BLM Emerging Risks Team - Report on Mobile Phones/EMFs

BLM Emerging Risks Team - Report on Mobile Phones/EMFs November 2014 Malcolm Keen Solicitor, BLM London T 020 7865 3381 E Malcolm.keen@blmlaw.com 1

Introduction Use of mobile phones has of course increased dramatically in recent years. According to Ofcom there were 83.1 million mobile phone subscriptions in the UK in Q4 2013. The same data stated that in Q1 2014 93% of adults in the UK own/use a mobile phone. With such ubiquity, and with increasing frequency and duration of use, concerns have increased about whether exposure to electromagnetic fields from mobile phones may cause adverse health effects. There has been a plethora of scientific research concerning the possible adverse health effects of mobile phones. Whilst the balance of scientific evidence does not prove a clear health risk there is uncertainty. Because mobile phone use is comparatively recent, current studies do not take account of the effect of exposure over very long periods of time. Many conditions (cancer or noise-induced hearing loss for example) have very long latency periods (the time between exposure to the harmful agent and onset of symptoms). Lack of long-term evidence is of course a typical feature of emerging risks. Uncertainty also results from gaps in scientific knowledge, continual developments in mobile phones themselves, and changes in patterns of use. Electromagnetic fields Electromagnetic fields (EMFs) are naturally occurring (such as the earth s magnetic field). EMFs also arise as a result of the use of electric power. The electromagnetic spectrum includes radio waves (as used in mobile phones), microwaves, ultraviolet light and x-rays. Extremely low frequency fields Extremely low frequency fields (ELFs) are generated by the transmission of electric power. Such exposure can occur within the home and workplace as a result of electrical appliances. Radio frequency Radio frequency (RFs) are frequencies between 3 KHz and 300 GHz. They are widely used for telecommunications such as radio, television and mobile phones. Mobile phone frequencies are within the ranges 872 960 MHz and 1,710 1,875 MHz. Microwaves These are at frequencies within the RF range. They have a wide variety of uses such as radar and satellite communications, and cooking. Light Light is at higher frequencies and includes infrared and ultraviolet light. 2

Ionising Radiation This is found at the higher frequencies of the spectrum and include x-rays and gamma rays. AGNIR In April 2012, the Advisory Group on Non-ionising Radiation (AGNIR - which reports to the Health Protection Agency HPA) published its report on the health effects of radio frequency electromagnetic fields (EMFs). The study (Health Effects from Radiofrequency Electromagnetic Fields, Independent Advisory Group on Non-ionising Radiation, HPA, April 2012) noted that exposure to the general public to low level radio frequency (RF) fields from mobile phones, wireless networking, TV and radio broadcasting, and other communications technologies is now almost universal and continuous. The study noted that there are now over 80 million mobile phones in the UK, supported by nearly 53,000 base stations. The AGNIR noted the expansion in the number of peer-reviewed scientific papers relevant to this area. In undertaking this study, the AGNIR considered that: Careful scientific review is needed to draw sound conclusions from this mass of evidence. For the purposes of its review, the AGNIR defined RF fields as that part of the electromagnetic spectrum between 100 khz and 300 GHz. These frequencies are used for a great variety of applications including mobile phones. The AGNIR addressed the scientific research related to the potential health effects from exposures to RF fields, concentrating on new evidence since 2003. The AGNIR considered many hundreds of scientific studies. The AGNIR noted that current exposure guidelines are based on the thermal effects of RF fields. No consistently replicable effects have been found from RF field exposure at levels below those that produce detectable heating. In particular, there has been no convincing evidence that RF fields cause genetic damage or increase the likelihood of cells becoming malignant. The evidence suggested that RF field exposure below guideline levels does not cause adverse health effects in humans. Short-term exposure to RF fields at levels well above guideline limits can cause thermal injury to tissues. Although some positive findings have been reported in a few studies, overall epidemiological research does not suggest that use of mobile phones causes brain tumours or any other type of cancer. The data, however, is essentially restricted to periods of less than 15 years from first exposure. The AGNIR study concluded that: There are still limitations to the published research that preclude a definitive judgment, but the evidence considered overall has not demonstrated any adverse health effects of RF field exposure below internationally accepted guideline levels. In addition: The accumulating evidence on cancer risks, notably in relation to mobile phone use, is not definitive, but overall is increasingly in the direction of no material effect of exposure. 3

