Venice, december 17th, 2007.ISPESL & ICEMS Foundations of bioelectromagnetics: Anna Zucchero MD...

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.

ELECTROSENSITIVITY (ES)ELECTROSENSITIVITY (ES)

((PerceptionPerception of electromagnetic field - of electromagnetic field - emf)emf)

ELECTROHYPERSENSITIVITY (EHS)ELECTROHYPERSENSITIVITY (EHS)

((ReactionReaction to emf : imply an established to emf : imply an established casual trigger or decisive relationship casual trigger or decisive relationship between symptoms and emf. WHO, between symptoms and emf. WHO, 2006)2006)

Venice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department

“Effects on hypersensitive people” Venice-Mestre Hospital



The perception threshold of the most sensible person is The perception threshold of the most sensible person is 8 fold (men) and 15 fold (women) lower than the related 8 fold (men) and 15 fold (women) lower than the related mean values;mean values;Considerably more women are classified as very Considerably more women are classified as very sensible (4.2%) compared with men (1.7%);sensible (4.2%) compared with men (1.7%);Electrosensitivity in very sensible people have more Electrosensitivity in very sensible people have more variability in different days variability in different days as regards the normal as regards the normal people.people. 2% of very sensible people don’t have subjective EHS 2% of very sensible people don’t have subjective EHS symptoms.symptoms.

THE AUTHORS MAKE A HYPOTHESIS THAT THESE THE AUTHORS MAKE A HYPOTHESIS THAT THESE DIFFERENCES DEPEND OF DIFFERENT STATUS OF THE DIFFERENCES DEPEND OF DIFFERENT STATUS OF THE AUTONOMOUS NERVOUS SYSTEM (LYSKOV ET AL. 2001)AUTONOMOUS NERVOUS SYSTEM (LYSKOV ET AL. 2001)

Leitgeb et al. 2003 - Leitgeb et al. 2003 - AustriaAustria

ES: the distribution of men population according to the ES: the distribution of men population according to the perception level of low frequency emf (50 Hz) (Leitgeb et perception level of low frequency emf (50 Hz) (Leitgeb et

al. 2002)al. 2002)Venice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department




EHSEHS GENERAL GENERAL

POPULATIONPOPULATIONT-testT-test

ElectrosensitivElectrosensitivee

56%56% ~18%~18% P<0,00P<0,0011

Very Very electrosensitiveelectrosensitive

11%11% 2 %2 % P<0,00P<0,0011

Schröttner J. et al - 2007 - Austria

EElectric current perceptionlectric current perception: the distribution of : the distribution of population according to the perception level of low population according to the perception level of low

frequency emf (50 Hz)frequency emf (50 Hz) in general population and EHS in general population and EHS population.population.

Comment: In this study it sees that the EHS have the perception Comment: In this study it sees that the EHS have the perception threshold lower than the general population but 33% not differ from threshold lower than the general population but 33% not differ from general populationgeneral population. .

Electric current perception ability of elderly Electric current perception ability of elderly people don’t differ from adult general people don’t differ from adult general population;population;

Question of the authors:Question of the authors:• ES is precondition to develop health problem or ES is precondition to develop health problem or

ES is a consequence of imprecise health problem ES is a consequence of imprecise health problem of EHS people?of EHS people?

• Nervous system status dysbalance could be Nervous system status dysbalance could be important rather than a causal EMF interaction? important rather than a causal EMF interaction?

(Lyskov et al. (Lyskov et al. 2001)2001)



Schröttner J. et al - 2007 - Austria

THE MAGNETIC THE MAGNETIC ELECTROHYPERSENSITIVITYELECTROHYPERSENSITIVITY

Definition: “symptoms that are experienced in Definition: “symptoms that are experienced in proximity to or during the use of electrical proximity to or during the use of electrical equipment and that result in varying degree of equipment and that result in varying degree of disconfort or ill health and that an individual disconfort or ill health and that an individual attributes to activation of electrical equipment”attributes to activation of electrical equipment”

(Hillert L. 2004, Sweden in “(Hillert L. 2004, Sweden in “Proceeding Proceeding International Workshop on EMF HypersensitivityInternational Workshop on EMF Hypersensitivity.” .” Prague, 2004. Publication of WHO, 2006);Prague, 2004. Publication of WHO, 2006);

The symptoms appear at the EMF level more lower The symptoms appear at the EMF level more lower than those considerate dangerous for the health due than those considerate dangerous for the health due to the thermal effects.to the thermal effects.



