and 3 seconds. Most humans, however, can barely make it a minute and a half.

For a diver, the degree of difficulty increases exponentially. Lungs shrink to half their size at a depth of 10 meters (33 feet). After about 30 seconds, blood vessels in the arms and legs constrict, redirecting red blood cells to vital organs, including the heart and brain, part of the “mammalian dive reflex.” After a minute or so, trapped carbon dioxide causes the diaphragm to spasm, signaling the brain to breathe.

Keep going, and eventually the spleen will release stores of red blood cells to keep you alive for a while longer. Below 50 meters, capillaries around the alveoli in the lungs expand to create a cushion to protect the rib cage from collapse as pressure increases on the body. Most people will shortly lose consciousness. If you’re still under­water at that point—watch out.
Freedivers—a slightly mental group of thrill-­seekers who focus on holding their breath while descending into the open sea—have figured out how to stay underwater for 3, 4, or 5 minutes at a time. They say the key to the sport is to relax, that humans can override the urge to breathe underwater by learning to embody the energy that flows throughout the universe. They say you can stay under­water for minutes even after the first contractions of the diaphragm.

A key motivation is to be more at ease in the water.
Photographer: Wendy Timmermans for Bloomberg Pursuits
Nine meters below the surface of the Red Sea, in my mask, wetsuit, and fins, I’m trying my best to do just that. But my lungs feel squeezed, as if in a vise. My arms and legs turn heavy as the blood vessels constrict. Every few seconds, my diaphragm heaves more intensely as the carbon dioxide increases. My brain feels fuzzy as the pressure in my head builds.

The payoff for this seemingly crazy stunt, I’m told, is a euphoria unlike any other. Freedivers talk among themselves of being addicted to the sport. The body and mind are altered. Surface cares dissolve, replaced by a profound immersion in the present.

It sounded great back on land, in the laid-back Egyptian village of Dahab on the eastern shore of the Sinai Peninsula. My instructor, the world-record-­setting freediver Sara Campbell, teaches Yoga for Freediving, a weeklong course that promises to unlock my potential. Our training begins with yoga and meditation in a sun-­speckled hut at the Coral Coast Hotel, timing our inhale with the mantra ong namo and our exhale to guru dev namo, meaning, “I bow to the divine teacher within.” Campbell tells us that at a certain depth, gravity will pull you down into the dark stillness and squeeze you in a loving hug. “It’s the one you have been waiting for your entire life,” she says.

Underwater, it feels more like strangulation. I’d already gotten tangled in the rope that extends from a buoy at the surface. At a depth of 9 meters, I reach neutral buoyancy—too light to sink, too heavy to rise—and I’m supposed to hang out and chill. But after a minute and 20 seconds, the convulsions are overwhelming. I stare at the white-and-red rope through my mask with only one thought: I have to get to the surface, or I’m going to die. I climb up hand-over-hand toward the light and emerge gasping for air.

In ancient times, people dove to these sorts of depths out of necessity, to harvest shellfish, sponges, and pearls. Only after the mid-1940s did divers start competing to sink deeper. Interest in freediving rose after the 1988 movie The Big Blue, a fictionalized rivalry between two real-life European free­divers. Four years later a group of enthusiasts formed a volunteer governing body—the International Association for the Development of Apnea, or AIDA—to organize competitions and set protocols. Since the ’90s the sport has attracted a dedicated and growing number of divers who want to go underwater as deep, as long, and as far as possible on one breath. Most everyone has a 30-meter dive and a 4-minute breath-hold inside them, says Grant Graves, head of USA Freediving.

Russian freediver Alexey Molchanov set a men’s record for a fin-propelled freedive in October 2016 when he swam down to 129 meters and stayed under for 3 minutes and 50 seconds. “It’s like surrendering to the pressure of the ocean,” he says. “And that brings peace of mind and calmness and acceptance.”

