1997:19

Possible health implications of subjective
symptoms and electromagnetic fields
A report prepared by a European group of experts
for the European Commission, DG V
Ulf Bergqvist and Evi Vogel (eds)
Leif Aringer
Joe Cunningham
Fabriziomaria Gobba
Norbert Leitgeb
Luis Miro
Georg Neubauer
Ingeburg Ruppe
Paolo Vecchia
Cecilia Wadman

EUROPEAN COMMISSION
DIRECTORATE-GENERAL V
EMPLOYMENT, INDUSTRIAL RELATIONS AND SOCIAL AFFAIRS
Public health and safety at work
Public health analysis, policy and programme coordination and development

This work was made possible by financial support from the DG V of the European
Commission (SOC 96 200576 05FO1).
Neither the European Commission nor any person acting on behalf of the Commission
is responsible for the use which might be made of the following information.
A great deal of additional information on the European Union is available on theinternet. It can be accessed through the European server (http://www.europa.eu.int).

arbete och hälsa vetenskaplig skriftserieISBN 91–7045–438–8 ISSN 0346–7821

National Institute for Working Life

National Institute for Working Life
The National Institute for Working Life is Sweden'scenter for research and development on labour market,
working life and work environment. Diffusion of information, training and teaching, local development andinternational collaboration are other important issues for
the Institute.
The R&D competence will be found in the following
areas: Labour market and labour legislation, workorganization and production technology, psychosocial
working conditions, occupational medicine, allergy,
effects on the nervous system, ergonomics, work
environment technology and musculoskeletal disorders,chemical hazards and toxicology.
A total of about 470 people work at the Institute, around370 with research and development. The Institute’s staff
includes 32 professors and in total 122 persons with apostdoctoral degree.
The National Institute for Working Life has a large
international collaboration in R&D, including a numberof projects within the EC Framework Programme for
Research and Technology Development.

ARBETE OCH HÄLSA
Redaktör: Anders Kjellberg
Redaktionskommitté: Anders Colmsjö
och Ewa Wigaeus Hjelm© European Commission DG V, National Institute for Working Life
& the authors 1997
Arbetslivsinstitutet,
171 84 Solna, SverigeISBN 91–7045–438–8
ISSN 0346-7821
Printed at CM Gruppen

Table of Contents
Summary, conclusions and recommendations
Description
Literature review
Risk perception and risk communication
Available information
Handling
Recommendations
Introduction
General background
Organisation of the project work
Invited experts and acknowledgements
Description of Òelectromagnetic hypersensitivityÓ
Preamble
Questionnaires
Symptoms
Attribution to sources
The extent of Òelectromagnetic hypersensitivityÓ
Some case descriptions
Stage 1

1
1
1
2
3
3
4
5
5
6
7
8
8
8
9
10
11
13
14

Stage 2

15

Stage 315

Possible causal factors for subjective symptoms related to "electromagnetic
hypersensitivityÓ
General population-based studies
Low frequency fields and neurasthenic or similar endpoints

16
16
16

Radiofrequency fields and neurasthenic or similar endpoints

17

Skin symptoms among VDU users
Reactions among individuals with possible special sensitivity
Individual and possibly predisposing factors

18
18
19

Electric or magnetic fields and "electromagnetic hypersensitivity"

19

Other suggested factors for "electromagnetic hypersensitivity"

20

Perception and communication of risks due to electromagnetic fields
Risk perception
Factors influencing risk perception
The appraisal of risk

21
21
21
23

Risk communication
Risk communication about electromagnetic fields
The role of the media
Conclusions
Information material used in different countries of the EU
Stakeholders involved in the preparation and dissemination of
information material
Companies

24
24
25
26
27
27
27

Health authorities

28

Scientists

28

Self-aid groups and other private organisations
Information material prepared for different target groups
General public, including schools and fringe groups

29
29
29

Occupationally exposed people

30

Authorities, such as health authorities, ministries and otherdecision makers
Conclusions
Handling of individuals claiming "electromagnetic hypersensitivity"
Rationale for handlingOn the identity of " electromagnetic hypersensitivity"

31
31
32
32
32

On the causation of "electromagnetic hypersensitivity"

33

On handling of individuals with "electromagnetic hypersensitivity"
General outline
Prevention of symptom appearance in a population
Intervention or early handling of afflicted cases
Treatment of individuals with long-lasting symptoms and severe
handicap
Concerning actions directed towards electric, magnetic orelectromagnetic field sources
Recommendations
Handling of individuals with Òelectromagnetic hypersensitivityÓ
Information activities
Further scientific research
References
Appendix 1. Questionnaire results
Introduction
Methods
Results

33
34
35
36
37
38
40
40
41
42
44

App 1:1
App 1:1
App 1:2
App 1:3

Awareness and contact with the problem

App 1:3

The extent of the problem

App 1:5

Concerning situations where problems appear

App 1:6

Attributed sources

App 1:7

Commonly occurring symptoms

App 1:8

Concerning consequences for the afflicted individuals

App 1:12

Correspondence between Óelectromagnetic hypersensitivityÓ
and other syndromes

App 1:13

Appendix 2. Questionnaires to centers for occupational medicine and self aidgroupsApp 2:1
Questionnaires to centers for occupational medicine
App 2:2
Questionnaires to self aid groups
App 2:9
Appendix 3. Review of investigations into possible causal factors for
subjective symptoms related to "electromagnetic hypersensitivityÓ
Preamble
General population-based studies
Aim

App 3:1
App 3:1
App 3:3
App 3:3

Neurasthenic symptoms and exposure to low frequency fields

App 3:3

Neurasthenic symptoms and exposure to radiofrequency fields App 3:11
Skin symptoms among VDU users
Reactions among individuals with possible special sensitivity
Aim

App 3:15
App 3:21
App 3:21

Groups defined by self-definition, symptoms and/or attribution App 3:22
Individual and possibly predisposing factors

App 3:23

Sensitivity and reactions to external factors

App 3:27

Summary - individuals with possible special sensitivity
References
Appendix 4: Risk perception and communication
References

App 3:33
App 3:36
App 4:1
App 4:5

Appendix 5. Information material
App 5:1
Address list of organisations and institutions asked for informationmaterial on electromagnetic fields
App 5:1
Contact letter
App 5:7
Evaluation checklist
App 5:8
Information brochures from different European countries
App 5:10

Summary, conclusions andrecommendations
Ulf Bergqvist, Evi Vogel, et. al. Possible health implications of subjective
symptoms and electromagnetic fields. Arbete och HŠlsa 1997;19.
The aim of the project was to investigate the occurrence of "electromagnetic
hypersensitivity" across Europe. The relevant scientific literature was to bereviewed and the publications and case reports concerning symptoms or adverse
health effects were to be analysed in view of a better health protection andprevention. Data on risk perception and communication as well as available
public information in connection with this phenomenon and electromagnetic
fields were to be evaluated, and specific advice on handling and further
recommendations were to be deduced.
The term "electromagnetic hypersensitivity" is used here to designate aphenomenon where individuals experience adverse health effects while using or
being in the vicinity of electric, magnetic or electromagnetic field sources anddevices (EMF devices). The use of the term "electromagnetic hypersensitivity"
does not - by itself - presuppose or indicate any causes of these adverse reactions.
The project was made possible by a grant from DG V of the European
Commission.

Description
Certain individuals experience adverse health reactions while using or being in
the vicinity of EMF devices. Symptoms vary substantially among different
individuals, but in the majority of cases they present mild non-specific symptoms,
with objective signs normally absent - unless another disease is present. There are,however, some cases experiencing severe problems with major consequences forwork and everyday life. There are no known long-term diseases related to thisphenomenon. In the absence of diagnostic criteria, the observed symptoms are
attributed to Òelectromagnetic hypersensitivityÓ.
Both symptoms and attributions do vary substantially between different
afflicted individuals. The occurrence and appearance of this phenomenon also
vary considerably throughout Europe. It is possible that the varying use of a term
like "electromagnetic hypersensitivity" for many different types of claimed
adverse health effects could be one source of this diversity.

Literature review
The scientific literature was evaluated for information on relationships between
relevant symptoms and exposure to electromagnetic fields (EMFs), and for1

information on possible causal factors for "electromagnetic hypersensitivity".
There is a need to differentiate clearly between biological/physiological effects
and adverse health reactions. In terms of relationships with EMFs, it should be
noted that the report deals with situations where field levels are below acceptedinternational limits. Extrapolation between frequencies is not justified. Some
investigations are difficult to interpret because of inadequacies in exposure
assessments, absence of clear definitions of medical terms etc.
This review was unable to establish a relationship between low or highfrequency fields and "electromagnetic hypersensitivity" or with symptoms
typically occurring among such afflicted individuals. The results are often
inconsistent and conflicting. Furthermore, the absence of credible mechanisms(both physical and physiological) should be noted. In addition, other possible
causal factors were suggested, such as low humidity or flickering light. Amongsuch other factors, the possibility that the risk perception/worry could be a causal
factor for certain symptoms must be considered. Like most disorders andillnesses, there were indications of a multifactorial causation of "electromagnetic
hypersensitivity".
Two large groups of afflicted individuals have been identified; individuals withmostly neurasthenic symptoms with a general or varied attribution to various
sources of electromagnetic fields, and individuals working with visual display
units having primarily skin problems. These different groups may require separate
descriptions and approaches, as their individual traits, symptoms, attributions andprognoses appear to differ.

Risk perception and risk communication
The concepts of risk perception may be used to describe the reactions of people
when using or being in the vicinity of EMF devices. As is the case with any risk,
perception varies depending on social background, country and education. Risk
perception appear to influence what symptoms are reported by people claiming"electromagnetic hypersensitivity", and would therefore contribute to theheterogeneity of the picture.
Very different perceptions are found among different stakeholders, in particularbetween experts and the general public. This also has to be taken into accountwhen risk perception is analysed in order to deduce communication concepts. It
has to be kept in mind that inadequate communication, such as bias among thecommunicating parties, selecting wrong target groups or using ill prepared
information invariably lead to misunderstandings and problems. In the worst casethere is an increased concern, a loss of credibility of the experts and/or an increaseof symptoms.
It is acknowledged that public media information is of a transient nature andcan change long-term habits only very slowly. However, as public media play animportant role, journalists as opinion leaders are an important target group. It is2also necessary that officials or scientists communicating with journalists arecapable of presenting their knowledge and the results of studies and research.

Available information
In order to get a better understanding of the information people have about EMFs,
information brochures available within different EU states were collected andreviewed. The main finding is that the availability of such leaflets is very nonhomogeneous across the EU and the various groups. The leaflets obtained wereprepared by different stake holders, such as authorities, industry, scientists, selfaid groups and other organisations. In the reviewed material, information on
EMFs was fairly good and comprehensive. However, only a few different target
groups were addressed, and "electromagnetic hypersensitivity" was mentioned
very rarely or only marginally. For the layout and the preparation of such
brochures, it appears that often no professional help, e.g. by communication
specialists, was used.

Handling
In some countries and within some organisations, schemes to handle"electromagnetic hypersensitivity" center around:
1. Prevention, mainly concerned with information and mitigation of factors
known to give rise to adverse health effects such as indoor air quality or stressconditions.
2. Intervention or early handling of afflicted cases, including medical examination to detect if the individual suffers from a known disease, and investigationsof the relevant situations for other factors besides EMF.
3. Treatment, primarily directed towards reducing symptoms and functional
handicaps.
Practical experience strongly suggests that early intervention greatly reduces
the likelihood of more serious problems.
To reduce the exposure to electromagnetic fields in the relevant situation(s) is acommonly asked for action by individuals claiming "electromagnetic
hypersensitivity". There are, however, both advantages and disadvantages of suchactions, such as measuring and reducing field emissions or avoiding field
exposures. These must be carefully considered, case by case.

3

Recommendations
This project led to the following recommendations:
The phenomenon known as "electromagnetic hypersensitivity" requires various
actions. The extent to which such activities are needed may differ considerably
between different European nations and between different organisations.
It is strongly advocated that further information on "electromagnetic
hypersensitivity" should be made available. Such information, however, must be
based on currently available scientific information, and be carefully tailored to
specified target groups. The limited number of seriously afflicted individuals, andthe absence of evidence for EMFs as causal factors, do not justify alarmist
reports. Well designed information plays a major role in prevention and early
handling.
The existence of individuals with severe health problems who claim to be"electromagnetic hypersensitive" is a clear motivation for adequate handling.
Such handling would emphasise the need to reach afflicted individuals at an earlystage, and to avoid concentrating on single factor explanations. A case-by-caseapproach within broad recommendations may prove to be effective.
Because of the inability to clearly describe the syndrome and causation of"electromagnetic hypersensitivity", further scientific research is warranted.
Research should be centred on the causation of specified symptoms or syndromes,
and verification of specific hypotheses. The phenomenon also gives rise to otherareas of investigations, such as the role of risk perception and risk
communications.

4Introduction

General backgroundIn many countries there is increasing concern about reports of cases of various
suspected environmental illnesses. One such is that of individuals claiming thatthe reason for their adverse health symptoms could be exposure to electric,
magnetic and electromagnetic fields (EMFs) from nearby electric appliances. Thisis a major concern in a few countries, where also practical health related work is
directed towards this problem. The concern appears to increase in some countries,
but it is little noticed in other nations. The fact that the majority of people undersimilar exposure conditions does not exhibit any reactions - even in countries withmajor concerns - is assumed to be due to affected persons having an increased
sensitivity to such environmental factors. This explanation has been adopted bypublic media and coined in various terms like ÒelectrosensitivityÒ, ÒelectricallergyÒ, Òelectromagnetic hypersensitivityÒ or Òsensitivity to electricityÒ. These
terms and their applications are based on the conviction and self classification ofindividual subjects.
Within this project, the term Òelectromagnetic hypersensitivityÒ is used todescribe a phenomenon where individuals experience adverse effects while using
or being in the vicinity of devices emitting electric, magnetic or electromagnetic
fields (EMF devices). The use of this term does not imply an already establishedrelationship between EMFs and the health reactions. For this reason, the term is in this document - always within quotation marks (Ò...Ó).
Presently the issue of Òelectromagnetic hypersensitivityÓ has gained
considerable public attention and led to the formation of self aid groups (SAGs)
of afflicted persons in different countries in Europe as well as overseas. Although
the role of the electromagnetic environment is still unclear, it has to beacknowledged that there are people with health problems of unknown origin thatmight become so severe that they quit their workplace and even change their
entire life and move from their home in cities to rural areas.
It is also recognised that this topic has received different awareness in various
European countries: In Sweden, a substantial part of the EMF research and healthrelated efforts is directed towards Òelectromagnetic hypersensitivityÒ primarily in
relation to office work situations and visual display units (VDUs). In othercountries like Austria and Germany, concerns of people appear to be moreconcentrated on the exposure at home and focused on power lines and transmitter
stations.
In recognition of this problem, DG V of the European Union has supported thisproject. It was the aim of this project to collect and evaluate the scientificknowledge and practical experience on possible health implications of subjective
5

symptoms allegedly related to EMFs. The prevalence of the phenomenon within
the various member states of the European Union was also to be assessed.
Based on the assumption that information plays a major role, the presentationand dissemination of information material within different European countries
was investigated, taking into account risk perception and risk communication.
Originally it was also planned to prepare a compendium of information material
for use throughout the EU. However, one of the main results of our investigation
was that effective information has to be tailored exactly to the situation (target
group, country, subject) and therefore ready-made and general information appear
to be of limited value.

