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Doi:10.1016/j.pathophys.2009.01.01

Public health implications of wireless technologies a Sage Associates, 1396 Danielson Road, Santa Barbara, CA 93108, USA b Institute for Health and the Environment, University at Albany, Rensselaer, NY, USA Received 18 January 2008; accepted 30 January 2009 Abstract
Global exposures to emerging wireless technologies from applications including mobile phones, cordless phones, DECT phones, WI-FI, WLAN, WiMAX, wireless internet, baby monitors, and others may present serious public health consequences. Evidence supporting a publichealth risk is documented in the BioInitiative Report. New, biologically based public exposure standards for chronic exposure to low-intensityexposures are warranted. Existing safety standards are obsolete because they are based solely on thermal effects from acute exposures. Therapidly expanding development of new wireless technologies and the long latency for the development of such serious diseases as brain cancersmeans that failure to take immediate action to reduce risks may result in an epidemic of potentially fatal diseases in the future. Regardless ofwhether or not the associations are causal, the strengths of the associations are sufficiently strong that in the opinion of the authors, taking actionto reduce exposures is imperative, especially for the fetus and children. Such action is fully compatible with the precautionary principle, asenunciated by the Rio Declaration, the European Constitution Principle on Health (Section 3.1) and the European Union Treaties Article 174.
2009 Elsevier Ireland Ltd. All rights reserved.
Keywords: Wireless technology; Brain cancer; Radiofrequency; Cell phones; Wireless antenna facilities; Childrens’ health 1. Introduction and background
brainwave activity (altered EEG) are also reported in the sci-entific literature mechanisms that may Exposure to electromagnetic fields (EMF) has been linked account for such effects can be found in various articles and to a variety of adverse health outcomes that may have sig- nificant public health consequences most serious The public health implications of emerging wireless tech- health endpoints that have been reported to be associated with nologies are enormous because there has been a very rapid extremely low frequency (ELF) and/or RF include childhood global deployment of both old and new forms in the last 15 and adult leukemia, childhood and adult brain tumors, and years. In the United States, the deployment of wireless infras- increased risk of the neurodegenerative diseases, Alzheimer’s tructure has accelerated greatly in the last few years with and amyotrophic lateral sclerosis (ALS). In addition, there 220,500 cell sites in 2008 Eighty-four percent of are reports of increased risk of breast cancer in both men the population of the US own cell phones Annualized and women, genotoxic effects (DNA damage and micronu- wireless revenues in 2008 will reach $144 billion and US cleation), pathological leakage of the blood–brain barrier, spending on wireless communications will reach $212 bil- altered immune function including increased allergic and lion by 2008. Based on the current 15% annual growth rate inflammatory responses, miscarriage and some cardiovascu- enjoyed by the wireless industry, in the next 5 years wireless lar effects Insomnia (sleep disruption) is reported in will become a larger sector of the US economy than both the studies of people living in very low-intensity RF environ- agriculture and automobile sectors. The annualized use of ments with WI-FI and cell tower-level exposures cell phones in the US is estimated to be 2.23 trillion minutes Short-term effects on cognition, memory and learning, behav- in 2008 are 2.2 billion users of cell phones world- ior, reaction time, attention and concentration, and altered wide in 2008 many million more users of cordlessphones.
∗ Corresponding author. Tel.: +1 805 969 0557; fax: +1 805 969 5003.
Over 75 billion text messages were sent in the United States, compared with 7.2 billion in June 2005, according to 0928-4680/$ – see front matter 2009 Elsevier Ireland Ltd. All rights reserved.
doi: C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 CTIA, the Wireless Association, the leading industry trade is reduced, resulting in altered circadian rhythms and disrup- group consumer research company Nielsen Mobile, tion of several physiological functions. (Chapters 5–12 of the which tracked 50,000 individual customer accounts in the BioInitiative Report papers in this Supplement.) second quarter of this year, found that Americans each sent These effects can reasonably be presumed to result or received 357 text messages a month then, compared with in adverse health effects and disease with chronic and 204 phone calls. That was the second consecutive quarter in uncontrolled exposures, and children may be particularly which mobile texting significantly surpassed the number of vulnerable The young are also largely unable to remove themselves from such environments. Second-hand The Electronics Industries Alliance (EIA) represents 80% non-ionizing radiation, like second-hand smoke may be con- of the $550 billion US electronics industry “that provides sidered of public health concern based on the evidence at two million jobs for American workers.” Its members include companies from the consumer electronics and telecommuni-cations industries, among others There is intense industry competition for market share.
Telecom taxes form an immense revenue generator for the At present, the most persuasive evidence for cancer result- government sector. Sale of the airwaves (auctions selling ing from RF exposure is that there is a significantly increased off wireless bandwidth) is a multi-million dollar industry risk of malignant glioma in individuals that have used a for governments, and multi-billion dollar global advertising mobile phone for 10 or more years, with the risk being ele- budgets are common. Lobbying dollars from the telecom- vated only on the side of the head on which the phone is used related industries are estimated to be $300 million annually.