WHO SUMMARY WORKSHOP PRAGUE WHO SUMMARY WORKSHOP PRAGUE 2004 2004

Publication 2006Publication 2006 ““The symptoms are The symptoms are realreal and can vary and can vary

widely in their severity. For some widely in their severity. For some individuals the symptoms can change individuals the symptoms can change their life style”their life style”

Like other Idyopathic Environmental Like other Idyopathic Environmental Intolerance (IEI) it is:Intolerance (IEI) it is:

• An acquired disorder with multiple recurrent An acquired disorder with multiple recurrent symptoms;symptoms;

• AssociatedAssociated with diverse environmental factor with diverse environmental factor tolerated by the majority of peopletolerated by the majority of people

• Not explained by any known medical psychiatric Not explained by any known medical psychiatric or psychological disorder or organic diseasesor psychological disorder or organic diseases



ETIOPATOGENESISETIOPATOGENESIS

EXISTSEXISTS



EMF – EHS CAUSAL RELATIONSHIPEMF – EHS CAUSAL RELATIONSHIP

DON’T EXISTSDON’T EXISTS

There are two scientific positionsThere are two scientific positions


EXISTSEXISTSThere is a causal relationship EMF-EHS or trigger or There is a causal relationship EMF-EHS or trigger or

decisive. Many studies found a temporary-spatial decisive. Many studies found a temporary-spatial relationship between EMF sources and persons relationship between EMF sources and persons with EHS symptoms; other studies founded with EHS symptoms; other studies founded biological mechanism explaining EHS.biological mechanism explaining EHS.

Experimental study:Experimental study:Johansson O. Sweden: “Evidence for effect on the Johansson O. Sweden: “Evidence for effect on the

immune system” Bioinitiative report 2007immune system” Bioinitiative report 2007Lai H. USA : “Evidence for effect on neurology and Lai H. USA : “Evidence for effect on neurology and

behavior”. Bioinitiative report 2007behavior”. Bioinitiative report 2007Goldsworthy A. UK: “The biological effects of weak Goldsworthy A. UK: “The biological effects of weak

electromagnetic field”: Ca++ theory.electromagnetic field”: Ca++ theory.Venice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department



EXISTSEXISTSOBSERVATIONAL STUDY:OBSERVATIONAL STUDY:RESIDENTIAL EXPOSURERESIDENTIAL EXPOSURE::

Santini R. 2002 France Santini R. 2002 France Navarro E. 2003 SpainNavarro E. 2003 SpainOberfeld G. 2004 SpainOberfeld G. 2004 SpainPreece A.W. 2005 CiprusPreece A.W. 2005 CiprusHutter E.R. 2006 AustriaHutter E.R. 2006 AustriaAbdel Rassoul. 2006 EgyptAbdel Rassoul. 2006 Egypt

OCCUPATIONAL EXPOSUREOCCUPATIONAL EXPOSURE

Hansson Mild K. et al Hansson Mild K. et al





EXISTSEXISTS CLINICAL STUDY: CLINICAL STUDY:

Huss A. 2006 Huss A. 2006 Switzerland. GeneralSwitzerland. General Practitioners observed in clinical work Practitioners observed in clinical work problems in patient to use mobile phone or to problems in patient to use mobile phone or to live near base-stationlive near base-station

APPEALS (Bamberg, Friburg, Ireland)APPEALS (Bamberg, Friburg, Ireland)

ANIMAL STUDY: ANIMAL STUDY: Balmori A.2005. Spain (The behavior of the Balmori A.2005. Spain (The behavior of the white stork)white stork)Johansson O. Sweden (Thiroid biopsies in Johansson O. Sweden (Thiroid biopsies in rats ).rats ).






DON’T EXISTSDON’T EXISTSThe problem is The problem is REALREAL but there isn’t an established but there isn’t an established

causal relationship between EHS symptoms and causal relationship between EHS symptoms and EMFEMF

Health policyHealth policy organization WHO:organization WHO:WHO 2004, Prague (published 2006) propose a new WHO 2004, Prague (published 2006) propose a new

name for EHS people: ELECTROMAGNETIC name for EHS people: ELECTROMAGNETIC FIELD FIELD ATTRIBUTEDATTRIBUTED SYMPTOMS: SYMPTOMS:like multichemical attributed symptoms is like multichemical attributed symptoms is idiopathic environmental intolerance (IEI), term idiopathic environmental intolerance (IEI), term originate on 1996, in Berlin at the International originate on 1996, in Berlin at the International Program of Chemical Safety of the WHO. Program of Chemical Safety of the WHO.

