24/02/2006 - Response to the October 2005 HPA-RPD report on Electrical Sensitivity

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Summary

At the beginning of November 2005 we wrote a preliminary preview of the long-awaited HPA-RPD report "Definition, Epidemiology and Management of Electrical Hypersensitivity". Unfortunately this report was limited to a carefully conducted review of the published literature - which for EHS is extremely sparse. This HPA-RPD review gathers some useful information together but offers little of any practical use from a public health perspective. This is a missed opportunity and GPs would have greatly benefited from some practical advice - at present they tend to blame the effects on stress and prescribe tranquilisers and other psychoactive medication. We have to ask why, if they really do not have the expertise to recognise medical conditions, did the NRPB commission this report in the first place? Who was it for? Who should do what now?

In the words of the review's foreword, the review "was commissioned by the NRPB to consider the definition, epidemiology and management of ES." To do this the review was largely defined by seven questions as follows:

1. Is there a characteristic set of symptoms associated with ES?
2. Are the triggers the same in all sufferers?
3. Is there a characteristic time course and prognosis for the condition?
4. Is the condition more common in certain groups in the population?
5. Is there a diagnostic test or pathophysiological marker characteristic of ES?
6. Are there management strategies that are known to be effective?
7. Us there an overlap with other syndromes such as multiple chemical sensitivity or other environmental illnesses?

Although there are overlaps, questions "a", "b" and "e" can be seen as defining ES, "c" and "d" as the epidemiology of ES, and "f" and "g" as the management of ES.

Definition of ES

The review concluded that "It has not been possible to construct a meaningful definition of ES..." (Section 5.1 paragraph 1).

This conclusion is quite reasonable, due mainly to the wide range of symptoms experienced by ES sufferers and the wide range of sources that appear to cause these symptoms. The statement that "the review found no consistent evidence of objective clinical signs or sensitive/specific pathophysiological markers" (Section 5.1 paragraph 2) is similarly reasonable, though it could be taken as implying that the symptoms may not actually exist - which they do.

The final paragraph in the section is also acceptable, though it has an unnecessary final sentence that seems to have been inserted in order to weaken the section. Having noted that ES seems to share a number of its symptoms with other "functional somatic syndromes" and "idiopathic environmental intolerances" (the difference being that ES is normally attributed by the sufferer to a specific EMF source), the review finishes with "Other than noting the ongoing debate about this attribution, however, this review is unable to comment further". This is a real shame as the content of the review gave plenty of room to make further comments, and the lack of comment is therefore a deliberate decision as opposed to there being a lack of data to comment on.

It could be argued that they are implying that there is not sufficient evidence to make a genuine association between ES symptoms and an EMF source except for the assertion of the sufferers, whereas some of the research cited in the review clearly suggests otherwise. For example, they cite a published questionnaire in section 4.5.5 (Symptoms of ill health ascribed to electromagnetic field exposure, International Journal of Hygiene and Environmental Health 2004), where 394 people with self-attributed ES had to score the effectiveness of actions they took to reduce the problems they were experiencing from 1 (ineffective) to 6 (very effective), and we see these results as offering good evidence of the reality of EHS. The actions taken and mean effectiveness score for reducing symptoms are displayed in the table below:

With such a huge correlation between the removal of exposure (all top 3 actions fit into this category) and improvement of well-being, it is clear not only that this may well be useful in defining ES for (b) above, warranting further investigation, but it also provides a starting point for management of the condition (f). Recommendations of further work to be done to test these should have been made.

Epidemiology of ES

The review looked at studies from both workplace and of general populations to estimate the prevalence of ES. The following is taken from section 4.6 of the review, and relates to the findings of the EC expert group (NIWL, Bergqvist et al) who attempted to estimate the extent of ES within EU countries.