regularly (ipsilateral use) While the risk for The media is nearly silent on health issues, perhaps in part adults after 10 or more years of use is reported to be more because of global advertising revenues that compromise jour- than doubled, there is some evidence beginning to appear nalistic independence and discourage balanced coverage of that indicates that the risk is greater if the individual begins to use a mobile phone at younger ages. Hardell et al. reported higher odds ratios in the 20–29-year-old group thanother age ranges after more than 5 years of use of either ana- 2. Evidence supporting a public health risk
log or cordless phones. Recently in a London symposiumHardell reported that after even just 1 or more years of use Even if there is only a small risk to health from chronic there is a 5.2-fold elevated risk in children who begin use of use of and exposure to wireless technologies, there is the mobile phones before the age of 20 years, whereas for all potential for a profound public health impact. RF radi- ages the odds ratio was 1.4. Studies from Israel have found ation now saturates the airwaves, resulting in exposure that the risk of parotid gland tumors (a salivary gland in the to both users and non-users. The effects are both short- cheek) is increased with heavy cell phone use The risk term (sleep disruption, hormone disruption, impairment of of acoustic neuroma (a benign but space-occupying tumor cognitive function, concentration, attention, behavior, and on the auditory nerve) is also significantly increased on the well-being) and they are almost certainly long-term (gen- ipsilateral side of the head after 10 or more years of mobile erational impacts on health secondary to DNA damage, phone use relationship has also been documented physiological stress, altered immune function, electrosensi- in some of the published reports of the WHO Interphone tivity, miscarriage risks, effects on sperm quality and motility Study, a decade-long 13-country international assessment of leading to infertiility, increased rates of cancer, and neuro- logical diseases including Alzheimer’s disease and ALS—at Kundi reports that “(E)pidemiological evidence compiled least for ELF exposures). (Chapters 5–12 of the BioInitiative in the last 10 years starts to indicate an increased risk, in particular for brain tumors (glioma, meningioma, acoustic There is credible scientific evidence that RF exposures neuroma), from mobile phone use. Considering biases that cause changes in cell membrane function, metabolism and may have been operating in most studies the risk estimates cellular signal communication, as well as activation of proto- are rather too low, although recall bias could have increased oncogenes and triggering of the production of stress proteins risk estimates. The net result, when considering the different at exposure levels below current regulatory limits. There is errors and their impact is still an elevated risk” [19].
also generation of reactive oxygen species, which cause DNAdamage, chromosomal aberrations and nerve cell death. A The latency for most brain tumors is 20 years or more number of different effects on the central nervous system have when related to other environmental agents, for example, to also been documented, including activation of the endoge- X-ray exposure. Yet, for cell phone use the increased risks nous opioid systems, changes in brain function including are occurring much sooner than twenty years, as early as memory loss, slowed learning, motor dysfunction and per- 10 years for brain tumors in adults and with even shorter formance impairment in children, and increased frequency of latencies in children. This suggests that we may currently be headaches, fatigue and sleep disorders. Melatonin secretion significantly underestimating the impact of current levels of C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 use of RF technology, since we do not know how long the the time they reach school age Their exposure is invol- average latency period really is. If it is 20 years, then the untary in all cases. Children are largely unable to remove risk rate will likely be much higher than an overall doubling themselves from exposures to harmful substances in their of risk for cell phone users if the peak comes later than 10 years. It may also signal very troubling risks for those whostart using cell phones, and perhaps all wireless devices, in 2.2. Plausible biological mechanisms for a relationship early childhood. We may not have proof of effect for decades until many hundreds of thousands of new cases of malignantgliomas are set in motion by long-term cell phone use.
2.2.1. DNA damage and oxidative stress The preliminary evidence that mobile phone use at Damage to DNA from ELF and from RF cell phone younger ages may lead to greater risk than for older persons is frequencies at very low intensities (far below FCC and of particular concern. There is a large body of evidence that ICNIRP safety limits) has been demonstrated in many stud- childhood exposure to environmental agents poses greater risk to health than comparable exposure during adulthood have been reported by various researchers in different labora- There is reason to expect that children would be tories. This is damage to the human genome, and can lead to more susceptible to the effects of EMF exposure since they mutations which can be inherited, or which can cause cancer, are growing, their rate of cellular activity and division is more rapid, and they may be more at risk for DNA damage and Non-ionizing radiation is assumed to be of too low energy subsequent cancers. Growth and development of the central to cause direct DNA damage. However both ELF and RF nervous system is still occurring well into the teenage years radiation induce reactive oxygen species, free radicals that so that neurological changes may be of great importance to react with cellular molecules including DNA. Free-radical normal development, cognition, learning, and behavior.
production and/or the failure to repair DNA damage (sec- A greater vulnerability of children to developing brain ondary to damage to the enzymes that repair damage) created cancer from mobile phone use may be the consequence of by such exposures can lead to mutations. Whether it is greater a combination of patterns of use, stage of development and free-radical production, reduction in anti-oxidant protection physical characteristics related to exposure. In addition to the or reduced repair capacity, the result will be altered DNA, fact that the brain continues to develop through the teen years, increased risk of cancer, impaired or delayed healing, and many young children and teenagers now spend very large premature aging Exposures have also been linked periods of time using mobile phones. The brain is the main to decreased melatonin production, which is a plausible bio- target organ of cell phones and cordless phones, with highest logical mechanism for decreased cancer surveillance in the exposure to the same side as the phone is used. Further, due to anatomical reasons, the brain of a child is more exposed to An increased risk of cancers and a decrease in survival has RF radiation than the brain of an adult is caused been reported in numerous studies of ELF and RF by the smaller brain size, a thinner pinna of the ear, thinnerskin and thinner skull bone permitting deeper penetration 2.2.2. Stress proteins (heat shock proteins or HSP) into the child’s brain. A recent French study showed that Another well-documented effect of exposure to low- children absorb twice the RF from cell phone use as do adults intensity ELF and RF is the creation of stress proteins (heat shock proteins) that signal a cell is being placed under phys- In addition to concerns about cancer, there is evidence for iological stress) The HSP response is generally short-term effects of RF exposure on cognition, memory and associated with heat shock, exposure to toxic chemicals and learning, behavior, reaction time, attention and concentration, heavy metals, and other environmental insults. HSP is a signal altered brainwave activity (altered EEG) all of of cells in distress. Plants, animals and bacteria all produce these effects argue for extreme caution with regard to expo- stress proteins to survive environmental stressors like high sure of children. The development of children into adults is temperatures, lack of oxygen, heavy metal poisoning, and characterized by faster cell division during growth, the long period needed to fully develop and mature all organ systems, We can now add ELF and RF exposures to this list of and the need for properly synchronized neural development environmental stressors that cause a physiological stress until early adulthood. Chronic, cumulative RF exposures may response. Very low-level ELF and RF exposures can cause alter the normal growth and development of children and cells to produce stress proteins, meaning that the cell adversely affect their development and capacity for normal recognizes ELF and RF exposures as harmful. This is learning, nervous system development, behavior and judg- another important way in which scientists have documented that ELF and RF exposures can be harmful, and it happens Prenatal exposure to EMF has been identified as a possible at levels far below the existing public safety standards. An risk factor for childhood leukemia (1). Maternal use of cell additional concern is that if the stress goes on too long, the phones has been reported to adversely affect fetal brain devel- protective effect is diminished. The reduced response with opment, resulting in behavioral problems in those children by prolonged exposure means the cell is less protected against C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 damage, and this is why prolonged or chronic exposures People who are chronically exposed to low-level wire- may be harmful, even at very low intensities.
