But our first witness is Senator Lyons. There she is. Okay. As we thought we might, we have found there is an awful lot of interest in this bill as well. So that's Dr. Leonard. Okay. So Senator Lyons, you're the sponsor. And my intention is once we've looked at the insurance impacts, I'm going to relinquish it to help it welfare. But insurance turned out to be a really big issue or leaves a lot of interest. So we're going to walk our way through that and then to you and I and our three co-conspirators down the hall. So we have a majority right here. So go for it. Yeah, we do. So anyway, you know the time crunch. As fast as you can tell us what your purpose is. Very briefly, I will share with you how important S247 is. This is a bill that we did have in our committee, a last session and we did pass it out to the full Senate and eventually it was on the last day of the session it went over to the house, but it was never, it was a slightly different bill with more sections and more provisions. This bill really deals more as you now know with long-term care insurance and life insurance. We know that in 2008, the genetic information non-discrimination act was passed at the federal level, protecting health insurance. So that we are under that umbrella, but we also know that with the onset of things like ancestry and 23, whatever the 23 you and me is. 23 and me, my sister had ours done. I'm not a lyrish. And people believe that looking at individual chromosomes might predict something about who we are. And we know that in the past we've looked at single, trying to understand single gene inheritance, color of eyes for example, but as time has gone on, we've seen greater complexity in our genetic expression. And I should share with you that I am a professor of biology. I have taught cell biology and immunology for many years. So I have my feet on the ground with this one, but I will allow for Dr. Leonard and others to speak to the genomic medicine that's going on today and how very personal it is becoming and how much it can tell us about both prevention and treatment of diseases. But if that information is shared and becomes more publicly shared then their concern is a very real concern about people not willing to share genetic information even with their medical providers or with laboratories when it could be to their advantage. So I believe that this bill is an important one. It will allow for folks to sign on whenever their genetic information is being shared and utilized particularly in the medical environment. There's a section in the bill that provides for that no one's genetic information can be shared or utilized without some informed consent. So those things are all very important to us because our genome is us, it is us. And we know since we've learned greatly since the 90s and I've done research in some of this area how much the environment, both the chemical environment and the social environment will influence genetic expression. So there is a lot embedded in the bill. I will not talk any further, but I think that allowing people protection of their own genome and non-discrimination is critically important and I will end it there. Okay, thank you. I wanna make sure we have time for all the other witnesses. Does anyone have a time constraint? A hard, okay. This is normally when I do the non-professionals because it's snowing outside, but we're all zooming. So I'm gonna go on to Emily Brown who is director of rates, there you are. Okay, Emily, director of rates and forms from DFR, thoughts? Hi, so for the record, Emily Brown, I was the director of rates and forms. I'm now the director of insurance regulation at DFR. Oh, we gotta update our list. Okay, fairly new, so that's fine. Yeah. So at this point in time, the department does not support or oppose this bill, but what I thought it might be helpful to do and I'll let you obviously decide is if I walk through what our current law allows or requires. Yeah, that would probably be a good foundation. Yep, okay, all right. So currently, and when I'm talking, I'm talking about all insurance. So I know that Senator Lyons mentioned life insurance and long-term care. What I'll be talking about is really the requirements for all insurance at this point because it is all currently grouped into one section of our law. So as of now, insurers cannot use any medical information, including genetic testing, if it does not relate to the risks that is being insured. So the burden is on the insurance companies currently to prove that if they are using information, your medical record, that it actually is having an impact on the risks that they are assuming. Another piece of Vermont law, which I think is important to this discussion is that insurers are not allowed to require any individual to undergo genetic testing in order to procure insurance. And then they're also not allowed to use any of a family member's genetic information unless it's in the policyholder's medical file. And I do believe that Vermont does currently have one of the strongest or restrictive genetic testing laws in the country. And so I think I'll just leave it there if there are any questions about how the current law is operating. So currently, you cannot use genetic information you cannot require a genetic test or anything. Exactly. If one has been done and it's in your medical records, that either you or one of your siblings has the female gene that's connected with ovarian and other female cancers, that's in your medical record and you are going for health or perhaps life insurance, then that information could be used because it impacts the risk and that influences your rate. If we didn't allow that to be used, does that mean that the pool as a whole would, that that risk would get spread out? Yeah, so just one clarifying piece before I answer your question. So for major medical or comprehensive health insurance, currently they are not allowed to underwrite. So if you are purchasing a plan through your employer or on the exchange, they are not allowed to underwrite you. So they can't look at your medical information currently and reject or raise your premium based on if you have some genetic predisposition. But so what it would essentially do or what the risk is, is that if an insurer, for instance, a life insurer doesn't have access to information, maybe you've had a genetic test and if they aren't allowed to access that information, that could then potentially lead to individuals who may know that they are at higher risk of something than going and purchasing a policy, maybe for a higher amount than they would if they didn't have that information or purchasing a policy when they wouldn't have previously without that knowledge. So that is a potential outcome. There's obviously, and I'm sure you'll hear about it later from the other witnesses, but there's also the risk of maybe people not undergoing genetic testing if they feel like they can't then procure a life insurance policy. And in this instance too, I do believe the bill is modifying not only for life insurance and long-term care, but it would also put restrictions on the ability of, for instance, disability insurance companies, I believe, sometimes use family medical history to determine your insurability. So I believe that the impact of this would extend beyond the long-term care and life insurance market in effect. So there's disability. Yeah. Okay, maybe workers comp. All right. Questions for Emily at this point. And Emily, is there a chart somewhere with what different kinds of insurance are allowed to consider? Yeah, so right now, and are you just talking about for genetic testing or are you talking about generally? I think medical records and genetic testing, but if you've got it just generally, that might be helpful for us to have just to know where we're starting. Yeah, and so currently as it stands, health insurance, major medical health insurance is the only line of insurance in our state where you cannot use an insurance medical record to determine insurability or underwriting or the premium that they'll be charged. Conditions, yeah. Exactly, and in a Medicare supplement, but that's kind of a different situation. Okay, yeah. All right, but you can in other insurances. All right, but you can't require that the test be done. Exactly. Okay, any questions for Emily at this point? I am not seeing any, so I'm gonna move to Jill Remick. I'd say welcome back, not Remick, this is Rickard. I am gonna have trouble with those names. I should never have them both on the same agenda. Welcome back Jill Rickard, new hat. It wasn't too long ago, you were here in another job, but welcome and tell us where you are now and what you'd like us to hear. Thank you, Madam Chair. I actually used to get emails for Jill Remick and she used to get them for me, so. Yeah. So thank you for having me. My name is Jill Rickard and I am now representing the American Council of Life and Chairs. I have with me as well, Dr. Dave Rangicherry who serves as a medical director on behalf of ACLI and he will be able to answer any. I'm glad you pronounced his name because I just massacred Mazer, so. Yeah, Rangicherry is, or you can call him Dr. Dave. Okay, I can do that. So he can answer any technical questions you have about life insurance and writing. So a little, the American Council of Life and Chairs is the leading trade association driving public policy and advocacy on behalf of the life insurance industry. 90 million American families relying on life insurance industry for financial protection and retirement security. We have 280 member companies and they represent 94% of industry assets in the US. Each day, life insurers pay out $3.6 million in life insurance and annuities to Vermont families and businesses helping Vermont to secure the things that matter the most through all stages of life. Did you just say $3.6 million a day to Vermont? No, that's gotta be. I'll get back to you with the correct figure. I apologize, that's what I wrote down, but you may be right that it's not. I know, it just, it sounds high, but. It does, you're right. Let me check on that. You may have some expenders there, so okay. Yeah, go ahead and check that one. Thank you, the ACLI opposes S247. As Director Brown explained, unlike health insurers, life insurers have only one opportunity to evaluate a person's risk before issuing a policy that will remain in place for the person's lifetime, which could be 30, 40, 50 years. Once a policy is in place, a life insurer cannot cancel it or raise premiums because of changes in a person's health or because of subsequent test results. For that reason, it's very important that life insurers have access to an applicant's complete and accurate medical record, which could include family medical history and genetic information. Insurance, as you know, is based on a relatively simple concept. A group of people can collectively bear costs that would be too great for one member of the group to handle on their own. Grouping people together makes it possible for an insurer to offer affordable protection against financial loss. As Senator Bray correctly noted after last week's walkthrough, this bill would create an opportunity for adverse selection. If genetic information is available to life insurance applicants, but not life insurance underwriters, then people with a high risk of disease may be more likely to purchase insurance and conversely, people with a lower risk may be less likely to purchase insurance and people masking a higher than average risk based on their genetic test results could purchase policies at the same price as people with a very low risk. As a result, the risk experience in the insurer's pool could be altered and this could ultimately destabilize the insurance pool and the market. To illustrate a basic example of adverse selection is if a smoker claims to be a non-smoker on their life insurance application and receives the non-spoking risk classification, if this happens often enough, then too many smokers get added to the non-smoking risk pool, then the premiums charged