Electromagnetic hypersensitivity - state of
the art and the legal situation in Sweden

Martin Tondel, MD, PhD
CONSULTANT
specialist in occupational and environmental medicine
Occupational and Environmental Medicine
Sahlgrenska University Hospital, Gothenburg, Sweden
Public Health Management, Department of Knowledge
Based Policy and Guidance, National Board of Healthand Welfare, Stockholm, Sweden• a government agency under the Ministryof Health and Social Affairs• activities and duties within– social services– health and medical services– environmental health– communicable disease prevention– control and epidemiology• the Government determines the policy
guidelines for our work2

Public Health Management• Responsibility for health protection and environmental medicine• Detect, prevent and eliminate health hazards in the environment• Central authority in the enivronmnental health• Guidance for municipalities, counties and county councils• Investigate and revise relevant regulations• Evaluate the application and effect of law within the sphere ofenvironmental health3

Health protection network
Counties
n=21

Municipalities
n=290
National Boardof Health andWelfare

OEM at thecounty councilsn=84

Magnetic fields (µT)

Distance (m)reference value 100 μT
5

Magnetic fields 1 m above ground in central Gothenburg
Green <0.2 µT, yellow >0.2 µT, red >1 µT
http://www.fas.se/upload/dokument/publiaktioner/pdf/FAS-EMF-2009.pdf

6ELF

†

0.1 m (μT)

0.5 m (μT)

1.0 m (μT)

Freq (Hz)Ref value* (μT)

Vacuum cleaner 1600 W

60.3

<0.05

50100

Hairdryer

30

0.5<0.0550100

Alarm clock

2.10.140.0850100

Microwave oven 700 W141.50.30

50

100

Flat computer screen 19 inch

<0.05

<0.05

<0.05

50100

TV, not flat screen

0.80.1<0.0550100

Electrical stove

0.80.1<0.0550100† 50 Hz similar values as electric oven
Inductionoven
Alsomagneticfields
1.2
0.07

<0.05

25,000*6.25
publicOccupation

Freq (Hz)Typical exposure (µT)

Ref value** (µT)

Engine driver train

16.7

10

1,500

Relay interlocking plant 400 kV

50

10-40500

Welding50

1-300500

Officework50

0.2500* *occupation

Magnetfält och hälsorisker 20097

Switchboard

More base stations = Lower output = Lower exposure!
talking in mobile phone 1,000 > than the mobile base station
2 m distance from person talking in mobile phone 200 > than themobile phone base station

8Mobile base station
Power density (W/m2)

1211

Reference value UMTS (3G)

1098
76
5

Reference value GSM 900

432
1002

4

68

101214161820222426

2830Distance (m)9Average power density 48 places in Gothenburg area
Measurements

Reference values

SourceFrequency(MHz)

Power density(mW/m2)

Power density(mW/m2)

Exp rate(%)

FM radio1000.28

2 0000.014Analogue TV

6000.06

3 0000.002

Digital TV

7000.02

3 5000.0006

NMT base stations

4500.0005

2 2500.00002

GSM900 base stations

9000.144 5000.003

GSM1800 base stations

1800

0.04

9 5000.0004

3 G base stations

1 9000.04

9 500

0.0004

Others

--

0.002

----

Total

--

0.57

RF from the sun and sky 3 μW/m2

0.02
Nilsson J, Rydh M. 2004. “RF Exposure from Broadcast
and Mobile Phone Systems” Institutionen för
Elektromagnetik, Chalmers Tekniska Högskola, Göteborg

10Terminology
Sensitivity to electricity
Electromagnetic hypersensitivity (EHS)
Allergy to electricity
Idiopathic Environmental Intolerance
attributed to exposure to electromagnetic field11

Electromagnetic hypersensitivity (EHS)• symptoms near or when using electrical equipment• giving varying degrees of discomfort or illness of theindividual• and the individual relates to the activation of theelectrical equipment(Bergqvist RALF 2000)

EHS is not a diagnosis in Swedish healthcare

EHS is characterized by a variety of non-specific symptoms,
which afflicted individuals attribute to exposure to EMF.
dermatological symptoms• redness, tingling, and burning sensations
neurasthenic and vegetative symptoms• fatigue, tiredness, concentration difficulties, dizziness,
nausea, heart palpitation, and digestive disturbances
not part of any recognized syndrome.