Still, it’s a risky proposition. The enormous water pressure can cause ruptured eardrums and create lung-squeeze, which can result in internal bleeding. The lack of oxygen from an extended breath-hold can lead to blackout, most often just before or after resurfacing. Molchanov’s mother, Natalia, also a champion freediver, drowned after giving a lesson in August 2015 near Ibiza. She was 53.

But fatalities are rare. According to the association, there’s been only one death in an AIDA competition over 25 years and more than 40,000 dives. In the past decade the number of countries that participate in AIDA events has more than doubled, to 35, and more people join each year, says the association spokesman, Denys Rylov, by phone from his native Ukraine.

The most popular competitions are held in places such as Kalamata in Greece, Roatán in Honduras, and what many consider the best location, Dean’s Blue Hole in the Bahamas. Despite little sponsorship or prize money, new contests keep coming. This September, the Authentic Big Blue will be held on Amorgos Island, Greece; another, the Sabang International Freediving Competition & Workshop in Indonesia, begins in November.

What makes Dahab a favorite, especially among Europeans, is convenience. Sharm El Sheikh International Airport is an hour south of the town. Rooms with a sea view can be had for less than $50, and it’s hard to spend more than $25 on a three-course fish dinner. Divers can plop down their gear a few feet from the water at dozens of open-air cafes with big cushions and the occasional stoned waiter. With its azure sea and jagged mountain peaks, the resort can lure visitors who arrive for a week to remain for years.

That’s what happened with Campbell. On vacation from her high-stress life in London almost 13 years ago, she had an epiphany: While on horseback on the shore at sunrise, a voice inside her said, “You’re home.” She returned to England, wound down her public-relations consulting company, and moved to Dahab to teach yoga.

It’s a popular spot for divers because of its storied Blue Hole, a large opening in a reef offshore that drops 91 meters. Locals call it a divers’ cemetery, because scuba divers can get lured in too far. But for freedivers, who descend and rise quickly, the conditions are perfect: The water is deep, clear, and warm, and has very little current.

Campbell took up freediving a year into her new life, and after nine months of training, she broke three world records at the Blue Hole, including diving to 90 meters using a monofin, which looks like a mermaid’s tail.

After Campbell set another record in 2009, with a dive to 96 meters, others began to seek her out as a guru. She credits her success to the relaxation and breathing techniques she learned through yoga and chanting. Campbell began teaching private sessions and weeklong courses, among them Yoga for Freediving, which I joined with four others in May.

The enormous water pressure can cause ruptured eardrums and create lung-squeeze, which can result in internal bleeding.
Photographer: Wendy Timmermans for Bloomberg Pursuits
In our first session, we practice pulling ourselves headfirst down the rope extended from the buoy, a discipline called free immersion. “Whether you are on the surface or going down, you are letting the ocean move you, and this becomes your first teacher,” Campbell says.

Don’t let the Zen-speak fool you: Freedivers, including Campbell, can be as fixated with numbers as any other extreme sportsmen or women, and quests for personal bests are always right below the surface. “Every time we say we do freediving, that’s the first question,” says Bart Denys, 48, a physiotherapist from Belgium and one of my course mates. “ ‘How deep do you go? How long can you hold your breath?’ I’m more interested in ‘How relaxed are you?’ ”

Kerry Hollowell, 41, a member of the US Freediving team and an emergency medicine doctor in North Carolina, is the most advanced diver in our group. She’s preparing for her goal of an 85-meter monofin dive, 10 meters deeper than her personal best, in the AIDA world championships this summer in Honduras.

Freediving, she says, “helped me find my authentic self. And when I’m in a stressful situation and a patient is dying in front of me, I don’t freak out. There is a bigger energy, a bigger sense of purpose that I have.”

I was curious to see how I’d fare in the undersea world. I’ve been a swimmer most of my life, and in a one-day basic certification before the course, I surprised myself by kicking with fins down to almost 18 meters. So I set a 30-meter target for the course.