Organisation of the project work
The project was managed by the National Institute for Working Life (Sweden)
and was co-ordinated by U. Bergqvist (Sweden) and E. Vogel (Germany).
The following researchers have participated (in alphabetic order):Dr Leif ARINGER
National Board of Occupational Safety and Health, Sweden,
Dr Ulf BERGQVISTNational Institute for Working Life, Sweden,
Dr Joe CUNNINGHAM
Electrical Supply Board, Ireland,
Dr Fabriziomaria GOBBA
Department of Biomedical Sciences, University of Modena, Italy,
Prof Norbert LEITGEB
Institute for Biomedical Engineering, Austria,
Prof Luis MIRO
Centre Hospitalier Universitaire de Nimes, France,
Dipl.-Ing Georg NEUBAUER
Austrian Research Center Seibersdorf, Austria,
Dr Ingeburg RUPPE
Federal Institute for Occupational Safety and Health, Germany,
Dr Paolo VECCHIA
National Institute of Health, Italy,
Dr Evi VOGEL
Federal Institute of Radiation Protection, Germany, and
Ms Cecilia WADMAN, scientific project secretary
National Institute for Working Life, Sweden.
The project was based on:· three meetings of the participating scientists,· the elaboration and evaluation of a questionnaire which was sent to official
institutions as well as self aid groups,

6

· the evaluation of information brochures about EMFs, available in different EU
countries and· contributions and talks of invited experts at the second meeting in MŸnchen,
November 1996 and the third meeting in Stockholm, March 1997 (see below).

Invited experts and acknowledgements
The following experts were invited to some project meetings (the titles of theirrespective talks are also indicated):
Prof Eduard David, Germany
UniversitŠt Witten Herdecke, Institut fŸr Physiologie, WittenÒElectrosensitivity and magnetosensitivity - psychosocial aspectsÓ,Mr Lars Gršnqvist, Sweden
National Institute for Working Life, Solna (currently at the National Board ofTechnical Development)ÒElectrosensitivity in Sweden - the role of the mediaÓ,Ms Renate Harrington, Haltenbek, GermanyÒThe role of media in the communication of negative and positive newsÓ,Dr Lena Hillert, Sweden
Environmental Illness Research Centre, HuddingeÒMedical approaches to electrosensitivityÓ,Prof Oswald Jahn, Austria
Abteilung Arbeitmedizin, UniversitŠt Wien, AKH, WienÒHandling of electrosensitive peopleÓ,Dr Mike Repacholi, Switzerland
WHO Office of Global and Integrated Environmental Health, GenevaÒThe international EMF projectÓ,Dr Turid Vendshol, Norway
Norwegian Board of Health, OsloÒProject on sensitivity to electric and magnetic fieldsÓ,Prof Arne Wennberg, Sweden
Department of Occupational Medicine,National Institute for Working Life, S-171 84 Solna, and
Dr Peter Wiedemann, Germany
Forschungzentrum JŸlich, Gruppe MUT, JŸlich
ÒRisk perceptionÓ.
We would like to express our gratitude to these invited experts for their valuable contributions to the project. It is also appreciated that due to the additional
support by the National Institute for Working Life, Stockholm, Sweden and theFederal Institute of Radiation Protection, Munich, Germany (beyond that includedin the project), as well as by their respective affiliations, it was possible to profit
from the expertise of all these experts.

7Description of Òelectromagnetic
hypersensitivityÓ

Preamble
According to the plans laid out for this project, the following information of a
descriptive nature was to be obtained:· A description of cases of Òelectromagnetic hypersensitivityÓ in the different
participating EU member nations - including symptoms, situations where
symptoms appear, and allegations as to causes.
· Formal definition(s) of cases (if possible), and a discussion of the extent of the
problem - with data (when available) from different countries.
It was quickly apparent that the data basis for responding to several of thesequestions does not exist. For this reason, a questionnaire was sent out acrossEurope to overcome this lack of information, and enabling some comparisons
between different countries. The information gained by this questionnaire is
described below, augmented by some information from other sources.
Two further comments based on the information described here and elsewherein the report are appropriate. Firstly, no formal definition or diagnosis ofÒelectromagnetic hypersensitivityÓ is possible, because of a/ the nonspecificity ofthe symptoms, b/ the apparent heterogeneity of the afflicted individuals and c/ thelack of an established aetiology. (A working definition for the purpose of thestudy was given in the introduction, see above). Secondly, and for similar reasons,no ÒtypicalÓ cases of Òelectromagnetic hypersensitivityÓ could be identified,therefore the case descriptions given below should be seen as examples only, andnot as an attempt to establish any typicality.

Questionnaires
In order to assess the appearance of Òelectromagnetic hypersensitivityÓ, aquestionnaire was designed to solicit responses from certain organisations toquestions concerning the awareness of the problem, estimates of the extent,
situations where problems appear, symptoms and consequences for the afflictedindividuals.
Questionnaires were sent to centres for occupational medicine and other similarorganisations (COMs) and self-aid groups (SAGs) in different European nations.
The questionnaires were written in English, German, Italian, French and Swedish(see Appendix 2 for the English versions). The numbers of questionnaires sent out
and received were as follows (see also Table 1):8

· 138 questionnaires to centres of occupational medicine (COM) in the following
18 European countries: Austria, Belgium, Denmark, Faroe Island, Finland,
France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Norway,
Portugal, Spain, Sweden, The Netherlands and United Kingdom. The reply rate
was 45 %. Non-responding countries were Belgium, Greece, Luxembourg,
Portugal and Spain.
· 15 questionnaires to self aid groups (SAG) of Óelectromagnetic hypersensitiveÓ
individuals in the following countries: Denmark, France, Germany, Norway,
Sweden and Switzerland. In all we received 10 answers from all of thesecountries except Switzerland, including answers from 2 SAGs in Ireland.
It should be emphasised that the selection of addresses, the response rates aswell as the type of questions asked do not permit detailed and absolute
quantitative assessment of the situation across Europe. The intention behind thisquestionnaire was rather to have a descriptive and - to some degree - acomparative assessment between different countries. Nevertheless, a roughestimate of the extent of the problem could - in our opinion - be obtained.
A detailed description of the responses is given in Appendix 1, and summarised
below.

Symptoms
The respondents, both the COMs and the SAGs, were asked to list the five mostcommon symptoms reported in connection with the use of electrical appliances orproximity to EMF sources. The answers may be classified into the following
groups - the first two are further specified:· Skin symptoms; objective, subjective or undefined.
· Nervous system symptoms; sleep disturbances, decreased arousal, neurasthenia,
stress, irritation, anxiety and headache.
· Hormonal and metabolic disorders, general body symptoms, cardiovascularsymptoms, eye symptoms, ear/nose/throat problems and digestive problems· Other responses concerned different types of cancer, allergy, reproductive andpregnancy problems and various symptoms attributed to the sick building
syndrome.
Overall, the most common symptoms for Òelectromagnetic hypersensitivityÓ
encountered among the responses were various neurasthenic symptoms, headacheand skin symptoms. Other more specific symptoms such as sleep disturbances oranxiety occurred less consistently among these descriptions.
The answers differed considerably between different European nations,however, especially considering the relative importance of nervous system andskin symptoms. In the Nordic countries - with the exception of Denmark - skin
symptoms occurred fairly often among the COM responses, while skin symptoms
were not so reported from France, Ireland, Italy and United Kingdom. In COM
9responses from Austria, Denmark and Germany, some mention of skin symptoms
was made, but appeared to be of minor importance compared to nervous system
symptoms.
Essentially, all replies from the different countries did suggest a number ofvarious nervous system symptoms in connection with Òelectromagnetic hypersensitivityÓ. Neurasthenia was the most common among the six different symptom
types (except for the COM reply from Ireland) followed by headache, butotherwise no obvious pattern of nervous system symptoms could be found thatwas consistent among the different European nations. Likewise, it was difficult todiscern general patterns among other types of symptoms.
Comparisons of symptom prevalences between individuals with Òelectromagnetic hypersensitivityÓ and other individuals that has been made in someSwedish investigations (19, 20) deserve some further comments. It was noted thatthe symptoms occurring among Òelectromagnetic hypersensitiveÓ individuals also
occurred in other groups of individuals - thus no specificity of symptoms could bediscerned. The differences were more directed towards the number of symptoms
reported by an individual - Òelectromagnetic hypersensitiveÓ individuals appeared
to report a larger number of symptoms (20). Based on symptoms, it was also
indicated that individuals with Òelectromagnetic hypersensitivityÓ could be
separated into several subgroups (see further below).
Finally, it should be noted that most descriptions were aimed at the identity ofdifferent symptoms - not at the severity. The majority of individuals do appear toreport mild symptoms, however, there are a smaller number of cases with severe
health problems (see further below).

Attribution to sourcesÒElectromagnetic hypersensitivityÓ reactions were seen in different situations andhave been attributed to different sources - and these appear (again) to differ
between different European nations.
In most countries, according to the COMs, problems arose most frequently at
the workplace, with the exception of Germany and possibly also Austria, where
primarily situations at home were associated with Òelectromagnetic hypersensitivityÓ. In contrast, outdoor situations in general seem to play a minor role (thiswas indicated by only a few COMs). The same pattern was reported by the SAGs,
except for France and Ireland, where the SAGs emphasised home situations,whereas the COMs pointed towards work situations (note, however, that we do
not have SAG replies from all countries).
More pronounced differences between countries were found when the COMs
and the SAGs were asked for specific EMF sources being reported in connection
with Òelectromagnetic hypersensitivityÓ. Basically, sources of radiofrequency(RF) fields such as telecommunication masts, broadcasting or TV towers andradar stations were strongly reported by several COMs and SAGs in Denmark,Germany, France, Ireland and Italy, while more localised sources such as
10

induction heaters, plastic welding or microwave ovens were mentioned in theanswers from Denmark, France, Germany, Italy and United Kingdom. Mobile
phones were reported by Germany, Ireland, Italy and Sweden. With this last
exception, no mention of RF sources as being a common source of problem wasmade from Sweden, Norway or Finland.
For sources of low frequency EMFs, power lines or transformer stations wereemphasised in the replies from a number of countries except Sweden and Finland,
while electrical appliances at home were emphasised by Danish, German,
Swedish and French COMs or SAGs. Visual display units (VDUs) or fluorescenttubes (thus also sources of light) were reported primarily from the Nordic
countries (Denmark, Finland, Norway, Sweden) but also by a few German and
Italian COMs.
Thus, these data do suggest some fairly distinct geographical variation, with aÒNordicÓ scene where use of VDUs (and possible vicinity to fluorescent tubes)
predominate, while other countries exhibit a more diverse attribution to various
sources of both low and higher frequency fields.
The questions whether individuals who reported Òelectromagnetic hypersensitivityÓ also tended to report allergic problems, problems with dental alloys or
multiple chemical sensitivity were indicated rather differently by different
organisations. The SAGs generally affirmed this, whereas the COMs by and large
restricted such correlations to dental alloy attributions or failed to suggest suchcorrelations.

The extent of Òelectromagnetic hypersensitivityÓIn Table 1, the answers to some questions related to the estimated extent of thisphenomenon in different European countries are shown (for further details, see
Appendix 1).
The results show that the estimates of the total number of cases differ
substantially between these countries as well as between the answering groups:
SAGs usually give numbers about one order of magnitude higher than COMs.
The countries with the highest estimated occurrence of Òelectromagnetic
hypersensitivityÓ, as estimated by SAGs as well as by COMs appear to be Sweden
and Germany, followed by the other Nordic countries. SAGs in Ireland andFrance also estimate a high number of cases, in contrast to the respective COMs
who give very low numbers. From Austria, Italy and the Netherlands, we only
received answers from COMs, indicating low numbers of Òelectromagnetic
hypersensitivityÓ. COM replies from United Kingdom do not really suggest thepresence of the phenomenon (we had no SAG reply from United Kingdom). No
replies were obtained from Belgium, Faroe Island, Greece, Iceland, Luxembourg,
Portugal and Spain - which might suggest that in these countries, there is limited
occurrence or at least awareness of this phenomenon.

11With a few exceptions, the proportion of severe cases to the total number of
estimated cases is in the order of 10% throughout the European nations that haveprovided any estimates; this ratio is the same for both SAGs and COMs.
Table 1. Estimated extent of Òelectromagnetic hypersensitivityÓ in some European
nations
Country
Austria /COMNo ofreplies
4

Phone calls/
week a/<1/week

Number ofmembers b/-

Median nocases c/10-100Median no severe cases d/<10Denmark/COM-Ó/SAG

13
1<1/week-

75

100-1 000
1 000-10 000

10-1 000
100-1 000Finland/COM

2<1-4/week-

10-100 and
100-1 000

10-100France/COM-Ó/SAG

6
2<1/week-

4 + ? e/10-1001 000-10 000<10100-1 000

Germany/COM-Ó/SAG

8
3³5/week-300

1 000-10 000>10 000

1 000-10 000>10 000

Ireland/COM-Ó/SAG

1
2

no reply-

350 f/

10-100>10 000<101000 - 10 000
and >10 000

Italy/COM

4<1/week-

10-100<10

Norway/COM-Ó/SAG

6
1<1/week-

90

100-1 000
100-1 000

10-100100-1 000

Sweden/COM-Ó/SAG

8
1<1/week-

1800

1 000-10 000>10 000

100-1 000
1 000-10 000

The Netherlands/
COM
United Kingdom/COM

1<1/week-

10-100<10

7<1/week

-

<10

<10

Notes for table 1
a/ The ÒaverageÓ number of phone calls received - the question was only asked to COMs. Medianof all COM replies indicated.
b/ The number of members in all SAGs who replied (combined).
c/ The estimated number of cases in the country. The median of all COM or SAG replies indicated(unless otherwise indicated).
d/ The estimated number of severely afflicted cases in the country. The median of all COM or
SAG replies indicated (unless otherwise indicated).
e/ Not specified by one of the two SAG replies.
f/ Number of ÒcontactsÓ by one of the SAG. The other reported 3 members.

It should be commented on, that media have often quoted estimates of theprevalence of Òelectromagnetic hypersensitivityÓ from a few percent up to 30%,and have argued that Òif a third of the general population belonged to the12Òelectromagnetic hypersensitivityÓ group, then existing exposure limits appear tobe far too highÓ. From Table 1, it can be derived that the prevalence of theseestimates - when compared to the total populations of these countries - are far
below these figures; ranging from less than a few per million (COM estimatesfrom United Kingdom, Italy and France) to a few tenth of a percent (SAG in
Denmark, Ireland and Sweden), and with severe cases - generally - with one orderof magnitude lower occurrence. (An obvious uncertainty in this evaluation is dueto the fact that some SAGs reported >10 000 cases with no upper limit specified.)As shown in an Austrian investigation, the number of individuals who believe
they are Òelectromagnetic hypersensitiveÓ but who do not have any actual
problems related to EMF sources may be higher (11, 12). In accordance with theworking definition (see above), these individuals would then not be considered ascases, as they present no symptoms.