The AGNIR noted that the weakness in reaching a firm conclusion about cancer risk and RF exposure included the lack of information on brain tumour and acoustic neuroma (an acoustic neuroma is a non-cancerous brain tumour on the vestibulocochlear nerve which helps control hearing and balance) after 15 or more years of mobile phone use, as well as the risks of brain tumour after childhood exposures. In relation to this, the AGNIR considered the importance of further research, noting that studies of highly exposed occupational groups would be of considerable interest. HPA s response In May 2012, the HPA responded to the AGNIR s report. The HPA noted that AGNIR s main conclusion is that, although a substantial amount of research has been conducted in this area, there is no convincing evidence that RF field exposures below guideline levels cause health effects in adults or children. These guideline levels are those of the International Commission on Non- Ionizing Radiation Protection (ICNIRP), which form the basis of public health protection in the UK and in many other countries. The HPA s view was that the continuing possibility of: (a) biological effects, although not apparently harmful, occurring at exposure levels within the ICNIRP guidelines, and (b) the limited information regarding cancer effects in the long term, support continuation of the UK s precautionary approach to mobile phones. The HPA stated that: Excessive use of mobile phones by children should be discouraged, while adults should make their own choices as to whether they wish to reduce their exposures, but be enabled to do this from an informed position. The HPA stated that it will undertake another comprehensive review of the scientific evidence and its advice when sufficient new evidence has accumulated. The HPA became part of Public Health England in April 2013. Public Health England Public Health England (PHE) stated in December 2013 that its advice is the same as that issued by the HPA: there is no clear evidence that the health of the general public is being affected adversely by the use of mobile phone technologies. Nevertheless PHE stated that uncertainties remain and a continued precautionary approach to their use is recommended. PHE noted that mobile phones are a new technology that many people have become exposed to over the last 10 years or so, so there are bound to be gaps in scientific knowledge. The PHE recommends that a precautionary approach should be adopted for mobile phone technology, in particular the use of handsets by children. Handsets give the highest exposures to radio signals because they are normally held close to the head. These exposures are far higher than those from phone masts. PHE recommends that excessive use of mobile phone handsets by children should be discouraged. 4

Interphone The results of the Interphone study, set up in 2000, were published in June 2010. 1 No causal link between mobile phone use and cancer was made. The Interphone study was reviewed in the same publication 2. The review concluded that Interphone s findings indicated that the question as to whether mobile phone use increases the risk of brain cancer remained open. The director of the International Agency for Research on Cancer (IARC) said that: An increased risk of brain cancer is not established from the data from Interphone. However, he said that further investigation was merited. 3 The AGNIR considered that: As with all epidemiological studies, and particularly case-control investigations that rely on recall of complex past exposures from memory, there are uncertainties in interpretation. Nevertheless, within the limits of those uncertainties, which are discussed at some length in the report, the study provides no clear, or even strongly suggestive, evidence of a hazard. 4 The International Commission on Non-Ionizing Radiation Protection (ICNIRP) concluded that existing evidence did not support an increased risk of brain tumours in mobile phone users within the duration of use investigated so far. 5 IARC The IARC classifies radiofrequency electromagnetic fields as 2B, possibly carcinogenic to humans. In its press release, the IARC stated that this decision was based on an increased risk for glioma, a malignant type of brain cancer, associated with wireless phone use. 6 The HPA stated that it supported the call for additional research into the long-term, heavy use of mobile phones. The HPA considered that the IARC classification was consistent with previous reviews of the science. Hardell et al In December 2012, Hardell et al published a meta-analysis (ie. a statistical way of reviewing, summarising and quantifying previous research) of evidence concerning the association between use of mobile phones and brain tumours. 7 Hardell et al note the IARC s decision in May 2011 to 1 E. Cardis et al, Brain tumour risk in relation to mobile telephone use: results of the INTERPHONE international case-control study, International Journal of Epidemiology, 39, 3, 675-694, June 2010 2 R. Saracci & J. Samet, Commentary: Call me on my mobile phone or better not? a look at the INTERPHONE study results International Journal of Epidemiology, 39, 3, 695-698, June 2010 3 Dr. Christopher Wild, IARC, Press release No. 200 4 Brain tumour risk in relation to mobile telephone use: results of the interphone international case-control study - A statement from the Advisory Group on Non-Ionising Radiation (AGNIR), May 2010). 5 Note from the International Commission on Non-Ioniozing Radiation (ICNIRP) on the Interphone Publication, May 2010 6 IARC classifies radiofrequency electromagnetic fields as possibly carcinogenic to humans, WHO press release No. 208, 31 May 2011 7 Hardell et al, Use of mobile and cordless phones is associated with increased risk for glioma and acoustic neuroma, Pathophysiology (2012) 5