to the pool may be too low to account for the increased mortality and morbidity risks due to the number of smokers. The pool may eventually become financially unsound because the insurer is not collecting enough premiums to pay the higher rate of claims. Adverse selection is the greatest threat to insurer's ability to underwrite and price appropriately. Too many instances of adverse selection are likely to drive up costs for all future consumers and could affect the availability and affordability of insurance products. Life insurers ask is simple. They want access to the same information that the applicant has at the time of application. They do not view genetic test results as separate and apart from a routine medical file and they also don't view test results as definitive. Test results do not dictate the issuance or non-issuance of a life insurance policy. Life insurers take a holistic approach in the underwriting and they consider a wide range of factors, including the steps the person might be taken, taking to manage their health risks. In fact, genetic information could benefit a consumer in life insurance. For example, a person with heart disease that's taking the appropriate medications may pay lower rates, pardon me, than a person is who is doing nothing to address their health risks. In many cases, knowledge of a genetic condition encourages people to take a more active role in their personal health, which may in turn place them in a lower risk or a better risk category. Life insurers are in the business of issuing policies and want to provide life insurance products to as many people as possible, but also want to price those products accurately and make them as affordable as possible for all consumers. Today, 93% of people qualify for life insurance coverage the first time they apply. Vermont's existing laws regarding genetic testing already provide strong consumer protections and some of the strongest restrictions in the nation. I won't go into those as I was planning to do because Director Brown provided a good overview, but I do want to mention with respect to the privacy of genetic information. Life insurers do not share or resell genetic information to third parties. Our members take consumer privacy very seriously and abide by a wide array of federal and state privacy laws protecting not just genetic test results but all health information. During last week's meeting, the committee asked whether other seats been posed similar prohibitions on the use of genetic information. In our neck of the woods, Connecticut was mentioned. Connecticut did enact a law in 2021, but that law is almost identical to the provisions already existing in states in Vermont's statute. The Connecticut law prohibits insurers from using the results of direct to consumer genetic testing went 23 and B without the informed written consent of the applicant. We don't oppose that. It also prohibits underwriting based on a requirement of the applicant to undergo genetic testing or the results of a genetic testing of an individual's family member if they're not contained in a medical record, which is what we have in Vermont law. I also want to touch on underwriting based on family medical history. As written, we read the bill as prohibiting the use of family medical history and life insurance underwriting. Underwriting based on family medical history is a longstanding practice in Vermont and in all other states and no state currently prohibits this. However, I also understand based on the walkthrough last week that the carve out in section three of the bill, which would be added to eight BSA 3702 is intended to allow life insurance to continue to underwrite based on family medical history. So long as there is a relationship between that history and the cost of the risk undertaken. If that is the intent, then to accomplish this purpose, the carve out also needs to be added to the other relevant sections of law. In addition, we would request this exemption be permitted to apply to longterm care and disability income insurance. Finally, I want to mention as I sort of briefly touched on direct to consumer testing, such as 23 and me, the bill would prohibit insurance from insurers from requesting, requiring purchasing or using information obtained from these BTC genetic testing without the informed written consent of the individual who's been tested. We have no issue with this provision. Insurers do not use these test results nor do they underwrite or they don't access the test results nor do they underwrite based on them. ACLI members are committed to a robust and competitive insurance market that offers a variety of products that are affordable and meet consumers insurance needs. Life insurance companies have been able to provide affordable insurance coverage because applicants have shared with consent their complete medical records. It only makes sense that if a life insurance company is going to make a long-term promise that it knows an applicant's true health condition. Finally, Vermont consumers have long benefited from accuracy, transparency and confidentiality in the underwriting process. Prohibitions like those contained in S247 would result in higher prices and fewer choices for Vermont consumers. Thank you for your time and I would be glad to take any questions or to pass it off to Dr. Rangitari as well. Okay. Dr. Rangitari, do you have anything to add at this point? I would if you don't mind. I think there's several good points. I would if you don't mind. I've heard several good points, exactly. I think that maybe the two other things that I would want to make clear that have come up so far on the first one and this is probably the number one, two and three question that we get when these issues arise. Well, why can't you just maybe raise the prices a little bit and spread that risk around the pool? What I would want to make clear is that in this particular case and the way that this particular bill has been written and insurer would not be allowed to limit the amount that is applied for. So if an individual would normally apply for say 300,000 but now they knew they had a markedly reduced life expectancy, it would make all the sense of the world for that individual to apply for 3 million. Well, wait, why not stop there? Why not 10 million, 30 million? That kind of risk cannot be spread around but let me make it also more clear than how extreme of a bill it would be to completely ban the use of predicting diagnostic testing genetic testing in Vermont. This bill of course would not be limited to the residents of Vermont and what does build in any single person from the Northeast or honestly, literally the entire country would be able to go in to get into Vermont and get a policy that they would not be able to get in any other state in the union when you consider that addition of family history in particular. And so what this bill would be asking for were the residents of Vermont to shoulder the entire burden of the nation's unsustainable policies there. Again, not limited by a face amount. So for that, I just wanna make it as clear as possible or not exaggerating that this has real threats to the availability and the pricing of life insurance within Vermont. The third point that I would just wanna make briefly is forget about all the, for a moment about the financial impacts. I wanna speak to it for a moment from the fairness impact because I think if you just look at it from the outside well, boy doesn't really kind of seem fair to use genetic information. What I would wanna make clear as a medical director every day, we see applications for people with all sorts of diseases that they didn't ask for. We see people with multiple sclerosis. We see people with genetic information and we see people say for example with spinal cord injury that has nothing to do with genetic information. We make a commitment, a pledge to not play favorites in terms of medical disease, right? We go by the life expectancy and we don't pick and choose in terms of who we would apply it a treatment for. We don't make those decisions around a fairness. So with that, thanks very much for the opportunity and I'll happy to also to entertain any questions. Okay. Any questions for Jill and Dr. Ranjikari at this point? All right. Again, I think we're all on a very steep learning curve here. Some of us heard from, I believe Dr. Leonard last year. I think, yeah, you were in health and welfare. I think we, so, but the rest of this committee has not. So Dr. Leonard, I'm gonna go to you and then Dr. Wilden. Thank you, Senator Cummings and members of the Senate Finance Committee. My thanks to the senators who sponsored S247, including Senator Hardy from this committee. My name is Deborah Leonard. I'm here today to ask for your support of S247, a bill that would protect Vermonters from discriminatory practices based on their genetic information. To introduce myself, I am the chair and a professor of the Department of Pathology and Laboratory Medicine at the University of Vermont Health Network and the Robert Larner College of Medicine at the University of Vermont. In addition to my medical training, I have a doctorate in molecular biology, which is the study of genetic material used to control cell and body functions. My medical specialty is called Molecular Pathology or Genomic Medicine, which focuses on testing of genetic material, specifically DNA and RNA. I won't give you the longer technical names of those for medical purposes, including for cancer infectious diseases and inherited diseases. I've practiced for almost 30 years and seen major advances during the course of my career, including testing advancements that allow us to know the genetic sequence of an individual's genome for medical purposes, for research, or even for an individual's curiosity about their genomic information. I've served on a national genomics committee advisory to the Secretary of Health and Human Services and National Academies of Medicine Genomics Roundtable. In Vermont, we are transitioning our healthcare and payment models to a focus on early detection and even prevention of disease to keep people as healthy as possible. Overall health and wellbeing are determined by many factors. About 60% of overall health is based on social determinants, such as education level, income, which can determine access to housing, food, and medical care, and personal behaviors such as exercise, smoking, and diet. Information about all of these health determinants would still be available for life insurance companies to use for their underwriting, along with personal and family medical history. Medical care only contributes about 10% to overall health and wellbeing. The other 30% is determined by an individual's genetics, yet we do not use this information in healthcare. The University of Vermont Health Network is changing this. On November 1st, 2019, we began offering genomic testing to our patients through a group of our primary care providers working to integrate genetically determined health risks into the care of our patients. While we often think about genetic risks as rare conditions, genetic diseases are associated with approximately 6,000 of our 20,000 genes. And we are finding that single gene genetic disorders affect about 20% of the Vermont population and carrying a genetic change that could cause a disease in your children is present in about 80% of Vermonters. By identifying genetically driven disease risks before the onset of symptoms, we are able to monitor for disease onset, to identify the early stages of disease when interventions may be more effective, to provide appropriate treatments because we have a diagnosis. And in some cases, mitigate the onset of symptoms or disease through lifestyle changes or medical intervention. So genetic information is not always deterministic of disease severity or outcomes without options for healthcare interventions. I'd like to, if you'll allow me, share a personal story. My husband, Greg Merhar, and I gave each other our genome sequences for Christmas in 2014 and received our