After that first panicky day, the revelations come easier. I find I can expand my lungs to a greater degree by breathing into my belly first and then up into my chest. I learn that a hooded wetsuit helps me stay warm and lead weights help me to descend. And I discover the point after neutral buoyancy where gravity takes over and pulls you down in a ­free fall. “Flying in the sea” is how one classmate puts it.

The second day is full of breakthroughs. My dives begin to improve, because I slip down into the water like a seal, going in backward as I pull on the rope, instead of face first. I also learn to crouch and descend slowly, bending my knees to release tension, instead of rushing down.

I dive to 21 meters and stay under for 2 minutes and 26 seconds. But I keep forgetting to equalize on the way down; when my ears ache, I pinch my nose and blow too hard, causing “mask squeeze”—bright red blotches in the whites of my eyes from ruptured blood vessels. After that, I mostly use a nose clip instead of a mask.

After five days of training, I still haven’t reached 30 meters. On the roof of a divers’ hangout overlooking the Blue Hole, Campbell tells us to forget about the numbers—they’re a projection of our ego. “You have to let go of the outcome and be in the present moment, and then what it is you want to achieve comes naturally,” she says. “Just let your inner dolphin out to play.”

The sea that day is unsettled, and I bob on my back as choppy waves splash my face. Hollowell resurfaces after a 70-meter dive, flailing her head and shoulders in a “samba,” the term divers use when lack of oxygen briefly causes a loss of motor control. Campbell and Denys pat her face and call her name, and she’s soon alert, but it’s disconcerting.

I breathe deeply and slip into the silence, reaching along the rope as if raising a flag on a pole. At 20 meters, I find enough air to equalize and continue the free fall headfirst. But the pain in my ears makes me stop again, and in a moment, I decide the number isn’t worth bursting my eardrums. I pull back up from a depth of 26 meters.

Coming out of the water, I tell Campbell I want one more shot the next morning. “It’s not about the number, Patrick,” she says. But of course it is.

On my final dive, the urge to breathe doesn’t hit until after a minute. I welcome the first contractions as I look up at the divers’ dangling flippers, like frog legs at the surface. At a minute and a half, I feel the weight in my chest and arms increasing, but I’m able to shake my hips and relax the back of my knees.

At 2 minutes, I picture my spleen releasing oxygen-filled blood to my core as my arms tingle. I wiggle my neck to release tension and still feel in command. At 2:30, my arms start to quiver, and my head feels lighter, squeezed harder. The contractions are coming faster and stronger.

I pull back up the rope and feel a new reserve of air. My lungs and sinuses enlarge, giving me the sensation of being inflated with pure oxygen. It’s the closest I’ve gotten to that famous euphoria. And I don’t even know how deep I went. I pop up out of the water, catch my breath, and look at my watch: 2 minutes and 57 seconds. A personal best.

A six-day Yoga for Freediving course in Dahab starts at $775 per person. Fly into Sharm El Sheikh International Airport, a one-hour drive away. Standard rooms at the four-star Swiss Inn Resort range from $63 to $81. The Coral Coast Hotel (rooms from $34) is also popular with freedivers and scuba divers.

A DIVIDED AMERICA: HOW WE DIE DEPENDS ON WHERE WE LIVE
by DEENA SHANKER, BLOOMBERG
January 12, 2017

As lawmakers prepare for a showdown over health insurance legislation, a new report finds that for rural Americans, a lack of coverage is just one of many reasons they are more vulnerable to early death than their urban counterparts.

While the top five causes of death were the same for all Americans from 1999 to 2014—heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke—they were more likely to kill the 15 percent of Americans living in rural areas than their urban counterparts, according to research from the Centers for Disease Control and Prevention. “This new study shows there is a striking gap in health between rural and urban Americans,” said CDC Director Tom Frieden.