Some case descriptions
In order to further illustrate the findings of the questionnaire and also in order to
input experiences of different organisations dealing with this problem, thefollowing descriptions of cases in different stages are given. Cases have occurredin different age and gender groups, as well as in relation to different situations(see above).
In general, health complaints of unclear origin are at the beginning of the
problem. In this situation people might look for possible explanations, especiallyenvironmental factors. Whether or not Òelectromagnetic hypersensitivityÓ
develops appears to depend on different circumstances - as is suggested in thevariations between different European nations.
In many cases, even mild symptoms may be interpreted by the afflicted persons
as warning signals of serious diseases which may lead to avoidance behaviour that
may cause inability to work and social isolation. Some patients, however, report
intolerable symptoms, most commonly pain or severe paralysing fatigue if they do
not avoid the vicinity of EMF sources. As a result, these patients may move frommodern society to isolated cottages without any electricity. If the symptoms
persist in spite of these measures, as is frequently the case, the patients interpret
this by having been exposed for too long a time before or by residual fields which
exist even in their new environment.
It should also be noted that the same or similar symptoms occur also in
individuals who do not claim to be Òelectromagnetic hypersensitiveÓ, and they canthus presumably be caused by various factors, also those not necessarily occurringin the vicinity of electrical appliances. Of some possible interest in thesecircumstances are a high working load, poor psychosocial situation, flickering
light or low indoor humidity etc. In addition, the observation that - in a given
situation - only some individuals develop Òelectromagnetic hypersensitivityÓ
clearly points to the involvement also of internal factors relating to the individual.
For these and other related reasons, the symptoms occurring among13Òelectromagnetic hypersensitiveÓ individuals should be considered to have amultifactorial aetiology.
In principle, the following different stages can be discerned among reported
cases. Some individuals may - during the progression of the problem - undergo allthese different stages. The examples given illustrate these stage descriptions andare taken from case series in COMs. It should be emphasised that the symptoms,
situations and age information given here are not typical, as there is no typicalcase of Òelectromagnetic hypersensitivityÓ, the examples are only used to describe
the stages.
Stage 1At this stage the patients experience temporary symptoms. Usually, they haveheard of the existence of Òelectromagnetic hypersensitivityÓ and may consider apossible relationship between the occurrence of these symptoms and exposure toelectromagnetic fields. According to some Swedish experiences, cases ofÒelectromagnetic hypersensitivityÓ start in more than 90% with VDU-related skinproblems with generally very good prognosis (9, 20) About 60-70% of the cases
show a recovery within 2 to 5 years (5). In this early stage, by providing
information and alternative explanations for their problems, in most cases thedevelopment of Òelectromagnetic hypersensitivityÓ can be avoided or can betreated with a fairly good prognosis and the chance of complete rehabilitation.
(As already pointed out above, this predominance on VDU work origin and on
skin problems may not, however, be relevant for situations in other countries,
though.)For example, C.N., 32, lived in a newly built house. When the utility built a
new power line 50 m away from the house, C.N. began to suffer from headacheand sleeplessness. In reaction to C.N.Õs complaints, C.N. was informed about thecurrent scientific knowledge concerning interactions between the fields and thebody, and the field contribution from the power line was measured. It could bedemonstrated that this contribution was much less than the fields from the daily
used electric appliances. After some time, C.N. phoned back and told that thesymptoms had disappeared.
In another example, an employee, A.K., 42, was told by a colleague that A.K.«sadverse health symptoms like headache, fatigue, anxiety were caused byelectromagnetic fields, in particular from a VDU. When having contacted an
institute for occupational health, A.K. was informed about the scientificknowledge concerning electromagnetic fields. Furthermore, in a blind experiment,
A.K. was exposed to various electromagnetic fields without any reactions. As aresult, A.K. accepted that the causes for the symptoms had to be due to otherreasons than electromagnetic field exposure.

14

Stage 2
If the symptoms persist and increase either in intensity, duration and/or number ofsymptoms, the assumption of a connection between electromagnetic fields
exposure and symptoms develops toward certainty and patients may start to lookfor further confirmation of their Òelectromagnetic hypersensitivityÓ hypothesis.
For example, R.G., 44, in a situation when personal conflicts at the workplacecoincided with the reorganisation of the work and the introduction of computers,developed adverse symptoms like reduction of concentration ability, nervousness,
low blood pressure, tingling sensations and metallic taste in the mouth. These
symptoms occurred in particular when working at the visual display unit (VDU).
R.G. started to collect publications on the impact of EMFs on health. Gradually
the conviction grew that EMFs were responsible for the health problems. This
opinion was supported by contacts with other persons claiming to beÒelectromagnetic hypersensitiveÓ. When R.G. contacted a center for occupational
health, R.G. was not able to detect electromagnetic fields in a blind exposure
situation, but insisted, however, to be affected by electromagnetic fields due to a
distant visible VDU even at unmeasurable low intensities. Staying convinced tosuffer from Òelectromagnetic hypersensitivityÓ, R.G. changed the lifestyle andavoided the use and proximity of electrical appliances as far as possible.
Stage 3This stage is reached by a few people only. At this stage frequently neurovegetative symptoms are reported to be triggered by vicinity to mostelectromagnetic field sources, and the patients are already convinced of a causal
relationship between their symptoms and EMF sources. In this stage, theprognosis of a successful treatment is poor, supportive therapy usually only
results in some improvement of daily life.
One example that might illustrate this stage is the technician P.S., 37, who
experienced the first stinging and burning sensations in the face after severalhourÕs work at the VDU. Within one year, P.S. discovered a reaction also tofluorescent light tubes and other kinds of EMF sources, including theelectromagnetic fields of the car. After one more year, P.S. reacted strongly tovarious electrical environments, and went on sick leaves - but problems appearedalso at P.S.Õs own house. Therefore P.S. decided first to sleep in the car (with theignition off) and then to live in an aluminium caravan. P.S. would have had to quit
the employment if the company would not have enabled P.S. to work in aironsheeted (shielded) room.

15

Possible causal factors for subjective
symptoms related to "electromagnetic
hypersensitivityÓ
As described in the introduction, "electromagnetic hypersensitivityÓ is used todescribe a phenomenon where individuals experience adverse health effects while
using or being in the vicinity of devices emanating electric, magnetic orelectromagnetic fields (EMFs). Often, these attributions are specifically directed
to EMFs from these devices, even if other factors - both physical and others have also been suggested. This attribution to specific factors must not be confusedwith a statement of an established causality, however.
In the text below, we describe the results of scientific investigations which have
tried to establish or indicate whether there is a link between certain factors(especially exposure to various EMFs) and symptoms typical of those claiming tobe "electromagnetic hypersensitive". Studies have been performed both on thegeneral population and on individuals reporting Òelectromagnetic hypersensitivityÓ.
A full review based on details in a large number of studies, supplemented byseveral reviews, is found in Appendix 3 - where also the specific references arelisted.

General population-based studies
Studies were reviewed that aim to detect whether the occurrence of certain
adverse health reactions are associated with exposure to EMFs. Several adverse
health reactions were considered, with main emphasis on neurasthenic symptoms
in the general populations, and skin reactions among individuals using visualdisplay units. While considerable concerns are attached to various diseases(notably cancer and possibly also some neurological disorders) and EMFs,
scientific investigations of such diseases are not considered in this review as theycannot be included in the given definition of Òelectromagnetic hypersensitivityÓ.
It should be noted, however, that the worry and concern about such healthoutcomes may be of relevance for "electromagnetic hypersensitive" persons.
Low frequency fields and neurasthenic or similar endpoints
The most consistent human experimental results appear to come from investigations of EEG activity changes caused by EMFs. While these indications domotivate further investigations, it is worth pointing out that the interpretation ofthese changes is unclear - they do indicate a biological effect, but not necessarily
an adverse effect. EMFs have been shown to reduce pineal melatonin synthesis or16increase the melatonin degradation in four studies on rodents, but failure to findsuch effects have also been reported in one study. Data on non-rodent mammals
are very scarce, and - in the two studies performed - essentially non-positive. A
few groups have investigated this possibility in humans, and generally failed toindicate any relationships.
A limited number of epidemiological studies on headaches, depressive or
similar symptoms and suicide were also found and reviewed. For depressive
symptoms, an association with powerline proximity was suggested in some, but
not in other studies. Based on available data, it is, however, difficult to separate(presumed) effects due to the physical presence of the fields from those dependent
on psychosomatic mechanisms. For headaches (migraine or non-migraine) and forsuicide, no affirmative conclusions or strong indications about associations withelectric or magnetic fields could be made. The absence of direct measurements offield levels in most studies, the lack of a well formulated hypothesis of interaction
and the varying and in some studies limited scientific quality, all contribute to theinability to make any firm conclusions.
In conclusion, while some results exist that do motivate further research into thepossibility of adverse neurasthenic reactions to low frequency fields, current
scientific knowledge is unable to prove this possibility.
Radiofrequency fields and neurasthenic or similar endpoints
It is not possible to extrapolate results between different frequencies, so results
obtained in subjects exposed to extremely low frequency fields cannot be directly
applied to radiofrequency field (RF) situations and vice versa.
For individuals regularly exposed to high levels of RF fields capable of causing
substantial thermal effects, or accidentally exposed to very high levels, various
neurological and other adverse effects have been demonstrated. The main concern
here, however, is with low level RF field exposures - i.e. below those causing
thermal interactions with the body, and below the exposure limits set by various
national and international guidelines or standards.
Epidemiological and experimental studies that investigate the possibility ofneurasthenic effects of such low level RF exposures are very few. Again, it iscurrently not possible to describe and verify mechanisms that could elicit abiological response of RF exposures below those relevant for known (thermal)interactions. In some contrast, it is possible to formulate a psychosomaticmechanism of interaction - but of course only for situations where the individualis aware of the exposure. In an investigation of sleep problems reported around a
Swiss short-wave transmitter, efforts to exclude a psychosomatic mechanism
explanation were made, but not fully successful.
A few other studies have also investigated sleep parameters and other outcomes- both biological (EEG changes) and adverse reactions. Overall, the data is atpresent not sufficient to establish neither the reliance of adverse neurasthenic
effects of low RF exposure on mechanisms other than psychosomatic ones nor

17

indeed their general existence. A few observations and reports are worthy offurther investigations, though.
Skin symptoms among VDU users
Skin symptoms are - in some countries - fairly common among those working
with visual display units (VDUs). Overall, an excess occurrence of subjectively
reported skin complaints or symptoms was found among VDU users, whereas arelationship with objective signs or diagnosed skin disorders appears less clear - acase can probably be made for seborrhoeic eczema, and possibly for non-specificerythema. Most - but perhaps not all - of the cases can be described as mild, andmany often appear to improve or disappear even without any remedial action
being taken. (The information available on studies from other countries than
Sweden and Norway is limited and have produced varied results, even if it can beargued that three out of four available studies have at least indicated an excess ofproblems among VDU users vs. non-users.)
Some investigations have attempted to find possible causal factors for thisphenomenon. The evidence for or indications of an involvement of various
electric or magnetic fields on such VDU-related skin problems appear weak toalmost non-existent. Some further attention could be given to the possibility thatthe bodyÕs static charges may lead to a higher facial deposition of skin irritants,though.
Generally, a fairly large body of evidence connects indoor air climate or stressfactors with skin problems - evidence obtained in other than VDU work
situations. Additional VDU-specific studies reviewed here are - in our opinion sufficient to indicate that such generally accepted factors for skin complaints areoperating also in VDU work situations, and to at least suggest that these may
actually be major explanatory factors for the noted association between VDU
work and skin ailments.

Reactions among individuals with possible special sensitivity
The evidence for the existence of groups with special sensitivity that could be of
relevance to "electromagnetic hypersensitivity" was reviewed. Furthermore,investigations into possible causal or contributing factors for symptoms amongsuch individuals with "electromagnetic hypersensitivity" were also summarised
and evaluated.
There are indications that "electromagnetic hypersensitive" individuals should
not be considered as a homogeneous group. A basic distinction - based primarily
on Swedish data - appear to exist between individuals with skin symptoms who
attribute them to VDU work situations, and individuals with (primarily)
neurasthenic symptoms who attribute them to a variety of situations. Such a
distinction can be supported not only on diversity of symptoms and attribution,
but also - in a few investigations - on specific findings.
18

As already outlined before, there is a considerable diversity across different
European nations when examining the appearance of "electromagnetic
hypersensitivity". Even if the distinction between the skin symptoms andneurasthenic symptoms groups, described above for Sweden, seems valid, thenumber and the proportion of the subjects included in these groups vary a lot. One
possible rationale would be that of a more general occurrence of individuals withneurasthenic symptoms attributed to a variety of sources in several European
nations. In addition, observed skin problems among VDU workers would be
attributed to "electromagnetic hypersensitivity" in a few countries, while inothers, they would be considered as related to other factors and/or called
differently.
Individual and possibly predisposing factors
It must be pointed out that further attempts to identify individuals with a special
sensitivity of possible relevance to "electromagnetic hypersensitivity" is based ona limited number of investigations, with somewhat varying approaches.
One investigation indicated that individuals with VDU-related skin complaints
differed from non-cases in terms of certain hormonal reactions (prolactine andthyroxine) while working with a VDU, and the authors suggested that this could
be related to a "stress reactivity". Some investigations have examined relationships between e.g. prolactine levels and EMFs - both in "electromagnetic hypersensitive" and general public individuals - in most cases without finding any such
relationships.
Some other results on increased reactivity and other possible predisposing
factors among "electromagnetic hypersensitive" individuals consist of observations of increased facial skin temperatures, on different psychological profiles(e.g. concerning socialisation or difficulty in taking initiative), on dermatologicalor histopathological findings etc. It has been argued that the presence of such orother similar predisposing factors could be involved in transforming a mild andperhaps insignificant reaction (including a reaction within the ÒnormalÓ physiological range) into a stronger and definitively adverse reaction. Arguments havealso been forwarded for a contributing role of risk perception and worry in suchprocesses.
It should be pointed out, however, that while these studies point to aninteresting set of descriptors, further work concerning their possible role in theorigin of the "electromagnetic hypersensitivity" are warranted before any moredefinite conclusions should be made.
Electric or magnetic fields and "electromagnetic hypersensitivity"
Provocation studies have been carried out on individuals with skin complaints
during VDU work as well as on individuals with Óelectromagnetic hypersensitivityÓ, mostly in Sweden and Norway. In one study, weak indications ofreactions to electric/electrostatic fields in terms of tingling or pricking sensations
19

were reported, while in another, various symptom did appear after exposure tomagnetic fields at varying frequencies (0.1 Hz to 5 MHz). (It should be noted that
the US study cited above with varying frequencies - together with a UK study - isbased on individuals primarily claiming multiple chemical sensitivity, and that therelationship between this syndrome and "electromagnetic hypersensitivity" hasnot been resolved.) The results in the other 9 of the 11 studies were an inability toa/ detect fields and/or b/ to react to them in terms of symptoms. Individuals withÒelectromagnetic hypersensitivityÓ often developed symptoms during these tests,
but these symptoms appeared to be independent of the field variation in thestudies.
Taken altogether, provocation studies to date have not been able to verify adirect link between (mainly) low frequency fields and problems of "electromagnetic hypersensitivity" that is shown to be independent of awareness of the
fields. For fields of higher frequencies, the limited number of studies and thelimited number of individuals actually tested enable no conclusions to be made.
Other suggested factors for "electromagnetic hypersensitivity"
A noteworthy observation obtained in a few of these provocation studies was thatwhile the actual fields were not associated with increased discomfort occurrencein the subjects during the test, guessing that the fields were "on", were so related.
While this is an interesting observation in terms of the possibility ofpsychosomatic (worry-driven) mechanisms, the interpretation is far from clear(did discomforts influence the guesses that the fields were on, or did the belief inthe fields being on influence the development or perception of symptoms?).
Among some cases of "electromagnetic hypersensitivity", attribution has been
to "electrical" appliances that also emit modulated light (VDUs, fluorescenttubes). Based on these observations, a few investigations have indicated that some"electromagnetic hypersensitive" individuals are more sensitive to such light
modulations ("flicker") than the controls. At present, the limited amount of dataoffer no firm conclusions - beyond observing that other physical factors than
EMFs might be of interest for at least some subgroups of "electromagnetic hypersensitive" individuals.
Finally, it should be observed that a number of cases of skin problems among
VDU operators have been diagnosed as "normal" skin disorders (such as contact
dermatitis).

20Perception and communication of risks
due to electromagnetic fields

Risk perception
Along with ongoing debates, the awareness of possible risks of exposure toelectromagnetic fields radiated or emitted by a variety of sources is increasing in
all industrialised countries. The way these risks are perceived by different people,
however, is not the same.
The personal risk attitude influences the response of individuals, including tosome extent subjective health symptoms, which thus might be of psychosomatic
nature. This hypothesis is supported by a recent study by McMahan and Meyer(14) on residents living adjacent to power lines. The results indicate that theprevalence of subjective EMF-related health problems (headache, migraine, poor
appetite, etc.) is higher in people who are more worried about EMFs (see further
discussion in the previous section above). Therefore, understanding the mechanisms of risk perception is of fundamental importance not only to improve thecommunication between scientists and the general public, but also to evaluate theplausibility and relevance of claimed effects such as Òelectromagnetic
hypersensitivityÓ.
Factors influencing risk perception
Some general methods of analysis have been developed, which are described inoverview papers (e.g., 22). In particular, Covello (3) identified a number offactors which influence the perception of risks in studies concerning nuclear
power, toxic substances and environmental pollution (see Table 2). Kunsch (10)also suggested a number of such factors which may be relevant for the perceptionof risks from EMFs. However, their relevance varies for different sources. The
importance of individual factors seems in fact to differ from one kind of EMF toanother.
With this regard, it is important to note that, also due to the large use of genericterms in different countries such as Òelectromagnetic pollutionÓ or ÒelectrosmogÓ,lay people tend to consider non-ionising radiation as a whole, with no clear ideaof the basic differences, for example, between magnetic fields from power lines
and high frequency fields radiated by cellular phones.