results in 2015. My results were rather boring, but Greg's results were life-changing. Greg's genome showed genetic changes that cause a genetic disease called familial Mediterranean fever or FMF. We realize now that Greg had symptoms of FMF since he was a child, but the symptoms are not very specific, although very severe and include extreme abdominal pain, slow healing of injuries, and general aches and pains. Over his lifetime, Greg underwent many medical studies and tried many over-the-counter remedies, but nothing worked. We didn't have a diagnosis. To our surprise and joy, we found that FMF is treatable with a drug called Colchicine, a drug also used to treat gout. Greg has been taking Colchicine since 2015 and is largely pain-free. He says he met me so he could get a diagnosis and feel better. This primary care physician has patients with FMF, but didn't really think about FMF as a cause for Greg's symptoms because Greg does not look Mediterranean. He has blonde hair and blots. So genetic identification of disease risks can help physicians also consider diagnoses they may not otherwise think about. And genetic results can be life-changing for people. Unlike Greg and me, who were just curious and bold about learning our genomic information, many people fear the misuse of their genetic information. So may not agree to have genetic testing to inform their health and healthcare. The Federal Genetic Information Non-Discrimination Act or GINA of 2008 only protects Americans from health insurance and employment discrimination based on their genetic information. But does not protect against other forms of discrimination based on genetic information. Vermonters may see the risks of genetic discrimination as greater than the potential health benefits and not agree to have genetic testing to inform their health care. These risks are documented in articles my colleague, Jason Williams shared with the committee. S247, if passed, would more fully protect Vermonters from discrimination based on their genetic information, including life insurance and long-term care insurance and help ensure Vermonters feel safe having genetic testing to help understand their disease risks and can take appropriate preventative measures to improve it. As we are already moving forward with broader use of preventive genetic testing here in Vermont, these protections will be important for Vermonters to benefit from this advancement in health care. Thank you for your attention and I'd be happy to answer questions. Questions for Dr. Leonard, Senator Bray. Thank you, Dr. Leonard. It's great to have you joining us here today, especially given how deeply you know this subject matter. So I'm just curious about how you think about the issue of adverse selection. So I'm entirely supportive of the idea that I hate to have people fearful from getting a test because they might think the information would then lead to negative consequences for them financially or otherwise. And then maybe foregoing diagnosis the way your husband had it and then treatment. So that's definitely not anything that anyone wants. But I'm just wondering if someone does undergo some sort of genetic analysis, find something and it has consequences and it then drives adverse selection. How do you sort that one out? So while I like to think of Vermont as leading in the US and in healthcare reform and we are, the United Kingdom is also offering genomic testing and has protections against misuse of genetic information and use of this information in life insurance underwriting. And there have been no adverse effects on underwriting or life insurance companies in the UK. Canada likewise does not allow this. Florida and California also have laws in the United States that prevent this. So there have not been adverse outcomes with these types of blocks on using genetic information that is not part of the medical record and medical and family history can be used. So from family history, you get some genetic information. Sure. In other places where this has been done, there has not been a negative impact. Okay. If the genetic testing is part of your medical record because insurers can't require that you have a genetic test now. But if there's a family history of a certain cancer, I know I'm always asked that would be okay to use, but if there has been a test done on your sister and it says, you know, that the gene is there for that whole array of female cancers, ovarian being the big one, the insurance company could not use the test or could not know about the test. Correct. So right now, they can use the family history that you have a sister who had early onset breast cancer and even had genetic testing if it is in your medical record that shows that there is a BRCA one or two gene. That shows that there is a BRCA one or two gene mutation that caused this. But you couldn't use that. Breast and ovarian cancer.  And that is very important information for a patient to feel safe. And we know that studies have been done and patients refuse to have the testing because of a fear of not being able to get life, long-term care or disability insurance. Okay. So this should not be. Once you buy a life insurance policy. So I can see if you're 22 and you don't have life insurance. But once you buy a life insurance policy, they are not privy to any tests you would do. I think that was, I see duck. So we're dealing with this probably a fairly small group. Well, right now in Vermont it's becoming a larger and larger group of people who will have genetic information in their medical record. And we have to inform them that Dr. Wildon will talk about this. We have formed them of the risks that they may not be able to get life insurance or it will cost more or long-term care insurance or disability insurance. And some of our patients are choosing not to get this testing done. And yet we're finding that 20% of people we test have something that's medically important and 80% of them are carriers for a disease that could be passed on to their children and show up unexpectedly. Okay. Other questions. Dr. Leonard, you said you had submitted to the committee and I've got my documentation or you said your colleague had but I think you may be thinking of the Health and Welfare Committee. Jason Williams should have provided my testimony to the committee. Otherwise I can provide it to face. I'm just looking for the documentation that shows statistics for how many people refuse to go forward because they're afraid they can't get life insurance. I think that was the context you said there was documentation. There are articles that Jason Williams provided. Jason, has Jason been here? We can provide that. Maybe he was last week. I've got the wrong screen up but I just wanna make sure we get that information. Okay. Any questions for Dr. Leonard right now? Okay. We're gonna go on to Dr. Robert Wilden and Dr. Wilden, just tell us your name because we need a voice to go with the name on the tape and who you represent and the floor is yours. Madam Chair, just one second just to clarify for what Dr. Leonard just said I think he sent it to us on the 24th of January. Okay. And he's essentially the lobbyist for UVM. Okay. That's why he sent it. Okay. Yeah, just so you know. If it was there, I didn't think we had heard from him but if it is on, if we've got it, then that's fine. Okay, that's, I just wanna make sure we have it. Okay. Sorry. Thank you. Dr. Raina Chandra had his hand up for a question. I don't know whether you wanna go with that or me first. Wait, who had their hand up? Okay. I'm getting notes here on. Dave Rugginshaw, Shari. I have you on my agenda and I think you're the last.  Yes, I just, I think that's very generous, Dr. Will. I just wanted to make one quick comment because it was brought up that there are legislations in other jurisdictions there, but two things. Number one is that those would in many cases limit the amount that we're talking about to the hundreds of thousands of there. This bill has no such a limitation. And the second is, is that this bill would introduce family history into that ban by our reading. There is no law of such an in the nation or otherwise I see some shaking of head so that if that's not the intent, that's welcome shaking of heads and obviously look forward to that conversation. Okay, we're gonna, we will go through this but basically if there was some limit, like if you were going to take out a million dollar policy, something above the norm that further testing might be allowed that would limit adverse selection. There are all sorts of avenues to provide reasonable protections that we've worked at now in dozens of states for both consumers and patients alike. And so absolutely hope and open to any of those types of things short of what this bill would do, which is an all out ban on predictive diagnostic testing. Okay, so we will take a look at other states before making any decisions. So I'm going back to Dr. Wilden and I probably massacred your name too. No, actually you got a perfect, thank you very much. Okay, one for me this week. Great. All right, good afternoon, Senator Cummings, Senator Lyons and members of the Senate Finance Committee. I am really grateful for the opportunity to explain today why I ask you to support S247, a bill to prevent discrimination based on inborn and unchosen genetic characteristics, principally before they cause symptoms or even diagnosed. I'm a medical geneticist. I specialize in the diagnosis, management and counseling of individuals and families affected by genetic disease. My clinic is at the Children's Specialty Center of the UVM Medical Center in Burlington. I and my geneticist and genetic counselor colleagues see patients of all ages who already have genetic disease or who have symptoms that might signal a genetic condition. We also see healthy people who have a blood relative diagnosed with a genetic disease and are worried they may come down with the same thing. People who want to expand their family worry about passing something on, they may not even know they have. Genetic testing is one of the tools we offer them but it comes with a catch for those who don't have any symptoms. In seeking the knowable risks, they can lose access to resources and services many of us take for granted like life insurance. It's difficult to watch as people try to make the best decision for themselves and their families under this odd paradox. For most of my career, the only way to prevent disease was through family planning and for a very few rare disorders, special diets. This is changing. More and more treatments exist for both rare and common genetic conditions. At the beginning of my career, children with cystic fibrosis rarely lived past 20 and people with Marfan syndrome often died before 35. Now people with Marfan syndrome who are diagnosed early have a normal lifespan and thanks to improved care and amazing breakthrough medicines, people with cystic fibrosis may live to be as old as you or I. Cancer is more treatable when it is detected at early stages. Early treatment also costs less and has less impact on one's family and livelihood. The same is true for genetically driven disease. Marfan syndrome and cystic fibrosis have early signs that astute healthcare providers can recognize, but many genetic disorders destroy silently undetected in routine care. Genetic susceptibility leads to advanced cancer at young ages when it's not on anyone's radar. Susceptibility to heart rhythm disorders can end teenagers' lives suddenly, something that if known in advance is preventable. Screening for genetic susceptibility, either in those with disease in their family or with DNA screening tests allows for early medical treatment. Even without preventative options, education for self-efficacy helps people at risk recognize warning signs and when they occur, seek care immediately. We don't know everything about how to use hidden information in one's DNA to improve health and wellbeing, but we know enough to make a difference. We manage uncertainty as we do always in medicine and we learn something