11/11/2001 - Critical review of NRPB's Doll2 report on ELF fields and Cancer.

Doll II - ELF EMFs and the Risk of Cancer. Docs of the NRPB Vol. 12 No. 1 2001.
Bias and omissions flaw report - incompetence, malfeasance or hidden agenda?
by Alasdair Philips

'Public and politicians must understand and debate risk ... and agree when the precautionary principle must take priority. Advisory committees cannot be stuffed with the great and the good; they must include the lay public and the doubters.' [New Scientist, Editorial, 4th Nov.2000]

The first major update since 1994 from the NRPB Advisory Group on Non Ionising Radiation (AGNIR) was published on 6th March 2001. This has become informally known as the "Doll II" report. Although it contains some useful information, this report is seriously flawed by the blinkered approach of what I see as an unenlightened group of scientists who fail to recognise the recent bio-electromagnetic insights that are changing the way that modern science understands life processes in living beings. It is also undermined by missing important studies, misunderstanding others, not providing the pithy analytical comment required, and also by some very sloppy use of scientific and statistical terms. If submitted to a reputable journal it would have been most unlikely to pass the peer review process.

Even worse is that they do admit to a doubling in the incidence of childhood leukaemia in ambient power-frequency (50 Hz) magnetic fields of 0.4 microtesla (µT) or higher, but then go on to dismiss this as a negligible health hazard to the UK population in general. This is politico-scientific prevarication at its very worst. It leaves parents with children living in these higher magnetic fields in a worrying limbo-land and leaves local authorities powerless to prevent the building of new houses close to high-voltage power lines. Either there is a problem that needs addressing with guidance changes, or there isn't a problem. AGNIR admit that there do appear to be real associations between some cancers (including childhood leukaemia) and ELF EMFs, but then seem to say 'problem? what problem?'.

Indeed, their premise seems to ignore the modern epidemiological concept that it is necessary to identify susceptible sub-groups in the population and advise guidelines that help protect these vulnerable people. Gone is the time that we can expect to identify problems caused by single factors that affect almost everyone exposed (e.g. cholera spread by drinking contaminated water). We now have many different and novel hazards that people react to in different ways, some being more susceptible to them than others. In whole population studies, the problems of susceptible individuals get masked by the majority of people and so the apparent relative risks (RR) are low and often insignificant, whereas they are much higher and significant for the susceptible groups of people. At the 2001 Bradford-Hill Memorial Lecture, Dr David Strachan described the modern task of epidemiology to help provide 'safety for the susceptible'. This requires a significant change of emphasis for many epidemiologists, including AGNIR's.

What we need is a precautionary approach. Dr John Stather, the Assistant Director of the NRPB has repeatedly stated that the NRPB have never chosen to give precautionary advice. I claim that this is just not acceptable for a publicly funded body charged with the duty to advise on health risks of radiation and electromagnetic fields. The AGNIR ask for a high level of scientific proof that EMF causes cancer when for all other walks of life we rely on a Risk Analysis approach. A precautionary approach IS needed, and they are the only official voice that can recommend such a course of action. It is a complete cop-out to say that a precautionary approach is political and they, as scientists, can only advise on certainties. Scientists who sit on advisory committees have a particular responsibility to comment on the implications of scientific findings especially in situations where strict causal proof may be lacking.

They should provide an analysis that covers the spectrum from certainty of hazard (where we need legislation) through to weak association (where a warning might be appropriate). Then the politicians are in a position to do the political bit and choose a level of precautionary approach. There is no way the politicians are going to implement any precautionary science-based policies if their advisers fail to set out the issues and possible ways of dealing with them. We are talking about risk-benefit analysis, but done in a way that identifies susceptible sub-groups of the population.

The introduction (p5) sets out the terms of reference of the AGNIR group: 'to review the work on the biological effects of non-ionising radiation relevant to human health and to advise on research priorities'. I find it ironic that the NRPB who have repeatedly 'corrected' people for using the word 'radiation' to describe power frequency electric and magnetic fields, choose to use it themselves when setting AGNIR's terms of reference.

..... That was the first page of six that go on into some quite technical detail.