WHO factsheet 296 2005 13

wellness

WELL &HEALTHYDISEASES
hypertension
cancer in situ
genetic carrier e.g.

disease

Huntington

fractureanaemiacancerhealthy

ILLNESSES
multiple chemical sensitivity
electromagnetic
hypersensitivity
sick building
syndrome

illness

14

Sensitivity to electricity• 1,5 % Stockholm
county• 3,2 % California– Levallois, 2002

– Hillert L, 2002

• 1,9 % Skåne county• 4 % England– Eltiti, 2007

– Carlsson F, 2005

• 8-10 % Germany- Infas 2002-2006• 5 % Switzwerland– Schreier, 2006

Environmental Health Report 2009
Swedish: http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8494/2009-126-70_200912670_rev.pdf
English: http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8338/2009-126-116_2009126116_rev.pdf

hat impact on your health, do you believe
electromagnetic fields from e.g. electrical appliances,
power lines have?

egative impact:
HR 2001

3,1 % (200,000 adults in Sweden)
women 50-59 years 4,9%

Environmental Health Report 2009
Percentage of people ≥1 time/week

Heat/burning sensationin the skinItching, burning eyes
Fatigue
Headache
Nausea, dizziness
Difficulties to concentrate

EHS
27 %

Population
2.0 %

2252
24
8.7
25

7.5
34
12
3.4
5.9
17

EHS - provocation
studiesRubin GJ et al - review(Pychosom Med 2005, Bioelectromagnetics 2010)•

46 studies involve 1,175 volounteers•

little evidence suggest that individuals with EHS candetect EMF•many studies have found evidence that a nocebo
effect can explain acute symptoms•

research needs to clarify chronic exposures and test
new varieties of electromagnetic emissions•

best evidence suggests that EHS should not beviewed as a bioelectromagnetic phenomenon

Hypothesis to EHS
Electrical or magnetic fields– via serotonin/melatonin effects, free radicals
Increased excitability of nervous system
Psykological mechanisms– Stress/conditioning– Attribuation– Somatization– Nocebo
Light flickering
Chemical influences– e.g. phenols, flame retardants, mercury from amalgam”Multi-factorial”

No support for the hypothesis that people with electrical
hypersensitivity have an increased sensitivity to EMF andRF
No scientific support for the relationship between RF andacute symptoms or objective measurable physiologicalresponses
FAS 2008
FAS 2009
SCENIHR 2009
SSM 2009:36

Future research• provocation studies probably does not leadto any new findings• nocebo-effect has been emphasized inseveral recent studies and reviews• functional brain imaging promising to study
placebo- and nocebo-mechanisms

SSM 2009:36

General guidelines on the reception of patients with regard totheir problems with amalgam and electricity SOSFS 1998:3
Medical professionals:• listen, take the patient seriously and foster trust• give time to the patients to describe
his/her various symptoms• understand that problems andsymptoms are real and not imagined• respect the patient's explanation• right to an all-round medical examination
22

General guidelines on the reception of patients with regard totheir problems with amalgam and electricity SOSFS 1998:3
Medical history
symptoms in details
previous and current diseases
medicationsocial situation incl occupation, workconditions, family situation,
tobacco/alcohol consumption

Physical examination
Laboratory tests
blood status, ESR
serum ironB12/folic acid
electrolytes including calcium
S-creatinine
liver tests
S-glucosethyroid tests
urine status
Borrelia, viral serology

Differential diagnoses
skin diseases such as atopic eczema,
rosacea and other exanthemaallergies, asthma, bronchial hyperactivity
anaemiamalabsorption
endocrine or metabolic illness
neurologic diseases
infection
collagenosis
malignancy
mental disturbance such as depression,anxiety etc.
somatoform syndrome
other environment-related symptom
23

Treatment and actions
adapted to the conditions in each caseexperience with successful drug therapy is limited
cognitive behavioral therapy can be positive if thepatient is motivatednone established effects by reducing EMF exposure
long-term sick leave should be avoided

Sensitivity to electricity• primary care important• knowledgeable and interested physicians
early in the disease process• professional and dignified treatment• unbiased assessment important25

Prognosis
Good, if appropriate action:- early in the course of the disease- in mild cases with only skin symptoms
Worse, for long-standing cases with multiple
symptoms

26

No list of disability or impairments (no “authorizeddisabilities”)
Financial support to NGOs with disability issues on theprograms e.g. the Swedish Association for the Electro
Sensitive
Social and medical support based on the appraisal ofthat person’s ability or hindrance and not on specified
diagnoses27• Building and operation of mobile base stations
are not licensed under the Swedish
Environmental Code• People's concerns can not alone be the basis foractions against the establishment of mobile basestations with the support of the Environmental
Code• The precautionary principle is therefore notapplicable to mobile base stations
28

Medical effects of EMF• High exposures to low frequency fields induces
currents in the body that can cause:– nerve stimulation 10-100 mV/m
– painful sparks 0.6-1.5 kV/m– magnetophosphenes 5-15 mT (50 Hz)• High exposures to RF fields induce heat in the bodyand can cause internal burns. Catarract appears at
100 W/kg.