every day. People deserve a choice to have that information and share it with their healthcare providers without fear that it will disadvantage them and their desire to protect themselves and their family. Fear of negative consequences, real or imagined, has dramatically impacted willingness to take even simple measures that reduce the risk of death or disability. We've experienced that intensely over the last year. Within the realm of genetics, scientific studies have found that people often choose not to get genetic testing because legal protections against non-health uses of the information are incomplete. And I'll insert here that many of those people, if they got genetic testing, would find out that they aren't at risk and don't have to complete a bunch of medical screenings just because there are risks by family history. So they lose the opportunity to find out that they're actually not at risk. Amazingly, this state officially recognizes this gap as real. Both Vermont and New York require people seeking medical genetic testing to sign a written informed consent that includes information on the risk of non-health insurance discrimination. So as a physician, what that means to me is I'm charged by the state with informing someone of a risk that they may have if they get genetic testing that's protecting the interests of an entirely different industry. The state also recognizes the value of early detection and treatment in the routine process called newborn screening. We screen every baby to prevent death and permanent disability from a small number of treatable genetic disorders. I'm here to support S247 because it will help people to gather and use their own private genetic information to take control of their own risks without fear of losing something else. Thank you. Okay, thank you. Do you have a copy of that informed consent? You could email to us. Yes. Okay, that would be good to see. Senator Bray. Thanks, Dr. Wilden. Just a quick question. We're all coming in as a committee to this discussion now, but I'm just wondering in how many years this will be would you think that this might become routine part of your medical care that we will use this kind of screening as part of you may not even need to be sort of called out as particularly at risk. It'll just be an ordinary screening procedure. So an ordinary screening procedure like colonoscopy for colon cancer or mammography for breast cancer beginning at a certain age. And what we would do if someone has a predisposition to those is to start those screenings earlier. And it's hard to predict. We're trying to pilot that idea right now. And it seems to be giving us useful information. And so it's really a matter of how quickly we can sort of diffuse that idea and disseminate it and make sure that it's not a financial barrier for people so that everyone can get the same benefit. I mean, I think part of the reason I'm asking it is kind of a closing either opening or closing the door and the barn after the animals gone. So it's making me think if we are prevent, I'd love to know how many people we're preventing from moving forward. And if that number is gonna only grow year by year then that would be of concern. Yeah, I think that's what we're concerned about. I mean, we know that it's impacting people now even when they only come in because of a family history of genetic disease. But when we begin screening people that are known to have a family history of that then that could be a much, much larger group of people who would potentially refuse that opportunity. And I think the area that this committee is focused on is it seems to be life insurance, not medical insurance and trying to limit the adverse selection. I mean, if I didn't want my life insurance impacted by a genetic test, I think I'd go out and buy the life insurance two days before I got the genetic test. Maybe I'm just cageier than other people. But I think it's finding out that and I am forgetting the disease but you're almost guaranteed to die in your 40s. Yeah, folk singer, not Arlo, Arlo's father, Woody Guthrie died from it. If I knew I had that and I was 29 or 35 I might be inclined to go out and buy a million dollar life insurance policy knowing I might only live four or five years so I wasn't ever really gonna pay off that policy. And that a couple of those, a million, three million could make life insurance less affordable. And then I don't know if they could come into this state and buy an insurance policy they couldn't in another state. So I think we need to look at that. I don't think we wanna deny people life insurance but I think we do wanna prevent them from really impacting the life insurance market so that you end up pricing other people out of it. So I think we'll look at that, Senator Pearson. Thank you, Madam Chair. I'm wondering if any of our witnesses and perhaps particularly folks representing insurance could just help me understand from your point of view right now the problem when you have access to the genetic history all of the specter that we're discussing right now exists today and the insurance risk and the actuarial risk is all sort of the same today. And as I listen to the discussion I'm sort of wondering, well, okay, we're helping individuals understand their particular situation but the pool of remonters in this case looking to buy life insurance, the health isn't changing. So help me understand what, I guess you've mentioned the cap and maybe we could look at that but help me understand what really is the difference because I guess I'm not seeing it. So, well, first of all, to be clear we're not advocating for a change here and what the basic principle that we're advocating to maintain is one that we call a level playing field that is central to the core of life insurance underwriting and that's basically that whatever information is available to the applicant that if they are looking to buy a voluntary policy at the amount that they choose that they are willing to share that information with the insurer and not keep selective pieces of information available, especially then to Senator coming up, I think she's referring to Huntington's disease absolutely corrected. If you have a markedly lower life expectancy and you knew that then it would only make all the sense in the world to buy an enormous policy to her point that she would have gotten that testing two days before, I mean, I'm sorry, gotten the policy two days before getting the genetic testing, we would be fully supportive of that because again, the idea here is that you are level with your understanding of your own medical history and we would absolutely encourage and have encouraged with genetic counselors and physicians that open transparent discussion around insurance before the genetic testing is pursued or only ask is once the genetic testing is pursued and the results are negative that it seems only at that point to be fair and reasonable in terms of the sharing of information. One more point I just have to make and I apologize to be absolutely clear in Dr. Wilden's example that if there were an adverse family history but the genetic testing were negative, well, the way that the law is written is that you could not use that negative genetic testing in favor of the person applying for insurance. So that's the kinds of ideas that happen when you try to move for these complete bands on certain types of principles. And it's been testified that this kind of a bill is law in Florida and Canada and the UK, are you predicting the market's insolvent there? I mean, is it crashing? What would we know or what are you seeing after in the places that have already made this change? So two comments on that. So one is the UK and other countries an entirely different, of course, system around that but an entirely different law in particular, a mark of limitation of their restrictions in terms of the amount that we're talking about, right? So a moratorium in the hundreds of thousands of dollars and other countries have said, okay, for these, you know, six conditions there will be principles around that but for the remainder of conditions is a different set of principles. There are other jurisdictions where it's entirely tour, I mean, life insurance is a long, you know, a land business, right? And we're talking in some cases about laws that are, you know, two years on the books. The final thing I'll mention about Canada, of course, is that is a federal bill and there you don't then run into the issue of one state doing something that the entire rest of the nation is not doing and then people being able to come into that state to purchase insurance selectively. We already have that with Florida. To say Florida, there has that but they do not have the family history piece. And again, I don't want to present Florida as going well, right? Because we are already hearing those stories out of Florida where people are not able to use information in favor of the applicant as examples and then types of things where insurers would love to partner with applicants in terms of bringing out these types of testing, encouraging these types of testing but not being able to incorporate that type of testing into product because of the way that the Florida law is written. So I wouldn't portray the Florida law as going well. Okay. I'm going to go to Senator Bray. A quick question, it's probably again for one of the folks representing insurers is, I mean, I'm just trying to think all the way around the issue and one thought that occurs to me is if people get tested, they're probably highly motivated if they discover something to pursue a course of treatment that's beneficial to them. So it also seems as though it could confer a benefit on the people you're insuring as in, they discover something that might have gone undiscovered and would develop further for longer and by finding out sooner, they may have better than predicted outcomes because they've been proactive. So is there no benefit that accrues to that side? Oh yeah. I think you've been at this for longer than you're letting on because these are the exact types of questions that we go through. And these are the types of questions that we go through when we make individual ratings and actuarial assessments, they're absolutely, you're exactly right. We take in both the negative factors and the positive factors and we make the fairest assessment possible. But that's all we're trying to say here is don't remove only one side of the equation because the actuarial is gonna be the first person to raise his hand or her hand and say that's not sustainable. Okay, so right now, you cannot require genetic testing. So the only way you can get genetic information is if it's in the medical record. And I'm assuming if I wanted to have a test done and not have it sent to my general practitioner, I could prevent that information from being sent to my doctor. So it would not be in my medical record. It might be on the computer somewhere. So right now you have access to my medical record, which I have some control over and you have access to my family history. What this would prevent is if in my medical record it said that my sister or my mother had genetic testing and these were the results. You could not know that. You could know now whether or not my mother, my grandmother and my father had all died of heart disease or but you rely pretty much on me to tell you the truth. If I don't wanna tell you the truth, it's not there. I mean, my doctor relies on me to tell her the truth about family history. So I'm wondering, I wanna see the information on how many people actually don't get genetic testing because they're afraid they won't get life insurance. And then I wanna see what other states that ban genetic information do about limits on life insurance. I don't think I wanna become a Mecca for people if they are able to come here. I somehow just don't think you can walk into Vermont and buy a life insurance policy if you're not a resident but I'm gonna check that out. And I don't, Emily popped back up. Can I just drive over the