About half a century ago Dr Brackenridge was asked by the Guardian Assurance Co. to write a booklet for the guidance of underwriters and doctors issuing reports on applicants for insurance. From this sprang Medical Aspects of Life Assurance 1962, since 1977 known as the Medical Selection of Life Risks, and still going strong. Brackenridge says in his introduction that this will be the last edition he will be personally involved in, due to failing vision. Aging is, obviously, a serious life risk, with dangers of declining cognitive function – “one of the most difficult aspects of underwriting” as well as physical impairment. In particular it has to be noted that “normal may not be normal enough”. Clinical tests tend to extend the lower limits of normal. This improves the specificity of the test – there are less “false positives” but the corollary is that there are bound to be more “false negatives” so older people at the lower end of normality on a test scale may in fact be in the early stages of disorder. Visual disorders are not a major life assurance problem however, noting in particular that “longevity is likely to be normal among those who lost their sight in adolescence or adult life than among those who have been blind since birth or early infancy.” All in all Dr Brackenridge sounds to me to be quite a reasonable life risk for his age.
Brackenridge claims that the first life policy was issued in 1583. The early history is confused with tontines, burial clubs (which, of course, have a history stretching back long before 1583 to some of the earliest known human records), and with the practice of betting on people's deaths (in effect, taking out life insurance on someone without necessarily telling them). In 1662 John Graunt published Natural and Political Observations Made upon the Bills of Mortality including a Table of Survivors. This was followed up by Edmund Halley, who, in the intervals of spotting comets, drew up An Estimate of the Degrees of Mortality of Mankind, Drawn from the Curious Tables of the Births and Funerals at the City of Breslaw. I note with some interest that if I lived in Breslau in 1690, according to Halley, I would, statistically speaking, expect just less than ten further years of life, whereas nowadays I am calculated to have nearly 19 to go. Once the statisticians got seriously involved, life insurance became a reasonable proposition, with the setting up of the Amicable Society for a Perpetual Assurance Office in 1706 (subsequently incorporated in the Norwich Union company, so still going strong), which I would class as the first real step. Either way, this book has a long and, on the whole, respectable history.
The current edition is divided into two halves (the whole book is now getting so unwieldy that, by the next edition, if it goes on growing, the publisher really ought to consider two separate volumes). The first half covers the subject from the insurance angle, with chapters on types of policy, risk selection, life tables, impaired life annuities, application processing, the problems of underwriting different groups – old age, child and adolescent, the disabled, and a cautiously sensible, possibly even over‐cautious, chapter on underwriting genetic disorders. The second half covers the medical angle, with chapters on methods of physical examination, laboratory testing and physical build, followed by about 20 chapters on specific groups of disorders – blood pressure, diabetes, cardiovascular, oncology, etc. All of these are considered from an insurance doctor's point of view, i.e. combining a clinical description of the disorders with a risk assessment and a discussion of ratings. On the whole these chapters are well‐organised and comprehensive. There are one or two surprising omissions – erectile dysfunction in men is only mentioned under Diabetes for example. There is an increasing public awareness of this, in contexts other than the diabetic, so there really ought to be a urogenital chapter covering them – the present urinary chapter seems more concerned with the kidneys than with anything lower down. There are also some overlaps that could have been removed by more careful editing – as there is a whole chapter devoted to substance abuse there does not need to be a large section on substance abuse within the chapter on psychiatric disorders for example. As a whole, however, this book can be recommended as being eminently fit for its purpose.
The target readership is clearly the individual insurance doctor. Medical school libraries and major medical libraries should also consider it for purchase. Although the clinical chapters are aimed at clinicians, and would in some cases be hard going for the lay reader, there is general interest in the subject of risk. In the UK there is some government pressure to make the public more aware of medical risks, so major public reference libraries and public health education information services may also wish to consider acquiring copies, to sit somewhere alongside a general medical reference books like that of Weatherall et al. (1996).