21

Table 2. Factors involved in public risk perception, from Covello (3)FactorAccident history

Conditions associated with increased publicconcern
Major and sometimes minor accidents

Benefits

Unclear benefits

Catastrophic potential

Fatalities and injuries grouped intime and space

Controllability

Personally uncontrollable

Dread

Effects dreaded

Effects on childrenChildren specifically at risk

Effects on future generations

Risk to future generations

EquityInequitable distribution of risks and benefits

Familiarity

Unfamiliar

Media attention

Much media attention

OriginCaused by human activities or failures

Personal stakeIndividual personally at risk

Reversibility

Effects irreversible

Scientific evidence

Risk estimates based on human evidence

Trust in institutions

Lack of trust in responsible institutions

Uncertainty

Risks scientifically unknown or uncertain

Understanding

Mechanisms of process not understoodVictim identity

Identifiable victims

Voluntary exposure

Involuntary

As a consequence, factors which are mainly related to a specific source may
also influence the attitude of the public towards others. The most evident example
is the problem of cancer, connected with several of the factors listed in Table 2:effects on children, effects on future generations, (ir)reversibility etc. There issome evidence, though controversial, of an association between ELF magnetic
fields and cancer, but no such evidence exists for high-frequency fields (18). In
spite of that, concern is widespread within the public, e.g. for brain tumours from
cellular phones. On the other hand, symptoms which were initially reported for
VDU operators, such as dermatological effects, are claimed also in the case of22

residence near power lines, where an etiological role of EMFs is difficult to
substantiate.
The effects of familiarity also seem different for power frequency and highfrequency fields. People are generally not familiar with radiofrequency andmicrowaves, but are familiar with electricity. In the first case, the lack offamiliarity may be a cause of concern, as suggested by Covello (3); on the other
hand, it has been noted that people tend to strongly react with fear when they
discover, or suspect, hazards from agents they are used to live with, and whichhave been considered safe for a long time, such as electricity.
As shown in the Appendix 4, it may be presumed that most of the factors listed
in Table 2 are relevant in the case of electromagnetic fields, the exceptions being
limited to catastrophic potential, victim identity and accident history.
The appraisal of risk
Both the overall perception of risks and the relative importance of the factors
listed above differ from one individual to another, and among social groups,
depending on e.g. education, age, gender, social class etc. Other questions cantherefore be addressed by risk research, such as: ÒHow does risk perception differ
in different groups?Ó or ÒHow is risk perception modified by knowledge (onmechanisms, scientific findings, etc.)?Ó. In particular, a question of crucial
importance to improve good communication is: ÒHow different is the perceptionof risks between lay people and experts?Ó. This question has been addressed byFremling (6) and by the Harvard Center for Risk Analysis (7, 8) who indicated a
substantial difference in appraisal, and a large variety in the confidence about thevery existence of health risks, even within the scientific community.
The relationship of knowledge and familiarity of risks with their perception has
been the object of a study on power lines performed by Morgan and co-workers(16) and more recently by Maerli (13). The main findings of these studies, which
are discussed more extensively in Appendix 4, are that the same risk is perceived
differently according to voluntarity, and that information about scientific findings
generally leads to the perception of risks as more dreadful.
This confirms once again the crucial importance of correct communication,
which influences not only the perception of risks, but also its possible modifications, as analysed by Wiedemann and SchŸtz (22). They identified several
factors which might influence the further development of risk perception in thesociety, and found that the most relevant are science and technology (i.e. thecapability of science to prove or disprove the existence of risks, and of technology
to mitigate them); societal structure (i.e. possible new social and political conflicts
that may limit the attention given to technological risks); and economy (i.e. theeconomic capability of the society to deal with the problem of health hazards
from EMFs).
The future relevance of qualitative factors discussed above, and consequently
the development of the EMF controversy, will depend to a large extent on thesesocietal conditions.
23

Risk communication
The American National Research Council stated that risk communication is Òaninteractive process of exchange of information and opinion among individuals,
groups and institutions; often involves multiple messages about the nature of risk
or expressing concerns, opinions or reactions to risks messages or to legal andinstitutional arrangements for risk managementÒ (17). This definition clearlyshows that communication about risks, especially highly uncertain risks is a very
intricate and demanding process. The roots of risk communication research dateback to the 1980s where the first research activities in the United States where
supported e.g. by the Environmental Protection Agency, the National Science
Foundation and also the industry. Up to now most groups have been working onquestions related to nuclear power, radon or chemical pollution (e.g. 1, 4). Only a
few research teams have been studying risk communication with respect to nonionising electromagnetic fields (e.g. 15, 22).
In the following, the application of risk communication to EMFs, with a glanceat the role of the media, will be discussed.
Risk communication about electromagnetic fields
Until recently, EMF risks have not constituted a subject of high involvement by
the general public, but the public is currently quite attentive towards this issue as
was discussed above. People having very close and/or permanent contact withsources of EMF, e.g. living very close to powerlines, broadcasting or mobile
phone towers and particularly sensitive people attribute a high relevance to EMF.
Nevertheless, issue research (2) tells us that risk controversies start in small fringegroups, they ÒnameÒ the risk, as has happened with EMFs, e.g. Òelectromagnetic
pollutionÒ as the term is used in some English speaking countries, orÒelectrosmogÒ in German speaking countries. Then the media coverage grows, as
has also already happened in this case. The next stages described in issue research
have not yet been reached in general through Europe: such as an escalation ofmedia reports and the reaching of a crisis point, where related products orindustries face a decisive decrease in acceptance and report dropping sales.
Therefore it is necessary to analyse carefully the current debate in order to prevent
such a crisis situation and not to enhance apprehensions of people which may leadto a reduced quality of life.
The traditional approach to risk communication has involved conferring withexperts to see what people need to know. Subsequently, information material havethen been prepared. However, this approach very often encounters cognitive difficulties and does not show the desired result. At Carnegie Mellon University/Pittsburgh, USA, a new approach to risk communication was developed andalso applied to low frequency EMF (15). In this approach, expert understanding
on EMF was obtained in parallel with investigations on how people frame thisproblem and what they know or belief about it. Then the decision problems

24

people face were extracted and a mental model was developed, i.e. a model
describing the process of understanding and decision taking. In a further step theability of this model to support peopleÕs decisions was tested and only then was
information material designed and communicated to the people. This approachtakes into account that people do not process and interpret new information in an
isolated way. They process and filter information with reference to existingknowledge understandings and beliefs. The main finding of this study was that lay
people do have a variety of incomplete and confused understandings about low
frequency EMF, but relatively few beliefs that are outright wrong. However, someof these incomplete and incorrect understandings will pose problems in public
policy decision making.
A German study (22), also using interview and discussion group techniques,
focused on risk perception and risk assessment in the case of high frequency
fields. Additionally, it considered the differences in risk assessment amongexperts, because risk discussion is also a discussion led by experts, depending
very much on the credibility of experts, especially when new technologies such as
mobile phones begin to spread. One of the main findings was that among different
groups very different communication patterns exist and therefore different
strategies have to be used to address them effectively.

The role of the media
The influence of mass media on the communication of positive or negative news
is tremendous, even rational people can be influenced quite a bit by the media.
Journalists are trained how to spread, control and sell news effectively because
this is a big business; some main aspects of which are:· Facts, background knowledge and any correlations are presented in a very
reduced way, so to speak as a black and white picture. However, scientificfindings usually do not fit such a picture but have many facets, so when they
are forced in such a black and white scheme the content as well as the message
could become wrong.
· News may be created from opinions only, however opinions are very variableand public opinions can change in the process as a topic develops.
· News are presented as a kind of entertainment.
Due to the entertainment aspect, bad news or even panics are well received by
the people but they are very slow in actually changing the habits of the people
permanently. They may however make people want others, officials or industry,
to change something. This is a way of passing the responsibility, something which
also already happens at the stage when news are consumed but there is an
artificial distance between the consumer and the action on the screen or the text inthe paper.
Therefore journalists themselves do believe that the influence on the public orthe individual is very much overestimated and that people are very well able to25discern between serious news and entertainment (Harrington, R., presented to theproject group in MŸnchen 1996). In order to produce such serious news one does
not only need journalists with a special training in e.g. science but one also has totrain the researchers: Good journalists do have to discern between results of asingle study, which cannot be generalised and replicable results which can beused as a basis for further conclusions. On the other hand, researchers have topresent their results in an understandable way, avoiding technical language andcomplicated descriptions when they appear in the media (Gršnqvist, L., presented
to the project group in MŸnchen 1996). They also should learn how to present
themselves when asked for an interview. An analysis of how the media treated
information about EMFs (21) lead to similar conclusions.

Conclusions
According to the findings of risk perception and risk communication research ingeneral and of studies on electromagnetic fields, as well as due to the key aspectsof the use of media, the following conclusions can be drawn:· The personal attitudes, not only towards one specific risk, influence theresponse of individuals.
· The perception of risks differs among individuals, social groups, countries, aswell as between lay people on one side and experts on the other one.
· Risk perception and risk communication are deeply interrelated: understanding
perception is important for communication approaches, whereas
communication strongly influences the appraisal of risks.
· For a valuable communication it is essential to find out how much scientificbackground people of different groups do have on electromagnetic fields and on
what kind of mental model they base their decisions. Information programmes
should then be based on these models.
· Different approaches are also needed for different countries, because the risk
perception, the type of problems and the attitude towards information as well as
authority and the administrative structures do vary considerably.
· Risk communication should not be mistaken as just another type of public
relations or advertisement. Therefore it is wrong to rely on the usual spreadingof information or on the effect of mass media. The interaction between thecommunicating parties is very important.
· The strategies of risk communication have to be adapted carefully to the focus
group to be reached. Different focus groups concerning EMFs are e.g.: thegeneral public, especially vulnerable people, such as pacemaker patients or
people showing symptoms due to the use or the proximity to sources of EMFs.
· It has to be taken into account that not only the content of a piece of information is important but also the roles taken by the people communicating andthe opinion they have on each other.
· The question of credibility of the experts, i.e. how to remain or become credible
has to be addressed.

26

Information material used in different
countries of the EU
There are many stakeholders involved in the communication of possible healtheffects of electromagnetic fields (EMFs). The ones trying to reach the public orcertain groups of the public through written information material are mainly:
companies selling technologies which involve EMFs, health authorities, media,
scientists and self aid groups. Information materials distributed by some of thesegroups were collected within the EU - see Appendix 5 for a list of solicited andreceived material. It should be noted, however, that it was not possible to reach all
sources of information material within the time interval given. In addition, newchannels for information such as the world-wide web are increasingly used also
for this type of information, and the material offered there is changing rapidly.
Therefore, the material collected cannot be considered complete, but sufficientmaterial was obtained to draw certain overall conclusions.
In the following, first of all possible aims and means of the stakeholders, asseen from the range of information material obtained, are described. Then aclassification of the information material is made according to the target groups.
For that reason, layout, content and argumentation space as well as general data ofeach document were independently evaluated by three members of the projectgroup according to a standard evaluation form (see Appendix 5). Additionally,
five non-experts were asked to evaluate one of the leaflets using the sameevaluation form. This led to the conclusion that experts tended to evaluate such
documents in a more positive way and that the evaluations appeared to depend on
the professional education of the reader.

Stakeholders involved in the preparation and dissemination of
information material
Companies
Two priorities of public or private companies selling technologies or devices
which involve EMFs are to maximise the technical effectiveness of their productand to earn money. In addition, companies have to observe current norms andsafety regulations in general. In the case of relatively Òold technologiesÒ, such as
power lines, the policy of the utilities usually is to deal with any EMF concerns
professionally (there already is a background for it) and to ensure that the positionof the company is known: Pamphlets are distributed, especially when new sites
are proposed, hearings are given, measurements in homes are offered andpresentations in schools are made including special written information material

27

for schools. Concerning relatively new technologies, such as mobile phones, it
was shown more clearly that there are groups of different acceptance levels
among the public. For example, ÒyuppiesÒ like to use handies whereas muchprotests arise with the public whenever a new mobile phone tower is to be built.
The companies, especially the big ones, need to tailor their information strategies
much better according to the group addressed. As the market for new technologies
is still much more variable compared to the older technologies, more money islikely to be invested in the communication of possible risks and even the help ofcommunication experts is used.
Health authorities
There are international, national and regional health authorities. The international
health authorities such as the ICNIRP (the International Commission on NonIonising Radiation Protection) or WHO usually write comprehensive reports forscientists and other specialists. These reports are, however, not intended for nor
suited to be used directly for the general public. Therefore only national andregional authorities will be dealt with here as sources of information leaflets.
They usually give advice to the government, regulatory bodies and to the public.
Reports on different aspects are written on request e.g. from the government,
sometimes with the help of invited scientists. Information brochures are preparedon subjects of general interest, specific advice may be given by phone or letters.
Additionally, press releases on new topics are prepared and sometimes there are
telephone help lines with changing information on special subjects.
National health authorities usually choose very careful wording, due to the factthat they try to take into account all different sources of knowledge. However, thisis not always appreciated or accepted by the public and by the mass media
because they would prefer more definite answers. There are examples where
information brochures prepared by local health authorities, e.g. in cities, are rather
emotional and subjective. This may be due to the fact that such brochures are used
as an instrument of local politics. It is also obvious that the authors often did nothave much background knowledge about EMFs.
In general, health authorities do not - as yet - use the latest techniques of risk
communication and up to now did not employ such specialists to help them with
the information material. Mostly scientists and technicians employed at theauthority together with the public relations department will devise the informationmaterial.
Depending on different cultural backgrounds etc., information given byauthorities is either believed by the public (or even demanded) or it is mistrusted.
Scientists
Scientists are used to describe their results to other scientists, therefore they use
many technical terms and intricate descriptions which are difficult to understandfor non-experts. Nowadays scientists - involuntarily as well as voluntarily - get28increasingly involved in communicating with the public. They may be asked forinterviews in the media or they give presentations of their findings for the press.
Scientists may also be asked to assist with official reports on specific subjects,
such reports are written e.g. for the government but could be available on request
for the public. Then they have to change their wording and streamline theirdescriptions (compare the section on risk communication above), otherwise theirmessage will not reach the public and may lead to misunderstandings.
Self-aid groups and other private organisations
Papers prepared by self aid groups are in general usually highly emotional andoften mix science with non-scientific statements. Sound background information
for the reader is often missing and the style used is very persuasive. Usually thelayout is poor. Often the authors do not have enough background knowledge.
However, such information may be widespread, e.g. by Internet.
In some countries, private organisations have appeared, offering Òenvironmental counsellingÒ. As they want to sell information, measurements or certain
devices, such as Òprotective materialÒ, they tend to offer information brochureswith a well prepared layout. These are, however, often found to present biased
views and to lack substantial information, due to the fact that the content isintended to support the services offered.