border from New Hampshire and buy a life insurance policy? You cannot. So legally you're supposed to have a Vermont residence to be able to purchase life insurance in the state. I'm not sure if that's how it works all the time. Yeah, if I had a second home here and I lived here four or five months of the year, I assume I could get, I've got a Vermont residence. So I could under those circumstances, all right. But I couldn't drive in from Ohio and buy a policy. I'll defer to, I'm proud on that. I obviously would very much want that checked because in our understanding and other discussions it's any contract in which the state is signed regardless we're talking about multiple millions of dollars available. And the question is, is would you change your state of residence if the answer were multiple millions of dollars? That I could leave to my family because I know, yeah, okay. I have a feeling we may be dealing in some extreme cases. So I wanna see if we can get a hold to NCSL and there may be end coil has some, and yeah, there's enough insurance organizations out there to see what the experience has been, what other states laws are, what their experience has been. I will grant you that other countries have very different systems. So I think we're gonna look at this country and we'll see where we go from there, all right. Cause the insurance is really what we need to be looking at. And right now it is after five. And so I thank everybody for hanging with us. This is the legislature, the floor went long and everything got pushed back. So I appreciate you being with us and I'm glad I'm not sending you out into the snow. I hope many of you are zooming from home, or at least at your offices. And thank you all and we will, committee, if you think of anybody you'd like to hear from or questions, email them in and we'll try and get some witnesses and see if we can't get this one out. We've got a couple of big bills we do need to get out. So thank you all and I'll see y'all tomorrow.


The tube sock murders are believed to be the work of a serial killer who has never been caught. He took the lives of at least four people in Mineral Washington and possibly others too. In August of 1985, Stephen Harkins and Ruth Carper worked at a vocational school in Tacoma. When neither Stephen nor Ruth turned up for work the next day, they were reported as missing, two days after they were last seen alive. Stephen's missing body was found by hikers in his sleeping bag at a campsite. His lifeless dog was also found at the same campsite. Ruth's remains were found two months later, half a mile away.  Months later, Mike Reimer, Diana Robertson, and their young daughter planned a camping trip. As the true crime story goes, on December 12th, the day the couple were last seen, their daughter was found abandoned at a Kmart parking lot. Mike and Diana were never seen again, and the killer has never been caught.


In this episode of Mind Pump, we talk about something that annoys probably everybody that works out in the gym. All of us have that one body part that for whatever reason, just a stubborn. Like everybody, every other body part responds and reacts and we work out and they change. And there's that one body part that just is so stud, just doesn't listen to anything that you tell it. It's like an annoying teenager. Well, in this episode, we actually give you the solution for stubborn body parts. You don't have to have a body part that doesn't respond. Believe it or not, we have worked with many, many clients on fixing this issue and actually turning a stubborn body part into a strong body part. Now there's four key components that we're gonna cover in this episode. The first one has to do with poor connection. Then we talk about ranges of motion. Then we talk about lack of prioritization. And then finally, bad programming and don't worry, we give you the solutions. Now in this episode, we do talk a lot about priming and how that can contribute to getting stubborn body parts to finally respond. Now, if you're confused by the word priming or you don't know how to really assess your body to figure out how to prime your body properly, if you go to mapsprimewebinar.com, we're actually giving a free priming class. Justin is teaching the class. He's gonna teach you how to do a self-assessment so you can assess your own body, figure out where your movement issues are.  Now the classes, when they're being put out there live, we're all gonna be on there answering questions. So we'll be on there active. So if you ask us questions, we'll be right there. But if you miss the class, don't worry, you get a free replay. So no matter what, you get to watch the whole class, you get to learn how to assess your body and you get to learn how to prime your body. Again, it's mapsprimewebinar.com. It's free. Make sure you go there and it'll help you out. Also, this episode is brought to you by Legion, one of our favorite performance-enhancing supplement companies. They make amazing supplements like protein powders, pre-workout supplements. They have a creatine supplement, which is excellent, one of my favorite creatine supplements I've ever taken. Now we work with Legion because they're very transparent. When you look at the label, it tells you exactly how much of each ingredient is in the product. They have third-party testing and they only use efficacious doses. So that means if you're taking a pre-workout and there's beta-alanine in there to help you with stamina and strength, the dose of beta-alanine that's in there is the one that's been shown in clinical studies to be effective. Many supplements will have the ingredient that you think is gonna work for you, but they put it at such low doses, they pixie-dust it in there and you get no benefit. Legion doesn't do that at all. They have one of the most popular supplements is their pre-workout supplement and it comes with caffeine or without caffeine, so you can actually get it stimulant-free. So here's the deal. Because you listen to Mind Pump, you get a discount on any Legion supplement. Here's what you do. Go to byLegion.com that's B-U-Y-L-E-G-I-O-N .com forward slash Mind Pump.   So go make sure you check that out. Also, all month long, MAPS Starter, our wonderful at home, Physioball dumbbell-based workout for the whole body is 50% off. Here's how you get that discount. Go to MAPS Starter.com that's M-A-P-S-S-T-A-R-T-E-R.com and use the code Starter50. That's S-T-A-R-T-E-R-5-0, no space for the discount. Let's talk about one of the most frustrating aspects of working out. Easily, for me, the most frustrating and it's gotta be for a lot of people.  And it's the stubborn body part. It's the body part that like it just doesn't seem to. It just doesn't respond, doesn't grow, doesn't do what you want it to do. Everybody's got one unless you're that genetic freak who is blessed to be, you know, that was born to be a bodybuilder. It's super common. Like every person has that one body part, right?  Well, it's really in relation to the rest of your body because if your whole body's stubborn, you don't have a stubborn body part, you're just not, everything matches.  Like what's going on? Is it not there? You know what, there's very few, like can you think of, I like this conversation, I'm glad we're going this way because this should strike a chord with everybody because as I'm like recalling all the people that we've trained, I think I've seen a pretty even split of every body part. Like I've definitely had plenty of clients that couldn't get their butt to grow. I've had plenty of clients that couldn't get their calves to grow, I've got plenty of clients that couldn't get their chest to respond, like every muscle group I think I have seen, and I would say all of them are pretty damn common. Maybe shoulders would be one of the least, but even then I think I've seen that too. Like- Yeah, that was Doug. Doug's stubborn body part was delts for a long time. So yeah, no, we have someone in the room who's had that one. Yeah. I've seen them all.  Now personally for me, you know, I've had shoulders at one point was a stubborn body part. My calves were stubborn, still are. Chest, that's my nemesis. It's still, I would consider a stubborn body part, but I've gotten it to go very, very far from where I was. So I personally have dealt with this myself. Now here's the interesting part though, is that we're saying that and we're claiming that. And I agree with you because my chest was that. At one point I would even thought my shoulders, my calves. So, but more often than not, it's not stubborn. It's not stubborn that it's- Like that's not something intrinsically wrong. Right, exactly. Right, right, right. There's things that need to be addressed. And that's, so we should definitely dive into that. Yes. Because one of the things that all the muscle groups that I thought were so stubborn on myself, there was a missing component or something that I wasn't doing. Yeah, I'm glad you went there because there are definitely genetic factors that can be used in the future. Genetic factors that can make somebody parts appear to respond better or to look more stand out. That's definitely true. So I don't wanna discredit that. I don't wanna invalidate that particular factor. But the fact is that the genetic components, which I'll go over, the genetic components are things you can't control. So it's kind of a waste of time to focus on them anyway. So what's one genetic component? Well, the length of what's called the length of the muscle belly, maybe one, right? So if you have, so if you, when you look at a muscle and you go from tendon to tendon, right? So look at your bicep that goes muscle belly. This is where all the muscle fibers are. It's the bulk of the muscle. Then it goes into connective tissue and then tendon. The muscle belly itself can genetically be longer or shorter or shorter. So if you look at someone, if you look at a bicep, if the belly itself is really short versus really long and you build them both, the longer belly just has more visual potential for growth. It's like calves. Like you ever see somebody with really, really high calves?  Yeah, they could develop them, but they're not gonna be like Justin's calves that go down to his heel. You know, he's got these really long calves. They go all the way down. They're very long calves. So there's a lot of potential. Now that's a genetic factor. So I'm not taking away from that. You just can't control that. There's nothing you can control about that. It is what it is. Besides that, what Adam's saying is 100% true. Nine out of 10 times, that's not the main reason why the muscle, that particular muscle isn't responding. The main reason has to do more with what you're doing or not doing. And that's why it's not responding. You have to do a little detective work to find out what the missing link is. Yes, there's a few favorite things that I would hear from a potential client.  And there's a few words and phrases that are what I would call like money phrases. And what I mean by that is you'd hear it and you'd know right away, I can show that person value in that. Like I'm gonna show them what I can do. One of them is pain. My shoulder hurts, my hip hurts, my knee hurts. And if it's not acute injury, I knew right away, oh, they're gonna love me after about a month or two because I'm gonna take away some of the pain. That's just so valuable, right? The other one was a stubborn body part. That was one of my favorites. Like, if I met somebody who's been working out, which is less common than people who don't work out, but there were decent chunk of people who were working out, who would come hire me. And they would say to me, and I'd ask them, well, what are your main goals with personal training? And they said, well, I work out all the time and my upper body is very developed and my legs just don't respond. Or my arms are just really stubborn or I can't get my back to really respond. I used to love that. It was a money phrase because I knew that there was something that I could do with them that would make that body part respond and then they would see the value in my training. I vividly remember when this came together for me. I had just finished up my corrective exercise specialist certification. And so I was early to mid-20s and really understood on a much deeper level than the surface level I understood lower cross syndrome.  