For Alasdair' Philips full critique of 'Doll2'; see 'Doll2-extra'.

Sir Richard replied, and this is set out below:

As I understand it, Alasdair Philips does not disagree with the conclusion of the Advisory Group that wrote the report, namely, that "the epidemiological evidence is currently not strong enough to justify a firm conclusion that such fields cause leukaemia in children, Unless, however, further research indicates that the finding (the prolonged exposure to high levels of power frequency magnetic fields that are seldom encountered by the general public in the UK is associated with a small risk of leukaemia in children) is due to chance or some currently unrecognised artefact, the possibility remains that intense and prolonged exposures to magnetic fields can increase the risk of leukaemia in children."

Where he thinks the report fails is in its omissions and, in his view, misinterpretation of some of the laboratory evidence. One omission is important: namely any recommendation about the precautionary measures that, in the present circumstances, might be undertaken. This was, however, intentional, as it was outside the Advisory Group's terms of reference. SOME SCIENTISTS MUST, of course, be prepared to suggest possible measures and attempt to weight the possible benefits against their economic and social cost. Any such proposals must, however, be based on an assessment of the scientific evidence, and that was what we had been asked to make. If we were to advise of action to avoid risks that were possible but unsubstantiated, we should run the risk of being biased in our assessment of future evidence.

It is, in our view (and that of the NRPB) essential that the Advisory Group should not be prejudiced in favour of one or other conclusion (which we should be in danger of being if we had given so-called precautionary advice) and that we should be able to assess any new evidence with a completely open mind. It is the responsibility of others, informed by our conclusion, to recommend what, if anything, should now be done.

We are aware of many of the other omissions to which Philips refers and had, indeed, drawn attention to several of them. We share his concern about the appropriate measure of exposure for assessing risk, which would, of course, be different for different effects and we shall certainly explore the possibility of a specific relationship with night-time rather that 24 hour exposure.

We shall also review the possibility of cancer being related to electric, rather than magnetic, field exposures, after the UK Childhood Cancer Study findings become available (which, in June 2001, I expect to be quite soon). Similarly, we shall also review the possible effect of corona ions on the exposure of internal organs to carcinogenic agents, after receiving further specialist advice of its likely extent.

Another omission is any reference to such possible effects such as depression and suicide, but these are being reviewed separately and the report to which Mr Philips refers was specifically limited to the risk of cancer.

Others are mostly matters of detail (such as the reasons for using arithmetic or geometric means). Their inclusion would have made the report more complete, but they were left out in the interests of brevity, for the material that we already had to include already ran to 179 pages. As to our differences over the scientific evidence, I can only express the hope that people will read our account of it as well as his and judge for themselves. For our part, we are happy to leave it to the future to show whose interpretation is most often correct, for we would not claim that it was necessarily always ours.

Sir Richard has written a helpful reply to my critique, accepting many of my criticisms. Although he states that they didn't want the report to be any longer than it was (179 pages), which seems a rather spurious criterion for a public health assessment, he does most helpfully write that the lack of precautionary advice was intentional for a number of reasons.

Now both Dr John Stather and Dr Mike Clarke have been on radio and TV with me strongly implying (at the very least!) that AGNIR "do not recommend a precautionary policy". Of COURSE that is so - they have never been asked to take a view on that issue!

It seems to me that it is the NRPB's responsibility to devise and implement a structured and formal way of assessing the cost/risk/benefit of precautionary action in these matters. The Government Office of Science and Technology, Draft Code of Practice for Scientific Advisory Committees (latest draft March 2001) on reporting risk and uncertainty, states:
"45. Committees should aim at having a transparent and structured framework to examine, debate and display the nature of the risk. It is for committees to decide what form their risk assessments should take, but whatever procedure is used, it should be a systematic one. Whenever their work involves an assessment of risk, committees should consider carefully, taking into account the nature and scale of the problem, what precision of estimates is appropriate or realistic, in terms of costs, resources and time. Where a committee is asked to advise on risk management, it will normally be helpful for it to follow a formal structure based on recognised principles of risk assessment." [BSE Inquiry Report V.1 p.1290]

Alasdair Philips

The text below was last updated on 15 April 2001

UK It was sad to hear of the death of Dr Stephen Perry on 12th April. He was the pioneering English GP who, between 1979 and 1989, linked proximity of powerlines and high power-frequency magnetic fields from wiring with the increased risk of depression and suicide.

