Thursday, May 26, 2016

Should Cellphones Have Warning Labels? (Wall Street Journal)

On May 25, Microwave News reported that a $25 million federal government study found that cellphone radiation caused brain cancer in rats. The FDA had, in 2001, called for a government-funded study to resolve their concern that cellphone radiation is harmful. The federal government has funded one major study, the National Toxicology Program study reported on by Microwave News. Even though the study examines the effects of second-generation cellphone technology and soon most cellphones will switch to fourth-generation LTE for voice communications, these results are relevant today because we should not wait another 15 years and spend millions of dollars to research newer technology before we improve public education about precautionary measures.

Earlier this week the Wall Street Journal published a debate on whether cellphones should have warning labels. I was asked to write for the “pro” side; Dr. Larry Junck, a neurology professor, was asked to write for the opposition. The two essays were published with the title, "Should Cellphones Have Warning Labels?" and appeared in print on May 23, 2016. 

Prior to publication, the Journal shared with me only four of Dr. Junck's assertions. I was not provided his entire “con” essay in advance. Below are references supporting my arguments as well as comments on the debate.

The Wall Street Journal asks …
Wall Street Journal, May 23, 2016

Post-Publication Additional References and Comments

The editors state in the debate Preface that advocates recommend that cellphones come with labels outside the devices. I would argue that cellphone users need more conspicuous precautionary information whether by means of software inside the devices, package labeling, or other forms of communication.

Pro-Warning Labels for Cellphones: Additional References

Paragraph 2. Data on the proliferation of Cellphone use in the U.S. 

Paragraph 3. Exposure to radio-frequency radiation, a major risk of cellphone use. Warnings should be obvious: legal duty. Mentions of RF radiation and safety tend to be buried if they are provided by the manufacturer.

Paragraph 4. Many consumer groups are demanding stronger warnings about RF, the Environmental Working Group, a coalition of consumer groups wrote a letter; see also Consumer Reports.

Paragraph 5. International Agency for Research on Cancer declaration on possible carcinogenicity of RF radiation.

Paragraph 6. Citations on epidemiology, brain tumor risks.

a. Scientific reviews of epidemiological research on cellphone use and brain tumor risk

Hardell, Carlberg (2013). Using the Hill viewpoints from 1965 for evaluating strengths of evidence of the risk for brain tumors associated with use of mobile and cordless phones.

Morgan, Miller, Sasco, Davis (2015). Mobile phone radiation causes brain tumors and should be classified as a probable human carcinogen (2A) (Review).

Myung, Ju, McDonnell, Lee, Kazinets, Cheng, Moskowitz (2009). Mobile phone use and risk of tumors: a meta-analysis.

World Health Organization (2013). IARC monographs on the evaluation of carcinogenic risks to humans. Volume 102: Non-ionizing radiation, Part 2: Radiofrequency electromagnetic fields.
 b. Epidemiological studies that report evidence of increased brain tumor risk associated with long-term, heavy mobile phone use: Malignant tumors (glioma)

Carlberg and Hardell, 2012

Cardis et al, 2011

Coureau et al, 2014

Hardell et al, 2002

Hardell et al, 2004

Hardell et al, 2005

Hardell et al, 2006

Hardell et al, 2006

Hardell et al, 2009

Hardell et al, 2010

Hardell et al, 2013

Hardell et al, 2013

Hepworth et al, 2006

Interphone Study Group, 2010

Lakhola et al, 2007

Schuz et al, 2006

c. Epidemiological studies that report evidence of increased brain tumor risk associated with long-term, heavy mobile phone use: Non-malignant tumors (acoustic neuroma or meningioma)

Aydin et al, 2011 (child study; unclassified tumors)

Benson et al, 2013 (acoustic neuroma)

Cardis et al, 2011 (meningioma)

Carlberg and Hardell, 2015 (meningioma)

Coureau et al, 2014 (meningioma)

Hardell et al, 2006 (acoustic neuroma)

Hardell et al, 2009 (acoustic neuroma)

Hardell et al, 2013 (acoustic neuroma)

Hardell et al, 2013 (acoustic neuroma)

Interphone Study Group, 2011(acoustic neuroma)

Lonn et al, 2004 (acoustic neuroma)

Moon et al, 2014 (acoustic neuroma)

Schoemaker et al, 2005 (acoustic neuroma)

d. Evidence of increased brain tumor incidence in the United States: Non-malignant tumors (also see
Brain tumor increases in the 1990's that preceded widespread cellphone use may be accounted for by cordless phone use. Cordless phones were adopted before cellphones; they emit RF radiation, and Hardell's studies have found them to be associated with increased brain tumor risk. 