The difference can be attributed to a confluence of environmental, economic, and social factors, including smoking rates, opioid use, poverty levels, poor nutrition, levels of physical activity, and access to health care, according to the CDC. Solving these problems requires better access to public health and health care services, said Alana Knudson, co-director of the NORC Walsh Center for Rural Analysis. Both "require financial resources," she said, to lower the mortality rate.

For example, unintentional injury death rates are 50 percent higher in rural areas than urban areas, in part a result of more high-speed motor vehicle traffic-related deaths. But once a person is in an accident in a rural setting, they are also less likely to receive prompt medical attention. Geographical distances make it take ambulances longer to arrive; once they do, a trauma center is less likely be near. Only 11 percent of all doctors practice in rural areas of the country, the CDC noted.

Rural dwellers are also less likely to have access to health insurance through employment, according to a 2014 report (PDF) from the Henry J. Kaiser Family Foundation. From 2012 to 2013, 51 percent of the U.S. rural population had employer-sponsored insurance coverage, compared to 57 percent of the metropolitan population. While the Affordable Care Act targeted uninsured individuals with low-to-moderate incomes—who are more likely to live in rural areas—many states chose not to expand Medicaid coverage under the ACA. Nearly two-thirds of rural Americans uninsured in 2014 lived in one of the 24 states not implementing Medicaid coverage. (That number has since dropped to 19 states.)

President-elect Donald Trump has promised to repeal the ACA, which the CDC doesn't consider a cure-all in any event. "Focusing on access to health care in rural areas of the United States alone is not sufficient to adequately address complex health outcomes," the report concluded. Different causes of death require different solutions, and the report offers a number of suggestions, including more substance abuse services, more cancer screening programs, and the enforcement of seatbelt and drunk driving laws. Better health insurance certainly couldn't hurt.

This Freediver’s Advantage Is All in His Mind
Looking for a challenge beyond marathons and Olympic-distance triathlons, Kurt Chambers took up freediving.
by By Jen Murphy, Wall Street Journal
Dec. 16, 2017, 7:00 AM

Most athletes embrace the Olympic motto “faster, higher, stronger.” Kurt Chambers used to be one of them. He spent 10 years competing in marathons and Olympic-distance triathlons. Looking for a new challenge, he turned to freediving and adopted the philosophy “slower, deeper, calmer.” Holding your breath “requires a level of fortitude I’ve never had to muster,” he says.

Mr. Chambers, now 36 years old, grew up in Texas. In 2003, he moved to Hawaii to attend graduate school and began dabbling in spearfishing, which required him to hold his breath underwater for sustained periods. “I didn’t display any special talent early on,” he says. Intrigued by the idea of diving deeper, he signed up for a freedive course and educated himself on the science of breath-hold diving.

Five years later, he started competing. In May 2016, he set two U.S. records at the Caribbean Cup in Roatán, Honduras. In the constant weight discipline, where divers are aided by the use of fins, Mr. Chambers dove to a depth of 331 feet in just under 3 minutes. In the free immersion discipline, which doesn’t allow fins but does allow divers to pull themselves down by a guide rope, he reached 308 feet. His personal record for holding his breath underwater without swimming is 7 minutes, 18 seconds.

 “All humans have an inherent mental reflex to breathe,” he says. “Advanced divers learn not to ignore that urge, but to tolerate it amidst discomfort.” He attributes the mental fortitude he developed finishing brutal track workouts, masters swim workouts and cycling hill repeats for giving him an edge in negotiating the intense discomfort, which includes pressure in the chest and ears.

Mr. Chambers, who also teaches freedive courses at home on the Kona coast of the Big Island, believes anyone can learn to hold their breath. The benefits, he says, translate to other sports, like surfing and rowing, and even day-to-day life when we need to stay calm under pressure. “Freediving is like meditation,” he says. “We focus so much on working the physical body we forget to work our mind.”