less antenna emissions report symptoms such as problems insleeping (insomnia), as well as other symptoms that include 2.2.3. RF-induced gene expression changes fatigue, headache, dizziness, grogginess, lack of concen- Many environment agents cause diseases, including can- tration, memory problems, ringing in the ears (tinnitus), cer, not by direct damage to DNA but rather by up- or problems with balance and orientation, and difficulty in down-regulation of genes that regulate cell growth and func- multi-tasking n children, exposures to cell phone tion. Usually there are many genes whose expression is radiation have resulted in changes in brain oscillatory activity changed, and it is difficult to determine the exact changes responsible for the disease. Both ELF and RF exposures have loss of mental concentration, distraction, speeded mental been shown to result in altered gene expression. Olivares- function but lowered accuracy, impaired judgment, delayed Banuelos et al. that ELF exposure of chromaffin reaction time, spatial disorientation, dizziness, fatigue, cells resulted in changed expression of 53 transcripts. Zhao headache, slower motor skills and reduced learning ability et al. vestigated the gene expression profile of rat neu- in children and adults have all been reported rons exposed to 1800 MHz RF fields (2 W/kg) and found 24 These symptoms are more common among “electrosen- up-regulated genes and 10 down-regulated genes after a 24-h sitive” individuals, although electrosensitivity has not been exposure. The altered genes were involved in multiple cellular documented in double-blind tests of individual identifying functions including cytoskeleton, signal transduction path- themselves as being electrosensitive as compared to controls ways and metabolism. Kariene et al. xposed human owever people traveling to laboratories for test- skin to mobile phone radiation, and found by punch biopsy ing are pre-exposed to a multitude of RF and ELF exposures, that 8 proteins were significantly altered in expression, con- so they may already be symptomatic prior to actual testing.
sistent with gene induction. Several other studies have found There is also evidence that RF exposures testing behavioral altered gene expression following RF exposure, although changes show delayed results; effects are observed after ter- none have been found that explain specific disease states mination of RF exposure. This suggests a persistent change in the nervous system that may be evident only after time has DNA activation at very low ELF and RF levels, as in passed, so is not observed during a short testing period.
the stress response, and DNA damage (strand breaks andmicronuclei) at higher levels, are molecular precursors to 3.1. Plausible biological mechanisms for changes that are believed to lead to cancer. These, along with gene induction, provide plausible biological mecha-nisms linking exposure to cancer.
The biochemical pathways that are activated are the same While there remains controversy as to the degree that for ELF and for RF exposures, and are non-thermal (do not RF and ELF fields alter neurobehavioral function, emerg- require heating or induced electrical currents). This is true ing evidence provides a plausible mechanism for both effects for the stress response, DNA damage, generation of reactive on sleep and cognition. Sleep is controlled by the central oxygen species as well as gene induction. Thus it is not sur- circadian oscillator in the suprachiasmatic nucleus, located prising that the major cancers resulting from exposure to ELF in the hypothalamus. The activity of this central circadian and RF are the same, namely leukemia and brain cancer. The oscillator is, in turn, controlled by the hormone, melatonin, safety standards for both ELF and RF, based on protection which is released from the pineal gland There is con- from heating, are irrelevant and not protective. ELF exposure siderable evidence that ELF exposure reduces the release levels of only 5–10 mG have been shown to activate the stress of melatonin from the pineal gland—see Section 12 of the Bioinitiative Report There has been less study of the effects of RF exposure on melatonin release, but investiga-tions have demonstrated a reduced excretion of the urinarymetabolite of melatonin among persons using a mobile phone 3. Sleep, cognitive function and performance
for more than 25 min per day In a study of womenliving near to radio and television transmitters, Clark et al.