Information material prepared for different target groups
Among the different target groups addressed are: the general public including
schools or special fringe groups such as Óelectromagnetic hypersensitiveÓ
individuals, occupationally exposed persons, authorities and medical doctors. In
the following, scientific reports, sometimes ordered and/or paid by authorities orthe industry or written by international organisations such as the WHO, generally
will not be included. Their content usually cannot be used as such for general
information.
As most information material obtained is directed to the general public, this partwill be discussed more thoroughly than the information material directed to othertarget groups.
General public, including schools and fringe groups
The contents of the information brochures for the general public range fromgeneral information on EMFs to information on special questions only, such as
mobile phones. In addition there is quite a variation in length, ranging from ashort folder to book format; for schools also posters were prepared. Usually thebrochures contain fairly good comprehensive information on the nature of the
fields and the possible sources. The results of different studies can only bereported in any details in the somewhat longer brochures, however most of the29brochures did hint at some existing controversies. Only in half of the informationmaterial were limits cited, when cited however, mostly national limits are given,
although in some cases the values recommended by international organisations
such as ICNIRP or WHO were presented. In about half of all brochures obtainedsome recommendations were given for daily life. Only very rarely did theinformation material for the general public contain information on the question ofÓelectromagnetic hypersensitivityÓ, the only brochures referring to Óelectromagnetic hypersensitivityÓ more clearly, including examples, came from Sweden
and Switzerland.
The layout in general relied on the presentation of some pictures or photos,
often well chosen, with graphs and tables or lists and inserts used to underline thetext. In some cases the graphs and tables seem to be somewhat complicated forthe public addressed. The language was usually also well suited for the readersreferred to. As was already discussed in the chapter above, the professionally oflayout and the type of presentation used differs depending on the type of
stakeholder preparing the information.
The argumentation space used was a little more heterogeneous, as here theinfluence of the authors or editors seemed to have quite some influence. The typeof information can in most cases be described as an instruction. The form of a
dialogue or a persuasion appeared rarely. In almost no documents were theargumentation written as a clear warning. About the same number of brochurescontained either no clear cut between information and debating or such a clear
cut. Most documents seem to be fairly objective, but there were some that werevery subjective.
Many brochures only gave the address of the authors and thus do not give theinterested reader a chance to get a source for further information.
The brochures directed to schools were nor written directly for pupils but they
obviously rely on the interpretation of a teacher of natural sciences. However, theinformation given was usually a good enough background for some hours ofteaching, with all the possible criteria discussed above well fulfilled.
We did not find brochures specifically prepared for fringe groups such asÓelectromagnetic hypersensitiveÓ people apart from those from the self aid groups
themselves. The general layout was then usually very poor, as already discussed
in the chapter above, and the content did not cover well either the nature of EMFs,
the sources, the results of respective studies or established limits for fields
strengths. The argumentation space tended to be very subjective in those cases,
with no clear cut between informing and debating; sometimes even theinformation value was very small.
Occupationally exposed people
Only some brochures obtained were directed at people exposed at the working
place. (This is also due to the fact that we asked for information for the public
when collecting the brochures.) Information material for working people wasusually more technical. The nature of EMFs and their sources as well as studies
30

were well described. Compared to the information material for the public, limits
such as norms or international recommendations were much more emphasised.
Possible psychosomatic effects were practically not mentioned. The content of thebrochure was mostly instructive and objective, the language was well suited. The
photos, tables and graphs used were fairly well laid out, however their number perbrochure differed largely.
Two brochures were directed at medical doctors, specialised in working life.
They were fairly comprehensive, however the style used was somewhat dry. As
they were meant to be used in counselling occupationally exposed people, theyused dialogues to explain facts. A clear cut was made between arguing andexplaining.
Authorities, such as health authorities, ministries and other decision makers
As was already mentioned above, the relatively large number of scientific ortechnical reports written for them is excluded from this discussion. There were,
however, a few brochures which are well worth a short discussion: They were
either directed directly to other decision makers, experts or the industry andcontained mainly information on possibilities of risk communication with the
public. Therefore they contained almost no background information on the subjectof electromagnetic fields, sources and electromagnetic field limits.

Conclusions
Notwithstanding the difficulties in obtaining an objective evaluation of thecollected information material and also that the collection of such material was
not complete, the following general conclusions and suggestions can be made:Within the EU countries the distribution of information material on EMFs
appears to be quite inhomogenous. The information material obtained appeared inmost cases to be fairly suitable for the target groups and did also give quite
objective information of todayÕs knowledge. However, the layout and thecontribution themselves could be improved with the help of communication
experts. Photos, tables and graphs should be selected more carefully according to
the respective target group. In addition, different target groups should be
identified and the subject of the information material could be more specifically
geared towards such target groups (i.e. not only containing information on EMFs
in general) in order to improve information flow. It would be helpful to choose
target groups which could serve as intermediates, e.g. physicians or labour
inspectors. The Internet can be used to advertise such a brochure, e.g. on the home
page of the organisation who prepared it.

31

Handling of individuals claiming"electromagnetic hypersensitivity"

Rationale for handling
A basic premise is that "electromagnetic hypersensitivity" is a real condition in
the sense that many afflicted individuals suffer real and - for some - serious healthproblems. This seriousness, and also the consequences for others around that
person (family, work place, etc.) dictate a need for remedial activities and/or help
in coping with the situation. Such actions could be taken both in occupational or
general public settings as well as by health care (medical) institutions. Close
cooperation between these activities is advantageous.
The following recommendations on handling are based on what was elaborated
in this report and partly also on some experience gained primarily in Sweden. As
this chapter is a very central one in the report, the main findings of this reportwhich was considered useful for determining what actions should be taken, aresummarised also here.
On the identity of " electromagnetic hypersensitivity"· The identification of an "electromagnetic hypersensitive" individual is based on
his/her experience of adverse effects while using or being in the vicinity ofelectric, magnetic or electromagnetic devices (EMF devices). Thus, theindividualÕs appreciation or apprehension of being in the vicinity of some EMF
devices is (normally) a precondition for the term "electromagnetic
hypersensitivity" to be applied.
· However, situations where individuals in one country or region may attribute
their problems to "electromagnetic hypersensitivity", may not lead to such
attribution in another area. This is presumably or at least partly due todifferences in available information and media attention - major geographicaldifferences occur in these respects.
· ÒElectromagnetic hypersensitivityÓ has different appearance and extent indifferent countries.
· There are currently no methods for identifying individuals with "electromagnetic hypersensitivity" apart from these individualsÕ attribution of their ill
health (symptoms).
· Due to the general non-specificity of the symptoms, the lack of consistentobjective findings, the absence of an establish aetiology, and the probableheterogeneity of the problem, the designation "electromagnetic hypersensitivity" should not be confused with a medical diagnosis.

32

On the causation of "electromagnetic hypersensitivity"· The causation of "electromagnetic hypersensitivity" is not established. The
term, if used, should not be taken as a suggestion that e.g. electric or magnetic
fields have been identified as causal factors.
· Manifestations - and presumably also the origin - of "electromagnetic hypersensitivity" are likely due to combinations of different factors, both internal(predisposing factors for the individual) and external (factors present in a
specific situation).
· So far, investigations concerning a mechanism by which the vicinity toelectrical devices and appliances is involved in the appearance of healthproblems, have not established a direct physical link between electric or
magnetic fields and the health problems, even if further investigations into
these and other possible external factors appear warranted.
· There are other external factors which have, at least tentatively, been indicatedin the problem, ranging from physical factors such as modulated light(ÒflickerÓ) to more organisational factors such as various stress conditions.
· Indications exist that psychosomatic reactions may play an important part in therise and/or maintenance of the syndrome. If so, concern and worry could be
important factors for the effect.
· "Electromagnetic hypersensitivity" may be a heterogeneous condition different afflicted individuals would then not be expected to have the same setof causal factors.
On handling of individuals with "electromagnetic hypersensitivity"· Upon medical investigations, some individuals claiming to be "electromagnetic
hypersensitive" have been found to have other, medically known and often
treatable conditions.
· A common experience is that problems - for an afflicted individual - will beless pronounced, and improvements in the situation easier to accomplish, if
intervention is made early.
· If the problem of "electromagnetic hypersensitivity" is indeed multifactorialand heterogeneous, then care should be taken not to concentrate efforts on one
preconceived type of factor(s) - a broad approach appear better motivated.
· Based on the observation that the occurrence of "electromagnetic hypersensitivity" is sometimes "clustered", and the possibility that concern and worry
are at least aggravating factors in "electromagnetic hypersensitivity", carefulconsiderations must be given also to individuals around an afflicted individual,
so that remedial actions warranted for one individual do not increase theirworry or concern ("they are doing things, so it must be dangerous").
Information efforts should be made in order to explain what is being done andwhy. This may be especially relevant in occupational settings.

33

General outline
We have not found any officially sanctioned handling program in any of theEuropean nations that we studied. The Norwegian Board of Health is currently
evaluating the possibility of developing a strategy for treatment (Turid Vendshol,presented to the project group in Stockholm 1997). There are, however, several
programs used at single medical centers for prevention, intervention and treatment
of individuals with "electromagnetic hypersensitivity", and also a number of programs adapted by e.g. several larger companies (Lena Hillert and Oswald Jahn,
presented to the project group in MŸnchen 1996). The majority of such programs- as far as we have found - do emanate from Sweden.
Different approaches to handle "electromagnetic hypersensitive" individuals
should be made in different countries, since the approach taken must - in our
opinion - be geared to the varying appearances of the phenomena. A balance mustalso be set between the legitimate need for an individual to receive help, and the
problem of increasing concern among others. This balance is most likely different
in different countries or regions. The structure of health care systems also varies
in different European nations and this variation must be taken into account as
well.
Any system or informal way set up to handle the problem of "electromagnetic
hypersensitivity", should include means by which early detection of anindividualÕs problem is made. Profound differences in possible such means
obviously differ between occupational settings and the general public domain, andbetween different European countries. This also implies that different strategies
should be used for problems attributed to situations in the workplace - where
often organisational possibilities for early handling are fairly good - and problems
appearing in other situations. In the latter, the general practitioner is most likely aprime candidate for early handling, and thus an important target for information
concerning "electromagnetic hypersensitivity".
In principle, the effort undertaken should be structured in accordance with thefollowing normal procedures:· Prevention of symptom appearance in a population.
· Intervention or early handling of afflicted cases.
· Treatment of individuals with long-lasting symptoms and severe handicap.
As already indicated, these activities would normally be handled by variousorganisations and professionals; occupational safety officers in workplaces,
general practitioners, medical personnel in occupational health centers or special
clinics etc. The important role played by information in adequate handling of"electromagnetic hypersensitivity" also suggests that it is important that these
professionals do have access to balanced information on the topic - and that theyshare a common view.

34

Prevention of symptom appearance in a population
Prevention is used for the situation where no cases of "electromagnetic hypersensitivity" have appeared. Since the symptoms involved are non-specific, they
could also be caused by various commonly occurring factors such as skin- andairway irritants, allergens and different stressors such as noise, flickering light,
and psychosocial factors. However, increased concerns about such symptoms regardless of their factual origin - might increase their intensity, causing still moreconcern etc. in a vicious circle.
Thus, the recommended strategy is to generally reduce excessive exposure to
factors known to cause these symptoms or to reduce mental stress (see further
Table 3). This should be combined with balanced information on what we know
and do not know about suspected health effects from the use of electricity or fromexposure to EMFs - in order to interrupt or prevent such viscous circles. This
information should be composed of several components such as:· a better understanding of the fields,· current understanding of the causes and appearance of "electromagnetic
hypersensitivity", and· current knowledge concerning the possibility of disorders such as cancer being
linked to EMF exposure.
Table 3. Some suggestions for actions to be taken for prevention of symptom appearance
in a population.
Workplace
About EMF, health risks, andnational standards. Information
about company policy to meetpresent standards andrecommendations.

General environment
About EMF, health risks andnational standards.

Environmental actions

Optimising the work environment: indoor climate, air
pollution, noise, lighting,ergonomic factors, psychosocial
factors.

Optimising the generalenvironment including traffic
pollution, environmental
tobacco smoke, and emissions
from factories and houses.

Stakeholders

Government agencies andinstitutions.
Occupational health services.
Employers.

Government agencies andinstitutions.
Electricity companies.
Mobile phone manufacturers
and network providers.

Information

In our opinion, the information must be balanced and avoid the extreme
positions of either inflating or neglecting the issues involved. In practice, information activities may often prove to be the main effort at this stage.

35

Intervention or early handling of afflicted cases
In situations where symptoms and the attribution to "electromagnetic hypersensitivity" has occurred among one or some individuals, early handling of thesituation is essential in order to prevent a chronic situation with aggravation of thesymptoms (see also Table 4).
Table 4. Some suggestions for actions to be taken for intervention or early handling ofafflicted cases.
Medical actions

Environmental actions

Workplace
Medical investigation motivatedby symptoms and signs to identify
specific medical illnesses orconditions, but not to identifyÓelectromagnetic
hypersensititvityÓ - since thislatter condition cannot be
identified by medical
examinations.

General environment
Same.

Work environment investigation
to reduce exposure to factors
other than EMFs that might beassociated with the presented
symptomatology. Such factors
might be these listed underprimary prevention and work
place above.

Environmental investigation to
reduce exposure toenvironmental factors known togive rise to the presented
symptomatology. Such factors
may be those listed underprimary prevention and generalenvironment above.

Concerning electromagnetic fields
see table 6 and the text below.

Stakeholders

The afflicted individual.
Occupational health service.
Employers.

Concerning electromagnetic
fields see table 6 and the text
below.
The afflicted individual.
General health service.
Community health and welfare
officers.
Environmental health agencies.

A fundament in the handling should always be a medical examination
performed by a physician. This is to identify if a ÒknownÓ disease is responsible
for the symptom and which should then be subject to appropriate medical
handling. The non-specificity of the symptoms involved makes it - in some cases entirely possible that the symptoms could be manifestations of other disorders, but
misinterpreted by the individual or his/her surroundings. It has occasionally beenreported that individuals with alleged "electromagnetic hypersensitivity" havebeen found to suffer from e.g. hypothyreosis, tumours in the nervous system orcontact allergy.
The second basic step is a thorough check for possible contributing environmental factors by a hygienist. Examples of such environmental factors are listed36

in Table 3 above, and the actions are partly motivated by the same argument as
when performing primary prevention, but - here - perhaps with increased priority.
Another reason for these actions is to initiate a communication with the patient
attempting to find strategies for coping with the situation, i.e. to gain control ofenvironmental factors of possible importance for the symptoms.
It is - in our view - important that whatever action is taken here is done with thefollowing two objective in mind:· Actions taken should be done in close co-operation with the afflictedindividual.
· Actions should preferably have a broad basis. This means that one should avoid
all activities and discussion to be focused on only one or a few factors.
This latter point requires some further comments and perhaps justification. The
non-specificity of the symptoms, and the possibility that increased concern might
aggravate symptoms leads - in our evaluation - to the possibility that concentration on one factor (which might not be justified for that particular case)would then lead to increasing demands for reductions when actions taken are noteffective - again increasing the vicious circle problem. It should be pointed outthat this argument is - in our opinion - general, not just geared towards EMF.
Finally, correct and balanced information is also an important part at this stage.

Treatment of individuals with long-lasting symptoms and severe
handicap
For individuals claiming "electromagnetic hypersensitivity" with long-lasting andsevere symptoms, therapy should primarily be directed towards reducing
symptoms and functional handicap (see Table 5). We recommend that this should
be handled in close co-operation between:· a physician (for adequate medical handling),· a hygienist (to exclude or eliminate factors in the environment that are known
to cause symptoms or adverse health effects of relevance to those of thepatient), and· a psychotherapist (who would initially focus on the patientÕs situation in
conjunction with the development of symptoms and consequences brought onby the symptoms).

37

Table 5. Some suggestions for actions aimed at reducing symptoms and functional
handicap.
Workplace
Actions to reduce symptoms
and functional handicaps.

General environment
Same.

Environmental actions

As above. Concerning
electromagnetic fields, see
Table 6 and the text below.

Same.

Stakeholders

The afflicted individual.
Occupational health service incollaboration with otherspecialists.

The afflicted individual.
General health services.

Medical actions

In principle, information activities are relevant at all stages - including this.
There is a need here, however, to avoid situations of conflict between e.g. thephysician and the patient as to the causes of the disorder - the emphasis here
should probably be more on alleviating and assisting in coping, not to change
opinions.

