One of my
fears when I wrote my previous post about Wi-Fi was that I was opening a
Pandora’s Box on the whole field of electromagnetic fields and health. As I
expected, shortly after I posted that blog a number of people tweeted to me
explaining how wrong I was about Wi-Fi, with many describing stories of
Electromagnetic Hypersensitivity (EHS). Well as my dad used to say: in for a
penny, in for a pound. I may as well cover that topic as well. In this post,
therefore, I will look into the topic of EHS and in doing so will re-visit the
concept of the Nocebo effect.
The World Health
Organization defines EHS as:
a variety of non-specific
symptoms, which afflicted individuals attribute to exposure to EMF
[electromagnetic fields]. The symptoms most commonly experienced include
dermatological symptoms (redness, tingling, and burning sensations) as well as
neurasthenic and vegetative symptoms (fatigue, tiredness, concentration
difficulties, dizziness, nausea, heart palpitation, and digestive
disturbances). The collection of symptoms is not part of any recognized
syndrome.
Before I can
go into a discussion of EHS, however; I will need to introduce a couple topics
I have not yet covered in my blog: the double-blind study and the concept of a
systematic review or meta-analysis.
In my
previous post Risk
Assessment Epilogue: Have a bad case of Anecdotes? Better call an
Epidemiologist I describe the field of epidemiology which the World Health Organization
defines as the study of the distribution and determinants of health-related
states or events (including disease), and the application of this study to the
control of diseases and other health problems. In the field of epidemiology the
most reputable testing is carried out through clinical trials. A clinical trial
is a prospective study in which humans are exposed to “something” at the
discretion of the investigator and followed for an outcome. The biggest problem
with clinical trials is that they are conducted on humans and by humans. This
is a problem because humans are not machines; we are a very social species who
give off any number of non-verbal cues every time we interact. This is a
problem in epidemiology because in order to confirm that an outcome of a study
is due to the “something” in the study, we have to ensure that those very
things that make us human do not influence the outcome. As a consequence, in
the field of epidemiology randomized double
blind placebo control (RDBPC) studies are considered the “gold standard” of
studies.
In an RDBPC study
both the subjects participating in the study and the researchers carrying out
the study are unaware of when the experimental medication or procedure has been
given. In drug tests this means splitting the participants into groups where
some of the participants get the active ingredient (or medicine) and the other
half are given a placebo (historically a sugar pill made to look like the
medicine being tested) and ensuring that the treating physicians are not aware
of which of the subjects got the real pill and which got the sugar pill. In the
testing of EHS this means that neither the scientist doing the experiment, nor
the subject of the test actually know when the subject of the test is being
exposed to an EM field. As I will describe later, a lot of testing has been
done on EHS using either double-blind or single-blind (the person getting the
test does not know) methodologies and as I will discuss the results have been
entirely consistent.
As I have
mentioned previously at this blog, the statistics we use in science are very
sensitive to population size (number of subjects tested). The more subjects
tested, the more likely you will be able to identify a small signal or weak
effect in a large population. The problem with clinical trials is that each individual
study is limited by its budget, its geography and the number of subjects it can
test. In a field like EHS there are hundreds of people all over the globe who
claim to be particularly sensitive to EM fields. They can’t all be tested at
the same time or in the same study so instead the literature is full of small
studies of a handful of individuals. In order to take advantage of the strength
of population statistics, scientists have developed the tools of the
meta-analysis. A meta-analysis
or alternatively, a review article,
represents an attempt by one or more authors to summarize the current state of
the research on a particular topic. In a meta-analysis the authors will often
combine the findings from independent studies in order to enlarge the sample
size in the hopes of identifying an effect that might have been missed in the
individual studies included in the analysis.
This long
introduction is intended to save me a lot of time because, like the study of RF
in humans, there is a broad literature on EHS and numerous reviews and
meta-analyses have been carried out. This is fortunate for me because that
means someone else has done all the work for me. So let’s see what the
literature says?
In 2005,
Rubin, Munshi and Wessley conducted a Systematic
Review of Provocation Studies on Electromagnetic Hypersensitivity. Their
conclusion:
The symptoms described by
“electromagnetic hypersensitivity” sufferers can be severe and are sometimes
disabling. However, it has proved difficult to show under blind conditions that
exposure to EMF can trigger these symptoms. This suggests that “electromagnetic
hypersensitivity” is unrelated to the presence of EMF, although more research
into this phenomenon is required.
