catastrophy

>Look what they have finally adopted as a conclusion from WHO Meeting on ES
>in Prague (of October 2004.)
>If you don't want to read in full, just scroll to the bottom to see the
>conclusions!
>Shameless!
>
>Drasko
>
>
>=======================
>WHO workshop on Electrical Hypersensitivity
>Prague, Czech Republic
>October 25-27, 2005
>WORKING GROUP MEETING REPORT
>On October 27, 2004, a working group meeting was held, which included the
>speakers, the
>WHO secretariat and other interested parties. The working group meeting
>included break-out
>sessions on the following topics: (i) Characterization, diagnosis and
>treatment, (ii) Research
>needs, and (iii) Policy options. The reports from each of these groups is
>provided below.
>(i) Report on CHARACTERIZATION, DIAGNOSIS AND TREATMENT
>Rapporteur: Lena Hillert, Department of Public Health Sciences, Karolinska
>Institute,
>Sweden
>Participants:
>Jan Bures, The Academy of Sciences of the Czech Republic
>Eduard David, Universität Witten-Herdecke, Germany
>Gerd Friedrich, Forschungsgemeinschaft Funk e.V., Germany
>Bruce Hocking, Medical Specialist, Australia
>Sheila Johnston, Neuroscience Consultant, United Kingdom
>Patrick Levallois, Institut national de santé publique du Québec, Canada
>Torbjörn Lindblom, FEB - The Swedish Association for the ElectroSensitive,
>Sweden
>Ludìk Pekárek, The National Reference Laboratory for Non-Ionizing Radiation,
>Czech Republic
>Martin Röösli, Department of Social and Preventive Medicine, University of
>Bern, Switzerland
>Berndt Stenberg, Department of Dermatology, University Hospital Umeå, Sweden
>Arne Wennberg, National Institute of Working Life, Sweden
>Oldøich Vinaø, Charles University Prague, Czech Republic
>BACKGROUND
>There are individuals that report a wide range of symptoms that they
>attribute to
>electromagnetic fields or being close to electrical equipment1. To date,
>experimental and
>epidemiological studies have failed to provide clear support for a causal
>relationship between
>electromagnetic fields and complaints. The reported symptoms are generally
>non-specific
>and no consistent set of symptoms has been identified.
>NAME AND WORKING DEFINITION
>Name
>The term Idiopathic environmental intolerance (Electromagnetic field
>attributed symptoms),
>or IEI-EMF, is proposed to replace terms that imply an established causal
>relationship
>between symptoms and electromagnetic fields (e.g. electromagnetic
>hypersensitivity,
>electrosensitivity and hypersensitivity to electricity). Should a causal
>relationship to EMF or
>1 The term "electrical equipment" in this report includes any equipment
>which emits electric, magnetic or
>electromagnetic fields 0-300 GHz, e.g. power lines, electric motors, hair
>dryers, mobile phones and base stations
>etc. EMF is used as an abbreviation for these fields.
>1
>any other explanation be established in the future, the name of this
>condition may be changed
>according to this new knowledge. The specification "EMF attributed symptoms"
>is
>motivated by the need to distinguish the group of individuals who attribute
>their symptoms to
>EMF from individuals who attribute their ill health to other environmental
>agents, e.g.
>odorous chemicals. In the remainder of the text, it will be referred to as
>IEI.
>Working definition
>Symptoms that are experienced in proximity to, or during the use of,
>electrical equipment,
>and that result in varying degrees of discomfort or ill health in the
>individual and that an
>individual attributes to activation of electrical equipment.
>CHARACTERIZATION
>In the absence of any diagnostic criteria, further characterization of IEI
>is necessary. Several
>factors may be included in standardized protocols and questionnaires to
>characterize IEI
>individuals, as further detailed below.
>i. Symptoms
>Scores of most typical symptoms or indices of these symptoms (e.g. skin
>symptoms and
>neurovegetative symptoms, 'headaches' with mobile phones).
>Note that IEI is not to be used as a diagnostic classification. In the
>absence of any
>identified disease, diagnosis should be based on the most pronounced
>symptoms (e.g.
>headache), according to ICD-10 (International Classification of Diseases;
>for diseases
>and/or symptoms) or DSM-IV (Diagnostic and Statistical Manual 4th edition;
>for
>psychiatric disorders)
>ii. Self reported triggering or aggravating sources
>Include information on the EMF sources that are considered by the patient to
>be the cause
>of their ailment, for example:
>1. Electrical environment in general
>2. Specified electrical equipment or sources of EMF (e.g. VDU environment,
>mobile
>phones, power lines, other specific electrical equipment)
>iii. Exposure (assessment)
>Assess EMF exposure to determine if the person's exposure is below existing
>EMF limits.