categorise radiofrequency electromagnetic fields (RF-EMF) from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields, as a Group 2B - a possible human carcinogen. Hardell et al considered that there is reasonable basis to conclude that RF-EMFs are bioactive and have a potential to cause health impacts. In addition, Hardell et al concluded that there is a consistent pattern of increased risk for glioma and acoustic neuroma associated with use of wireless phones (mobile phones and cordless phones) mainly based on results from casecontrol studies from the Hardell group and Interphone Final Study results and that the current safety limits and reference levels are not adequate to protect public health. Hardell et al also cited a decision of the Supreme Court of Italy which considered the association between mobile phone use and brain tumours. In July 2014 a letter by Hardell et al, Mobile Phones and Cancer, was published in Epidemiology. Hardell et al stated that we have discussed elsewhere the increasing incidence of brain tumours in several countries including Denmark. They state that there was a sharp increase in the incidence of brain tumors during 2003 2012 (41% in men and 46% in women). The authors conclude that in considering the most up-to-date publications, we find increasing evidence of an association between the use of mobile or cordless phones and glioma and acoustic neuroma. Marcolini In October 2012, the Italian Supreme Court handed down judgment in a case in which the claimant, Innocente Marcolini, sought workers compensation in respect of a brain tumour. It has been reported that the claimant used mobile and cordless phones for 5-6 hours per day for 12 years. The Italian Supreme Court reportedly found in favour of the claimant in respect of causation. 8 It can also be noted that an earlier judgment in the case in a lower court in which the claimant was also successful received criticism. In a paper in 2011, Lagorio et al stated that an Italian Court has recently recognized the occupational origin of a trigeminal neuroma in a mobile telephone user, and ordered the Italian Workers' Compensation Authority (INAIL) to award the applicant compensation for a high degree (80%) of permanent disability. In the abstract to the paper it states that: it appears that the judge relied on seriously flawed expert testimonies. The experts who served in this particular trial were clearly inexperienced in forensic epidemiology in general, as well as in the topic at hand. Selective overviews of scientific evidence concerning cancer risks from mobile phone use were provided, along with misleading interpretations of findings from relevant epidemiologic studies (including the dismissal of the Interphone study results on the grounds of purported bias resulting from industry funding). The necessary requirements to proceed to causal inferences at individual level were not taken into account and inappropriate methods to derive estimates of personal risk were used. Lagorio et al concluded that a comprehensive strategy to improve the quality of expert witness testimonies in legal proceedings and promote just and equitable verdicts is urgently needed in Italy. 8 See for example Mobile Manufacturers Forum, Viewpoint, Italian Supreme Court and Mobile Phones, http://www.mmfai.org/public/ 6