The relationship of good sleep to cognition, perfor- no effect on urinary melatonin metabolite excre- mance and healing is well recognized. Sleep is a profoundly tion among pre-menopausal women, but a strong effect in important factor in proper healing, anti-inflammatory bene- fits, reduction in physical symptoms of such as tendonitis, The “melatonin hypothesis” also provides a possible basis over-use syndrome, fatigue-induced lethargy, cognition and for other reported effects of EMFs. Melatonin has important learning. Incomplete or slowed physiological recovery is actions on learning and memory, and inhibits electrophys- common when sleep is impaired. Circadian rhythms that iological components of learning in some but not all areas normalize stress hormone production (cortisol, for example) of the brain Melatonin has properties as a free- depend on synchronized sleep patterns.
radical scavenger and anti-oxidant and consequently, C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 a reduction in melatonin levels would be expected to increase output of the phone), the more powerful the RF signal will be.
susceptibility to cancer and cellular damage. Melatonin could Hence, newer cordless phones may in some cases be similar also be the key to understanding the relationship between to the power output of cell phones. The cumulative emis- EMF exposure and Alzheimer’s disease. Noonan et al. sions from cell and cordless phones taken together should reported that there was an inverse relationship between excre- be recognized when considering the relative risks of wireless tion of the melatonin metabolite and the 1–42 amino acid form of amyloid beta in electric utility workers. This form of PDAs such as the BlackBerry, Treo and iPhone units are amyloid beta has been found to be elevated in Alzheimer’s ‘souped-up’ versions of the original voice communication devices (cell phones). The often produce far higher ELF emis-sions than do cell phones because they use energy from the 3.1.2. Blood–brain barrier alterations battery very intensively for powering color displays and dur- Central nervous system effects of EMFs may also be sec- ing data transmission functions (email, sending and receiving ondary to damage to the blood–brain barrier (BBB). The large files, photos, etc.) emissions have been blood–brain barrier is a critical structure that prevents tox- reported from PDAs at several tens to several hundreds of mil- ins and other large molecules that are in peripheral blood ligauss. Evidence of significantly elevated ELF fields during from having access to the brain matter itself. Salford et al.
normal use of the PDA has public health relevance and has ve reported that a 2-h exposure of rats to GSM-900 been reported in at least three scientific papers radiation with a SAR of 2–200 mW/kg resulted in nerve cell In the context of repetitive, chronic exposure to significantly damage. In a follow-up study, Eberhardt et al. report that elevated ELF pulses from PDAs worn on the body, relevant 2-h exposures to cell phone GSM microwave RF resulted health studies point to a possible relationship between ELF in leakage of albumin across the blood–brain barrier and exposure and cancer and pregnancy outcomes neuronal death Neuronal albumin uptake was signif- We include discussion of the ELF literature for two icantly correlated to occurrence of damaged neurons when reasons. As mentioned above ELF activates the same biol- measured at 28 days post-exposure. The lowest exposure ogy as RF, it contributes to the total EMF burden of level was 0.12 mW/kg (0.00012 W/kg) for 2 h. The highest the body. In addition, PDAs and cell phones emit both exposure level was 120 mW/kg (0.12 W/kg). The weakest radiofrequency/microwave radiation (RF) and extremely low exposure level showed the greatest effect in opening the BBB frequency ELF from the battery switching of the device Earlier blood–brain studies by Salford and Schirma- (the power source). Studies show that some devices pro- duce excessively high ELF exposures during voice and datatransmission. ELF is already classified as a 2B (Possible)Carcinogen by IARC, which means that ELF is indisputably 4. What are sources of wireless radiation?
an issue to consider in the wireless technology debate. ELFhas been classified as a Group 2B carcinogen for all humans, There are many overlapping sources of radiofrequency not just children. The strongest evidence came from epidemi- and microwave emissions in daily life, both from industrial ological studies on childhood leukemia, but the designation sources (like cell towers) and from personal items [cell and applies to all humans, both adults and children cordless phones, personal digital assistants (PDAs), wire- Wireless headsets that allow for conversations with cell less routers, etc.]. Published data on typical levels found phones at a distance from the head itself reduce the emis- in some cities and from some sources are available at sions. Depending on the type of wireless device, they may operate (transmit signal) only during conversations or they Cell phones are the single most important source of may be operational continuously. The cumulative dose of radiofrequency radiation to which we are exposed because of wireless headsets has not been well characterized under either the relatively high exposure that results from the phone being form of use. Substantial cumulative RF exposure would be held right against the head. Cell phones produce two types expected if the user wears a wireless headset that transmits a of emissions that should be considered. First, the radiofre- signal continuously during the day. However a critical factor quency radiation (typically microwave frequency radiation) is where the cell phone is placed. If worn on a belt with a is present. However, there is also the contribution of the headset, the exposure to the brain is reduced but the exposure switching battery pack that produces very high levels of extremely low frequency electromagnetic field Cell towers (called “masts” in Europe and Scandinavian Cordless telephones have not been widely recognized as countries) are wireless antenna facilities that transmit the similar in emissions to cell phones, but they can and do pro- cell phone signals within communities. They are another duce significant RF exposures. Since people tend to use them major source of RF exposures for the public. They differ as substitutes for in-home and in-office corded or traditional from RF exposures from wireless devices like cell phones in telephones, they are often used for long periods of time. As that they produce much lower RF levels (generally 0.05 to the range of cordless phones has increased (the distance away 1–2 ␮W/cm2 in the first several hundred feet around them) that you can carry on a conversation is related to the power in comparison to several hundred microwatts per centimeter C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 squared for a cell phone held at the head. However they create under the skin. They create a detectable signal to track the a constant zone of elevated RF for up to 24 h per day. many hours per day, and the exposure is whole body rather thanlocalized at the head. These facilities are the distribution sys-tem for wireless voice communications, internet connections 5. Problems with existing public health standards
and data transmission within communities. They are often (safety limits)
erected on free-standing towers. They may be constructed ontelephone poles or electrical poles. They may be built into the If the existing standards were adequate none of the effects fac¸ade or rooftops of buildings behind wood screening. These documented above should occur at levels to which people are are called stealth installations for wireless antenna facilities.
regularly exposed. The fact that these effects are seen with Some installations are camouflaged to resemble ‘false trees our current ambient levels of exposure means that our exist- or rocks’. They emit RF to provide cell service to specific ing public safety standards are obsolete. It also means that “cells” or locations that receive the signal.
