"In this paper, we present a thorough analysis of the quality, validity and conclusion of the first report of a series of reviews from a renewed World Health Organization (WHO) initiative to assess the evidence of associations between (human made) radiofrequency electromagnetic radiation (RF-EMF) and adverse health effects in the general and working population. This initiative will publish several reports in “the Environmental Health Criteria (EHC) series”. The report we analyzed [1], is the first in the row, hereinafter ‘EHC2023’, published in August 2023. A companion protocol was published in 2021 [2], below just termed “the protocol”. A monograph summing up the results of these EHC reports on individual adverse effects is planned as an update of the 1993 WHO monograph on radiofrequency fields [3].
EHC2023 is a systematic review, including meta-analyses as to 14
different endpoints related to pregnancy and birth outcomes, based on
selected experimental laboratory studies on effects on pregnancy and
birth from RF-EMF exposure of non-human mammals. EHC2023 is a massive
work, carried out under the banner of objectivity, thoroughness and
scientific rigor by the use of statistical refinement and
technicalities, arguably in order to reach a sound and solid conclusion.
The final conclusion of the report is (EHC2023, p. 31, bold added):
In spite of the large number of studies collected, our systematic review could only partly answer the PECO question and did not provide conclusions certain enough to inform decisions at a regulatory level, but it can be considered a solid starting point to direct future research on this topic.
Our objective with this paper is, contrary to this conclusion, to
document as clearly as possible, that the conclusion of the EHC2023
review is far from supported, but contradicted, by the scientific
literature analyzed by its authors. What seems to be supportive, appears
so due to the many irrelevant studies included, to important
methodological choices not being documented or discussed, and due to
significant errors and flaws. By our stepwise testing, we found that
with flaws corrected, the original data and the EHC2023 methodology led
to an opposite conclusion: Evidence of hazard from subthermal exposure
to RF-EMF is well underpinned by its reviewed literature."
"The authors of EHC2023 considered 88 papers to be relevant and of
sufficient quality for their review. Parts of our analysis have been
carried out using the data from all these 88 papers."
"For a detailed quality assessment of the performed calculations in
EHC2023, we chose the procedure for doing calculations of the pooled
effects size based on Cohen’s d and its confidence intervals used for
nine of the 14 of the endpoints. To make the work manageable, we chose
the endpoint with the most studies reviewed: the “fetal weight” endpoint
(EHC2023 Figure 6), based on 44 papers, assuming this would be
representative for the EHC2023 meta-analyses. The assessment was done by
closely reviewing 43 of these papers and how they are handled in
EHC2023."
"Our main result: many flaws in EHC2023, all contributing to the conclusion “no conclusion can be drawn”
"More than half the studies included in EHC2023
are irrelevant for humans protected by IEEE/ICES and ICNIRP guidelines,
making the results irrelevant"
"For the EHC2023 review to be relevant for the assessment of hazards to
pregnant women and their fetuses in everyday situations, the exposure
conditions in the studies reviewed should mimic – or at least to a
reasonable extent be transferable to – everyday situations pregnant
women will encounter when in an environment with (manmade)
RF-EMFs/wireless technology. This means that only studies with “Low
nonthermal SAR” are relevant." ... "To be considered relevant, a study should therefore use subthermal
exposure conditions, and over several days. We found that over half the
studies selected for the EHC2023 review do not meet these criteria: They
are experiments with irrelevant exposure conditions."
The Systematic Review (SR) used a "A pooled effect size open for interpretation" ... "The equations used for relative weighting of the studies have the potential of skewing the results in any direction, and are neither documented nor discussed"
"The Risk of Bias (RoB) assessment of EHC2023 is highly biased towards thermal studies" ....
