Diapositiva 1

1
Venice, december 17th, 2007.ISPESL ICEMS
Foundations of bioelectromagnetics
Anna Zucchero MD towards a new rationale for risk
assessment and management
Internal Medicine Department Effects
on hypersensitive people

Venice-Mestre Hospital.
2

• ELECTROSENSITIVITY (ES)
• (Perception of electromagnetic field - emf)
• ELECTROHYPERSENSITIVITY (EHS)
• (Reaction to emf imply an established casual
  trigger or decisive relationship between symptoms
  and emf. WHO, 2006)

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3
Leitgeb et al. 2003 - Austria

• The perception threshold of the most sensible
  person is 8 fold (men) and 15 fold (women) lower
  than the related mean values
• Considerably more women are classified as very
  sensible (4.2) compared with men (1.7)
• Electrosensitivity in very sensible people have
  more variability in different days as regards the
  normal people.
• 2 of very sensible people dont have subjective
  EHS symptoms.
• THE AUTHORS MAKE A HYPOTHESIS THAT THESE
  DIFFERENCES DEPEND OF DIFFERENT STATUS OF THE
  AUTONOMOUS NERVOUS SYSTEM (LYSKOV ET AL. 2001)

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• ES the distribution of men population according
  to the perception level of low frequency emf (50
  Hz) (Leitgeb et al. 2002)

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Schröttner J. et al - 2007 - Austria
EHS GENERAL POPULATION T-test
Electrosensitive 56 18 Plt0,001
Very electrosensitive 11 2 Plt0,001
Electric current perception the distribution of
population according to the perception level of
low frequency emf (50 Hz) in general population
and EHS population. Comment In this study it
sees that the EHS have the perception threshold
lower than the general population but 33 not
differ from general population.





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Schröttner J. et al - 2007 - Austria

• Electric current perception ability of elderly
  people dont differ from adult general
  population
• Question of the authors
• ES is precondition to develop health problem or
  ES is a consequence of imprecise health problem
  of EHS people?
• Nervous system status dysbalance could be
  important rather than a causal EMF interaction?
• (Lyskov et al. 2001)

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THE MAGNETIC ELECTROHYPERSENSITIVITY

• Definition symptoms that are experienced in
  proximity to or during the use of electrical
  equipment and that result in varying degree of
  disconfort or ill health and that an individual
  attributes to activation of electrical equipment
• (Hillert L. 2004, Sweden in Proceeding
  International Workshop on EMF Hypersensitivity.
  Prague, 2004. Publication of WHO, 2006)
• The symptoms appear at the EMF level more lower
  than those considerate dangerous for the health
  due to the thermal effects.

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WHO SUMMARY WORKSHOP PRAGUE 2004 Publication 2006

• The symptoms are real and can vary widely in
  their severity. For some individuals the symptoms
  can change their life style
• Like other Idyopathic Environmental Intolerance
  (IEI) it is
• An acquired disorder with multiple recurrent
  symptoms
• Associated with diverse environmental factor
  tolerated by the majority of people
• Not explained by any known medical psychiatric or
  psychological disorder or organic diseases

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP
There are two scientific positions

• DONT EXISTS

• EXISTS

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• EXISTS
• There is a causal relationship EMF-EHS or trigger
  or decisive. Many studies found a
  temporary-spatial relationship between EMF
  sources and persons with EHS symptoms other
  studies founded biological mechanism explaining
  EHS.
• Experimental study
• Johansson O. Sweden Evidence for effect on the
  immune system Bioinitiative report 2007
• Lai H. USA Evidence for effect on neurology
  and behavior. Bioinitiative report 2007
• Goldsworthy A. UK The biological effects of
  weak electromagnetic field Ca theory.