new, biologically based public exposure standards for wire- Other forms of wireless transmission that are common in less technologies are urgently needed. Whether it is feasible areas providing cell service are wireless land area networks to achieve low enough levels that still work and also protect (WLAN), (WiMAX) and WIFI networks. Some cities are health against effects of chronic RF exposure – for all age installing city-wide WIFI service to allow any user on the groups – is uncertain. Whether we can protect the public and street to log into the internet (without cables or wire connec- still allow the kinds of wireless technology uses we see today tions). WIFI installations may have a signal reach for a few hundred feet where WiMAX installations may transmit sig- The nature of electromagnetic field interactions with nal more than 10 miles, so produce a stronger RF emission biological systems has been well studied or pur- for those in close proximity. Each type has its particular sig- poses of standard-setting processes for both ELF and RF, the nal strength and intended coverage area, but what they have hypothesis that tissue damage can result only from heating is in common is the production of continuous RF exposure for the fundamental flaw in the misguided efforts to understand those within the area. We do not know what the cumula- the basic biological mechanisms leading to health effects.
tive exposure (dose) might be for people living, working or The thermal standard is clearly untenable as a measure of going to school in continuously elevated RF fields, nor are dose when EMF stimuli that differ by many orders of magni- the possible health implications yet known. However, based tude in energy can stimulate the same biological response. In on studies of populations near cell sites in general, there is a the ELF range, the same biological changes occur as in the constellation of generally observed health symptoms that are RF, and no change in temperature can even be detected. With reported to occur In this regard it is important to DNA interactions the same biological responses are stimu- note that children living near to AM radio transmitters have lated in ELF and RF ranges even though the frequencies of been found to elevated risks of leukemia While the stimuli differ by many orders of magnitude. The effects of AM radio RF fields are lower in frequency than that common EMF on DNA to initiate the stress response or to cause molec- in mobile phones, this is a total body irradiation with RF.
ular damage reflect the same biology in different frequency The fact that leukemia, not brain cancer, is apparent in these ranges. For this reason it should be possible to develop a scale studies suggests that leukemia is the cancer seen at the lowest based on DNA biology, and use it to define EMF dose in dif- levels of both ELF and RF fields under the circumstances of ferent parts of the EM spectrum. We also see a continuous scale in DNA experiments that focus on molecular damage Commercial surveillance systems or security gates pose where single and double strand breaks have long been known an additional source of strong RF exposures. They are ubiq- to occur in the ionizing range, and recent studies have shown uitous in department stores, markets and shops at the entry similar effects in both ELF and RF ranges [144].
and exit points to discourage shoplifting and theft of goods.
Security gates can produce excessively high RF exposures Existing standard-setting bodies that regulate wireless (although transitory) and have been associated with inter- technologies, assume that there are no bioeffects of concern ference with pacemakers in heart patients. The exposure at exposure levels that do not cause measurable heating. How- levels may approach thermal public safety limits in inten- ever, it has been established beyond any reasonable doubt that sity, although no one expects a person to stand between bioeffects and some adverse health effects occur at far lower the security gate bars for more than 6 min (safety limits for levels of RF and ELF exposure where no heating (or induced uncontrolled public access are variable depending on the fre- current) occurs; some effects are shown to occur a thou- quency, but are all averaged over a 6-min exposure period).
sand times or more below the existing public safety limits.
RFID chips (radiofrequency identification chips) are being New, biologically based public exposure limits are urgently widely used to track purchases and for security of pets, and in needed. New wireless technologies for cell and cordless some cases to keep track of patients with Alzheimer’s disease phones, other wireless communication and data transmission and of children. RFID chips are implanted in fabrics, inserted systems affect living organisms in new ways that our anti- in many types of commercial goods, and can be implanted quated safety limits have not foreseen, nor protected against.
C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 The exposure of children to electromagnetic fields has medical uncertainties still exist, but where policy decisions not been studied extensively; in fact, the Federal Com- today may greatly reduce human disease and societal costs munications Commission (FCC) standards for exposure to radiofrequency radiation are based on the height, weight and Policy decisions in public health must address some amount stature of a 6-foot tall man, not scaled to children or adults of uncertainty when balancing likely benefits and estimated of smaller stature. They do not take into account the unique costs. Although new insight will allow better appreciation susceptibility of growing children to exposures, nor are there of difficult issues, such as those occurring in environmental studies of particular relevance to children.
and occupational health, an expanded perspective may also In addition there is a problem in the consideration of the enlarge the list of problems that need to be managed. Ignor- level of evidence taken into consideration by these bodies.