Despite being promised it earlier, we received a full copy of the NRPB Report on Sat 9th March . There are some good bits and some poor bits in it. We will review it as soon as possible on this site. We had time allocated to this at the time of release (5th, 6th & 7th March) but didn't receive the report, and last week were too busy to carry out this review. We hope to do this in the coming week. Our initial view is that some basic bits are good, but that some key research is mis-understood and mis-interpreted. Also some important findings (like the de-activation of Tamoxifen at 1.2 microtesla) seem to be left out altogether.

At last, the end of an era of denial. have been pushing for this admission for 15 years now! Powerlines CAN cause cancer and other illnesses. A short version was on the front page of the Sunday Times on 4th March 2001. Many further details are below. Useful key References are given at the bottom of this document.

However, the NRPB report conclusions fail to mention (a) any of the important Bristol work ~ Prof Henshaw's work is published in peer-reviewed journals and Dr Alan Preece's work has been accepted for publication and was sent to the NRPB for the committee to review; or (b) anything about the de-activation of the breast cancer treatment drug, Tamoxifen, by magnetic fields above 1.2 microtesla. The NRPB have now accepted that magnetic field levels of over 0.4 microtesla have a significant effect on children, doubling the risk of their developing leukaemia. In the light of this acceptance, their refusal to change their guidance regarding planning and powerlines does a great public dis-service. I judge the report as "incompetent", and I call for the NRPB function of providing advice for the protection of the general public to be removed from them. They are clearly not doing this, nor are they even providing an adequate commentary on important current science as they even fail to mention the issues.
"Advisory committees cannot be stuffed with the great and the good; they must include the lay public and the doubters."
(New Scientist, 4th November 2000). The NRPB AGNIR group only contains the 'great and the good'. It is clearly not adequate.
The UK National Radiological Protection Board have a very arrogant and exclusive attitude. It is time they were replaced.

Yesterday, on Monday March 5th, a German study was announced in the March 1st issue of the International Journal of Cancer (revised link now direct to the Abstract) that shows an increased risk of 3.21 (95% CI 1.33 - 7.8) of childhood leukaemia in children exposed to power-frequency magnetic fields of only 0.2 microtesla at night-time. For over ten years we have been asking that night-time exposure be separated out from daytime exposure, as it is at night that critical growth and repair processes take place in our bodies.

TODAY, Tuesday March 6th, the NRPB's Doll Report Mk II (ELF Fields and the Risk of Cancer) is released in Great St Peter Street, Westminster, London at 11 am. For the first time the NRPB admit an association of increased risk of childhood leukaemia with elevated magnetic fields. Genuine media attend ~ phone the NRPB on 01253 822 744.
Press copies of the new Report will be available at the Press Conference.

Although Prof Henshaw (et al)'s work has been published for a couple of years now, Sir Richard Doll's NRPB Advisory Group has never questioned him about his work. This seems odd for a group whose role is to advise on the importance of all new EMF related health research. You would have thought that they would have invited him to give a presentation and then given him a very hard viva-voce cross examination about the details of his work and hypothesis. How can they form a rightful judgement any other way? Dr Alan Preece's work showing a 50% increase in mouth cancer, a 30% increase in lung cancer, and a 14% increase in skin cancer near (and downwind) to high-voltage (132kV and above) powerlines should also have been considered. Sir Richard's NRPB AGNIR group have been sent details of these findings. They should be commented on in today's Report~ if not, why not?

We ask: "Is it a coincidence that the UKCCS Electric Field paper has been delayed by long over 6 months so that it comes out AFTER this Doll Report Mk II ?" We await the results from this electric field study with great interest. Why has it taken over three years to publish the results from this part of the study?