Also in
2005, Seitz et.
al. prepared a paper titled: Electromagnetic
hypersensitivity (EHS) and subjective health complaints associated with
electromagnetic fields of mobile phone communication—a literature review
published between 2000 and 2004. Their conclusion:
based on the limited studies
available, there is no valid evidence for an association between impaired
well-being and exposure to mobile phone radiation presently. However, the
limited quantity and quality of research in this area do not allow to exclude long-term
health effects definitely.
In 2007,
Oftedal et. al.
conducted an RDBPC on mobile phones titled: Mobile
phone headache: a double blind, sham-controlled provocation study. The
results of that study:
The study gave no evidence that
RF fields from mobile phones may cause head pain or discomfort or influence
physiological variables. The most likely reason for the symptoms is a nocebo
effect.
In 2008,
Roosli conducted a systematic review on radiofrequency
electromagnetic field exposure and non-specific symptoms of ill health. His
conclusion:
This review showed that the large
majority of individuals who claims to be able to detect low level RF-EMF are
not able to do so under double-blind conditions. If such individuals exist,
they represent a small minority and have not been identified yet. The available
observational studies do not allow differentiating between biophysical from EMF
and nocebo effects.
Between 2005
and 2010 there was a lot of hype on the topic of EHS and as a consequence a lot
more research was carried out on the topic. As a consequence, in 2010 Rubin,
Nieto-Hernandez and Wessley carried out an updated systematic review of
provocation studies on Idiopathic
Environmental Intolerance Attributed to Electromagnetic Fields (Formerly
‘Electromagnetic Hypersensitivity’). Their conclusion:
No robust evidence could be found to support
this theory. However, the studies included in the review did support the role
of the nocebo effect in triggering acute symptoms in IEI-EMF sufferers. Despite
the conviction of IEI-EMF sufferers that their symptoms are triggered by
exposure to electromagnetic fields, repeated experiments have been unable to
replicate this phenomenon under controlled conditions.
Most
recently, in 2012 Kwon et.al.
did another review titled: EHS
subjects do not perceive RF EMF emitted from smart phones better than non-EHS
subjects. Their conclusion was like all the rest of the studies:
In conclusion, there was no
indication that EHS subjects perceive RF-EMFs better than non-EHS subjects.
As you can
see, the academic literature is essentially unanimous. Every case where a
supposedly EHS sensitive individual was put under a double-blind procedure the
result has been the same: the supposedly sensitive individual was unable to
perceive an EM field at a rate higher than would be contributed purely by
chance. Don’t even try to ask me about Dr. Havas and her study in the European
Journal of Oncology. As described quite clearly at Skeptic
North that was not a blind study and was clearly a case of someone not
reading the warnings pamphlet that came with her heart rate monitor.
You will notice above that most of the reviews attribute the
symptoms of EHS to the “nocebo effect”. I have
written about the nocebo effect before at
this blog but to summarize. The “nocebo effect” is the opposite of the
placebo effect. While the placebo effect has the ability to help you feel
better in the absence of any active ingredients, the nocebo effect has the
ability to make a person feel poorly in the absence of any active stimuli. As
described in this review
paper the nocebo effect is not as well studied as the placebo effect but it
has been demonstrated to be real.
It is important to recognize a couple things about the nocebo
effect. First and foremost, people who “feel bad” or claim to be “sick” via the
nocebo effect are neither lying nor are they fakers, rather they are doing one
of two things. They are either associating actual symptoms from other causes to
the “nocebo” or they are having phantom symptoms based on their minds playing
tricks on them. There are any number of celebrated cases where people have be
shown that their “illnesses” were all in their minds. By far the most
entertaining one is described in this article from Daily
Tech. In that case a community complained about EHS symptoms even though
the radio towers supposedly causing the symptoms had been turned off during the
time the community members claimed they were being made ill by the towers.
So to summarize, as I described in my previous blog posting,
untold thousands of studies have been conducted on Wi-Fi and the results are
clear, RF is not a serious human health risk. Rather, it is almost a perfect
example, a de minimis risk (which I discuss in another blog post).
As I discuss, a de minimis risk is a
risk that, while it may exist, is too small to be of societal concern. EHS,
meanwhile is a real problem but not one related to the presence or absence of
RF fields. Instead it is related to the real concerns about Wi-Fi that have
been spread by individuals who ignore the mountains of peer-reviewed research,
meta-analyses and systematic reviews that demonstrate that Wi-Fi is not a risk
to human health. EHS has, quite literally, become the textbook example of the
nocebo effect. When a whole community can claim to be made sick by a transmission tower, that has been
turned off, you have a classic case of individuals quite
literally scaring themselves and their children sick.
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