Concerning actions directed towards electric, magnetic or electromagnetic field sources
To measure and to reduce the exposure to EMFs in the relevant situation(s) is acommonly asked for action by many of the individuals claiming "electromagnetic
hypersensitivity". As illustrated in Table 6, there are, however, both advantages
and disadvantages of such actions. Any action taken should balance the need for
remedial activity for an afflicted individual with that of avoiding unnecessary
worry and concern among others. Again, this balance should be tailored to thevarying situation in different countries.
General preventive action to reduce e.g. electric or magnetic fields can not be
motivated on the basis of the phenomenon of "electromagnetic hypersensitivity".
This is due both to the lack of any solid information that they are indeed involvedin the causality, and to the need to avoid the preconception among otherindividuals that the fields have been shown to have such a relation.
In view of these considerations, companies and other stakeholders involved
should consider the various advantages and disadvantages of measuring or
reducing electric and magnetic fields - some of which are noted in Table 6 below.
It should be observed that these discussions on field measurements andreductions are relevant to situations where field levels are known to be well below
established standards and hygienic limits. If there are grounds to suspect that
exposure levels could be in excess of such standards, then of course measurements and - if called for - actions to reduce exposures are warranted,

38

regardless of reported cases of Òelectromagnetic hypersensitivityÓ. In such asituation, relevant guidelines and protocols for measurements do exist.
Table 6. Arguments for and against actions concerning electric or magnetic field
exposures in situations where individuals with "electromagnetic hypersensitivity" exist.
Measuring fields

Arguments for
Ensure that levels of exposure of
EMF meet excising standards andrecommendations.

Arguments against
A causal relationship has notbeen proven and taking
measurements might beinterpreted as an indication thata hazard exists.

May provide a basis for possible
actions to be taken by theindividual to reduce exposure.

Lack of knowledge of possible
exposure parameter of relevanceand consequently lack of relevant guidelines or protocols formeasurements of such parameters.

To respond to the concerns of theindividual.

The absence of dose-response
relationship.

If measured levels are low thismay have a reassuring effect.

Might draw attention away fromother factors that might be more
relevant.

By using dosimeters andsymptom records, the hypothesisof an association between
symptoms and exposure levels in
the individual case might beinvestigated.
Reducing fields

As part of a prudent avoidance
strategy.

No medical or scientific basis
on which to reduce exposure tolevels lower than those limits
that already exists.

To respond to the concerns of theindividual.

In view of the ubiquitous natureof EMFs, reducing the levels ina particular location may notcontribute significantly to a
reduction in the individual's
total exposure.

May have a placebo effect inreducing symptoms.

May create unnecessary anxiety
among others.

In Sweden, five authorities responsible for activities related to electromagnetic
fields under general legislation, have recommended a precautionary principle
based primarily on suspected cancer risks in relation to low frequency magnetic
fields. It should be noted that that document is not directed to the problem of"electromagnetic hypersensitivity".
39

Recommendations
This investigation of Òelectromagnetic hypersensitivityÓ across Europe included
an evaluation of questionnaires to various organisations concerning their appraisalof the situation, descriptions of some case reports, a review of the relevant
literature on possible causal factors, a description of the available information forthe public on electromagnetic fields and did also take into account the concepts ofrisk perception and risk communication.
Based on these deliberations, the group has come to certain recommendations.
These are presented under three headings; recommendations on how to handle
individual with alleged Òelectromagnetic hypersensitivityÓ, recommendations on
information activities, and recommendations on further scientific research. It is ofcourse recognised that some of these are closely interrelated.
A central observation found when examining descriptions of cases, appraisals
by various organisations as well as evaluating the scientific literature is thatÒelectromagnetic hypersensitiveÓ individuals do not appear to form ahomogeneous group, but are more likely described best in terms of subgroups - a
few of which have been at least tentatively identified. This non-homogeneity ofthe phenomenon is of major importance also for a variety of the recommendations
made.

Handling of individuals with Òelectromagnetic hypersensitivityÓ
The existence of individuals with severe health problems is a clear motivation foradequate medical care and situation handling. The fact that most people claiming
to be Òelectromagnetically hypersensitiveÓ only do show very mild symptoms
also requires - in our opinion - adequate handling. Such preventive activity would
most likely have a major information content (see further below onrecommendations concerning information). In any case it is important thatÒelectromagnetic hypersensitiveÓ persons are taken seriously and that theircomplaints are analysed and taken care of in a proper way.
The main facets of adequate handling can be summarised as follows:· individual approaches,· approaches relevant to various stages (prevention, intervention, treatment) of
the individual, and· avoid concentration on single factor explanation.
It should be recognised that handling and medical care have the prime objectiveof helping an individual, not of providing scientific information. In practice, adecision as to when and how to emphasise scientific information in the handlingshould be made on a case-to-case basis.

40

Further elaboration and comments of ways to handle individuals with Óelectromagnetic hypersensitivityÓ are found in a separate section (above).

Information activities
As already stated above, the communication of information on electromagnetic
fields in general and on Òelectromagnetic hypersensitivityÓ forms an importantpart of prevention. Such information must of course be balanced, and appropriate
for the specific target group and situation. A case could be made for information
on electromagnetic fields in general to be available in similar fashion acrossEurope - keeping the different receivers in mind (general public, various
professionals etc.). For specific information on Òelectromagnetic hypersensitivityÓ, we would rather advocate a more varied approach, where also the situationin different countries (media attention, current existence of widespread concern or
not, etc.) could motivate different activities.
Concerning the general preparation of information material, the following
should be kept in mind:¥ Proper communication techniques have to be used for public appearance, forprivate consultation and for written material. Therefore communication and/or
layout specialists should be hired and workshops or training for scientists
should be offered and used in order to learn effective communication skills.
¥ For successful written information there should be a definition of the target
group, tests of the target group for specific omissions in information and a
feedback on trial information.
Concerning general information on electric, magnetic and electromagnetic
fields, the following additional recommendations hold:¥ The most important target groups to be addressed should be: generalpractitioners, local health authorities, politicians and other decision makers andschools i.e. intermediators. Journalist may serve as important links to various
target groups.
¥ The information material should be diverse and also specified, i.e. not only onelectromagnetic fields in general but there should also be shorter brochures on
special questions, e.g. mobile phones, household devices, powerlines etc.
Finally some recommendations concerning information on Òelectromagnetic
hypersensitivityÓ:¥ Here the most important target groups to be reached are: self-aid groups,
general practitioners and occupational health physicians.
¥ There should be a clear statement that there is currently no scientific basis for aconnection between Òelectromagnetic hypersensitivityÓ and exposure toelectromagnetic fields.
¥ Other factors that could lead to the same symptoms should be included in theinformation, thus emphasising concepts such as "multifactorial", Òbroad
approachesÓ etc.

41¥ Depending on target groups, the emphasis between "etiological" information
about knowledge on causes, and information on how to handle individuals
should be balanced.

Further scientific research
Further scientific investigations are needed because it is not currently possible toeither clearly describe the syndrome or definitively identify the cause(s) ofÒelectromagnetic hypersensitivityÓ. The following aim and comments areappropriate to the situation:¥ A better characterisation of the adverse health effect is required. This would
include the utilisation and in some cases the development of standard
questionnaires as well as standard anamnestic and medical protocols. Asides
from its use in research (see below), such improved effect assessments could
also assist in the handling of individual cases.
¥ Standardized assessments of effect could lead to a better development of a databasis. This could also enable comparison between a/ different European
nations, b/ different syndromes (see below) and c/ with the general population,and thus more clearly address the specificity or non-specificity of the different
symptoms and signs.
¥ When performing etiological research, specific hypotheses have to be
formulated and tested. This applies both to EMF and to other factors that could
presumably lead to the adverse health reactions. One problem here is the nonspecificity of e.g. some EMF-based hypothesis ("some parameters of the field
could be......"), such vague formulations are not easily testable in research. The
specificity of hypothesis is also aimed at the effect assessment - we would
argue for hypothesis to be geared towards specific effect endpoints rather thanÒelectromagnetic hypersensitivity" - taking cofactors such as higher specificsensitivity into account.
¥ Research hypothesis should be aimed at both physical and non-physical factors.
The possibility of interactions or synergetic effects have also to be taken into
account.
¥ Provocation studies offer one important approach to etiological studies, andshould be focused on both EMF as well as on other factors. Careful considerations have, however, to be given to inclusion criteria for testees, as well as
the occurrence of various cofactors.
¥ Possible connections or analogies with other syndromes of (partly) unclear
aetiology should be examined, such as multiple chemical sensitivity, amalgam
sensitivity, chronic fatigue syndrome, sick building syndrome etc.
In the fields of risk perception and risk communication, certain research issues
are also advocated, as their development would greatly contribute to understanding and handling of Òelectromagnetic hypersensitivity".
¥ Risk perception as a factor for attribution processes and also as a causal orcontributing factor for adverse reactions relevant to Òelectromagnetic hypersensitivity" should be investigated. Such investigations should take into account42

research performed in other areas, and not be limited to Òelectromagnetic
hypersensitivity", however.
¥ Means to identify possible risk groups and subgroups in terms of variations inrisk perception should be identified or developed.
¥ Research concerning the design and the evaluation of risk communication, in
general and for this specific purpose is also required.
¥ The issue of credibility of opinion leaders has to be taken up as well as the
improvement of conflict culture in order to improve communication.
Research activities on these and other relevant topics should be compared andpreferentially also co-ordinated between different countries. One important
example of such co-ordination efforts is the international WMF project of the
WHO.

43

References
1.
2.
3.

4.
5.

6.
7.
8.
9.

10.
11.

12.
13.
14.
15.
16.
17.
18.
19.

20.

ACS. Chemical risk communicationn. Washington D.C.: American Chemical Society, 1988.
Coates JF, Coates VT, Jarrat J, Heinz L. Issues Management. Mt Airy, MD: LomondPublications, 1986.
Covello VT. Educating and informing the public about radiation risks: A review of obstacles
to public understanding. OECD Workshop on Public Understanding of Radiation Protection
Concepts. Paris, Nov 30 - Dec 2, 1987.
EPA. An evaluation of radon risk communication approaches. Region 3/OPPE/ State of
Maryland Radon Risk Communication Project. Environmental Protection Agency, 1988.
Eriksson N, Hššg J, Stenberg B, Sandstršm M. Facial skin symptoms in office workers. A
five year follow-up study. In: Grieco A, Molteni G, Piccoli B, Occhipinti E, ed. Work with
Display Units 94. Selected Papers of the Fourth International Scientific Conference on Work
with Display Units. Amsterdam: Elsevier Science B V, 1995: 357-362.
Fremling JH. Power production, what are the risks? (2nd ed.) Adam Hilgar, Bristol, New
York, 1989.
HCRA. Workers, EMFs, and cancer. Report vol 3 no 2, Harvard Center for Risk Analysis,
Boston, Mass, 1995.
HCRA. EMFs and childhood cancer. Report vol 4 no 2, Harvard Center for Risk Analysis,
Boston, Mass, 1996.
Knave B, Bergqvist U, Wibom R. Symptom och subjektiva besvŠr vid "šverkŠnslighet mot
elektricitet" (Symptoms and subjective discomforts at "hypersensitivity to electricity", in
Swedish). Undersškningsrapport 1989:4, National Institute for Working Life, Solna, Sweden,
1989.
Kunsch B. Electromagnetic fields and risk perception. In: Simunic D, ed. COST 244 meetingon Electromagnetic Hypersensitivity. Graz: COST 244, 1994: 58-67.
Leitgeb N. Electromagnetic hypersensitivity. Quantitative assessment of an ill-definedproblem. In: Simunic D, ed. COST 244 meeting on Electromagnetic Hypersensitivity. Graz:
COST 244, 1994: 68-74.
Leitgeb N. ElektrosensibilitŠt. VEO Journal 1995;1:51-55.
Maerli MB. The Norwegian public«s perception of risk from electromagnetic fields. Radiat
Prot Dosim 1996;68:235-238.
McMahan S, Meyer J. Symptom prevalence and worry about high voltage transmission lines.
Env Res 1995;70:114-118.
Morgan MG, Florig HK, Nair I, CortŽs C, Marsh K, Pavlovsky K. Lay understanding of lowfrequency electric and magnetic fields. Bioelectromagn 1990;11:313-335.
Morgan MG, Slovic P, Nair I, et al. Powerline frequency electric and magnetic fields: A pilot
study of risk perception. Risk Anal 1985;5:139-149.
NRC. Improving risk communication. Washington D.C.: National Academy Press, 1989.
NRPB. Electromagnetic Fields and the Risk of Cancer. Doc NRPB 1992;3:1-138.
Socialstyrelsen. Elektriska och magnetiska fŠlt och hŠlsoeffekter (Electric and magnetic
fields and health effects, in Swedish). SoS-rapport 1995:1, Socialstyrelsen, Stockholm,
Sweden, 1995.
Wadman C, Bergqvist U, Medhage …, Linder G, Knave B. ElšverkŠnslighet - en studie bland
kontorsarbetare (Hypersensitivity to electricity - a study among office workers, in Swedish).
Arbetslivsrapport 1996:5, National Institute for Working Life, 1996.

44

21. Wartenberg D, Greenberg M. Epidemiology, the press and the EMF controversy. Public
Understand Sci 1992;1:383-394.
22. Wiedemann PM, SchŸtz H. The electromagnetic fields risk issue: Constructing scenarios on
the further development of public debate in Germany. Europ Rev Appl Psychol 1995;45:3539.

45

Appendix 1. Questionnaire results

Introduction
In the absence of a data base on Óelectromagnetic hypersensitivityÓ covering various European nations, it was decided to solicit some relevant information concerning awareness of the problem, estimates of its extent, situations where it would
occur, symptoms and consequences for the individual. Within the framework of
the nature of the information required, the time and resources available, aquestionnaire sent to various organisations for their appraisals was consideredfeasible.
In some European nations, self aid groups (SAGs) created around this issue
exist, thus constituting one obvious channel of such information. For two reasons,however, this avenue of information was not considered sufficient for our needs;
the possibility that they - because of their aims and roles - would forward
exaggerated estimates or at least estimates at the upper end of the scales, and thefact that SAGs were only identified in some European nations. Another type oforganisation from which information could be solicited were those where medical
attention is sought or cases are being referred to. In several or perhaps most
European countries, centres for occupational medicine or similar organisations(COMs) would - according to our previous experience - constitute such sources.
One alternative would be local physicians or general practitioners, but they would
have two serious drawbacks; they would presumably seldom have the overview
necessary to be able to estimate the overall extent of the problem, and to reach asufficient number of them would also become a major practical undertaking. In
addition, practical experience from some countries where it was felt that thegeneral environment rather than workplaces provided the majority of cases ofÓelectromagnetic hypersensitivityÓ, suggested that a number of such cases werestill referred to COMs. Accordingly, we decided to send the questionnaires to
SAGs and COMs in the different European countries. Still, in countries where thegeneral environment would provide the majority of the cases of Óelectromagnetic
hypersensitivityÓ, we would advocate some caution in the interpretation on two
points; 1/ COMs could perhaps tend to underestimate the extent, and 2/ they could
also be expected to overestimate the extent of serious cases in proportion to allcases, since the referral system would presumably tend to eliminate a number of
non-serious cases.