The Workout

“There is a notion that the source of our secret powers, the mammalian dive reflex, is strengthened by frequent stimulation,” he says, referring to the natural physiological reaction that occurs when mammals are submerged in water. When this reflex kicks in, the heart slows, peripheral blood vessels constrict so that more blood reaches the brain and vital organs and the spleen contracts to release more red blood cells. These reactions, he explains, help to reduce a diver’s consumption of oxygen while continuing to provide sufficient quantities of oxygen to the vital organs. “I try to exercise that reflex every day in the water,” he says. 

Mr. Chambers alternates between ocean and pool. “Supplemental tools, such as monofins, assist freedivers so much that a thorough understanding of swimming technique and muscle patterns isn’t even required to be competitive,” he says. “Many professional freedivers have technique so poor it would make a high school swimmer cringe.”

Technique and strength work, similar to how a swimmer trains, are key to his routine. A pool workout might include 10 reps of 100 yards going every 2 minutes and 30 seconds. Within each 100, he swims the first 50 yards entirely underwater in the “no-fins” discipline, basically an underwater breaststroke. He’ll then surface, take a single breath, and continue with another 50 yards on the surface breathing. “That second part is like how a swimmer feels when he takes the hand paddles off and resumes swimming without the added resistance,” he says.

Unlike many veteran divers who practice a single target dive in the ocean, Mr. Chambers performs many repetitions of a drill. Instead of diving to 200 feet once, he may dive to 100 feet 10 times, focusing intently on his entry, performing the first few strokes as quickly as possible, and trying to minimize the overall number of strokes.

This is the first year he’s added strength and flexibility to his training. “In the gym, I avoid muscle-building exercises like the bench press,” he says. “More muscle mass requires more oxygen.” He focuses on strengthening the back and abdominals, both key to an efficient dolphin kick and no fins stroke, as well as small stabilizing muscles around the shoulders and back to help him swim efficiently with his arms overhead. “That position is challenging with limited shoulder flexibility,” he says.

One of the hardest parts of training, he says, is recovery. “You’re breaking down your body in a different way from running a marathon,” he says. “After two deep dives, you need to be lazy to rebuild your red blood cells. I have to force myself to relax and watch

The Diet

At a freedive camp, Mr. Chambers was roommates with William Trubridge and Ken Kiriyama, two top freedivers who are both vegetarians. “I had to live with them for a week and thought I’d be a jerk to stock our fridge with meat,” he says. He adopted their diet and performed well. A few months later he met his girlfriend, a dedicated vegetarian. He’s been vegan for nearly three years now. “We don’t eat stereotypical rabbit food,” he says.

For breakfast he makes oatmeal with a plant-based milk. Lunch is a sandwich of sliced cucumbers, onion, tomato, avocado and vegan mayo. “Mexican food is extremely adaptable to being vegan,” he says. “We make black bean or tofu tacos for dinner a couple nights a week.

The Gear & Cost

Mr. Chambers recommends a mask and high resistance long-blade fins. “You get a lot colder than expected underwater, even in Hawaii,” he says. “When you swim, you create heat, but breath-holding you lose heat, so you want to invest in a good, buoyant wetsuit,” he says. He trains in a 3mm wetsuit by Merman Custom Gear. He also suggests a snorkel, weight belt and nose clips. His membership at Pacific Island Fitness is $70 a month. He uses free public pools.

Breathing Lessons

Learning to hold your breath under water starts by learning to breathe correctly on land.

“Most of us don’t breathe as well as we could and should,” says Hanli Prinsloo, a South African freediver and ocean conservationist. Slowing down the exhalation both oxygenates us better but also slows down the heart rate, which in turn conserves oxygen, she says.

Deep, slow breaths need to happen in and out of the belly, Ms. Prinsloo says. “To practice this, lie flat on your back and start focusing on feeling your belly rise as you breathe in and drop down as you breathe out,” she says.