Hence, by favoring thermal studies, the RoB analysis is also skewed
toward favoring old studies, while discrediting modern studies."...
we see that of the total papers reviewed, the majority is published
before 2001 (50 vs. 38 papers). Of papers published 1975–2000, 22 % were
rated High Concern for Risk of Bias (HC), while 52 % of the newer
studies (2001–2021) are rated HC. We also see that the newer papers are
almost all nonthermal, and as much as more than half of them are rated
(HC), while for older studies, published before 2001, a majority of the
papers are thermal, and that more nonthermal than thermal are rated HC." ... "
The overall conclusion from this analysis is that the RoB analysis is
biased, in particular as it downgrades modern studies of nonthermal
effects due to RoB questions unfit for quality assessment of such
studies." ...
The biased RoB analysis of the EHC2023 has the overall effect of
increasing the number of thermal studies used in the meta-analysis –
thereby reducing relevance, increasing heterogeneity and adding
uncertainty, and is then further used in a biased and flawed line of
logic to claim that the resulting small pooled effect sizes then found
are uncertain."
"Our in-depth analysis of the “fetal weight” meta-analysis reveals misciting and miscalculation behind the pooled effect size" ... "
"We found, in total nine studies (27 %) cited erroneously or with
unjustified divergences, and “cherry picking” experiments from 12
studies (36 %). In some cases, several flaws applied to the same study.
In total we found flawed handling of 19 (58 %) of the 33 nonthermal
studies analyzed in EHC2023 for the fetal weight endpoint....All of the flaws described skew the results in the direction of a
lower pooled effect size and/or higher uncertainty. The flaws make the
meta-analysis useless, unless for just that purpose."
"Misreporting of significant detrimental effects
found in reviewed papers due to choice of endpoints not used in modern,
nonthermal studies" ... we limited our analysis to the 28 relevant, nonthermal papers
selected for the EHC2023 fetal weight meta-analysis. We found that
significant detrimental effects were not reported, or misreported in
various ways: Of the 28 papers, eight report no effects found. Of the remaining 20
papers, significant results are reported in 13 papers (65 %) but omitted
in EHC2023 Table 3 (A very few of these omitted effects are
superficially mentioned elsewhere in EHC2023)....Only for the remaining seven of the 28 nonthermal papers are all
effects reported in EHC2023 Table 3, although they are still downplayed
in most cases."
... "Using biochemical parameters as endpoints is part of modern approaches
to assess health risks from subthermal exposure. Since such effects are
relevant to all mammals, they offer better assessments also as to human
health risks when experiments are carried out on animals. By
disregarding findings at such endpoints and downgrading such modern
approaches in their RoB assessment, the authors of EHC2023 favor old, irrelevant studies. Also, by their endpoints chosen, they effectively eliminate the huge majority of modern research observing physiological changes clearly caused from subthermal exposures [8]."
"Relevant correlated factors not taken into account" ... "EHC2023 checks for fetal weight reduction as an effect from RF-EMF
exposure. However, the well-known inverse correlation between fetal
weight and litter size has not been taken into account by the EHC2023
authors" ... "
It Is alarming that the two single endpoints" [fetal weight and brain weight] "in EHC2023 that we checked,
are so “saturated” with serious flaws, rendering the meta-analyses
useless, although both endpoints should have been rather simple to
evaluate."
"Sub-group analyses of non-thermal effects not made, although prescribed in protocol" ... "The protocol for EHC2023 specifies that sub-group analyses should be
made for subthermal RF-EMF exposure – for parameters such as frequency,
duration and modulation (the protocol, p. 9). EHC2023 deviates from its
protocol by only doing sub-group analysis for animal species, SAR-values
(SAR<0.1, 0.1≤SAR<5, SAR≥5 W/kg) and animal core temperature
increase." ... "Leaving out sub-group analyses for frequency, duration and modulation
means missed opportunities to spot effects on health from subthermal
exposure and their possible causes, as such analyses would do so better
than sub-groups for averaged SAR values from heterogeneous experiments."