When I really understood what was going on and that so many people suffered from that and why that also results in them being very quad dominant and not being able to develop their glutes and then what I needed to do to correct that and fix that, it was definitely, there was a huge explosion in my business at that time in my career because I became this butt guy. I became the guy who could help you start.  Yeah, it was a big butt guy for sure. You have the bumper sticker. Because I mean, that's a common one, right?  Totally.  That's extremely frustrating for somebody who's putting all the work in the gym, especially when they think they're doing all the exercises and doing the things they're supposed to. That was the most common one for me and all my clients that would come in in terms of like where they were not responding. That was like such a common thing because again, yeah, it's where it's set up, like the alignment and the way that their posture was stacked and everything. I mean, it just wasn't even there for them to recruit properly their glutes. And so that was just such an unlocking thing for me to be able to show them. Yeah, so think about it this way. The most effective exercises you could do for your body are typically compound movements. These are exercises where you're using more than one joint and this is widely understood, they're just very effective. Now your muscles work together like a team to have you perform a particular action, okay? This means that sometimes some muscles will do more work than other muscles and so this is just what ends up happening.  You know what I'm saying? Somebody whose chest doesn't grow often has great shoulders and triceps. Somebody whose back doesn't respond oftentimes has great biceps because they tend to work together with pulling movements and the other ones I talked about were pushing movements. There's another myth that I do wanna dispel though along these lines and this is a little bit more going into the weeds a little bit, so bear with me, but there's a myth that still floats around there that muscle fiber ratios in the body really determine if muscles respond more than others. Now there are two, this is very generalized, it's a little more complex in this, but there's two general types of muscle fibers. When you go into a muscle, the little strings or whatever are considered muscle fibers, and generally speaking you can break them up into two general categories. One is fast twitch. Fast twitch burns energy very quickly, burns out very fast, but generates a lot of power. Slow twitch is the opposite. It doesn't burn a lot of energy very quickly, it's got a lot of staying power, but it's got way less power. Fast twitch muscle fibers because their job is to generate power, getting bigger becomes very beneficial. They grow because it's bigger fiber, contracts harder, burns faster energy, but it contracts harder. Big less blood supply. Right, a slow twitch muscle fiber because it's goal is to give you more stamina, more staying power, it resists growing because a bigger muscle fiber just burns more energy and it wants to stay efficient. This is why sprinters who use power but burn out very quickly have bigger muscles than long distance runners who use the efficient, long lasting, slow twitch muscle fibers. Okay, so it makes sense that genetically you may be born with a propensity for more fast twitch muscle fibers, more slow twitch muscle fibers. That'll dictate to an extent how much muscle you can build. And then what people have done is they've taken that too far and said, oh, the rest of your body grows great because you have all these fast twitch muscle fibers. That one muscle group that doesn't develop well, your biceps, it's because you have too many slow twitch muscle fibers. Doesn't work that way. Your muscle, although some muscles generally have more slow twitch and others have more fast twitch, generally speaking, your whole body tends to match. You wouldn't have sprinter genes for your entire body except for your quads or your whole body except for your biceps. So that's a myth, that's a genetic myth that that's one of the main reasons. Besides muscle belly length, like I talked about before, the only things that tend to be the reason that this muscle group isn't responding has to do with things that you're either doing or not doing. And I think we should probably get into those. I like narrowing it down to what we think are the four key because when I was going through that, the corrective exercise specialist certification, and I learned about lower cross syndrome and I began helping people develop their glutes, it also, the light switch went off for me because at that time still in my career, I was struggling with my chest. And what you'll start to find is even though a chest and butt are completely different, the reasons why my chest wasn't developing is very similar to the same reasons why my clients glutes weren't developing. And so when that light bulb went off for me on how I could help them fix that, it completely changed my approach on how I trained and developed my chest. And the first one that I think of right away is just a poor connection. It's not firing. You gave a great analogy of what you see sometimes, somebody who can't develop their chest, well then that same person a lot of times has great anterior delts and or triceps. And that's because those muscles are taking over a movement that should be chest dominant. Just like the person who doesn't, that has the flat butt but has great quads, their quads are taking over the movement instead of their glutes. So even though we could talk about all different muscles, a lot of the common themes are the four main ones that we're gonna nail down to, will generally help you in, no matter what muscle. Chest and butt do have cleavage though. That's true, they do have something in common. Have you guys ever seen, I'm sure you haven't but I'll ask anyway, have you ever seen like a professional arm wrestler do a pull-up? You ever seen this? So they do lots of pull-ups, right? Arm wrestlers need very strong biceps. They need to pull very hard. In fact, certain positions in arm wrestling, I'm a little bit of a nerd with arm wrestling involves what are called pullers. It's a technique that you use. And so they do pull-ups to strengthen that pulling movement. But if you watch them do pull-ups. I don't even have to, I can tell you, I know how they do them. Yeah, it's an arm pull-up. Their back is supporting them, but they're not doing lat pull-ups. Didn't we do a YouTube video for pull-ups for biceps and we taught this? I think we might have, I think we might have. I love that you're going here. I wasn't even thinking this direction, but this is also how you can take one exercise and make it for a total different muscle. Absolutely. So if you watch these arm wrestlers do pull-ups, you'll notice rounded shoulders. It's mostly biceps and forearm. The back is there as a supporting roll, but the biceps and arms are doing most of the work. And of course we look at arm wrestlers, very developed arms, and their backs tend to not match their arms. Now pull-ups are known to be a back exercise. If you'd see a pull-up in a routine, nine out of 10 times, it's there because it's in back. People typically don't do pull-ups for their arms. Although they can be done for arms, it's actually quite rare. So it's all about their connection and how they're doing the movement. And what ends up happening over time is if you're doing an exercise, and I'm gonna put in quotations and my marks wrong, in other words, you're doing an exercise and you think you're trying to work one muscle, but in reality you're working with the supporting muscles, the more you do it that way, the better you get at doing it the wrong way.  In fact, a professional arm wrestler can probably do more pull-ups the wrong way than they could the right way, because they've trained it that way for so long. And that's where the poor connection comes from. So if you see somebody whose glutes tend to not be developed and you watch them do a barbell squat or a deadlift, you're gonna see more hamstrings in the deadlift and more quads in the squat, because the way that they're squatting is working other muscles more and other muscles less. And the more you do this, and this is why it's so hard, because when you're working with a beginner, all their body parts are stubborn. And I can start from scratch and I can teach you, you guys ever hear martial artists say it's easier to teach a beginner than it is to teach an expert into the martial art? Like if you're a tie boxer and you got a tight window black belt coming in, really hard to teach them how to do a tight kick. It's the same in music. I mean, like going in and trying to teach somebody that has already solidified the way that they, say it's piano, the way that they play the keys and they hold their hands up and all these, they've mastered their specific way of approaching this.  Exactly. Golfers will tell you the same thing.  And then all of a sudden you decide you really want to get serious about golfing and then you hire a professional and they just tear you apart. And it sucks because you'll end up regressing at the beginning because you've got to strip that person back down and get rid of all the bad habits even though they may have seen a little bit of success this way. And so the same thing goes with training.  Runners, sprinters or long distance runners. And then now they want to develop their butt. They're so used to running on their quads and training that way. And so, and your body, the way your body works, right? It doesn't go, oh, this is a chest exercise and it just automatically works the chest because it's supposed to be your chest. It's going to take the easiest path always. And so if you- It's gonna say press move bar this way. Exactly, move bar that way. That's how the brain operates. It sees that and it will default to what you are strong in. If you are somebody who has a chest that doesn't respond very well, but you've been bench pressing for a long time, right? One of the best exercise for chest. And let's say your max bench press is 250 pounds, okay?   This is why it can be so difficult. So I'm glad we're going here because the rule number one with a poor connection is to take 15 steps backwards. If you're doing pull-ups and your biceps are responding and your back isn't, rather than doing 15 pull-ups, you're doing three and your form is totally different. If you're bench pressing with 175 pounds and your chest isn't responding, we're going down to 115 pounds and you're changing your technique and really focusing on feeling the chest. It's gonna feel like an entirely new exercise. It is. So this is like a new skill you're developing. You have to approach it. Like I have to do this a completely different way. So yeah, you do have to acknowledge you're gonna regress, you're gonna start again from scratch. And since we're talking right now to people with stubborn body parts, which is assuming that you already worked out, you've already revealed to yourself that you have a stubborn body part, this is very important. Gotta take a bunch of steps back, identify how to get that muscle to connect. So in a bench press, what does the chest do? The chest brings the elbow to the centerline of the body. That's what the chest does. So I gotta change my technique. I gotta focus on that. That means I'm gonna have to bench press with like 70% or 60% or less of the weight that I'm used to. When you're doing a squat, what do the glutes do? Well, the glutes take your leg from in front of you and bring it to straighten your body out. They don't extend the knee, that's your quads. So I'm gonna have to learn how to sit back a little bit differently, how to activate the glutes. That means I'm probably gonna have to squat at like 50% weight and relearn. We are trying to reconnect. By the way, before you can develop a muscle, you have to connect to the muscle very well. It's not gonna work. It doesn't work any way. Well, it's a little more nuanced than that too. Like you just glazed right over two things that are important, I think, to know. Cause there's some people that understand how the chest works. Like, okay, yeah, move the elbow to the centerline.  