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• EXISTS
• OBSERVATIONAL STUDY
• RESIDENTIAL EXPOSURE
• Santini R. 2002 France
• Navarro E. 2003 Spain
• Oberfeld G. 2004 Spain
• Preece A.W. 2005 Ciprus
• Hutter E.R. 2006 Austria
• Abdel Rassoul. 2006 Egypt
• OCCUPATIONAL EXPOSURE
• Hansson Mild K. et al

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• EXISTS
• CLINICAL STUDY
• Huss A. 2006 Switzerland. General Practitioners
  observed in clinical work problems in patient to
  use mobile phone or to live near base-station
• APPEALS (Bamberg, Friburg, Ireland)
• ANIMAL STUDY
• Balmori A.2005. Spain (The behavior of the white
  stork)
• Johansson O. Sweden (Thiroid biopsies in rats ).

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• DONT EXISTS
• The problem is REAL but there isnt an
  established causal relationship between EHS
  symptoms and EMF
• Health policy organization WHO
• WHO 2004, Prague (published 2006) propose a new
  name for EHS people ELECTROMAGNETIC FIELD
  ATTRIBUTED SYMPTOMS
• like multichemical attributed symptoms is
  idiopathic environmental intolerance (IEI), term
  originate on 1996, in Berlin at the International
  Program of Chemical Safety of the WHO.
• This position is based on provocation tests review

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• DONT EXISTS
• 2 PROVOCATION TEST REVIEW
• 1) Rubin Y 2005, UK
• Author identify all blind or double blind
  provocation studies for EHS to answer the
  follwing questins are people who are apparently
  hypersensitive to weak EMFs better et detecting
  these fields under blind or boubleblind condition
  than non hypersensitive individuals.
• He valuate total number of correct discrimination
  between active and sham and/or self reported
  symptom of 13 provocation studies with visual
  display, 7 provocation studies with cell phone
  and 1 base station, 11 provocation studies with
  ELF (7) and varying frequency (4).

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• DONT EXISTS
• Even recognizing that the results of these
  studies will determine whether any more search in
  this area is needed and list methodological
  advises, conclude this systematic review could
  find no robust evidence to support the existence
  of a biophysical hypersensitivity to EMF

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• DONT EXISTS
• 2) Seitz H. 2005, Germany
• Author reviewed about EHS and subjective health
  complains associated with electromagnetic field
  of mobile phone communication.
• 11 papers and 2 reports had a quality criteria 7
  observational studies ( 2 base station and 4
  mobile phone exposure) and 6 experimental studies
  (1 base station and 5 mobile phone exposure).
  Conclusion the greater part of these studies
  is not able to address the issue of causality
  between exposure and outcome in order to obtain
  more insights in the phenomenon EHS an
  interdisciplinary research is needed

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• DONT EXISTS
• WHO despite the criticism of the same authors use
  these 2 review like a demonstration that there
  isnt causality between EMF and EHS.
• The principal criticism are
• methodological
• low number of studied subjects that reducing the
  significance
• There are different modalities of choice of
  sample (Schröttner, 2007) describes different
  results depending of the recruitment of people
• Absence of health controls (Rubin)
• Major number of studies with ELF than RF

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ETIOPATOGENESIS
EMF EHS CAUSAL RELATIONSHIP

• DONT EXISTS
• Variability of the EMF in the environment of the
  experiment amagnetic room is not used and the
  electromagnetic background indoor and outdoor
  level is not considered it contributes with
  exposed used EMF source to EHS and control
  subjects reaction. For example the ELF exposure
  reduces the pain threshold even on not EHS
  (Ghione, 2004. Italy)
• Variability of examined subject the sensibility
  threshold is varying day by day (Leitgeb, 2003)
  and the study must considerate this variation.
• Time to appearance and disappearance of symptoms
  is varying in the same or different subjects.
• Use of Health outcome not measurable and
  objective

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• Pain threshold of an exposure to 37 Hz emf
• (Ghione et al. 2004)

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The Epidemiology

• 1-3 of population (Hillert L. 2002, Levallois
  2002) (self help groups say about 10)
• Most frequently women (not all studies)
• All ages even children and elderly ( Roosli most
  frequently between 40 and 70 years old)
• Often associated to multichemiosensibility (MCS)
• The cultural level for someone indifferent, for
  other a level most elevated
• Premorbid situations cranial or spinal trauma,
  electroshock, metallic implants (Sick 2003, HPA)
• Trend increasing
• De Carlo 2006.USA 25 of population can
  become EHS in 2016
• Hardell, 2006, Sweden 50 of population
  can become EHS in 2009.