>iv. Temporal aspects
>Symptoms vary/do not vary within 1 hour (or alternatively 24 hours)
>upon change in presumed exposure Yes/No
>Symptoms increase with longer duration of exposure Yes/No
>Perceived exposure - response relationship Yes/No
>v. Behaviour
>Avoidance behaviour Yes/No
>Sick leave (If yes: Number of days) Yes/No
>vi. Clinical findings
>Pathological findings in medical work-up, e.g. in blood chemistry, skin
>tests
>2
>or in investigations of reactions in the autonomic nervous system (ANS)
>Yes/No
>In case of provocation tests (see discussion in next section), indication of
>a relationship
>between exposure (specify!) and complaints Yes/No
>Subgroups
>Typical subgroups may be described based on the variables above in order to
>focus on these
>specific groups in experimental or epidemiological studies. These groups may
>include, for
>example:
>A. A group of persons, without a reasonable alternative diagnosis, with
>predominantly skin
>symptoms that present themselves within one hour of work with VDUs, all
>persons still
>working part or full time.
>B. A group of persons, without a reasonable alternative diagnosis, with
>predominantly
>neurovegetative symptoms that present themselves within 24 hours of exposure
>to mobile
>phone base stations or other EMF source e.g. power lines (as reported by the
>persons
>themselves), working or on sick leave, all of which have taken measures to
>reduce their
>exposure to EMF in their homes or places of work.
>C. A group of persons, without a reasonable alternative diagnosis, with
>predominantly
>unpleasant feelings on the scalp (which the patient distinguishes from
>ordinary headaches)
>and sometimes feeling of slowness of thought, which the afflicted persons
>associate with
>use of mobile phones.
>MANAGEMENT AND TREATMENT
>The patient's medical history needs to be carefully taken to assess the
>plausibility of
>symptoms in relation to EMF exposures (dose-response) and possible
>alternative diagnoses.
>Physical examination should be carefully done to assess signs (e.g. skin
>changes) or
>alternative diagnoses.
>IEI patients suffer from real health problems, but there is no known
>biological marker or any
>diagnostic test for IEI. Different contributing factors have been indicated
>in scientific studies.
>The primary focus of the medical work-up is to exclude or identify any
>medical diagnosis or
>psychological condition that calls for specific handling or treatment (see
>Figure 1).
>Psychosocial factors that may influence the patient's well-being should also
>be considered.
>Several studies on IEI patients have indicated that this group of patients
>has an imbalance in
>their autonomic nervous system. Deviating reactions have been shown for
>different
>environmental stimuli (but not EMF) as well as indications of increased
>sympathetic
>activation. Standardized tests for investigation of individual patients may
>be developed. It is
>presently not known whether these findings may be predisposing factors or an
>effect of long
>suffering from ill health.
>Information on what is known about health effects from exposure to EMF and
>medically
>unexplained symptoms in general are important parts in the medical
>consultation. The
>prognosis of IEI seems to be good in many patients, especially in those
>reported early and in
>predominantly skin symptoms. The use of hands-free mobile phone kits have
>been reported
>to resolve the problem with complaints during mobile phone calls. If
>symptoms do persist in
>spite of medical work-up and interventions, it is usually necessary to
>refrain from pursuing a
>causal factor and focus on reducing symptoms and disability. The choice of
>treatment should
>be based on a broad evaluation of the patient's symptoms and situation and
>taking the
>patients motivation for different interventions into account. Regardless of
>the initial cause of
>3
>ill health, the patient may be in need of continued support from the medical
>doctor or a
>psychologist due to co-existing psychological conditions or secondary
>effects of suffering
>from ill health of unknown origin where no standard cure is to be offered.
>General recommendations to the physician for the medical consultation and
>follow-up
>include
>. allowing enough time and/or repeated visits
>. establishing a trustful relationship and agreeing on a shared ambition,
>i.e. the patient's
>improvement
>. ensuring follow-up of the patient
>. applying a non-judgmental and supportive approach, but informing the
>patient of your
>professional opinion
>. in case of persisting symptoms, focusing on reducing disability rather
>than searching for a
>specific causal factor.
>Measuring and reducing the exposure to electric and/or magnetic fields
>Patients who suffer from ill health and attribute it to electric or magnetic
>fields frequently ask
>for measurements of fields and actions to reduce the exposure to EMF.