So not only that, you have to learn to prime the body to be able to get the muscles that hold the shoulder girdle back in place while you also move that. So it's a little more nuanced. And the same thing goes for what you're talking about with developing your glutes. If you squat and you end up putting all your weight on your quads and you don't know how to move your hips properly, then you're still, even though your squat may look like it's a good squat, if it's not activating your glutes because you're quad dominant, there's more things going on than just actually performing the exercise. Yeah, I used to tell my clients, like first we gotta learn how to anchor the movement. And so like anchoring the movement, just like you said with the shoulder blades, bringing it back and being able to really provide stability first. Where are you gonna provide stability? How are you gonna hold your ground before even performing the movement? That's a vital part of that process, which then allows you to get the full access and full recruitment of your chest. Nine out of 10 times when someone has a weak body part and then you ask them, so they say, oh, my chest isn't developing. You say, do you feel your chest when you bench press? No, they know. Part of it's like, I do squats all the time. I just don't feel my butt. My quads get sore and I feel it in my quads. Okay, this is the real value of proper priming. I'm glad you said that, Adam, because if you prime properly, you can learn how to feel what you're supposed to feel because it's really, I'm gonna say this right now, unless you're very, very experienced with training, you know the nuances that we're talking about. You have to understand how to feel the muscle before you can feel it in the exercise. Just knowing form and technique, although very helpful, still can make it very difficult. I could tell somebody all day long who doesn't feel their glutes when they squat, here's what the glutes do, here's what the form should look like.  That's the part that makes a big difference and priming does that. I'm so excited that Justin is running this webinar right now because if you're listening right now and maybe you thought that this free webinar is not something that you need to listen to, but then this is resonating with you that, oh my God, I have a stubborn body part. You need to take that webinar. You need to go through that because more likely than not, this is part of the reason why. And so he's gonna go through there and show you the importance of these three core movements and then how to address it if you can't do it properly. And getting to that place is so important before you build on it or start to address the stubborn body part. Yeah, proper priming is like the magic wand for a stubborn body part. It really, really is because the big, I mean, we started with poor connection, but poor connection is the main reason why people have, but there's other reasons, which I wanna get into also. I think the next one, this one is also relatively common and it has, this one I see more often in men than women, mainly because we tend to ego lift a little bit more, which is just a lack of range of motion, a lack of full range of motion. And it tends to be because guys wanna go a little too heavy. Well, I would say that and then also if there was ever any previous pain or an injury or something that had followed you forever and you've been uncertain as far as like how far to go with the range of motion. And just doing that and repeating that range of motion, your body gets really familiar and comfortable with that. So it's hard to then really press yourself a little further beyond that. Oh yeah, I remember when I was younger, my back, I just couldn't feel, it's a hard one. Your back muscles, especially when you first start working out, it's hard to feel, hard to connect. It's behind you. I don't know what that's supposed to feel like or whatever. And so at one point, I considered my back, like maybe it's stubborn or not sure what's going on. And so what I did was, part of what I did, besides I did supersets, that helped a lot. I finally felt a little bit of a pump. But the other thing I did was when I would do a pull down or a pull up is I went all the way down to the stretch and went all the way up to the squeeze. I connected to the whole range of motion because up into that point, I was a kid working out and I just wanted to see how many more reps I could do or how much more weight I can use. And the truth is, of course, you can lift more weight when you do a shorter range of motion. I can half squat way more than I can full squat and I could do way more pull ups if I don't go all the way down to a stretch and go all the way up to where I get my chest to touch the bar and really squeeze. So that range of motion really does contribute to the first one we talked about, which was poor connection. Another one is the myth of tension. Now I blame bodybuilders for this. Bodybuilders, you gotta understand something. When a high level bodybuilder is communicating something to the average person, what they're often communicating is a technique that works for them at that point in their development. They're already jacked, they're already huge, they've been training for years, they've got crazy genetics, they might be on anabolic steroids. They've got great connection to muscles. Bodybuilders know how to connect to muscles and so they'll say something like, when I do a shoulder press, I don't lock out so I can keep tension on the shoulders or when I do a squat, I don't go all the way up because I'm trying to keep tension on my quads. Now this is a bit of a myth because the truth is you can keep tension on a muscle through stretch all the way up to lockout because it's intrinsic. Tension is an intrinsic thing. Now you can change your form to force you to have tension, but that's cheap. That's not nearly as effective as being able to connect to the movement yourself. So if I'm doing like a shoulder press, I'm better off going all the way up to lockout but not resting the weight on my joints but rather going all the way up and squeezing my shoulders, tensing my arms and maintaining that connection. That full range of motion and we know this, studies confirm this very, very well. They do show that for overall muscle development, longer range of motion or superior or shorter range of motion. This is one of the number one cardinal rules of, especially when you train people is to teach them how to do that. Wasn't our good buddy, Ben Pakolsky, the one that made the case for that. He's like the number one thing for him. He says is the squeeze. Yeah, the squeeze and the fully contracted position. Because it's poor connection. Like think about this. If you have a client whose glutes don't grow, how hard is it for them to squeeze it in the fully contracted position? It's hard for them to just feel it there. So people understand what you're referring to or what you're saying right there is that it's easy to feel a muscle in its stretch position because gravity is doing it for you. Think about being in an open position pulling a dumbbell for a bicep, right? Because it's stretched out. You don't even gotta think about it. You feel it pulling on the bicep but bring the arm all the way to your chest or bring it all the way up and you have to kind of intrinsically think about squeezing it because you don't have gravity resisting it in its stretch position. This is why I like isometrics too just because if you're focusing on this range of motion and you don't have that connection, you don't feel it, we can stay there a bit longer and really try and reinforce that process of how to recruit and how to generate that connection again and to be able to feel it is so important for you then to move forward and to be able to feel like you've got the strength and support you need throughout that range of motion. Yeah, so when I would train clients and they had a stubborn body part, I would focus a lot on the squeeze, always on the squeeze. Okay, we're at the top, squeeze your glutes. Okay, you're at the top of your bench. Hold it for a bit longer even. Squeeze your chest, connect to the chest. Oh, your shoulder, squeeze at the top. That squeeze, because that leads back to poor connection and the lack of range of motion contributes to the poor connection. Well, this is why I like what Justin just said because this is where isometric training really kicked in for me because I realized that, and I used to tell clients this all the time, like resistance training, all it is is flexion of the muscles with resistance. That's all it is. All you are doing is flexing the muscle. So the better you are at flexing this stubborn body part, the better you will be at developing it. And so, and one of the harder places to actually flex the muscle is in an isometric position because there is no movement, there is no gravity helping you out, there is no stretch position. You really have to learn to intrinsically do that. And so if you train that really well, then when you add resistance, you add weight, it's easier to make that connection. So this is another really great value in isometric training, another one of those lost arts that not a lot of people do. It is, and what helps you gain connection to ranges of motion? Priming. If you prime your body properly, now, so if I'm going into a bench press and my chest is a weak body part, the hardest part for me to feel my chest is gonna be at the top of the bench press. Okay, it is, it's just the hardest. How do I feel, you know, my chest squeezing at the top of the press, it's not even a full squeeze, like what is, but if I prime beforehand and I can identify the squeeze, and here's an easy, simple way to prime your chest. Now this isn't priming a movement pattern issue which is far more common. So what I'm about to give you is decent advice for somebody who's got good movement. I would grab a stick and I would just grab it and just drive inward with my chest, like I'm trying to slide my hands together but don't actually do that and squeeze my chest. Identify the feeling, so that's a form of priming, then I'd go bench press, now I know what to feel as I'm squeezing through. Now, as I said, for most people, it's more to do with lack of connection to the stabilizing shoulder blades and other parts, but priming helps so much with extending connected ranges of motion. So that's why again, it's so valuable bringing up stubborn body part. Now the next one that I think of is what made me realize that maybe I don't have as many stubborn body parts, I just, I'm not prioritizing. And I shared this story about, I did a YouTube video I think a couple of months ago about my shoulders and I had really, really terrible shoulders and it was brought to my attention by a female trainer of mine that was working for me at the time.  Oh, she told me out of me, I have very weak shoulders and that like just destroyed my ego. But the truth is at that time in my career, I, this is how I trained my shoulders. I thought, okay, they were kind of an afterthought. It was, well, every time I do heavy chest, I get some anterior delts. Every time I go a heavy back, I get some rear delt. Okay, I'll throw some lateral stuff in there. And then I'm done. And then I'm done. So it was just that, I would, of course I was getting my shoulder, and there's some truth to that because when you do your chest, you can't not use your shoulders. They're involved.  