“Slow the breath down until you are breathing in for eight counts and out for 10 or 12. Do this for at least three minutes before trying to take a really large breath. First feel your stomach expand again, then your chest and a last little bit in under the collarbones,” she explains. “This three-part breath is the way to fill your full lung volume. It might even feel uncomfortably full, but this is a good lung stretch, so try to relax into it.”

Ms. Prinsloo says holding your breath can help you learn to overcome performance barriers during anaerobic activity. If you want to take the practice into the water, she cautions, always go with a trained freediver or partner to avoid the risk of blackouts.

Universal Life Insurance, a 1980s Sensation, Has Backfired
A long decline in interest rates caused premiums to soar when they were supposed to stay level
by Leslie Scism, Wall Street Journal
Sept. 19, 2018

A popular insurance product of the 1980s and 1990s has come back to bite many older Americans. Universal life was a sensation when it premiered, and for some years it worked as advertised. It included both insurance and a savings account that earns income to help pay future costs and keep the premium the same.

That was when interest rates were in the high single digits or above. Today, rates are completing a decade at historically low levels, crimping the savings accounts. Meanwhile, the aging of the earliest customers into their 70s, 80s and even 90s has driven the yearly cost of insuring their lives much higher.

The result is a flood of unexpectedly steep life-insurance bills that is fraying a vital safety net. Some find they owe thousands of dollars a year to keep modest policies in effect. People with million-dollar policies can owe tens of thousands annually. Some retirees are dropping policies on which they paid premiums for decades. “I’m very scared that everything will go down the drain,” said
Bernice Sack, a 94-year-oldformer hospital billing clerk in North Carolina. A $56 monthly premium Mrs. Sack paid when she bought the policy 35 years ago has climbed to $285, despite her efforts to keep the cost down by reducing her death benefit.
Living with a daughter and getting by on Social Security, she skimps on medications to pay the insurance bill, sometimes runs late on her share of household costs and considers ice cream a splurge.

John Resnick, co-author of an American Bar Association book on life insurance, said of hundreds of older policies he has reviewed over a decade, “easily 90% or more actually were in trouble or soon to be in trouble.” Many people “are sitting on a ticking time bomb, and most probably aren’t aware of it,” he said. Universal life is among the reasons Americans are approaching retirement in the worst shape in decades. The insurance policy type emerged in an era nearly four decades ago when the Federal Reserve was fighting inflation with high interest rates. Some financial advisers suggested people forgo traditional “whole life” insurance and buy less-expensive policies that covered just a limited term, investing what they saved in the mutual funds and money-market
funds then proliferating. Insurance companies embraced this mantra of “buy term and invest the difference” by inventing a new product. With universal life, the customer buys a one-year term-insurance policy and renews it annually. In the early years, the premium the customer pays is a good deal more than the actual cost of the insurance. The excess goes into a tax-deferred savings account.

The policies are designed so the gains in the savings account, which the industry typically calls a “cash-value” account, offset part of the cost of renewing the term insurance each year. Much depends on what interest rate the account is earning. When these policies first were sold, U.S. interest rates were unusually high, and insurers often illustrated the policies to potential customers using a scenario of continuous 10% to 13% rates. Companies typically showed worst-case scenarios, too. But with high rates common, the
worst-case scenarios often got short shrift. The interest projections were proving unrealistic by the mid-1990s, and especially so after the 2008 financial crisis depressed rates. Although many policies didn’t allow the savings-account return to fall below 4% or 5%, that wasn’t enough for early customers. The cost of a year of term insurance soars once people reach their late 70s.

Compounding the problem, universal life offers flexibility that is alluring but dangerous. Within reason, customers plan their own monthly or annual premium payment. They can set it low, counting on high interest income in their savings account to keep the policy financially sound. Customers also can choose to pay less than their planned premium sometimes if money is tight. Or they can skip a payment altogether. And they can borrow against their savings account. Any such move, of course, will spell skimpier earnings in the account. It is widely accepted that not all customers—or even all insurance agents—fully understood years ago how borrowing or
skipping payments could undermine a universal-life policy.