ing the problems carries its own costs (as deferring a decision There have not been adequate animal models shown to have is a decision in itself). With environmental and other public cancer as an endpoint, and a perception that no single mech- health problems becoming increasingly complex and interna- anism is proven to explain these associations. Thus these tional in scope, scientific documentation alone rarely justifies committees have tended to ignore or minimize the evidence for direct hazard to humans, and believe there is no proof ofcause and effect. These bodies assume from the beginning Social issues regarding the controversy over public and that only conclusive scientific evidence (absolute proof) will occupational exposures to ELF and RF center on the resolute be sufficient to warrant change, and refuse to take action on adherence to existing ICNIRP and FCC/IEEE standards by the basis of a growing body of evidence which provides early many countries, in the face of growing scientific evidence of health risks at far lower levels The composition of The Radiofrequency Interagency Working Group of the these committees, usually with excessive representation of US governmental agencies involved in RF matters (RFI- the physics and engineering communities rather than public AWG) issued a Guidelines Statement in June of 1999 that health professionals, results in a refusal to adopt biologically concluded the present RF standard “may not adequately pro- based exposure standards. Furthermore, there is widespread tect the public” RFIAWG identified fourteen (14) belief that governments are ignoring this evidence and there is issues that they believe are needed in the planned revisions widespread distrust of and lack of confidence in governments of ANSI/IEEE RF exposure guidelines including “to pro- and their health agencies. The basis on which most review vide a strong and credible rationale to support RF exposure bodies and standard-setting agencies have avoided the con- guidelines”. In particular, the RFIAWG criticized the exist- clusion that the science is strong enough to warrant new safety ing standards as not taking into account chronic, as opposed limits for ELF and RF is to require a demonstration of abso- to acute exposures, modulated or pulsed radiation (digital lute proof before taking action. A causal level of evidence, or or pulsed RF is proposed at this site), time-averaged mea- scientific certainty standard is implicit in nearly all reviews of surements that may erase the unique characteristics of an the ELF and RF science, although this runs counter to good intensity-modulated RF radiation that may be responsible for reported biologic effects, and stated the need for a com- There is no question that global implementation of the prehensive review of long-term, low-level exposure studies, safety standards proposed in the Bioinitiative Report, if neurological-behavioral effects and micronucleus assay stud- implemented abruptly and without careful planning, have the ies (showing genetic damage from low-level RF) This potential to not only be very expensive but also disruptive important document from relevant US agencies questions of life and the economy as we know it. Action must be a existing standards in the following ways: (a) selection of an balance of risk to cost to benefit. The major risk from main- adverse effect level for chronic exposures not based on tissue taining the status quo is an increasing number of cancer cases, heating and considering modulation effects; (b) recognition especially in young people, as well as neurobehavioral prob- of different safety criteria for acute and chronic exposures at lems at increasing frequencies. The benefits of the status quo non-thermal or low-intensity levels; (c) recognition of defi- are expansion and continued development of communica- ciencies in using time-averaged measurements of RF that tion technologies. But we suspect that the true costs of even does not differentiate between intensity-modulated RF and existing technologies will only become much more apparent continuous wave (CW) exposure, and therefore may not ade- with time. Whether the costs of remedial action are worth the quately protect the public; (d) having standards based on societal benefits is a formula that should reward precaution- adult males rather than considering children to be the most ary behavior. Prudent corporate policies should be expected to address and avoid future risks and liabilities, otherwise, thereis no market incentive to produce safe (and safer) products.
The deployment of new technologies is running ahead of 6. Prudent public health responses
any reasonable estimation of possible health impacts and esti-mates of probabilities, let alone a solid assessment of risk.
Emerging environmental health problems require pre- However, what has been missing with regard to EMF has ventative public health responses even where scientific and been an acknowledgement of the risk that is demonstrated by C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 the scientific studies. There is clear evidence of risk, although the magnitude of the risk is uncertain, and the magnitude of Public health implications of wireless technologies argue for change ingovernmental and health agency actions.
doing nothing on the health effects cost to society is simi-larly uncertain. This situation is very similar to our history of Secure US and EU legislative mandates for safer technologies for communication and data transmission, for security and surveillance dealing with the hazards of smoking decades ago, where the power of the industry to influence governments and even con- Promote wired alternatives for voice and data communication (cable, flicts of interest within the public health community delayed action for more than a generation, with consequent loss of life Discourage or ban use of cell phones by children and young teen-agers and enormous extra health care costs to society. New stan- Provide permanent (unremovable) labels on cell phones “Not for use by dards are warranted now, based on the totality of scientific Implement national public education campaigns on health issues (cell evidence; the risks of taking no-action, the large population phones, cordless phones, PDAs, wireless internet, city-wide WI-FI, at risk, costs associated with ignoring the problem in new and upgraded site selection and construction, and the loss of Promote industry redesign for safer products: support innovation for public trust by ignoring the problem.
Slow or stop deployment of wireless technologies to discourage reliance Direct medical and rehabilitative health costs associated on wireless technologies for communication and security needs with treatment for diseases that are reasonably related to Put the burden of proof on industry to show “new wireless tech” is safe wireless technologies may be very large. Although there is uncertainty involved in how much disease is related to Adopt and enforce restricted use areas for sensitive or more vulnerable wireless exposures, the mere scale of the problem with sev- segments of society including low-EMF environments in public areasand “No Cell” zones in airports, hospitals, schools eral billion users of cell phones and even larger impacts Acknowledge FCC and ICNIRP thermal safety standards are obsolete for on bystander populations (from cell site exposures, from other WI-FI and wireless exposures in-home and commer- Appoint new standard-setting bodies familiar with biological effects to cial use, etc.) the associated public health costs will likely develop new guidelines for public safety limits.
be monumental. Furthermore the costs to families with can- Develop new biologically based standards that address low-intensity, cers, neurological diseases or learning disabilities in children Require standard of evidence and level of proof = public health related in part or in whole to wireless technologies extend Reject “causal” standard of evidence for taking action on science beyond medical costs. They may reasonably extend to fam- Make industry financially liable for “guessing wrong” and ignoring health ily disruption and family psychological problems, losses in The history of governments and their official health agen- cies to deal with emerging and newly identified risks to health requirements for redesign of wireless devices, proscription of is not good is particularly true where industry use of wireless devices by children and teenagers, strong and investments in new products and technologies occur without independent research programs on causes and prevention of full recognition, disclosure or even knowledge of possible EMF-related diseases, and consultation with all stakehold- health consequences. Large economic investments in pol- ers on issues relating to involuntary exposures (bystander or luting industries often make for perilously slow regulatory second-hand radiation exposures from wireless technologies) action, and the public health consequences may be very great The scientific information contained in this Supplement Free markets do not internalize the costs to society of argues for thresholds or guidelines that are substantially “guessing wrong”. Unexpected or hidden health costs of new below current FCC and ICNIRP standards for localized technologies may not be seen for many years, when the ability exposures to wireless devices and for whole-body exposure.