So, you know, my theory was they're getting plenty of attention and they, why aren't they developed that way? And then she really picked on me and then she said, listen, she said, why don't you start every week, every time you start a week off, you start with that area, start with your shoulders. And that was the first time I ever started like designating a workout for my shoulders. And I began to say, okay, if this is a weak body part, you know, because this happens to everybody. I don't care who you are.  Most people have, you know, ebb and flow of training.  Maybe even fall off for a week or two or even months sometimes at a time. And what the natural thing for you to do when you come back is to always gravitate towards the stuff you like to train. Yeah, we all have favorite exercises and body parts. Yeah, the stuff you like or you're good at. And the truth is, if you're really trying to develop a very symmetrical physique or work on a body part that is underdeveloped, then making it at the priority always. And this was something that I first started with my shoulders and then it ended up being my legs next that I started to think this way. I just made it a pack with myself that, okay, one, it's gonna start my week always off like that. And no matter where I end in my workout routine where I fall off for a little bit, when I come back, I'm always starting with the weak muscle. So I could have, let's just say, I've been on a kick for three months and I just had an awesome shoulder workout. Something happens in my life and I fall off for a week or two and then I come back to the gym. Well, I did shoulders last. So maybe I should do something. No, I'm gonna go right back to shoulders again. I'm starting again that week. So prioritizing was huge for me. Yes, and this is actually quite common. I mean, a majority of times when somebody has a body part that's weak, especially if it's for men, legs and calves and for women, arms and shoulders, typically I'm generalizing, but this is typical. Typically it's good. Athletes and Spiceps, I'm just gonna say that. Typically it's because they don't place as much prioritization or focus on them. If you really look at their routines, all my calves don't respond. I'm guilty of this. Yeah, my calves don't respond. I said it earlier in this episode. The truth is, what's the body part I've done, the least amount of sets, the least amount of exercises and what's the body part I never start to work out with, calves, right? So prioritization literally means you prioritize it. It's the first body part. By the way, studies show this. If you train full body, the body part or exercises you start with tend to get more of the gains. That's why you always want to start with the big compound lifts. But if you have a body part that's weak, you really want to focus on, start your workout that way. Never skip that body part that you need to train because that's a big one. Prioritize it, make it a priority, focus on it and that makes a big difference. I love that you brought that up because this was a question I know we've gotten a lot with people is because we've set up the programs in general to try and help the majority. But we always have encouraged people to modify. Of course.  But if that same person is like a major goal of theirs is to develop calves while they also do this program, that is an exception where I'd say listen, for now on start your maps anabolic with the calves in the front. Totally. If you think you already have good quads and a great bud and it's not like a major focus here, just by you simply addressing your calves first in the routine always will already make a huge impact.  Now this one I actually, and mainly because it was a body part I really, really liked to train and I really wanted to develop. When I first started working out shoulders were a body part that I was insecure about. I'm narrow naturally. I was kind of bony and I like the way I looked in t-shirts and I would follow my workout and I'd start to develop my arms developed very quickly but my shoulders kind of lacked. And so what I did is I just did more exercises, more sets and trained my shoulders more frequently. So I'd be out in the backyard doing laterals and presses and rear laterals. And you know what happened over time? It took time, but over time my shoulders became a strong suit. In fact, it's one of my better body parts but people don't know this. It started out being a weak body part but I had to prioritize it. This one takes a lot of self-reflection because I have trained many a times a dude that comes to me and goes my legs just don't grow. And what's the first body part they skip when they skip a workout? Legs. Does this just magically happen? Yes, yes. You have to prioritize it. Prioritize it. All right, the last one is probably, I'd say the least communicated in terms of which ones have the most impact although it's still relatively common which is just you have bad workout programming.  Now the reason why it's more common in women is because women are advertised crappy workouts more than men are. It's just the fact. If a workout is advertised to a woman it typically tends to be like don't do these exercises over here because they build bulk. Do these Pilates based exercises. They produce long lean muscles and do these short choppy exercises for your glutes because you feel the burn and use this hip circle because forget dumbbells and barbells and whatever because they'll make you look bulky.  And I look at their routine.  Like oh okay. It goes back to what you kind of brought up earlier about fast twitch, slow twitch, muscle fibers and like the difference between the two. And like you have to train your body completely different for both of those objectives. And that's something that again like with women that it's a very common that that's neglected and it's not advertised very often when in fact that's something that could stimulate such a massive difference for them and get like the kind of results they're looking for just by altering the amount of reps, the rest periods, like things like that that's gonna have a dramatic difference on the way that you're shaping the muscle now and getting more explosive response out of the muscle which tells it to grow in a different way. I'm gonna challenge that a little bit. I think guys are just up there too. And what I think about right away that comes to mind was the way Eugene Tao and I got connected was he did a post that was kind of encouraging the benefits of the hack squad and telling people that they don't have to squad. It's not a mandatory movement. And we had great dialogue. I challenged that way of thinking. And the reason why I did is from my experience with so many male clients that trained legs but it was leg extensions, leg curls, leg press. Yeah, that's true. You know what I'm saying? And then complain that their legs wouldn't develop and I'm guilty of this too. I mean, when I was younger, when I would squat my low back would bother me. And so I did all the alternative exercises and all the machines for my legs. And then, you know, bitched about why I didn't have great legs. And it was a lack of prioritization but it was also a lack of good programming. You know, once I learned the benefits of squatting and then when I learned how to deep squat, holy crap, I mean, I train my legs with less intensity, less volume today than what I was doing in my mid-20s and they're way more developed because of the exercise selection that I do now. I mean, if you just squat five to eight sets a week, it is, for me at least, I have found more value in that than 30 sets of leg press, leg extension and leg curls. That's true for most people. Throughout the week, yes. And that was a hard thing for me to get through my own head. And then it was a hard thing for me to communicate to a lot of my male clients and it's the reason why I challenged Eugene when he post that, not because I thought he was wrong but because, man, I remember myself at 20 years old. That's all you needed is a read a post like that. Yeah, give me a reason. Exactly. And if I was looking up to a guy like you and you gave me the okay to not squat, I bought into that and that's why I didn't because there were people at that time that were saying things like that, that how amazing the leg press could be and all these other machines, how they're great for leg development and nothing grew my legs more than learning how to squat. If you wanna develop your body and you wanna develop a weak body part, the routine needs to be centered around building muscle and building strength and it needs to be a good muscle building type routine. And if your program is not centered around that, then it's bad programming. You're not going to bring up a weak body part with a routine that's centered around shaping and small movements and yoga inspired and Pilates inspired and that kind of stuff. Nothing wrong with that. Those have their own values but they're not going to develop muscles nearly to the degree that resistance train, traditional resistance train will and they're definitely not gonna bring up weak body parts as quickly and what are some of the best exercises to develop your body parts? Free weight, barbell, dumbbell, compound movements and if they're not included in your routine as the primary exercises, you need to take a good look at your workout and of course sets and reps are your programs phased properly so you can go through different rep ranges and of course all the other stuff that we talked about. And I also wanna, here's another problem is and it's tough to get someone to break through this mentality is I feel it more when I do this exercise. So like sometimes you'll get somebody who doesn't like to do like a bench press or a squat because the exercises that are like machines that are more isolating exercises, they feel it because it's easier for them to feel there. That doesn't mean the exercise that you don't feel it so much isn't more valuable. It means you're not doing it correctly. This is what priming does. Priming, okay, so yes, you can feel the muscle more when you do a cable crossover than when you do a bench press if your chest is a weak body part. That's true. So the value of the cable crossover is there but the value is to prime you potentially for your bench press. That's where you get the value. This is the value of priming.  Of course not. The priming is what sets up all those awesome exercises I just talked about. Your barbell, dumbbell, free weight, compound movements. The priming sets you up so that those very powerful exercises now can give you what they can deliver, what their full potential can deliver. So that's the difference because I used to get that too with clients. Well, I know you're saying a barbell squat works is better for my butt growth but I feel these short dog pee exercises more in my glutes. I'd say, well, okay, you feel them more. That's great. Why don't we use those to prime the glutes, then do the barbell squats? Because by themselves, they just don't send. That's just the connection. That's not the work. That's right, that's right. You need the work to be able to change. And that's it. And look, check this out. Okay, we have a free class that's coming up. It's a webinar, it's online, it's unlimited, people can sign up. Doesn't cost anything. And Justin is literally gonna take you through a self-assessment. The self-assessment is going to identify root causes, root movement reasons why you may have weak body parts. And once you identify those issues, those root issues, which he's actually gonna coach you through, he's gonna show you an exercise for each of them that'll help prime your body, getting you to move better so that you can reap more value from I don't care what workout you're doing.  Just prime properly and watch what happened. That class you can sign up at mapsprimewebinar.com. Do it now. That way when the classes are broadcast live, Justin, Adam, myself, and Doug will be on there answering any questions. But if you miss the class, you get a free replay. So no matter what, you get to watch the entire class. Again, it's mapsprimewebinar.com.