Appendix 1:1

Methods
A questionnaire designed to cover the basic information needs given above wascreated by the project group, with similar but not identical formulations for thetwo different target groups (COMs and SAGs), in that the questions regarding
contact with patients/members were tailored to fit the two groups specifically.
Apart from such questions, the questionnaires were essentially the same for bothCOMs and SAGs. Each questionnaire was written in several language versions;
English, German, French, Italian and Swedish - see Appendix 2 for the English
versions.
Addresses to COMs were provided by the different project group members inaccordance with the structure of such centres in the countries concerned. Someself aid groups addresses were found in the Swedish self aid group monthly
magazine, with additional addresses provided by the project participants. We havenot approached organisations or SAGs dealing primarily with individuals
suffering from some other (ill-defined) conditions such as Multiple Chemical
Sensitivity or dental (amalgam) problems.
The questionnaires were sent to 138 different centres of occupational medicine
or similar centres in the 15 different EU member countries and also to the Faroe
Island, Iceland and Norway, and to self aid groups in Denmark, France, Germany,
Italy, Norway, Sweden and Switzerland. In total, we solicited answers from 15
different self aid groups (see Table 1 below). The initial response rates for somecountries were very low, necessitating a reminding letter to be sent out, in which
we emphasised the importance of replying even if they had no contact with the
problem of Óelectromagnetic hypersensitivityÓ.
In all we received 72 answers, of which 10 were from SAGs. Tenquestionnaires were sent back to us due to erroneous addresses. We had a
response covering 10 of the EU member countries and 3 non-member countries;
COMs in Belgium, Luxembourg, Greece, Spain, Portugal and the self aid group in
Switzerland did not respond to our questionnaire. We also received replies fromsome COMs and SAGs that not were on our address list, including two SAGs
from Ireland, who had obviously received questionnaires that were passed onfrom others. Accordingly, a strict response rate canÕt be given, nor is indeed
called for, as the main emphasis of the interpretation should be qualitative rather
than quantitative.
The symptoms reported by the COMs and SAGs were classified into different
symptoms groups by the medical doctors of the working group, as were someother conditions reported. Two of the different symptoms groups, the skin andnerve symptom groups, also included a number of subgroups. Apart from this andsome other categorisation of answers, the following information is basicallypresented as received - as we do not consider the material suitable for detailed
numerical analysis.

Appendix 1:2

Table 1. Number of distributed and received questionnaires by country.
Country

Austria
Belgium
Denmark
Faroe Island
FinlandFranceGermany
GreeceIceland
Ireland
Italy
Luxembourg
NorwayPortugal
Spain
SwedenSwitzerland
The Netherlands
United Kingdom
Total

Questionnaires distributed to______COMs___________SAGs_____
Sent out
Received
Sent out
Received
4
4
0
1
0
0
15
13
1
1
1
1
0
5
2
0
24
6
4
2
17
8
7
3
2
0
0
1
1
0
2
1
0
2 a/
28
4
0
1
0
0
9
6
1
1
5
0
0
2
0
0
10
8
1
1
0
1
0
2
1
0
9
7
0
138

62

15

10

Notes for Table 1. a/ See text above for comments.

Results
Awareness and contact with the problem
Information was solicited whether the COMs received Óquestions or requests etc.
related to individuals who consider themselves as Óelectromagnetic hypersensitiveÓ - i.e. who experience symptoms or other adverse health effects which
they attribute to electrical devices or to electric or magnetic fieldsÓ. Furthermore,questions were asked whether they knew Óof any (other) organisation that doesÓ.
Finally, they were asked to report the number of requests received in a given time
period Óin the last yearÓ (this information has been categorised - note that the<1/week category includes some answers from COMs that do not receive calls/
requests at all). In Table 2, the replies to these questions are shown.
Basically, most COMs reported that they received requests and that they knew
about other COMs and other authorities, industries, organisations and universities
that also received requests concerning Óelectromagnetic hypersensitivityÓ.
However, the large number of non-respondents should be kept in mind - it is quitepossible that among the non-responders, the awareness of the problem would be

Appendix 1:3

Table 2. Awareness by COMs of Óelectromagnetic hypersensitivityÓ and number of calls
received per week.
Country

Austria
Denmark
Faroe Island
FinlandFranceGermany
Iceland
Ireland
Italy
NorwaySwedenThe
Netherlands
UnitedKingdom

No ofreplies a/
4
13
1
2
6
8
1
1
4
6
8

Awareness of the problem
Receive
Know of othercalls b/centres c/
3
3
6
5
0
0
2
2
4
2
7
7
1
1
1
1
1
1
4
4
8
8

Number of calls per week d/< 1/week 1-4/week ≥5/week
1
10
0
1
5
2
0
0
3
5
6

0
0
0
1
0
1
0
0
0
0
2

0
0
0
0
0
4
0
0
0
0
0

1

0

0

1

0

0

7

3

3

2

0

0

Notes for Table 2. a/ Total number of replies, regardless of whether answers to these specificquestions were given or not. b/ Number of COMs that have received questions or requests. c/
Number of COMs that knew of other centres that do. d/ Number of COMs replying within eachcategory.

less. The number of COMs that received requests appear to vary considerably
between countries, though. For Denmark, Italy and United Kingdom, the majorityof the COMs that did reply did not receive requests, nor were they aware of othercentres that did. The single answers received from COMs in the Faroe Islands and
The Netherlands were likewise negative. In some contrasts, most replies from e.g.
Austria, France, Germany, Norway and Sweden were affirmative in receiving
requests and knowledge about other organisations that did. Similar responses (butbased on fewer overall replies) were apparent from the other countries.
Table 3. Number of members of each SAG, and existence of other SAGs in the country.
Country
Denmark
FranceGermany
Ireland
NorwaySwedenNumberof replies
1
2
3
2
1
1

Only self aid group? a/
Yes
No
1
0
0
1
0
3
0
2
1
0
1
0

No of members
75
4 and ? b/20, 120 and 160
3 and 350 c/
90
1800

Notes for Table 3. a/ Number of SAGs in each response category. b/ No number given by one
SAG. c/ Described as number of ÓcontactsÓ by one SAG.

Concerning the SAGs, questions were asked about the number of members andif their group was the only one that they knew of in their country dealing with thisproblem. The replies are shown in Table 3. Again, the number suggest quite a

Appendix 1:4

variation between different countries - but the limited number of countries forwhich we have identified SAG groups should be kept in mind.
The extent of the problem
Both COMs and SAGs were asked to give Óyour estimate as to the total numberof such ÓcasesÓ in your countryÓ, and also the Ótotal number of such cases withsevere handicap because of thisÓ. The replies were categorised in the following
manner; <10, 10-100, 100-1 000, 1 000-10 000 and >10 000. The number of
replies in the two extreme categories as well as the median responses are found in
Table 4 and 5.
As seen in the median values presented in Tables 4 and 5, the largest estimatednumbers were reported from Germany and Sweden. The proportion between thenumbers reported from SAGs and COMs were about one order of magnitude or
higher in the SAGs for most countries (except for Norway) with extreme
differences noted between COM and SAG replies from Ireland. Considering thenumber of cases in relation to the populations, the ranking order of all countries
were Sweden > Norway and Denmark > Finland > Germany > Ireland > Austria
and The Netherlands > Italy and France > United Kingdom according to themedian COM answers. For Sweden, the upper limit of the estimate is roughly
corresponding to 0.1%. A similar ranking was apparent from the (fewer) SAG
answers, with the exception of the ranking of Ireland and Norway; Ireland >Sweden > Denmark > Germany > France and Norway.
Table 4. COM estimates of the number of cases and severe cases of Óelectromagnetic
hypersensitivityÓ.
Country
Austria
Denmark
Faroe Island
FinlandFranceGermany
Iceland
Ireland
Italy
NorwaySwedenThe Netherlands
UnitedKingdom

No ofreplies a/
4
13
1
2
6
8
1
1
4
6
8

Estimates on no of cases b/
Estimates on no of severe cases b/<10Median b/>10 000 <10 Median b/>10 000
1
10-10003<1002
100-1 0000510-1 0000010-1 0000010-1000010-10003<10
001 000-10 000
301 000-10 000
2010-10001<10
0
010-10003<1000
100-1 0000110-100001 000-10 0002
0100-1 00001010-100

0

1

<10

0

7 d/

1

<10

0

1

<10

0

Notes for Table 4. a/ Total number of replies, regardless of whether answers to these specificquestions were given or not. b/ Number of COMs that replied in the two extreme categories, andthe median response from all COMs for each country. Note that two of the medians cover two
categories (Denmark and Finland). d/ Only on questionnaire responded to these questions.

Appendix 1:5

For the median estimated number of severe cases, similar patterns are seen,
with the largest numbers being reported from Germany and Sweden (and from the
Irish SAGs), and with more or less similar ranks between the relative number ofsevere cases in different countries as were seen for the cases. The main differenceis that here, Germany has a similar rank as the Nordic countries. The proportionsof cases to severe cases are about one order of magnitude or less, for both COMs
and SAGs.
Table 5. SAG estimates of the number of cases and severe cases of Óelectromagnetic
hypersensitivityÓ.
Country
Denmark
FranceGermany
IrelandNo ofreplies a/12
32

NorwaySweden1
1

Estimates on no of cases b/
Estimates on no of severe cases b/<10Median b/>10 000 <10 Median b/>10 000
0
1 000-10 00000100-1 000
00
1 000-10 0001
0100-1 00000
>10 000
30>10 000
20>10 000
20
1 000-10 000
1and >10 000
0100-1 00000100-1 00000
>10 000
10
1 000-10 000
0Notes for Table 5. a/ Total number of replies, regardless of whether answers to these specificquestions were given or not. b/ Number of SAGs that replied in the two extreme categories, andthe median response from all SAGs for each country. Note that one of the medians cover two
categories (Ireland).

A general and important caveat for this section is that all numbers are based on
estimates from some different organisations, and closer scrutiny of absolute
numbers - beyond orders of magnitude - should be avoided. The relative
comparisons between different European nations are - in our opinion presumably more reliable and therefore interesting.
Concerning situations where problems appear
All COMs and SAGs were asked to reply to the question Óto your knowledge, domost of the cases experience problems due to exposure at work-places, exposure
at home or exposure outdoors or other non-work situations.Ó They were also
asked corresponding questions as to where the problems started. The COM replies
are given in Table 6.
For the SAGs, the Danish, Norwegian and Swedish SAGs all replied Óat workÓ
to both questions, while all German and Irish SAGs specified Óat homeÓ being themost common situations where problems started and where they now appear. The
French SAG reported both Óat homeÓ and ÓoutdoorsÓ as places for current
problems to appear. As can be seen when comparing these replies to Table 6, isthat while the Scandinavian and German SAG replies corresponded well with the
COM replies, discrepancies were seen for the French and the Irish replies.

Appendix 1:6

Table 6. Indications by COMs of the most common situation (work, home or outdoors)
where problems appear and where the problems started.
Country
Austria
Denmark
Faroe Island
FinlandFranceGermany
Iceland
Ireland
Italy
NorwaySwedenThe Netherlands
UnitedKingdom

No ofreplies a/
4
13
1
2
6
8
1
1
4
6
8

__Problems appear mostly__ b/ __Problems started mostly__ b/
At work At home Outdoors At work
At home Outdoors
1
2
0
1
2
0
3
1
2
3
0
2
2
0
0
2
0
0
4
0
1
3
0
1
1
6
0
1
6
0
1
1
0
1
0
0
1
0
0
2
1
1
2
1
1
4
2
1
5
0
0
7
0
0
8
0
0

1

0

0

1

0

0

1

7

1

1

0

1

0

0

Notes for Table 6. a/ Total number of replies, regardless of whether answers to these specificquestions were given or not. b/ Number of COMs that reported the category as Ómost commonÓ isgiven (more than one category were chosen in a few replies).

Again, geographical differences are apparent, with the Nordic countries(Denmark, Finland, Norway and Sweden) emphasising work situations (by bothCOMs and SAGs), while the German situation is more centred at home (again byboth COMs and SAGs). For other countries, the replies appear mixed andsomewhat uncertain. Two examples are France and Ireland, where centres ofoccupational medicine (COMs) favoured workplaces, whereas the SAGs did not.
Attributed sources
Both COMs and SAGs were asked to Óindicate common sources of problems forthe casesÓ - several sources could be given. Below, the replies in the categoryÓvery oftenÓ are given.
Among the COMs in countries in the continental part of Europe or the British
Isles, there were several that reported various radiofrequency field (RF)equipment or installations as a Òvery oftenÓ reported source of the problems.
· Broadcasting stations, TV towers or telecommunication masts were the mostcommonly indicated RF sources, reported by COMs from France (2 of 6),
Germany (5 of 8), Ireland (1 of 1) and Italy (1 of 4).
· Radar stations reported by France (3 of 6) and Germany (2 of 8).
· Mobile telephones were indicated by 4 of the 8 German COMs and by 1 of the
4 Italian COMs.
· Induction heaters and plastic welding were reported by France (1 of 6) and Italy(2 of 4).
· Microwave ovens were suggested by the reply of 1 of the 7 United Kingdom
COMs.

Appendix 1:7

The COMs in the Scandinavian countries did not report any RF equipment as aÒvery often reported sourceÓ except for one Swedish COM that indicated mobile
telephones as such.
Among the SAGs, RF equipment or installations were reported to be a Òvery
often reported sourceÓ as follows; broadcasting stations, TV towers or
telecommunication masts were indicated by the Danish SAG, 2 of the 3 German
SAGs and both Irish SAGs. Microwave ovens were reported by the Danish, 1 ofthe 2 French and 1 of the 3 German SAGs. Both French SAGs reported induction
heaters and plastic welding, while mobile phones were indicated by 1 of the 3German and 1 of the 2 Irish SAGs. Radar stations were reported by 1 of the 2
Irish SAGs. Again, Nordic SAGs (with the Danish exception above) did notreport RF sources.
Concerning equipment emanating extremely low frequency (ELF) fields, powerlines or transformer stations were the most common to report according toAustrian (3 of 4), Danish (1 of 13), French (2 of 6), German (4 of 8), Irish (1 of1), Italian (2 of 4), Norwegian (1 of 6) and United Kingdom (1 of 7) COMs. It isnoticeable that this source was not reported at all by the Swedish, Finnish andsome other COMs. Electrical appliances at home were reported by 3 of 13
Danish, 2 of 8 Swedish and 1 of 8 German COMs. Electric wiring in houses andrailways were reported by 3 of 8 and 2 of 8 German COMs, respectively, whileelectric welding was not reported by any COM. The reporting of ELF sources by
SAGs was rather limited; electrical appliances at home were indicated by the
Swedish SAG, while the French SAG marked all ELF sources except railways.
Among some ÓmiscellaneousÓ equipment, light sources (fluorescent tubes and
VDUs) were suggested as Óvery often reported sourcesÓ of the problems by
primarily the Nordic COMs; VDUs were indicated by 2 of 13 Danish, bothFinnish, 2 of 6 Norwegian, and all 8 Swedish COMs. In addition, 1 of the 8German and 1 of the 4 Italian COMs also indicated VDUs. Fluorescent tubes weresuggested by Denmark (1 of 13), Finland (1 of 2), Germany (1 of 8) and Sweden(2 of 8). Medical equipment such as NMR or diathermy was reported by the Irish
COM.
The SAGs more generally did suggest both VDUs and fluorescent tubes as asource, apart from the German ones. The SAG from Norway did not report
fluorescent tubes as a Òvery often reported sourceÓ. Heavy machinery in theindustry were reported only by one French SAG.
Commonly occurring symptoms
Each COM and SAG were asked to list the 5 most common symptoms Óreported
in connection with the use of electrical appliances or proximity to electric or
magnetic field sourcesÓ. The number of COMs and SAGs who reported asymptom in any of the 12 symptom groups are shown in Tables 7-10. These latter
numbers should be regarded with some caution, as the number of symptoms fromdifferent groups are not readily comparable.

Appendix 1:8

Table 7. Number of COMs reporting different types of symptoms.
Country

Austria
Denmark
Faroe Island
FinlandFranceGermany
Iceland
Ireland
Italy
NorwaySwedenThe Netherlands
UnitedKingdom

No ofreplies
a/
4
4
0
1
4
7
1
1
1
3
7

NervousSkinsystemsympsymptoms toms
4
1
3
1
1
1
3
0
7
2
1
1
1
0
1
0
3
3
7
7

Hormonal/
metabolicdisorders
0
0
0
0
0
0
0
1
0
0

GeneralCardioDigestive
body
vascularproblems
symptoms symptoms
0
0
0
1
0
0
1
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
3
0

0

-

-

-

-

-

-

1

1

0

0

0

0

0

-

73

21

1

8

4

0

Total no of
symptoms b/

Notes for Table 7. The number of COMs reporting any symptom in each symptom group is given.
a/ Total number to this part of the questionnaire. b/ The total number of symptoms reported by all
COMs - note that a single COM could report more than one symptom in each group.