Other questions for Sir Richard could be: "On BBC Radio 4 Desert Island Discs, a couple of weeks ago, you said that the part of your work that you felt most satisfied with was discovering in the mid-1950s that there was no lower 'safe level' of ionising radiation. ALL exposure could cause cancer. Why then did it take a further 35 years for the UK NRPB to take up the same stance, and why did you testify at the Sellafield Gemma D'Arcy leukaemia case to say that pollution from the plant could not have caused her leukaemia. Because of your eminence in epidemiology, your dismissal of the evidence carried great weight in this High Court Case."

Dramatic new assessments of ill health near to high-voltage powerlines by Professor Denis Henshaw of Bristol University. These were given in February as 'advice to UK Government' and are available on his web site. He predicts excess cases of:
2 - 8 cases of childhood leukaemia caused by overnight magnetic field exposure above 0.3 microtesla
This estimate is mainly based on people living within 50 metres of 132 kV lines and above, but fields this high can be found up to a couple of hundred metres from the highest power lines, and are also caused by 33 kV, 11 kV and even 240/415 volt local overhead lines. People living within about 500 metres of overhead high voltage lines are also exposed to Corona Ion effects which cause toxic aerosols to get electrically charged and become more dangerous. We also find areas of the country where unseen and uncorrected underground electricity distribution cables cause fields greatly in excess of 0.3 microtesla (uT). About 300,000 people in the UK live in residential magnetic fields from external power lines of all sorts exceeding 0.3 uT. The only way to know is to have your fields measured (by your electricity supplier) or hire a meter from Powerwatch (£35/week) with instructions and measure them yourself.

14 extra cases of skin cancer

These are based on a risk assessment based on increased skin exposure to radon radioactive decay products and other carcinogenic agents via the 50 Hz oscillation of these particles within about 50 metres of high-voltage overhead power lines.

250-400 extra cases of lung cancer and a few thousand other illnesses associated with air pollution

Risk assessment based on increased exposure to air pollution via corona ion effects.

60 extra suicides and a causative factor in many tens of thousands of cases of clinical depression

Considered biologically plausible via magnetic field exposure with an apparent low threshold of 0.1 microtesla. 40% excess in suicide first found in the West Midlands and published in 1981 (!!!!) but not admitted by the NRPB. Increase in depressive illness that may be VERY widespread ~ a 2 to 3 fold increase found in severe clinical depression, and a 2 to 3.6 fold increase in suicide among electric utility workers.

For over five years, some multinational companies (including the World Bank) have been specifying low levels of power frequency magnetic fields (less than 0.2 microtesla, µT) for their new building designs.

A Swiss Ordinance (ORNI) that came into force on 1st February 2000 sets the maximum magnetic field from electricity supply installations at 1 µT. It requires the owners of such installations to arrange conductors and equipment in order to minimise magnetic fields that extent into work or living areas of property.

A document on EMF bio-effects from the Committee on Environment, Public Health and Consumer Protection, known as Tamino proposals, was discussed by the European Commission. A version was then passed by the European Parliament in 1999 in plenary [10.03.99 item 19] but rejected by the Council of Ministers as too costly to implement. Proposals included one to limit ambient of power-frequency flux to about 0.2 microtesla. The UK Power industry has already "given away" £2 billion sterling in the last few years: (a) as Directors and shareholder's bonuses and options, and (b) as a £50 refund to all UK electricity consumers on their bills about 5 years ago. We estimate that this would have been enough money to underground or move all the overhead power-lines over and close to groups of residential housing in the UK.

Breast Cancer

about 1995 there have been a series of peer-reviewed scientific papers from different laboratories showing a significant inhibition of Tamoxifen's oncostatic function when the ambient power-frequency magnetic flux is 1.2 µT or higher. TAMOXIFEN IS ONE OF THE MOST WIDELY USED DRUGS TO TREAT BREAST CANCER. Although these findings have not yet been incorporated into any legislation, from a Health & Safety viewpoint it does give a valid cause for concern in the workplace. Will this be commented on in this new NRPB Report ~ we certainly hope so!

The SwissRe 1996 publication "Electrosmog ~ a phantom Risk" should also be consulted as an indication of insurance industry thinking in these matters. In 1998 a working group of the US National Institute of Environmental Health Sciences classified power frequency EMFs as a "probable human carcinogen" in the same category as DDT, although the final printed 1999 NIEHS report was weaker.