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Hardell L. 2007
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Electromagnetic sources

• Exposure mode residential, personal and working
  (telecomunication, security staff, weld staff,
  hairdresser, power station, office staff)
• Beginning sources (Health Protection Agency,
  Irvine 2004)
• TV and computer monitors
• Electricity (power-lines, power stations,
  wirings, household appliances)
• Mobile telephony (base stations, cell phones,
  wireless), radio and TV installations, radar
• Trigger sources (association experience)
• Artificial low frequency, high frequency,
  (indoor outdoor)
• Natural volcanic area, meteo conditions
• Electrostatic charges (synthetic clothes,
  objects, environment ionizing with positive
  charge, near power lines, indoor)
• (noises, ultra-infrasound), sun light, laser
• (ionizing radiations)

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ICNIRP GuidelinesGUIDELINES FOR LIMITING
EXPOSURE TO TIME-VARYING ELECTRIC,MAGNETIC, AND
ELECTROMAGNETIC FIELDS (up to 300 GHz)
International Commission on Non-Ionizing
Radiation Protection

• Compliance with the present guidelines may not
  necessarily preclude interference with, or
  effects on, medical devices such as metallic
  prostheses, cardiac pacemakers and
  defibrillators, and cochlear implants.
  Interference with pacemakers may occur at levels
  below
• the recommended reference levels. Advice on
  avoiding these problems is beyond the scope of
  the present document but is available elsewhere
  (UNEP/WHO/IRPA 1993)
• Pag. 3

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The symptoms

• Appear with the exposure
• Dissapear with removal from electromagnetic
  sources

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Symptoms the manifestations (Bergdahl
1995-1998, Hillert 1999, Stender 2002, Roosli
2004, Associazioni di ES )

• General weakness, easy exhaustibility,
  indefinite indisposition, sensation of cold,
  intolerance to cold
• Neurologic headache, burning, piercing,
  lancinanting, osteomuscular pain, stiffness,
  muscular miolonic yerk and shakes, tremors,
  insomnia, non refreshing sleep, invertion of the
  rhythm sleep waking
• Psychological depression, irritability,
  hostility, anxiety, lost of control
• Cognitive lost of memory, low concentration
• Ocular burning, irritability, visual difficulty,
  light intolerance.

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Symptoms the manifestations (Bergdahl
1995-1998, Hillert 1999, Stender 2002, Roosli
2004, Associazioni di ES )

• Oto vestibolar excess of auditive sensibility,
  auricular constipation, tinnitus (noise on the
  ears), space disorientation, vertigo
• Nasal iperosmium
• Cardiovascular instability of blood pressure,
  palpitation, cutaneous vessel lability (pallor or
  irritation)
• Respiration thoracic oppression, short and/or
  irregular breath, breath pauses
• Digestive much or less appetite, thirst, nausea,
  indigestion, hiccup
• Cutaneous cutaneous reaction, fast nail-hair
  growth.

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Symptoms the characteristics(FEB, russian
studies)

• Localized generalized
• Reversible continous irreversible
• Time to appear few minutes, some hours
• Duration short or long (even months)
• No differences related to trigger or beginning
  sources
• Geographic differences.