Dolecek et al, 2015 (meningioma in adults)

Gittleman et al, 2015 (brain/central nervous system tumors in children & adolescents)

Ostrom et al, 2016 (meningioma in adolescents and young adults)

e. Evidence of increased brain tumor incidence in the United States: Malignant tumors (also see

Gittleman et al, 2015 (brain/central nervous system tumors in children & adolescents)

Zada et al, 2012 (glioblastoma multiforme)

Zhu et al (2016). The apoptotic effect and the plausible mechanism of microwave radiation on rat myocardial cells.

Paragraph 7. Sperm damage evidence available in 2014 review. World Health Organization’s IARC committee on cellphoneradiation. International Electromagnetic Field Scientist Appeal.

Paragraph 8. How cellphones may affect cells.

f. Mechanisms that explain biologic effects of low intensity radiofrequency fields

Barnes & Greenenbaum (2016) Some effects of weak magnetic fields on biological systems: Radiofrequency fields can change radical concentrations and cancer cell growth rates. 

Behari (2010) Biological responses of mobile phone frequency exposure. 

Dasdag & Akdag (2015) The link between radiofrequencies emitted from wireless technologies and oxidative stress. 

Juutilainen et al (2011) Review of possible modulation-dependent biological effects of radiofrequency fields. 

Pall (2013) EMFs act via activation of voltage-gated calcium channels to produce beneficial or adverse effects.

Ruediger (2009) Genotoxic effects of radiofrequency electromagnetic fields. 

Terzi et al (2016) The role of electromagnetic fields in neurological disorders. 

Volkow et al (2011) Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. 

Yakymenko et al (2015) Oxidative mechanisms of biological activity of low-intensity radiofrequency radiation.

Paragraph 9. Electromagnetic fields and insurance companies’ concerns, Lloyd’s of London reportSwiss Re.

Paragraph 10. The controversy over cellphone warnings shares many similarities to cigarette labeling. There were numerous dissenters from the scientific community in 1965 when Congress passed the CigaretteLabeling and Advertising Act.

Paragraph 11. Tips for safer use of wireless technology, including cellphones.

Con-Warning Labels for Cellphones: 
Comments on Arguments by Dr. Larry Junck in WSJ Debate

Comments on Paragraphs 1-3: Malignant tumors often require decades to develop before they are detected so one would not necessarily expect to see a strong correlation between cellphone adoption rates and brain tumor incidence.

Brain tumor increases in the 1990s that preceded widespread cellphone use may be accounted for by cordless phone use. Cordless phones were adopted before cellphones; they emit RF radiation, and Hardell's research has found cordless phone use to be associated with increased brain tumor risk. 

Comments on Paragraph 4: There is peer-reviewed evidence for several mechanisms that explain how low-intensity cellphone radiation can cause oxidative stress, free radicals, and DNA damage leading to cancer and neurodegenerative diseases. There are also papers that describe a mechanism for sperm damage.

The research shows that the cellphone's RF emissions are absorbed by the head and body. The young child's brain absorbs twice as much radiation as the adult brain.

Comments on Paragraph 5: It often takes decades of independently-funded research before scientific consensus is reached about a health risk. 

Much of the cell phone radiation research has been funded by the telecommunications industry. In our 2009 review of the epidemiological research, we found that studies with industry funding tended to use lower quality research methods. These studies either failed to find increased brain tumor risk or dismissed the significant evidence of risk that was observed. Dr. Henry Lai has reported that the industry-funded studies were also much less likely to report biological effects. 

The higher-quality research on long-term, heavy cell phone use among adults consistently finds increased brain tumor risk. The risk is roughly doubled after 10 years of cellphone use. Although little research has been conducted on children, a few studies suggest that the risk is greater for children and adolescents who use cellphones.

A few industry-funded scientists recommend we take precaution about cellphone use. But many argue we should wait 25 or more years until their current research studies are completed. In contrast, the 220 scientists who signed the International EMF Scientist Appeal believe that we have sufficient evidence to take precaution now. They argue for stronger regulations and better disclosure.

Regarding bias in studies that depend on patient recall, it is true that people err when they report their cellphone use in these studies. They tend to underestimate the duration of calls and overestimate the number of calls they make. These two biases cancel each other out. The net effect when the data are analyzed for the total amount of cellphone use is to underestimate the association between cellphone use and brain tumor risk.