"EHC2023 claims the effects found stem from the thermal studies. But when corrected, the strongest effects are in the nonthermal" ... "
This result shows that of all the nonthermal studies in the EHC2023
fetal weight analysis, those with the lowest SAR show the highest
reductions of fetal weight and therefore contribute the most to the
increase in pooled effect size for the “fetal weight” endpoint. It is
also significantly higher than the pooled effect size presented in
EHC2023 for the thermal, LSC studies (1.01 compared to 0.51)."
"Discussion: how may all the flaws in EHC2023 be explained?" ... "EHC2023’s many flaws strip the study of legitimacy and the results of
any credibility or trustworthiness, even when evaluated on the premises
of the so-called “thermal only tradition”....On the top of this, the authors of EHC2023 falsely claim that all
effects found be caused by results of experiments with thermal exposure
conditions and therefore, falsely inferring that realistic conditions
are harmless....A substantial part of the flaws may well be explained as resulting
from all the authors of the review belonging to “the thermal only
tradition:"
"The WHO EHC undertaking is organized by a group of 21 experts
selected by WHO’s office “The International EMF Project” (TIEP). All but
three of these experts are either affiliated with the guidelines
issuing foundation ICNIRP [9]
or connected through co-authorships linked to a tiny self-referencing
network of authors mainly affiliated with ICNIRP and IEEE/ICES or both [10]. Both ICNIRP and IEEE/ICES defend exposure limits
based on tissue overheating as sufficient for EMF protection, the
thermal only tradition. ICNIRP is closely connected to TIEP. IEEE/ICES
issues guidelines for RF-EMF used in USA, in co-ordination with ICNIRP." // ... The 21 experts selected the authors for the protocol and EHC2023. All these experts are proponents of the thermal only view."
Conclusions
"The rigorous protocol and extensive analyses presented in EHC2023 and its protocol, convey an impression of serious science, credibility, and reliability. However, we have shown that this is not the case.
We found EHC2023 to be a massive work with a rigorous and complex protocol and extensive and complex statistical analyses. A consequence of the complexity is that it can be assumed that no average reader – not even professionals – will check the results of the review, if not for other reasons, because of the major effort needed. Thereby, scientific exchange, debate and control is impeded and reduced to a matter of trust.
We had the opportunity to spend time on an in-depth analysis of representative parts of EHC2023 to assess its quality based to the extent possible on the review’s own premises – that is, independent of our opinion about the professional premises chosen.
We cannot prove that the flaws and omissions are deliberately added to reach wanted conclusions, as we have next to no information about the authors, neither of the process behind the authoring EHC2023 or its protocol. Anyhow, and whatever the cause, the EHC2023 review is clearly of such a low quality, also when evaluated within the thermal only tradition, that its conclusions are without scientific value.
Our findings show that the conclusion of EHC2023 is not well-founded, and therefore the final conclusions of EHC2023 that no conclusion can be drawn that are (EHC2023, p. 31) “certain enough to inform decisions at a regulatory level” cannot be trusted. The errors, flaws and omissions are grave enough to render EHC2023 unscientific and unethical, and it should therefore be retracted.
As it now stands, the conclusion of ECH2023 stands out as what appears to be a manufactured argument for current regulations being adequate to protect the health of human mothers and their offspring. Manipulating and skewing research results in order to manufacture a wanted conclusion is a well-known strategy to avoid stricter regulations [11], [12], [13], [14], [15]. Further investigations and better sources would be needed to prove such an assault on humanity to be the case as to EHC2023.
EHC2023 is just one of several studies commissioned by the same organization (WHO EHC no. 137) and states clearly that consistency has been assured in the protocols for these studies. Our analysis of EHC2023 may in this view be seen as a case study of the results of the entire WHO EHC undertaking: Since many of our concerns are related to core elements of the protocol, there are good reasons also to question the quality of all present and forthcoming results being part of the WHO EHC undertaking unless a thorough revision of its course is made."
Open access paper: https://www.degruyter.com/document/doi/10.1515/reveh-2024-0089/html
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