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Physiopathology
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Physiopathology Alterations of autonomic nervous
system

• Perception
• Schmelz et al, 1994 low frequency emf can
  activate branches of fiber C of human skin
  usually insensitive to the stimulus.
• Hocking, 2004cell phone users hypersensitive at
  auricular level presents alterations of fiber C
• Ghione et al, 2004 noted a lowering of the pain
  threshold in normal males exposed to 37 Hz as
  regards the controls.
• Answer
• Sandstrom et al, 2003 have demonstrated
  alterations of the cardiac frequency in EHS,
  exposed to emf as regards the controls
• Ghione et al, 2004 demonstrated alterations of
  arterial pressure and cardiac frequence in health
  males exposed to emf as regards the controls
• Beale et al, 1997 noted psychological effects in
  population exposed to low frequency
• Rea, 1991 noted pupillary alterations in EHS

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Natural history Hygiene and Medicine of work
Institute, Science Academy of URSS, 1965
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Natural history(Bergqvist e Vogel Sweden, 1997)

• Stage 1 Temporary symptoms
• Usually the subjects heard speaking of the EHS
  existence and think that its possible to be
  associated to their symptoms
• Stage 2 The symptoms persists and intensity
  increasing, duration, number the association
  with emf become sure and can get an avoid
  behavior
• Stage 3 This stage is lived by few persons. Often
  are reported symptoms neurovegetative near many
  emf sources. Avoiding can take extreme measures.

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Diagnosis

• 1. Clinical criterion there not exists standard
  criterion yet. Now the diagnosis is based on the
  symptoms refered by the subject and on the
  exclusion by the medical doctor of other
  psychiatric or organic diseases (WHO Report,
  Prague congress, 2004).
• Eltiti et al. 2006, have done a questionaire
  with validations
• 2. Provocation test (review Rubin 2005 and Seitz
  2005)
• now there not exists validate provocation tests.
  Anyway see the limits of these tests described
  before.

33
Diagnosis

• 3. Tests
• lab (characterization of lymphocytes,
  fractionated dosage urinary melatonin, hormonal
  dosage, liver, other tests)
• Instrumental (EEG, ECG sec. Holter, Holter blood
  pressure, EMG, ERG, VEP, laser doppler, electro
  dermal activity, other tests)
• Limits
• Many tests are normal if there isnt emf
  exposure
• There are not standardized it mean are not
  defined the sesitivity and the specificity
• Utility
• Can be useful for exclude other pathologies.

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Prognosis

• Generalized EHS worse than localized
• (Stenberg 2002, Eriksson 1997)
• The 3rd stage described by russian studies is
  irreversible.
• Survival unknown
• Handicap 10 of EHS have symptoms that can
  compromise the social, family, working life and
  the activities of daily life.

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EHS what to do ? Traditional medicine

• Swedish studies (Hillert L, Graz- Austria 1998,
  reported by HPA UK 2005
• Prevention of the EHS with information
• Medical visit at first symptoms tests at first
  symptoms and certification af disability (only
  in Sweden the EHS is recognized like disability).
• Advise if the symptoms persists
• behavior therapy, antidepressive drugs, shiatsu,
  hypnosis
• Avoiding emf without isolate

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EMF what to do ?

• Non conventional medicine
• Individual solutions (WHO says this is not
  necessary, Prague, 2004) but for many EHS are
  very useful
• shielding
• grounding
• avoiding
• Public solutions 2 positions
• WHO say there is no indication that lowering
  internationally accepted limits would reduce the
  prevalence of symptoms attributed to EMF.
• Santini R. 2006 advise EHS lives in a EMF
  environmental which tend to zero.

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EHS what to do ?

• Roosli 2005, Switzerland questionnaire results
• Solutions avoiding 67
• shielding 25
• Results no result 25
• a little better 37
• much better 29

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• Shielding material from EMF

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Power in V/m of GSM (1800-1900 Mhz)
in residential area

• Level of voice telephone cover 0.00194
  V/m
• Level measured in Italian cities 6 V/m

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Italian Association of Electrosensitive (from
2005)

• 100 persons
• 70 women
• age 12-80 years old
• Autoimune tiroiditis 50 of women
• metallic prostheses
• beginning soucrces RF,MW 95
• Begin of EHS 96-97
• Generalized 100
• MCS associated 10
• Graveness100 change life style at the work,
  society and family

• Based on
• Italian Constitution
• UN rules about disability 1993
• International Accord for Human Rights
• We asked recognizing of EHS like disease and
  disability.

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Galileo Galilei 1564-1642
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We need many Galileo Galilei for a free science
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