This position iThis position iss based on provocation tests review based on provocation tests reviewVenice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department



DON’T EXISTSDON’T EXISTS2 PROVOCATION TEST REVIEW2 PROVOCATION TEST REVIEW1) Rubin Y 2005, UK1) Rubin Y 2005, UKAuthor identify all blind or double blind provocation Author identify all blind or double blind provocation studies for EHS to answer the follwing questins: are people studies for EHS to answer the follwing questins: are people who are apparently hypersensitive to weak EMFs better et who are apparently hypersensitive to weak EMFs better et detecting these fields under blind or boubleblind condition detecting these fields under blind or boubleblind condition than non hypersensitive individuals. than non hypersensitive individuals. He valuateHe valuate total number of correct discrimination between total number of correct discrimination between active and sham and/or self reported symptom of 13 active and sham and/or self reported symptom of 13 provocation studies with visual display, 7 provocation provocation studies with visual display, 7 provocation studies with cell phone and 1 base station, 11 provocation studies with cell phone and 1 base station, 11 provocation studies with ELF (7) and varying frequency (4).studies with ELF (7) and varying frequency (4).





DON’T EXISTSDON’T EXISTS

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





DON’T EXISTSDON’T EXISTS2) Seitz H. 2005, Germany2) Seitz H. 2005, GermanyAuthor reviewed about EHS and subjective health Author reviewed about EHS and subjective health complains associated with electromagnetic field of complains associated with electromagnetic field of mobile phone communication.mobile phone communication.11 papers and 2 reports had a quality criteria: 7 11 papers and 2 reports had a quality criteria: 7 observational studies ( 2 base station and 4 mobile observational studies ( 2 base station and 4 mobile phone exposure) and 6 experimental studies (1 base phone exposure) and 6 experimental studies (1 base station and 5 mobile phone exposure). Conclusion: “…station and 5 mobile phone exposure). Conclusion: “…the greater part of these studies is not able to address the greater part of these studies is not able to address the issue of causality between exposure and outcome the issue of causality between exposure and outcome in order to obtain more insights in the phenomenon in order to obtain more insights in the phenomenon EHS an interdisciplinary research is needed…”EHS an interdisciplinary research is needed…”





DON’T EXISTSDON’T EXISTSWHO despite the criticism of the same authors use these WHO despite the criticism of the same authors use these

2 review like a demonstration that there isn’t causality 2 review like a demonstration that there isn’t causality between EMF and EHS. between EMF and EHS.

The principal criticism are: The principal criticism are: methodologicalmethodological: : • low number of studied subjects that reducing the low number of studied subjects that reducing the

significance;significance;• There are different modalities of choice of sample; There are different modalities of choice of sample;

((Schröttner, 2007) describes different results describes different results depending of the recruitment of people;depending of the recruitment of people;

• Absence of health controls (Rubin);Absence of health controls (Rubin);• Major number of studies with ELF than RF;Major number of studies with ELF than RF;





DON’T EXISTSDON’T EXISTSVariability of the EMFVariability of the EMF in the environment of the in the environment of the

experiment; amagnetic room is not used and the experiment; amagnetic room is not used and the electromagnetic background indoor and outdoor level electromagnetic background indoor and outdoor level is not considered; it contributes with exposed used is not considered; it contributes with exposed used EMF source to EHS and control subjects reaction. EMF source to EHS and control subjects reaction. For example the ELF exposure reduces the pain For example the ELF exposure reduces the pain threshold even on not EHS (Ghione, 2004. Italy);threshold even on not EHS (Ghione, 2004. Italy);

Variability of examined subject:Variability of examined subject: the sensibility the sensibility threshold is varying day by day (Leitgeb, 2003) and threshold is varying day by day (Leitgeb, 2003) and the study must considerate this variation.the study must considerate this variation.

Time to appearance and disappearance Time to appearance and disappearance of of symptoms is varying in the same or different subjects.symptoms is varying in the same or different subjects.

Use of Health outcome not measurable and Use of Health outcome not measurable and objective objective





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



The EpidemiologyThe 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.Venice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department


Hardell L. 2007Hardell L. 2007



ES/EHS in Sweden

R2 = 0,9568

0500000

1000000150000020000002500000

1989 1994 1999 2004 2009

Year

Nu

mb

er o

f p

oep

le

Electromagnetic sourcesElectromagnetic sourcesExposure mode:Exposure mode: residential, personal and working residential, personal and working

(telecomunication, security staff, weld staff, (telecomunication, security staff, weld staff, hairdresser, power station, office staff)hairdresser, power station, office staff)

Beginning sourcesBeginning 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, radarTrigger sources (association experience)Trigger sources (association experience) Artificial:Artificial: low frequency, high frequency, (indoor – low frequency, high frequency, (indoor –

outdoor);outdoor); Natural:Natural: volcanic area, meteo conditions; volcanic area, meteo conditions; Electrostatic charges (synthetic clothes, objects, Electrostatic charges (synthetic clothes, objects,

environment ionizing with positive charge, near power environment ionizing with positive charge, near power lines, indoor);lines, indoor);

(noises, ultra-infrasound), sun light, laser;(noises, ultra-infrasound), sun light, laser; (ionizing radiations);(ionizing radiations);



“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 belowthe 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

ICNIRP GuidelinesGUIDELINES FOR LIMITING EXPOSURE TO TIME-VARYING ELECTRIC,MAGNETIC, AND

ELECTROMAGNETIC FIELDS (up to 300 GHz)



International Commission on Non-Ionizing Radiation Protection

Appear with the exposureDissapear with removal from electromagnetic sources

The symptomsThe symptoms



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.