We are regularly called in to track down the causes of high magnetic fields in offices. Not only are these likely to cause direct health problems, but over about 0.8 uT they cause computer screens to flicker or shimmer. It is illegal, under the EU and UK Display Screen Regulations, for workers to use such computer displays. The causes include faults in internal building wiring and EMFs from local electricity substations and underground distribution cables. Eastern Electricity (now 24-7) and have recently been very positive about helping solve these problems, but Southern Electricity claim ignorance about the problem and have not been co-operative to date. We are currently involved in a dispute with East Midlands Electricity over very high (over 25 µT) fields from an old substation of theirs that are polluting a neighbouring office. They have refused to co-operate in installing shielding to reduce the severe problem, a very anti-social attitude.

We also know of several schools that had high fields (over 1 µT) due to internal wiring problems. I feel that power-frequency magnetic field measurements (which are easy to do) should be a regular part of maintenance inspections. This is not a reason to panic, but there is not good reason for ambient magnetic fields in buildings to exceed 0.1 µT. However, a precautionary approach is urgently needed.

References

Childhood leukaemia and magnetic fields

Ahlbom A, Day N, Feychting M, Roman E, Skinner J, Dockerty J, McBride M, Michaelis J., Olsen J H, Tynes T and Verkasalo P K, 2000. A pooled analysis of magnetic fields and childhood leukaemia, British Journal of Cancer 83(5), 692-698.

Greenland S, Sheppard A R, Kaune W T, Poole C and Kelsh M A, 2000. A pooled analysis of magnetic fields, wire codes and childhood leukaemia. Epidemiology, 11, 624-634.

Microwave News, Vol. XX, No. 5, September/October 2000, ISSN 0275-6595, PO Box 1799, Grand Central Station, New York, NY 10163.

UK Childhood Cancer Study Investigators (UKCCS)., 1999. Exposure to power-frequency magnetic fields and the risk of childhood cancer. Lancet, 354, 1925-31.

Childhood leukaemia, air pollution and parental exposure

Nordlinder R and Järvholm B, 1997. Environmental exposure to gasoline and leukaemia in children and young adults - an ecological study. International Archives of Occupational and Environmental Health 70, 57-60.

Pearson R L, Wachtel H and Ebi K L, 2000. Distance-weighted traffic density in proximity to a home is a risk factor for leukaemia and other childhood cancers. Journal of the Air and Waste Management Association, 50, 175-180.

Savitz D A and Feingold L, 1989, Association of childhood cancer with residential traffic density. Scandinavian Journal of Work and Environmental Health, 15, 360-363.

Savitz D A and Chen J, 1990. Parental Occupation and Childhood Cancer: Review of Epidemiologic Studies. Environmental Health Perspectives, 88, 325-337.

Shu X O, Stewart P, Wen W-Q, Han D, Potter J D, Buckley J D, Heineman E and Robison L L, 1999. Parental occupational exposure to hydrocarbons and risk of acute lymphocytic leukaemia in offspring. Cancer Epidemiology, Biomarkers & Prevention, 8, 783-791.

Skin cancer

1. Fews A P, Henshaw D L, Keitch P A, Close J J and Wilding R J, 1999b. Increased exposure to pollutant aerosols under high voltage power lines. International Journal of Radiation Biology, 75(12), 1505-1521.

Assessment of Skin Doses. Documents of the NRPB, Volume 8, No. 3, 1997. Chilton, Didcot, Oxon, OX11 0RQ.

3. Preece A W, Iwi G R and Etherington D J, 1996. Radon, skin cancer and interaction with power lines. US Department of Energy Contractors Review Meeting, San Antonio, Texas, 17-21.

Increased exposure to air pollution near powerlines

Carter P J and Johnson G B, 1988. Space charge measurements downwind from a monopolar 500 kV HVDC Test Line, IEEE Transactions on Power Delivery, 3, 2056-2063,

Erren T C, 1996. Re: Association between exposure to pulsed electromagnetic fields and cancer in electric utility workers in Quebec, Canada, and France. Am J Epidemiol, 143: 841.

Fews A P, Henshaw D L, Wilding R J and Keitch P A, 1999a. Corona ions from powerlines and increased exposure to pollutant aerosols. International Journal of Radiation Biology, 75(12), 1523-1531.