to recall or to identify the precise exposures related to dis- Uncertainty about how low such standards might have to ease outcomes is difficult or impossible. The penalty nearly go to be prudent from a public health standpoint should always falls to the individual, the family or the taxpayer and not prevent reasonable efforts to respond to the informa- not to the industry that benefits economically—at least in tion at hand. No lower limit for bioeffects and adverse health free-market economies. Thus, the profits go to industry but effects from RF has been established, so the possible health the costs may go to the individual who can suffer both dimin- risks of wireless WLAN and WI-FI systems, for example, ished quality of life and health and economic disadvantage.
will require further research. No assertion of safety at any If all disease endpoints that may be reasonably related to level of wireless exposure (chronic exposure) can be made chronic exposure to electromagnetic fields are considered at this time. The lower limit for reported human health even a small attributable fraction for one or more indus- effects has dropped 100-fold below the safety standard (for tries, it will have enormous global impact on public health.
mobile phones and PDAs); 1000–10,000-fold for other wire- The public health implications are immense. But they can less (cell towers at distance; WI-FI and WLAN devices). The be reduced by strong government and public health inter- entire basis for safety standards is called into question, and ventions providing information on alternatives to wireless it is not unreasonable to question the safety of RF at any technologies, public education campaigns, health advisories, C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 It is likely that for both ELF and RF, as for other carcino- the occupational studies for adult cancers and neurologi- gens, there is no threshold of exposure that is without risk, cal diseases report their highest exposure category is 4 mG but the magnitude of the risk increases linearly with the level (0.4 ␮T) and above, so that new ELF limits should target of exposure. Our society will not go back to the pre-electric the exposure ranges of interest, and not necessarily higher and pre-wireless age, but the clear evidence of health haz- ards to the human population from exposure mandates that Avoiding chronic ELF exposure in schools, homes and the we develop ways in which to reduce exposure through educa- workplace above levels associated with increased risk of dis- tion, new technologies and the establishment of biomedically ease will also avoid most of the possible bioactive parameters of ELF discussed in the relevant literature.
It is not prudent public health policy to wait any longer to adopt new public safety limits for ELF. These limits 7. Conclusions and recommended actions
should reflect the exposures that are commonly associ-ated with increased risk of childhood leukemia (in the New ELF limits are warranted based on a public health 2–5 mG (0.2–0.5 ␮T) range for all children, and over 1.4 mG analysis of the overall existing scientific evidence. These lim- (0.14 ␮T) for children age 6 and younger). Avoiding chronic its should reflect environmental levels of ELF that have been ELF exposure in schools, homes and the workplace above lev- demonstrated to increase risk for childhood leukemia, and els associated with increased risk of disease will also avoid possibly other cancers and neurological diseases. ELF lim- most of the possible bioactive parameters of ELF discussed its should be set below those exposure levels that have been linked in childhood leukemia studies to increased risk of dis- The rapid deployment of new wireless technologies that ease, plus an additional safety factor. It is no longer acceptable chronically expose people to pulsed RF at levels reported to to build new power lines and electrical facilities that place cause bioeffects, which in turn, could reasonably be presumed people in ELF environments that have been determined to to lead to serious health impacts, is a public health concern.
be risky. These levels are in the 2–4 milligauss (mG) range There is suggestive to strongly suggestive evidence that RF (0.2–0.4 ␮T), not in the 10 s of mG or 100 s of mG. The exist- exposures may cause changes in cell membrane function, cell ing ICNIRP limit is 1000 mG (100 ␮T) and 904 mG (90.4 ␮T) communication, metabolism, activation of proto-oncogenes in the US for ELF is outdated and based on faulty assump- and can trigger the production of stress proteins at expo- tions. These limits are can no longer be said to be protective sure levels below current regulatory limits. Resulting effects of public health and they should be replaced. A safety buffer can include DNA breaks and chromosome aberrations, cell or safety factor should also be applied to a new, biologically death including death of brain neurons, increased free-radical based ELF limit, and the conventional approach is to add a production, activation of the endogenous opioid system, cell safety factor lower than the risk level.
stress and premature aging, changes in brain function includ- While new ELF limits are being developed and imple- ing memory loss, retarded learning, performance impairment mented, a reasonable approach would be a 1 mG (0.1 ␮T) in children, headaches and fatigue, sleep disorders, neurode- planning limit for habitable space adjacent to all new or generative conditions, reduction in melatonin secretion and upgraded power lines and a 2 mG (0.2 ␮T) limit for all cancers (BioInitiative Report Chapters 5–10, 12) other new construction. It is also recommended that a 1 mG This information now argues for thresholds or guidelines (0.1 ␮T) limit be established for existing habitable space that are substantially below current FCC and ICNIPR stan- for children and/or women who are pregnant (because of dards for whole-body exposure. Uncertainty about how low the possible link between childhood leukemia and in utero such standards might have to go to be prudent from a pub- exposure to ELF). This recommendation is based on the lic health standpoint should not prevent reasonable efforts assumption that a higher burden of protection is required for to respond to the information at hand. No lower limit for children who cannot protect themselves, and who are at risk bioeffects and adverse health effects from RF has been estab- for childhood leukemia at rates that are traditionally high lished, so the possible health risks of wireless WLAN and enough to trigger regulatory action. This situation in partic- WI-FI systems, for example, will require further research ular warrants extending the 1 mG (0.1 ␮T) limit to existing and no assertion of safety at any level of wireless expo- occupied space. “Establish” in this case probably means for- sure (chronic exposure) can be made at this time. The lower mal public advisories from relevant health agencies. While limit for reported human health effects has dropped 100-fold it is not realistic to reconstruct all existing electrical distri- below the safety standard (for mobile phones and PDAs); bution systems, in the short-term; steps to reduce exposure 1000–10,000-fold for other wireless (cell towers at distance; from these existing systems need to be initiated, especially in WI-FI and WLAN devices). The entire basis for safety stan- places where children spend time, and should be encouraged.