Comments on Paragraph 6: The 13-nation Interphone Study reported in a 40% increased risk of glioma for heavy cellphone users who used cellphones 1,640 or more hours in their lifetime, which averages to about 30 minutes a day over 10 years (Table 2).This was a primary, not a secondary analysis of the data.

The Interphone Study has been criticized by many scientists for its methodological shortcomings, but most of the biases are in the direction of underestimating brain tumor risk. For example, the Interphone study presented a secondary analysis in Appendix 2 of the paper which corrected one methodology problem. This analysis found an 82% increased risk of glioma for the heavy cellphone users instead of the 40% increased risk reported in the main body of the paper.

In another paper, the Interphone Study reported a 289% increased risk of acoustic neuroma for heavy cellphone users.

The 30-member IARC expert group depended heavily on the Interphone study and research by Lennart Hardell and his colleagues when they decided to classify RF radiation as “possibly carcinogenic” in 2011.

IARC classified Asian pickled vegetables and coffee as “possible carcinogens” because consumption of the first increases risk of esophageal cancer, and the second, bladder cancer. The cellphone industry has cited these findings to diminish IARC’s classification of radiofrequency radiation as a Group 2B possible carcinogen to humans, which is also the same category as DDT and lead.

Comments on Paragraph 7: The most recent meta-analysis found that cellphone radiation harms both sperm motility and viability -- two of the three effects examined.

Several mechanisms have been proposed for sperm damage (see my post, “Effects of Mobile Phones on Sperm Quality”).

Cellphones emit radiation at least once a minute whenever they are powered on. Since males often store cellphones in their pants pocket, they are exposing their genitals to this radiation. A Cleveland Clinic study of 361 men undergoing infertility examination found that the “decrease in sperm parameters was dependent on the duration of daily exposure to cell phones.”

Comments on Paragraph 8: The U.S. Environmental Protection Agency found evidence of genotoxicity from exposure to cellphone radiation in the 1990’s. Based upon the research, the EPA advocated for stronger regulations than the FCC adopted in 1996. Congress ended the EPA’s funding for research on RF radiation so the EPA has not conducted any research since the 1990’s.

Microwave News reported on 5/25 that a $25 million federal government study found that cellphone radiation caused brain cancer in rats.

The FCC’s cellphone radiation regulations have not changed since 1996. Although the FCC has been gathering input from scientists and the public since 2003, it has never issued a review of the evidence it has received. A recent Harvard publication reported that the FCC has been “captured” by the industries it regulates including the telecommunications industry. Perhaps we will begin to see changes in the positions of our federal agencies following release of reports from the National Toxicology Program’s major study.

Before WSJ editing, my original essay contained information about the cellphone industry – their tendency to oppose and lobby against all “Right to Know” legislation that crops up from the grass roots. I know of six states where allegations have been made that proposed regulations designed to inform citizens about potential cellphone risks have failed under industry pressure.

Comments on Paragraph 9: Insurers are probably worried about both compensating victims of actual harm associated with cellphones, as well as paying for the expense of defending lawsuits regardless of the merits.

The insurance industry has a legitimate concern that the cellphone industry will someday be held liable for cellphone radiation health effects because the scientific evidence has grown substantially over time. Moreover, the cellphone industry funded much of the early research that found evidence of harm which suggests that the industry knew the risks but failed to act responsibly. Although most cellphone companies issue safety information about how to reduce RF radiation exposure, the information is not user-friendly.

Comments on Paragraphs 10-11: Hardell and his colleagues have found a three-fold risk of brain cancer for 25 or more years of wireless (cellphone and cordless) phone use and a four-fold risk of acoustic neuroma for 20 or more years of use. Given how widespread cellphone use is these risk estimates should be of great concern to neuro-oncologists. Some research suggests that children who use cellphones may have greater long-term risk of brain tumors.

I discussed two risks for which we have the most evidence: brain tumors and sperm damage. In addition, there is scientific evidence for other health problems associated with cellphone radiation. These risks include other head and neck tumors, breast cancer, electromagnetic hypersensitivity, and reproductive health risks including miscarriage and fetal effects (e.g., ADHD).

Bottom line: There is less “harm” in warning consumers about potential risks based on what we know or suspect than in failing to do so and later on facing another tobacco or asbestos debacle.

Precautionary warnings are the least we can do at this point in time.