Defending their sales, insurers say they have paid out more than $150 billion on universal life policies, and some owners received value from their policies by borrowing from them. Insurers stress that materials given to customers say only a minimum interest rate is
guaranteed; higher rates used in sales pitches are hypothetical. Insurers send customers annual statements showing the change in the value of their savings account and what it has cost to renew their term insurance. Some companies seek to identify
problematic older policies, sending customers extra communications to be sure they understand their situation. “Lincoln annually provides all policyholders with an updated statement that they and their agent can, and should, use to manage their policy and assess how various activities including withdrawals, missed payments and loans may impact its value,” said Scott Sloat, a spokesman for Lincoln National Corp. , the company that sold Mrs. Sack her policy. He said Lincoln sends additional letters to customers who could face a large, sudden jump in their premium in 10 years or sooner if they don’t take action, such as by voluntarily increasing
premium payments or reducing the policy’s death benefit.

Nicholas Vertullo, an 85-year-old former high-school teacher outside New York City, has three universal-life policies issued by a unit of American International Group Inc. One of them initially earned 9% on its savings account. The policies’ accounts today fetch 4% to 4.5% interest. “I was abstractly aware that interest rates could vary,” Mr. Vertullo said. After the 2008 financial crisis, “the whole thing came home in a way that it was no longer an abstraction....These life policies were quicksand.” For death benefits totaling about $475,000, Mr. Vertullo is paying about $30,000 a year, triple the original premiums. He had planned to replace the income his wife will lose when, on his death, his teacher’s pension and Social Security check stop. Years ago, he cut the death benefit to repay a loan
against the insurance, and now he is looking into a bigger cut to reduce his annual cost. Mr. Vertullo said he and his wife have forgone restaurant meals and travel, living “an austere and Spartan retirement.” “I hate to confess this: I simply went along,” Mr. Vertullo said. “I don’t think I understood completely what the hell I was doing.”

AIG said it doesn’t comment on individual situations. It said universal life is one of a wide range of solutions it offers to meet families’ specific needs. In the early years of universal life, buyers often were businesspeople and other professionals who found the tax-deferred interest feature attractive. The insurance industry’s reputation for conservative products helped allay skepticism. By 1985, universal life was generating 38% of the industry’s premiums for individual life policies, according to research firm Limra. Americans
bought two million to three million universal-life policies a year in the 1980s and early 1990s. As interest rates declined, some agents alerted owners that funding shortfalls were developing. One who did was Pennsylvania agent Allen Carr, who says he had been “gullible”to believe universal-life policies could be counted on to work as planned. When policies he had sold veered from their projected performance, Mr. Carr said, “it was embarrassing going back [to customers] saying, ‘We have a potential problem.’” Industrywide, some customers angrily canceled their policies. Others took a shame-on-me attitude for not having read the
details. Some began voluntarily paying larger premiums to put the policies on firmer financial footing. Lawsuits arose, and from the mid-1990s to early 2000s plaintiffs’ lawyers reached settlements over allegedly deceptive sales practices, such as promising the savings buildup would eliminate the need to pay premiums at all in a decade or so. State regulators tightened rules on how
insurers could illustrate the policies, including requiring them to cite interest rates that could
be justified for the long haul.