dards is called into question, and it is not unreasonable to These limits should reflect the exposures that are commonly question the safety of RF at any level.
associated with increased risk of childhood leukemia (in the A cautionary target level for pulsed RF exposures for 2–5 mG (0.2–0.5 ␮T) range for all children, and over 1.4 mG ambient wireless that could be applied to RF sources from cell (0.14 ␮T) for children age 6 and younger). Nearly all of tower antennas, WI-FI, WI-MAX and other similar sources C. Sage, D.O. Carpenter / Pathophysiology 16 (2009) 233–246 is proposed. The recommended cautionary target level is 0.1 • ELF limits should be set below those exposure levels microwatts per centimeter squared (␮W/cm2) (or 0.614 V per that have been linked in childhood leukemia studies to meter or V/m) for pulsed RF where these exposures affect the increased risk of disease, plus an additional safety factor.
general public; this advisory is proportionate to the evidence It is no longer acceptable to build new power lines and and in accord with prudent public health policy. A precau- electrical facilities that place people in ELF environments tionary limit of 0.1 ␮W/cm2 should be adopted for outdoor, that have been determined to be risky (at levels generally cumulative RF exposure. This reflects the current RF science and prudent public health response that would reasonably • While new ELF limits are being developed and imple- be set for pulsed RF (ambient) exposures where people live, mented, a reasonable approach would be a 1 mG (0.1 ␮T) work and go to school. This level of RF is experienced as planning limit for habitable space adjacent to all new or whole-body exposure, and can be a chronic exposure where upgraded power lines and a 2 mG (0.2 ␮T) limit for all there is wireless coverage present for voice and data transmis- other new construction, It is also recommended for that sion for cell phones, pagers and PDAs and other sources of a 1 mG (0.1 ␮T) limit be established for existing habit- radiofrequency radiation. An outdoor precautionary limit of able space for children and/or women who are pregnant.
0.1 ␮W/cm2 would mean an even lower exposure level inside This recommendation is based on the assumption that a buildings, perhaps as low as 0.01 ␮W/cm2. Some studies and higher burden of protection is required for children who many anecdotal reports on ill health have been reported at cannot protect themselves, and who are at risk for child- lower levels than this; however, for the present time, it could hood leukemia at rates that are traditionally high enough prevent some of the most disproportionate burdens placed to trigger regulatory action. This situation in particular on the public nearest to such installations. Although this RF warrants extending the 1 mG (0.1 ␮T) limit to existing target level does not preclude further rollout of WI-FI tech- occupied space. “Establish” in this case probably means nologies, we also recommend that wired alternatives to WI-FI formal public advisories from relevant health agencies.
be implemented, particularly in schools and libraries so that • While it is not realistic to reconstruct all existing electrical children are not subjected to elevated RF levels until more is distributions systems, in the short-term; steps to reduce understood about possible health impacts. This recommen- exposure from these existing systems need to be initi- dation should be seen as an interim precautionary limit that is ated and should be encouraged, especially in places where intended to guide preventative actions; and more conservative • A precautionary limit of 0.1 ␮W/cm2 (which is also Broadcast facilities that chronically expose nearby res- 0.614 V per meter) should be adopted for outdoor, cumula- idents to elevated RF levels from AM, FM and television tive RF exposure. This reflects the current RF science and antenna transmission are also of public health concern given prudent public health response that would reasonably be the potential for very high RF exposures near these facilities set for pulsed RF (ambient) exposures where people live, (antenna farms). RF levels can be in the 10 s to several 100 s work and go to school. This level of RF is experienced of ␮W/cm2 in residential areas within half a mile of some as whole-body exposure, and can be a chronic exposure broadcast sites (for example, Lookout Mountain, Colorado where there is wireless coverage present for voice and and Awbrey Butte, Bend, Oregon). Like wireless communica- data transmission for cell phones, pagers and PDAs and tion facilities, RF emissions from broadcast facilities that are other sources of radiofrequency radiation. Some studies located in, or expose residential populations and schools to and many anecdotal reports on ill health have been reported elevated levels of RF will very likely need to be re-evaluated at lower levels than this; however, for the present time, it could prevent some of the most disproportionate bur- For emissions from wireless devices (cell phones, per- dens placed on the public nearest to such installations.
sonal digital assistant or PDA devices, etc.) there is enough Although this RF target level does not preclude further evidence for increased risk of brain tumors and acoustic neu- rollout of WI-FI technologies, we also recommend that romas now to warrant intervention with respect to their use.
wired alternatives to WI-FI be implemented, particularly Redesign of cell phones and PDAs could prevent direct head in schools and libraries so that children are not subjected and eye exposure, for example, by designing new units so to elevated RF levels until more is understood about pos- that they work only with a wired headset or on speakerphone sible health impacts. This recommendation should be seen as an interim precautionary limit that is intended to guide These effects can reasonably be presumed to result preventative actions; and more conservative limits may be in adverse health effects and disease with chronic and uncontrolled exposures, and children may be particularlyvulnerable. The young are also largely unable to removethemselves from such environments. Second-hand radiation, References
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