29

International Agency for
Research on Cancer (IARC)
Group 1: carcinogenic to humans (α-, β-, γ-radiation)
Group 2a: probably carcinogenic to humans (UV-light)
Group 2b: possibly carcinogenic to humans (ELF)
Group 3: not classifiable as to its carcinogenicity tohumans (static electric fields)
Group 4: probably not carcinogenic to humans

WHO ELF (0-100 Hz)• Childhood leukaemia - possibly carcinogen• Other childhood cancer - evidence inadequate• Breast cancer - weak association• Reproductive/developmental disorders – inadequate• Cardiovascular disease - not shown association• Neurodegenerativ disorders - PD, MS no evidence
ALS, AD inadequate• Cognitive system - less clear• Electromagnetic hypersensitivity - unrelated
EHC 2007:238

Occupational exposure to ELF

Alzheimer’s disease

Amyotrophic lateral sclerosis

Kheifets, OEM 200932

Alzheimer’s disease

Power line

1 μT can occur

380 kV

50-80 m

220 kV

40-55 m

33

•
•
•
•
•
•
•
•
•
•
•
•

RF (100 kHz - 300 GHz)
Animal studies carcinogenicity - no consistent results
In vitro, ROS, genotoxicity, apoptosis, gene expression, immunology,
enzyme activity – no effectsGreat uncertainty about biomarkers (S100B, TTR)
Epidemiological, animal and cell studies - unlikely RF causes cancer
Brain tumours: more epidemiological studies with better methods andlonger follow-up time for safer conclusions, mobile use < than latency
BBB damage of cellphones – not confirmed
Cognitive effects, EEG changes, few studies – unclear significance
Functional imaging (PET, NIRS) – conflicting results
HRV, HT in a few studies of mobile phones and/or base stations
No scientific support for RF exposure and self-reported symptoms,
repeated studies are required due to contradictory results
No reproductve disturbance or abnormality in animals or humans
FAS 2008:1
The effect on sperm quality – no basis for assessment
FAS 2008:2
NO REASON TO CHANGE GUIDE LINES

FAS 2009
SSI 2008:12
SCENIHR
342009SSM 2009:36

Brain tumour incidence in Sweden 1960-2007
menwomen

Introduced
in market

Mobile telephone
generation

1981
1986

NMT 450
NMT 900

1992
1997

GSM 900
GSM 1800

2000

UMTS 3G

96%
92%
Mobileprevalence% from PTS

87%

Mobile phone subscriptions in Sweden

35

Statistical Yearbook of Sweden 2010

E Cardis (5th Ministerial Conferenceon Environ Health) Parma 2010

Health effects of RF not demonstrated at this point
But there are indications that there might be a risk
… if there is a risk, it is likely to be greater for exposures in childhood
and adolescents …

Why would the risk be larger?
••••

Children who start using phones will have many years of use
Much greater quantity of use compare to previous generations
SAR tend to be higher in children’s brain tissue
Child brain tissue more sensitive?
36

Links to documents
FAS årsrapporter www.fas.seSSM vetenskapliga råd årsrapporter www.ssm.seWHO’s faktablad 322, 304, 296, 299 och 193 om elektromagnetiska fält och folkhälsa http://www.who.int/en/EU-kommissionens vetenskapliga kommitté SCENIHR 2009
IARC vol 80 om ELF http://monographs.iarc.fr/ENG/Monographs/vol80/volume80.pdf
ICNIRP guidelines 1998 http://www.icnirp.de/
Myndigheternas försiktighetsprincip om lågfrekventa elektriska och magnetiska fält - en vägledning för
beslutsfattare 1996 http://www.av.se/dokument/publikationer/adi/adi_477.pdf
Socialstyrelsens Meddelandeblad om EMF från kraftledningar 2005
http://www.socialstyrelsen.se/NR/rdonlyres/6CB54FB2-CCE6-4EDF-A780-52133C469750/3579/2005110.pdf
Socialstyrelsens Meddelandeblad om Elektromagnetiska fält från mobilbasstationer och annantrådlös teknik 2008 http://www.socialstyrelsen.se/Publicerat/2008/10058/2008-1-11.htm
Miljöhälsorapport MHR 2009 http://www.socialstyrelsen.se/Publicerat/2009/10349/200-126-70.htm
Bemötande av patienter som relaterar sina besvär till amalgam och elektricitet SOSF 1998:3
http://www.sos.se/sosfs/1998_3/1998_3.htm
Magnetfält och hälsorisker http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8434/2009-126212_2009126212.pdf