>Measuring fields are
>not generally recommended since there is no known causal relationship
>between electric or
>magnetic fields and symptoms unless the EMF fields are likely to exceed
>recommended
>exposure limits. However, measurement in workplaces may be important to
>assess
>compliance with exposure standards. For further discussion on advantages and
>disadvantages
>of actions aimed at EMF, please see the chapter "Handling of individuals
>claiming
>"electromagnetic hypersensitivity" in Possible health implication of
>subjective symptoms and
>electromagnetic fields; A report prepared by a European group of experts for
>the European
>Commission, DG V. [Bergqvist U et al. Stockholm, Sweden; 1997: National
>Institute for
>Working Life. (1997:19)]
>http://ebib.arbetslivsinstitutet.se/ah/1997/ah1997_19.pdf .
>Provocation tests
>Provocation studies with double blind exposure sessions have failed to
>verify a causal
>relationship between electric, magnetic or electromagnetic fields and
>complaints. The option
>to conduct individually designed provocation tests on a single patient needs
>careful
>consideration by the physician and the patient, including discussions on how
>different
>outcomes of the tests might be interpreted.
>Should individually designed provocation tests be considered, it should be
>noted that the
>design needs to be carefully considered, e.g. regarding the exposure field
>intensity and
>modulations, blinded randomization of exposures, number of tests etc. If the
>patient states
>that he/she will not change his/her belief regarding the cause of ill
>health, regardless of the
>outcome in any provocation tests, a provocation test will not serve any
>purpose.
>4
>Referral to
>specialist/GP
>Specified
>electrical equipment/
>specified environments
>Electrical equipment
>in general
>Treatment on
>the basis of
>self reported
>symptoms*
>Improve
>environmental
>factors of
>possible
>importance for
>complaints.
>Treatment on
>the basis of self
>reported
>symptoms*, **
>Medically unexplained symptoms
>Alternative
>diagnosis
>of a
>condition
>that can
>explain
>symptoms/
>complaints
>(ICD-10
>and/or
>DSM-IV)
>MEDICAL WORK-UP
>Investigation based on reported symptoms and
>identified signs and pathological findings.
>Information on the present state of knowledge
>on health effects from exposure to EMF.
>Figure 1. Flow chart of investigation and intervention of IEI patients.
>*The choice of treatment may be based on reported success of different
>treatments for similar
>symptoms of other conditions and may include stress reduction strategies and
>cognitive
>behavioural therapy.
>**Different options that the afflicted person may choose to consider may be
>discussed (e.g.
>use of hands-free mobile phone kit, reduction of working time with a VDU),
>but the decision
>to take these actions is left to the patient.
>5
>(ii) Report on RESEARCH NEEDS
>Rapporteur: N. Leitgeb, Graz University of Technology, Graz, Austria
>Participants:
>Anders Ahlbom, Karolinska Institute, Sweden
>Jan Bures, The Academy of Sciences of the Czech Republic
>Robin Cox, Independent Occupational Physician, United Kingdom
>Lawrie Challis, Mobile Telecommunications & Health Research Programme,
>United Kingdom
>Kjell Hansson Mild, National Institute for Working Life, Sweden
>Maila Hietanen, Finnish Institute of Occupational Health, Finland
>Michel Israel, National Centre for Protection of the Public Health, Bulgaria
>*Olle Johansson, The Experimental Dermatology Unit, Karolinska Institutet,
>Sweden
>Eric van Rongen, Health Council of the Netherlands
>Monica Sandström, National Institute for Working Life, Sweden
>Herman Staudenmayer, Behavioural Medicine & Biofeedback Clinic of Denver,
>United States of
>America
>* Dr Johansson has reservations with the contents of this report
>The working group (WG) noted that electrical hypersensitivity (EHS) has
>gained relevance
>that goes beyond the number of individual cases but influences the risk
>perception of a much
>wider percentage of the general population.
>The WG was aware that the term "electrical hypersensitivity" is only one
>among others such
>as "electromagnetic hypersensitivity" and "sensitivity to electricity". It
>concluded that these
>terms are misleading and should be replaced by IEI (idiopathic environmental
>intolerance)
>which would fit better in the commonly used terminology for similar
>health-associated
>environmental factors.
>The working group concluded that specific diagnostic IEI facilities would be
>helpful and that
>there was a need for further research in this field. Research needs in the
>following ranges
>were identified:
>DIFFERENTIATION OF IEI
>IEI cases with EMF attributed symptoms needs to be differentiated from other
>IEI cases:
>a) there should be a search for a symptom cluster: Present studies were very
>valuable in
>determining groups of self-declared EHS cases. There is a need not to
>restrict the
>attempt to self-declared EHS cases but to study the group of IEI on a
>broader scale, e.g.