Ahlbom et al In June 2012 the Swedish Council for Working Life and Social Research (FAS) published their report reviewing research since 2003 on the state of knowledge in respect of the risk of disease and ill health as a result of exposure to RF EMFs. The report, by Ahlbom et al, found that the data on brain tumor and mobile telephony do not support an effect of mobile phone use on tumor risk, in particular when taken together with national cancer trend statistics throughout the world. Ahlbom et al also concluded that: Research on mobile telephony and health started without a biologically or epidemiologically based hypothesis about possible health risks. Instead the inducement was an unspecific concern related to a new and rapidly spreading technology. Extensive research for more than a decade has not detected anything new regarding interaction mechanisms between radiofrequency fields and the human body and has found no evidence for health risks below current exposure guidelines. While absolute certainty can never be achieved, nothing has appeared to suggest that the since long established interaction mechanism of heating would not suffice as basis for health protection. Despite Hardell et al, and the Italian Supreme Court decision, as noted above the weight of evidence, and particularly authoritative guidance, does not support causal attribution. Nonetheless, given the HPA s view above, and the uncertainty of long-term health effects, it is arguable that a precautionary approach remains appropriate. Other research Pettersson et al 2014, 9 investigated the possible association between mobile phone use and acoustic neuroma. The investigation was a population-based, case-control study. Eligible cases were persons aged 20 to 69 years, diagnosed between 2002 and 2007. Controls were randomly selected from the population registry, matched on age, sex, and residential area. Postal questionnaires were completed by 451 cases and 710 controls. The study concluded that its findings did not support the hypothesis that long-term mobile phone use increases the risk of acoustic neuroma. Coureau et al, 2014, 10 analysed the association between mobile phone exposure and primary central nervous system tumours (gliomas and meningiomas) in adults. Data about mobile phone use was collected through a questionnaire. A total of 253 gliomas, 194 meningiomas and 892 matched controls selected from the local electoral rolls were analysed. The study concluded that there was a possible association between heavy mobile phone use and brain tumours. COSMOS study The COSMOS study is an ongoing international cohort study investigating possible health effects from long term use of mobile phones and other wireless technologies. The study involves approximately 290,000 participants across 5 countries in Europe. The UK cohort, with nearly 105,000 participants, is the largest part of this international cohort. Recruitment to the study has 9 Pettersson et al, Long-term mobile phone use and acoustic neuroma risk, Epidemiology (2014) 25, 2, 233 10 Coureau et al, Mobile phone use and brain tumours in the Cerenat case-control study, Occ Env Med, (2014) 7

now been completed. The study is looking at changes in the frequency of specific symptoms over time, such as headaches and sleep disorders, and also the risks of cancers, benign tumours, neurological and cerebrovascular diseases. The research in the UK is being conducted by Imperial College London. The study in the UK is jointly funded by industry and government. The research is likely to be ongoing in 2015. Other bodies The National Institute of Environmental Health Sciences in the US states that current scientific evidence has not conclusively linked mobile phone (or cell phone) use with any adverse health problems, but more research is needed. The American Cancer Society states that the IARC classification (2B) means that there could be some risk associated with cancer, but the evidence is not strong enough to be considered causal and needs to be investigated further. It adds that individuals who are concerned about radiofrequency exposure can limit their exposure, including using an ear piece and limiting cell phone use, particularly among children. The U.S. Food and Drug Administration, responsible for regulating the safety of machines and devices that emit radiation (including mobile phones), notes that studies reporting biological changes associated with radiofrequency energy have failed to be replicated and that the majority of human epidemiologic studies have failed to show a relationship between exposure to radiofrequency energy from cell phones and health problems. The U.S. Centers for Disease Control and Prevention (CDC) states that, although some studies have raised concerns about the possible risks of cell phone use, scientific research as a whole does not support a statistically significant association between cell phone use and health effects. WHO The World Health Organisation (WHO) reviewed its Fact Sheet on EMFs and mobile phones in October 2014. 11 The WHO noted that there are an estimated 6.9 billion subscriptions globally, studies on potential long-term effects of mobile phone use are ongoing, and that the WHO will conduct a formal risk assessment of all studied health outcomes from radiofrequency fields exposure by 2016. The WHO noted: A large number of studies have been performed over the last two decades to assess whether mobile phones pose a potential health risk. To date, no adverse health effects have been established as being caused by mobile phone use. 11 Electromagnetic fields and public health: mobile phones, Fact sheet N 193, Reviewed October 2014, WHO 8