The industry responded by offering a new wrinkle: guaranteed universal life, which had a fixed premium designed to ensure lifetime coverage if paid on time. Many early universal-life policyholders swapped into this. The disappointed early buyers of universal life included people in the industry—a gauge of how poorly the policies often were understood. Early this year, MetLife Inc. alerted Ohio couple Thomas and Rebecca Bell they would need to start paying about $300 a month on a policy for which they had been paying $97 monthly since they acquired it in 1994. At that time, Mr. Bell was an insurance agent. The Bells owned a universal-life version with some added twists and risk, “variable universal life,” which let them invest the savings in stock and bond funds. After having paid
$26,000 in premiums over the years, the couple let the $25,000 policy lapse. “There was no way [a $300 monthly premium] would be in our budget,” said Ms. Bell, 79. Her 86-year-old husband, who was a tools salesman in addition to selling insurance, said he didn’t remember much about the policy’s particulars, but “It’s not what I expected it to be.” A MetLife spokeswoman said, “We understand it can be challenging to cover the cost of insurance” when a policy contains less built-up income than envisioned. She said MetLife
updates policyholders annually on their accounts’ value and urges them to contact their agents or the company.

The tumble in interest rates didn’t affect just customers—it also dinged insurers’ profits. As corporate-bond yields fell below 5% in recent years, insurers earned less from investing premiums, yet still had to pay guaranteed minimums of around 4% on universal-life savings accounts. With future profits expected to be hurt by low rates, at least a half-dozen insurers have invoked policy provisions that they say allow them to raise the rates used to calculate the annual cost of customers’ term insurance, according to ITM TwentyFirst, which provides policy-management services. This means some customers see costs rising not simply because they are a year older, or because their savings account didn’t grow as planned, but because their insurer has changed its price formula. As a result, even some customers who kept their policies well funded are being hit with unexpectedly higher costs.

One is Douglas Bradley, 83, a longtime health-insurance broker in California, whose premium roughly doubled because of a change made by insurer Transamerica. “I am absolutely stupefied at this,” Mr. Bradley said. Transamerica, a unit of Aegon NV, declined to comment on Mr. Bradley’s situation but said its change was contractually permitted. Such increases are “causing more life-insurance policies to expire even quicker than before” as customers who can’t afford them drop their policies and hand insurers “windfall profits,” said Henry Montag, a principal with The TOLI Center East in Melville, N.Y., which evaluates policies held in trusts. Mrs. Sack, the 94-year-old retired hospital billing clerk, was warned by her insurance agent in 2000 that the universal-life policy she bought in 1983 was financially off track. Mrs. Sack had borrowed a little over $4,000 from it and had skipped some payments. Also, while the policy’s savings account initially earned over 10%, by 2000 this was down to 5.7%. She lowered the death benefit to $21,000 from $25,000 to repay the loan but still had to nearly double her premium, to $100 a month. The premium kept rising. She borrowed a few thousand dollars more from the policy, and the interest return continued to slide, to the 4% minimum. Her experience is detailed in an inch-thick stack of documents, bills and correspondence, with scribbled names of Lincoln National representatives she and her daughters have spoken to in their efforts to figure out the situation. Mrs. Sack complained last year to North Carolina’s insurance department. It responded that “we understand your frustrations” but that the company appeared to be in compliance with policy provisions.
Even though Mrs. Sack has paid more for the insurance—approximately $39,000—than her heirs will ultimately receive, she doesn’t dare stop paying and let it lapse. “My prime concern is my burial,” Mrs. Sack said. “My children are all so supportive, but I don’t
want them to pay for mine.”

Appeared in the September 20, 2018, WSJ print edition as 'Insurance Policies Backfire On Retirees.'

UNDERSTAND OUR INDUSTRY BY LOOKING AT THE PAST.

General Timeline
Multiple class action and direct lawsuits in a variety of jurisdiction are filed against Axa, Trans, Lincoln, and others for breach of contract and false advertising relating to their COI Increases.
Risk Timeline
Industry gains in liquidity driving yields to mid-teens. Although volume in the secondary market is still sub $2b the tertiary industry continues to trade over $7-10b/ year of its available $90b of owned policies.

FOR MORE THAN A DECADE, PRESTON HAS ASSEMBLED – ASSET BY ASSET, DEAL BY DEAL – A PROPRIETARY DATABASE AND ANALYTIC ENGINE. THE FUTURE OF ANALYTICS... INTRODUCING...