Symptoms : the Symptoms : the manifestations manifestations

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



Symptoms : the Symptoms : the manifestations manifestations

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



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.

Symptoms: the Symptoms: the characteristicscharacteristics(FEB, russian studies)



PhysiopathologyPhysiopathology

Venice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD. Internal Medicine Department

“Effects on hypersensitive people” Venice Mestre Hospital

Physiopathology Physiopathology Alterations of autonomic nervousAlterations of autonomic nervous

systemsystem PerceptionPerception Schmelz et al, 1994: low frequency emf can activate Schmelz et al, 1994: low frequency emf can activate

branches of fiber C of human skin usually insensitive to the branches of fiber C of human skin usually insensitive to the stimulus.stimulus.

Hocking, 2004:cell phone users hypersensitive at auricular Hocking, 2004:cell phone users hypersensitive at auricular level presents alterations of fiber C;level presents alterations of fiber C;

Ghione et al, 2004: noted a lowering of the pain threshold Ghione et al, 2004: noted a lowering of the pain threshold in normal males exposed to 37 Hz as regards the controls.in normal males exposed to 37 Hz as regards the controls.

AnswerAnswer Sandstrom et al, 2003: have demonstrated alterations of Sandstrom et al, 2003: have demonstrated alterations of

the cardiac frequency in EHS, exposed to emf as regards the cardiac frequency in EHS, exposed to emf as regards the controls;the controls;

Ghione et al, 2004: demonstrated alterations of arterial Ghione et al, 2004: demonstrated alterations of arterial pressure and cardiac frequence in health males exposed to pressure and cardiac frequence in health males exposed to emf as regards the controls;emf as regards the controls;

Beale et al, 1997: noted psychological effects in population Beale et al, 1997: noted psychological effects in population exposed to low frequency;exposed to low frequency;

Rea, 1991: noted pupillary alterations in EHSRea, 1991: noted pupillary alterations in EHSVenice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department


Natural history Hygiene and Medicine of work Institute, Science Academy

of URSS, 1965



Natural historyNatural history(Bergqvist e Vogel Sweden, 1997)

Stage 1 Temporary symptomsUsually the subjects heard speaking of the EHS existence and think that it’s 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.



DiagnosisDiagnosis

1. C Clinical c 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.

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 isn’t emf

exposure;There are not standardized it mean are not

defined the sesitivity and the specificity;UtilityCan be useful for exclude other pathologies.

DiagnosisDiagnosis



PrognosisPrognosis 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.



EHS: what to do ? EHS: what to do ? Traditional medicineTraditional 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 persistsbehavior therapy, antidepressive drugs, shiatsu, hypnosis

Avoiding emf without isolate



EMF: what to do ?EMF: what to do ?

Non Non conventionalconventional medicine medicineIndividual solutions (WHO says this is not

necessary, Prague, 2004) but for many EHS are very useful:

shielding grounding avoiding

Public solutions: 2 positionsWHO 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.



EHS: what to do ? 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 %



Shielding material from EMFShielding material from EMF





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

Level of voice telephone cover 0.00194 V/m

Level measured in Italian cities ~6 V/m



Italian Association of Italian Association of Electrosensitive Electrosensitive (from 2005)(from 2005)

100 persons;100 persons; 70% women;70% women; age: 12-80 years old;age: 12-80 years old; Autoimune tiroiditis 50% Autoimune tiroiditis 50%

of women;of women; metallic prostheses; beginning soucrces

RF,MW 95% Begin of EHS ‘96-’97 Generalized 100% MCS associated 10% Graveness:100% change

life style at the work, society and family

Based on: Italian Constitution; UN rules about disability

1993; International Accord for

Human RightsWe asked recognizing of EHS

like disease and disability.



Galileo Galilei 1564-1642Galileo Galilei 1564-1642Venice, december 17th, 2007. ISPESL & ICEMS Anna Zucchero MD Internal Medicine Department


We need many Galileo Galilei We need many Galileo Galilei for a free science…for a free science…



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