Fews A P, Henshaw D L, Keitch P A, Close J J and Wilding R J, 1999b. Increased exposure to pollutant aerosols under high voltage powerlines. International Journal of Radiation Biology, 75(12), 1505-1521.

Fews A P, Wilding R J, Holden N K, Keitch P A and Henshaw D L. Lung cancer risk estimate in people living near high voltage powerlines. To be presented at the 23rd Annual Bioelectromagnetics Meeting, June 10-14, 2001, St Paul, Minnesota.

McDowall M E, 1986. Mortality of persons resident in the vicinity of electricity transmission facilities. British Journal of Cancer, 53: 271-279.

Air pollution

Allen J O, Dookeran N M, Smith K A, Sarofim A F, Taghizadeh K and Lafleur A L, 1996. Measurement of polycyclic aromatic hydrocarbons with size-segregated atmospheric aerosols in Massachusetts. Environmental Science Technology, 30, 1023-1031.

Cohen B S, Xiong J Q, Fang Ching-Ping and Li W, 1998. Deposition of charged particles on lung airways. Health Physics, 74(5), 554-560.

Harrison, R M, Smith J T and Luhana L, 1996. Source apportionment of atmospheric polycyclic aromatic hydrocarbons collected from an urban location in Birmingham, UK. Environmental Science Technology, 30, 825-832.

Katsouyanni K and Pershagen G, 1997. Ambient Air Pollution Exposure and Cancer. Cancer Causes and Control, 8, 284-291.

Seaton A, MacNee W, Donaldson K and Godden D, 1995. Particulate air pollution and acute health effects. The Lancet, 345, 176-78.

Venkataraman C and Raymond J, 1998. Estimating the lung deposition of particulate polycyclic aromatic hydrocarbons associated with multimodal urban aerosols. Inhalation Toxicology, 10, 183-204.

Venkataraman C, Thomas S and Kulkarni P, 1999. Size distribution of polycyclic aromatic hydrocarbons - gas/particle partitioning to urban aerosols. Journal of Aerosol Science, 30, 759-770.

Depression & Suicide

Beale I L, Pearce N E, Conroy D M, Henning M A and Murrell K A, 1997. Psychological Effects of Chronic Exposure to 50 Hz Magnetic Fields in Humans Living Near Extra-High-Voltage Transmission Lines. Bioelectromagnetics, 18, 584-594.

Dowson D I, Lewith G T, Campbell M, Mullee M and Brewster L A, 1988. Overhead High-Voltage Cables and Recurrent Headache and Depressions. The Practitioner, 232, 435-436.

Perry F S, Reichmanis M, Marino A A and Becker R O, 1981. Environmental Power-Frequency Magnetic Fields and Suicide. Health Physics, 41, 267-277.

Perry S, Pearl L and Binns R, 1989. Power Frequency Magnetic Field: Depressive Illness and Myocardial Infarction. Public Health, 103, 177-180.

Poole C, Kavet R, Funch D P, Donelan K, Charry J M and Dreyer N A, 1993. Depressive Symptoms and Headaches in Relation to Proximity of Residence to an Alternating-Current Transmission Line Right-of-way. American Journal of Epidemiology, 137, 318-330.

Reichmanis M, Perry F S, Marino A A and Becker R O, 1979. Relation Between Suicide and the Electromagnetic Field of Overhead Power Lines. Physiology Chemistry & Physics, 11, 395-403.

Savitz D A, Boyle C A and Holmgreen P, 1994. Prevalence of Depression Among Electrical Workers. American Journal of Industrial Medicine, 25, 165-176.

Van Wijngaarden E V, Savitz D A, Kleckner R C, Cai J and Loomis D, 2000. Exposure to Electromagnetic Fields and Suicide Among Electric Utility Workers: A Nested Case-Control study. WJM, 173, 94-100.

Verkasalo P K, Kaprio J, Varjonen J, Romanov K, Heikkilä K and Koskenvuo M., 1997. Magnetic Fields of Transmission Lines and Depression. American Journal of Epidemiology, 146, 1037-1045.