>by hypothesis-based studies of symptom groups according to the frequency of
>occurrence or symptom-trigger by specific sources.
>b) there is a need to define IEI inclusion/exclusion criteria, e.g.
>definitions based on
>baseline tests for characterizing the status of the autonomic nervous system
>and the
>psychological/ psychiatric status.
>6
>PROVOCATION STUDIES
>Provocation studies are considered to be the most powerful way of studying/
>proving a causal
>relationship. For proper design, apart from ethical considerations, the
>following aspects need
>to be considered:
>- differentiation between potential electromagnetic versus psychological/
>psychophysiological impact by adequate tests
>- double-blind placebo-controlled crossover design
>- inclusion of an appropriate psychiatric control group exhibiting similar
>symptoms
>(e.g. anxiety, affective disorders, somatoform reactions, etc.)
>- inclusion of a positive control factor, e.g. other environmental stressors
>like sound,
>flickering light or mental stress
>- accounting for potentially different individual reaction onset/recovery
>time
>constants
>- characterization of provocation conditions, including the duration of
>exposure and
>the duration of washout times
>- measurement of the EMF background level (which should be well below the
>provocation level)
>- consideration of person's belief/ experience when choosing provocation
>factors
>(e.g. fields, exposure time)
>- use of well documented and validated questionnaires and test procedures
>with
>preference given to yes/no questions (such as the Minnesota MMPI-2 test
>protocol
>or the SCL-90R- symptom checklist)
>- neuropsychological testing before and after exposure
>- consideration of appropriate signal characteristics, e.g. frequency,
>modulation and
>intensity
>There is a need to harmonize protocols and establish multinational/
>international cooperation.
>EPIDEMIOLOGICAL STUDIES
>For the time being, epidemiological studies are not considered helpful. The
>reasons for this
>are the following:
>- the definition of "cases" is still lacking
>- possible device-specific reactions could be missed because of the
>different devices
>encountered in daily life
>- exposure level might not necessarily be a selection criterion for exposure
>groups
>7
>(iii) Report on POLICY OPTIONS, COMMUNICATIONS WITH IEI INDIVIDUALS
>AND RECOMMENDATIONS TO NATIONAL AUTHORITIES
>Rapporteur: Jill Meara, National Radiological Protection Board, United
>Kingdom
>Participants:
>Pavel Sistek, National Reference Laboratory on Non-Ionizing EMF, Czech
>Republic
>Wendla Paile, STUK - Radiation and Nuclear Safety Authority, Finland
>Fabriziomaria Gobba, University of Modena & Reggio Emilia, Italy
>Christopher Muller, ergonomie & technologie (e&t) GmbH, Switzerland
>Emilie van Deventer, World Health Organization, Switzerland
>INFORMATION FOR GENERAL PUBLIC
>WHO to develop a general fact sheet that includes the following points:
>- range of symptoms of IEI
>- no attribution of causality to EMF
>- do not include prevalence of EHS but rather prevalence of the different
>symptoms (and
>longstanding history of these) in general population
>- do warn against commercial products to shield against EMF
>- discourage measurements in homes
>- exclude underlying somatic disease by usual physical examination
>- no proof of any correlation between these symptoms and later diseases
>- reminder of basic physics (NIR vs. IR, etc)
>- recovery is certainly possible without taking drastic measures
>- stress due to introduction of new technologies
>- need for coping strategies
>INFORMATION FOR PHYSICIANS
>- Information regarding ill-defined symptoms and undifferentiated illness
>should be
>included in post-graduate training
>- Experts should develop an international protocol for physicians that
>includes current
>diagnosis and treatment information
>- National governments should develop tailored information for medical
>practitioners
>ADVICE TO GOVERNMENTS
>Governments need to put the issue of IEI into their general risk
>communication strategies.
>They also need to address the following issues:
>- Patients have real symptoms, some of which are attributed to EMF, but
>there is no
>scientific evidence of causal link, therefore no grounds to use IEI as a
>diagnostic
>classification for handicap status. But symptoms could be used as a
>classification.
>- No indication that lowering the limits would reduce the prevalence of
>symptoms
>attributed to EMF
>- Discourage measurements in homes
>- Develop appropriate interaction with self-help groups
>- Anticipate problems with new technologies, and provide balanced
>information, promote
>dialogue. Note different attitude taken for new pharmaceuticals, both before
>introduction
>and post-marketing surveillance. Possible role for complaints registers?
>
>
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