In respect of short term effects, the WHO noted that tissue heating is the principal mechanism of interaction between radiofrequency energy and the human body. At the frequencies used by mobile phones, most of the energy is absorbed by the skin and other superficial tissues, resulting in negligible temperature rise in the brain or any other organs of the body. A number of studies have investigated the effects of RF fields on brain electrical activity, cognitive function, sleep, heart rate and blood pressure. To date, research does not suggest any consistent evidence of adverse health effects from exposure to RF fields at levels below those which can cause tissue heating. In respect of long-term effects, the WHO noted that epidemiological research examining potential long-term risks from RF exposure has mostly looked for an association between brain tumours and mobile phone use. The WHO considered that because many cancers are not detectable until many years after exposure, and since mobile phones were not widely used until the early 1990s, epidemiological studies at present can only assess those cancers that become evident within shorter time periods. However, results of animal studies consistently show no increased cancer risk for long-term exposure to radiofrequency fields. The WHO stated that it will conduct a formal risk assessment of all studied health outcomes from radiofrequency fields exposure by 2016. Conclusion As the US Food and Drug Administration has noted, over the past 15 years, scientists have conducted hundreds of studies looking at the biological effects of the radiofrequency energy emitted by mobile phones. While some researchers have reported biological changes associated with RFs, the majority of studies do not show an association between exposure to RFs from mobile phones and adverse health effects. Case law in the UK and USA suggests that where a claimant is unable to show exposure above official guidance (see Appendix below), and because of the lack of evidence in respect of the possible non-thermal effects of RFs (see Appendix below), causation is likely to be difficult to prove. However, given the uncertainty of long-term health effects, the possibility for future claims remains open. Whilst scientific evidence does not show a causal relationship between mobile phone use and adverse health effects, it is arguable that a precautionary approach remains appropriate. 9

Appendix causes of adverse health effects and guidance on acceptable exposure levels There are broadly two routes by which mobile phones could potentially cause adverse health effects: (i) Thermal effects - RF waves can penetrate the body and can potentially interact with biological tissues and cause damage through a direct thermal or heating effect. Biological tissues absorb the energy produced by electric fields resulting in heat production. The rate at which RF energy is absorbed by biological tissues is known as the Specific Energy Absorption Rate (SAR). SAR is measured in watts per kilogram (W/kg). (ii) Non-thermal effects. Can the non-thermal or indirect effects of RF exposure on biological tissues cause adverse health effects such as cancer? Guidelines The International Commission on Non-Ionizing Radiation Protection (ICNIRP) developed guidelines on exposures to EMFs. The guidelines are designed to provide protection against all known health effects from EMFs. The Guidelines relevant to mobile phones were published in 1998. The ICNIRP limits on occupational exposure are set out in the table below (with the general public exposure limits in brackets) ICNIRP Exposure Guidelines for EMF exposure (frequency range 10 MHz 10 GHz) Tissue region SAR limit (W/kg) Whole body 0.4 (0.08) Head, trunk 10 (2) Limbs 20 (4) According to its website, the ICNIRP is currently revising the guidelines on limiting exposure to high and radiofrequency fields in the range (100 khz - 300 GHz). European Commission EMF Directive The EMF Directive on the minimum health and safety requirements regarding exposure of workers to the risks arising from EMFs, originally published in April 2004, has not yet been implemented in the UK. Member States have been given 3 years, up to 1st July 2016, to transpose the Directive. 10