From this, it would seem that the real issue here is recognition of the syndrome. It is clear that the lack of recognition of Electrical Sensitivity as a condition is due largely to the lack of ability to clearly define it, either by symptoms or by cause, and this is therefore going to have a direct effect on the number of people estimated to suffer from it. The disparity in percentages may well be accounted for by the number of people with ES who are unable to continue their employment due to ill-health caused by EMF exposure at work and therefore drop out of occupational medicine statistics. They may then seek alternative sources of support such as self-help groups. It is therefore not possible to currently predict the prevalence of the condition either in the UK, or worldwide until there is a more formal method of defining who has the condition, especially when it seems to overlap with other sensitivity and intolerance responses. Powerwatch believes that around 3% of the UK population (~2M people) may experience some degree of electrical hypersensitivity [see Refs 1, 2 & 3].

Management of ES

The opening sentence of the "Policy/management options" section of the review (section 5.2) states "Given that the project did not specifically address the question of aetiology, it is unable to inform policy in terms of setting exposure guidelines". It then comments that there is not sufficient published evidence regarding evaluation of the symptoms and success of management strategies in dealing with the condition, though it does note that the "limited studies to date" show some success.

This section sums up what was really disappointing about the report: a lack of solid suggestions of how to move forward in an attempt to tackle the problem, perceived or otherwise, of Electrical Sensitivity. Aside from the comment that defining whether or not someone actually has ES is an exceptionally tricky prospect (aside from the fact the sufferer themselves thinks it is ES), the report has made some kind of recognition that a condition with apparent connections to EMF sources exists. However, beyond that, very little support is offered to people who report that they have the syndrome. In fact, the final paragraph in section 5.4 reads "Thus, although symptoms attributed to RF EMF (such as mobile phones/base stations) and other exposures appear to be similar in type, the findings of this review cannot apply in full to these attributions" , which is effectively stating once again that they are deliberately leaving open the chance that these symptoms are purely coincidental and are not related to EMF sources.

They conclude their "Future Research" section (5.5) by recommending that future research should control for the placebo effect, should engage with therapists and practitioners currently attempting to look at the condition to see if there are evaluations missed by this review and to conduct clinical trials on cognitive behavioural therapy (CBT).

Considering the results in the Actions/Effectiveness table (see above), it is infuriating that prevention has not been considered as a valid management tactic, focusing instead entirely on treatment. The results show quite clearly that the removal of the EMF source has the single strongest effect in ameliorating the symptoms. Surely it is worth recommending that studies are done to properly investigate the effectiveness of practical preventative measures.

If EHS is as prevalent as we believe, it is responsible for both a considerable loss and cost to the country, with people living and working well below optimal health. We urgently need the HPA and the Department of Health to proactively take this issue forward.

References and further reading:

The original report: HPA-RPD-010, 'Definition, Epidemiology and Management of Electrical Sensitivity' from the Radiation Protection Division of the Health Protection Agency, may be freely downloaded from their website here [www.hpa.org.uk].

[1] SIF report on hypersensitivity symptoms of members.

[2] 'Black on White' Voices and witnesses about electro-hypersensitivity - the Swedish experience, available from here [www.feb.se - 143 pages, 1.2 MB].

[3] The World Health Organisation have some ES information here [www.who.int], and the Proceedings of their 2004 conference are available from here [www.who.int].

Other worthwhile reading:
Electromagnetic Hypersensitivity, A Modern Illness, Alasdair & Jean Philips, available from EMFields.

Electromagnetic Hypersensitivity - 2nd Copenhagen Conference Proceedings Eds: Jyrki Katajainen and Bengt Knave ISBN 87-981-270-2-0, Denmark, 1995.

Bergqvist U and Vogel E (1997) Possible health implications of subjective symptoms and electromagnetic field. A report prepared by a European group of experts for the European Commission, DGV. Arbete och Hälsa, 1997:19. Swedish National Institute for Working Life, Stockholm, Sweden. ISBN 91-7045-438-8.

COST244bis (1998) Proceedings from Cost 244bis International Workshop on Electromagnetic Fields and Non-Specific Health Symptoms. Sept 19-20, 1998, Graz, Austria.