Table 8. Number of COMs reporting different types of symptoms or conditions.
Country

Austria
Denmark
Faroe Island
FinlandFranceGermany
Iceland
Ireland
Italy
NorwaySwedenThe Netherlands
UnitedKingdom
Total no of
symptoms b/

No of Ear, nose, Eyereplies throat
sympa/
problems toms
3
0
1
4
0
0
0
1
0
0
4
0
0
7
1
0
1
1
1
1
1
0
1
0
1
3
0
0
7
0
1

CancerAllergy

0
0
0
2
1
0
0
0
0
0

0
1
0
0
1
0
0
0
0
0

ReproducOther
tive or pregproblems
nancy problems
0
0
0
1
0
0
1
0
0
0
0
0
1
0
0
1
0
0
0
0

0

-

-

-

-

-

-

1

0

0

0

0

0

0

-

3

4

3

2

2

2

(Notes, see next page)

Appendix 1:9

Notes for Table 8. The number of COMs reporting any symptom in each symptom group is given.
a/ Total number to this part of the questionnaire. b/ The total number of symptoms (or equivalent)
reported by all COMs - note that one COM could report more than one symptom in each group.

It is readily apparent from a scrutiny of tables 7-10 that most COMs and SAGs
have reported nervous system symptoms to be among the most common ones inrelation to Óelectromagnetic hypersensitivityÓ. This is consistently reported fromall COMs and SAGs across Europe (with the exception of the Swedish SAG). The
second most common group is that of skin problems - but here a rather clear
geographical variation is seen; substantial reporting from the COMs of Finland,
Iceland, Norway and Sweden, some limited reporting from Austria, Denmark andGermany, and none at all from COMs in other European nations. The limited
number of SAG replies offered somewhat different geographical variations, see
Table 9.
Table 9. Number of SAGs reporting different types of symptoms.
Country

Denmark
FranceGermany
Ireland
NorwaySwedenTotal no of
symptoms b/

No of Nervous
Skin
Hormonal/
replies system
symp- metabolica/symptoms toms disorders
1
1
1
1
2
2
1
0
2
2
0
0
2
2
1
0
0
1
0
1
0

-

22

4

2

GeneralCardiobody
vascularsymptoms symptoms
1
1
1
0
0
0
0
0
0
0

2

1

Digestive
problems
1
0
0
0
0

1

Notes for Table 9. The number of SAGs reporting any symptom in each symptom group is given.
a/ Total number to this part of the questionnaire. b/ The total number of symptoms reported by all
SAGs - note that one SAG could report more than one symptom in each group.

For other types of symptoms or reported conditions, most appear to be isolated
reports from a few COMs or SAGs in only a few countries, with the possible
exception of eye symptoms, general body symptoms such as overall tiredness orear/ nose/throat problems which were reported from more than a few of theCOMs and SAGs in one or two nations.

Appendix 1:10

Table 10. Number of SAGs reporting different types of symptoms or conditions.
Country

No ofrepliesa/Ear, nose, Eye
Cancerthroatsymptoms
problems

Denmark
FranceGermany
Ireland
NorwaySweden

1
2
2
2
0
1

0
0
1
1
0
0

1
0
0
0
0
1

0
0
0
0
0
0

Total no of
symptoms b/

-

2

2

0

Allergy

Other
problems

0
0
0
0
0
0

Reproductive or
pregnancy
problems
0
0
0
0
0
0

0

0

0

0
0
0
0
0
0

Notes for Table 10. The number of SAGs reporting any symptom in each symptom group is given.
a/ Total number to this part of the questionnaire. b/ The total number of symptoms(or equivalent)
reported by all SAGs - note that one SAG could report more than one symptom in each group.

Accordingly, the following presentation of data will be centred on nerve system
symptoms and skin symptoms. As seen in Table 11, where the types of nerve
system symptoms are presented in more details, the most common ones to indicate as being common among cases of Óelectromagnetic hyper-sensitivityÓ areneurasthenic symptoms, followed by headaches - these were reported by amajority of the COMs and SAGs. For the other symptoms, a few additional but
less clear observations can be made; Among Austrian and German COMs andSAGs, reports of all these types of nerve system symptoms occurred, with thesingle exception that no German SAG reported anxiety symptoms. In the Nordic
country COMs, the emphasis appeared to be - among nerve system symptoms - on
symptoms of neurasthenia, headaches and decreased arousal, whereas theSwedish SAG did not report any nerve system symptoms as being Óvery
commonÓ. Replies from the other countries were scattered.
Skin problems were differentiated into objective, subjective and undefined.
Almost all organisations who reported any skin symptoms, did report either
subjective or undefined symptoms, the only exception being one Danish COM
and one French SAG.

Appendix 1:11

Table 11. Various nerve system symptoms reported by COMs and SAGs.
Country
Austria/COM
Denmark/COM-Ó- /SAG
Finland/COM
France/COM-Ó- /SAG
Germany/COM-Ó- /SAG
Iceland/COM
Ireland/COM-Ó- /SAG
Italy/COM
Norway/COM
Sweden/COM-Ó- /SAG
United Kingdom/COM
Sum

No of
replies a/
3
4
1
1
4
2
7
3
1
1
2
1
3
7
1

Sleep
problems
2
0
1
0
0
1
5
2
0
0
1
1
0
1
0

Decreasedarousal
1
2
0
0
0
0
3
1
0
1
2
0
2
4
0

Neurasthenia
2
3
1
1
2
0
6
2
1
0
3
2
2
6
0

1
-

0
14

0
16

3
34

Stress,Anxietyirritation
2
1
0
0
0
0
0
0
0
0
0
0
5
2
3
0
0
0
0
0
2
0
1
1
0
1
0
2
0
0
0
13

0
7

Headaches
1
0
0
1
1
2
5
1
1
2
0
1
2
3
0
1
21

Notes for Table 11. The number of symptoms reported by COMs or SAGs in each country is
indicated. Note that one COM/SAG could report more than one symptom under each heading. a/
Total number of replies to this part of the questionnaire.

Concerning consequences for the afflicted individuals
Both COMs and SAGs were asked to indicate their appraisal as to the severity of
the consequences of Óelectromagnetic hypersensitivityÓ. Five alternatives could
be marked by the notations ÓmostÓ, ÓseveralÓ, ÓfewÓ or ÓnoneÓ, the alternatives
being:· Perceive fields or minor symptoms but do not suffer in any consequence indaily life.
· Manage life, but have taken some actions due to the perception of fields orsymptoms.
· Show some impairment of well-being.
· Are frequently ill, have to see a doctor more often than common, or have tochange work.
· Have had to change life conditions entirely.
Most of the countries replied the middle alternatives ("several" or "few") for all
the five alternatives of severity of the problem. The Swedish COMs generally
replied ÓmostÓ on the mild problem alternatives and ÓfewÓ on the severe problem
alternatives. The Norwegian COMs did report ÓfewÓ for the mild problems, andÓnoneÓ as to the severe problems. In all, the participating organisations did reply
very differently to these questions, differences were found not only between
countries but also within countries and between the COMs and between the
SAGs.

Appendix 1:12

Correspondence between Óelectromagnetic hypersensitivityÓ and othersyndromes
The participating organisations were asked whether Óin your experience, do individuals who suffer from Óelectromagnetic hypersensitivityÓ also report problems
with Multiple Chemical Sensitivity. Allergic reactions or Problems with dental
alloys?Ó They were asked to reply with "most do", "some do", "a few do" and "noone does" as appropriate for the three syndromes.
Overall, most of the COMs who did report some correlations at all did suggest
such a correlation between Óelectromagnetic hypersensitivityÓ and also reporting
dental alloy problems. Allergic reactions were suggested only by one COM in
Germany and one in Denmark. The COMs of Austria, Finland, France and United
Kingdom did not suggest any correlations at all (by using the response Óno onedoesÓ). The COMs from Faroe Island, Iceland and The Netherlands did not reply
to these questions.
Most SAGs indicated very strongly that Óelectromagnetic hypersensitivityÓ
individuals also reported all three other types of problems - with little variations
between countries.

Appendix 1:13

Appendix 2. Questionnaires to centers foroccupational medicine and self aid groups
The English version of the questionnaires to the centres of occupational medicine (COMs) and selfaid groups (SAGs) are shown:· Possible health implications of subjective symptoms and electromagnetic fields. Questionnaires
to centers for occupational medicine, page 2-8· Possible health implications of subjective symptoms and electromagnetic fields. Questionnaires
to self aid groups, page 9-15
Questionnaires were also written in French, German, Italian and Swedish (not included here).

Appendix 2:1

a

Date

Our reference

96-xx-xx

EU/Q-EngOMYour letter dateYour reference

Attending to this matter

C Wadman

Possible health implications of subjective symptoms and electromagnetic fields
Questionnaires to centers for occupational medicine

Dear colleague
The European Commission is funding a project named "Possible health implicationsof subjective symptoms and electromagnetic fields". The aim of this project is toaccumulate scientific knowledge and practical experiences regarding individuals who
experience symptoms or other health problems related to the use of electricalappliances or proximity to sources of electric or magnetic fields. This phenomena iscommonly known as "electrosensitivity" or "hypersensitivity to electricity".
We represent a group of ten scientists in six different European countries (Austria,
France, Germany, Ireland, Italy and Sweden) who have been given this task. Our aim
is to complete a report on this within one year of the project start (which was May
1996).
In order to obtain an overview of the social prevalence of this problem in different
countries, we are sending out this questionnaire to the heads of self aid groups
formed around this problem, and also to various occupational health centers or
departments. With "social prevalence" we do mean the number of individuals whoreport health problems and who also report that these health problems are due toelectric or magnetic fields - regardless of other peoples evaluation of that claim.

Appendix 2:2

We ask you therefore to fill out this questionnaire and send it back as soon as
possible and no later than October 15, 1996 to the following address:
Ms Cecilia Wadman
Dept of Occupational Medicine
National Institute for Working LifeS-171 84 Solna
SwedenFor your convenience, we are including an addressed envelope with stamp alreadyincluded. (Alternatively, you may use fax, +46 8 82 05 56.)
We do intend to include the answers in an annex to our report. If you do not wish
your answer to be included in the annex, please make a note of that on the reply form.
After our report is finished and approved by the European Commission, we will send
you a copy of the summary.
Sincerely yours
For the Scientific group

Cecilia Wadman

Appendix 2:3

The name of your organisation ________________________________(institute, clinic or department)
Address________________________________________________________________________________________________

Contact person________________________________________________________________________________________________

1. Concerning the involvement of your organisation with this problem
1.a Does your organisation receive questions or requests etc related to individuals("cases") who consider themselves as "electrosensitive" - i.e. who experience
symptoms or other adverse health effects which they attribute to electrical devices orto electric or magnetic fields?
0
Yes
0
No
0
I don«t know
1.b Do you know of any (other) organisation that does?
0
Yes
0
No
1.c If "yes", please specify___________________________________________________________________________________________________________________________________________________________
1.d Comments _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix 2:4

2. Concerning the extent of the problem
2.a How many such requests or questions have you received in the last years? Please
specify as to "nn per year".
_________________
2.b What is your estimate as to the total number of such "cases" in your country?

0
0
0
0
0

Fewer than 10
Between 10 and 100
Between 100 and 1000
Between 1 000 and 10 000
More than 10 000

2.c To the best of your knowledge, do such cases occur throughout your country, or
0Overall, no specific areain specific areas?
0
In specific area(s)2.d If specific areas, please describe _________________________________________________________________________________________
2.e What is your estimate as to the number of such cases in your country with severe
handicap because of this?
0
Fewer than 100
Between 10 and 100
0
Between 100 and 1000
0
Between 1 000 and 10 0000More than 10 000
2.f Comments___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix 2:5

3. Concerning situations where problems appear
3.a To your knowledge, do most of the cases experience problems due to:__ exposure at work-places__ exposure at home__ exposure outdoors or other non-work situations(Please mark the most common description with "1", the next with "2" and the least
common with "3".)
3.b To your knowledge, for most of the cases, did the problems start at:__ work-places__ at home__ outdoors or other non-work situations(Please mark the most common description with "1", the next with "2" and the least
common with "3".)3.c In the list below, please indicate common sources of problems for the cases. Markwith "1" if very often a reported source, "2" if rather often, "3" if sometimes, "4" ifrather seldom, and "5" if it is very seldom a reported cause.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

broadcasting stations, TV towers or telecommunication
masts
electrical appliances at home (electric clocks, hairdryers,
vacuum cleaners etc)
electric wiring in houses
heavy machinery in industry
induction heaters and plastic welding
light sources (fluorescent tubes or other)
medical equipment such as NMR, diathermy
microwave ovens
mobile phones
power lines or transformer stations
radar stations
railwaysvisual display units or TV sets
electric welding(other, please specify)_____________________________(other, please specify)_____________________________

3.d Comments________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix 2:6

4. Concerning symptoms and related problems
4.a Please list symptoms occurring in cases which are reported in connection with theuse of electrical appliances or proximity to electric or magnetic field sources. Thenmark with a cross in 0 (up to) the 5 most common symptoms.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common

4.b In your experience, do individuals who suffer from "electrosensitivity" also reportproblems with:
Multiple chemical sensitivity?
_____________
Allergic reactions?
_____________
Problems with dental alloys (amalgam)?
_____________(Please indicate "most do", "some do", "a few do", "no one does" as appropriate.)
4.c Comments_____________________________________________________________________________________________________________________________________________________________________

Appendix 2:7

5. Concerning consequences for the individuals
5.a Please indicate - based on your knowledge - the percentage of each category
below that:
Perceive fields or minor symptoms but
do not suffer any consequence in daily life _____________%
Manage life, but have taken some actions
due to the perception of fields or symptoms _____________%Show some impairment of well-being_____________%
Are frequently ill, have to see a doctor more
often than common, or have to change work _____________%Have had to change life conditions entirely_____________%(If you can not give a percentage figure, please give one of the following descriptive
terms; "most", "several", "few" or "none".)5.b Comments_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for your help

Appendix 2:8

a

Date

Our reference97- 10- 02

EU/Q-EngSelf

Your letter dateYour reference

Attending to this matter

C Wadman

Possible health implications of subjective symptoms and electromagnetic fields
Questionnaires to self aid groups

Dear ladies and gentlemen
The European Commission is funding a project named "Possible health implicationsof subjective symptoms and electromagnetic fields". The aim of this project is toaccumulate scientific knowledge and practical experiences regarding individuals who
experience symptoms or other health problems related to the use of electricalappliances or proximity to sources of electric or magnetic fields. This phenomena iscommonly known as "electrosensitivity" or "hypersensitivity to electricity".
We represent a group of ten scientists in six different European countries (Austria,
France, Germany, Ireland, Italy and Sweden) who have been given this task. Our aim
is to complete a report on this within one year of the project start (which was May
1996).
In order to obtain an overview of the social prevalence of this problem in different
countries, we are sending out this questionnaire to the heads of self aid groups
formed around this problem, and also to various occupational health centers or
departments. With "social prevalence" we do mean the number of individuals whoreport health problems and who also report that these health problems are due toelectric or magnetic fields - regardless of other peoples evaluation of that claim.

Appendix 2:9

We ask you therefore to fill out this questionnaire and send it back as soon as
possible and no later than October 15, 1996 to the following address:
Ms Cecilia Wadman
Dept of Occupational Medicine
National Institute for Working LifeS-171 84 Solna
SwedenFor your convenience, we are including an addressed envelope with stamp alreadyincluded. (Alternatively, you may use fax, +46 8 82 05 56.)
We do intend to include the answers in an annex to our report. If you do not wish
your answer to be included in the annex, please make a note of that on the reply form.
After our report is finished and approved by the European Commission, we will send
you a copy of the summary.
Sincerely yours
For the Scientific group

Cecilia Wadman

Appendix 2:10

The name of your group ________________________________
Address________________________________________________________________________________________________

Contact person________________________________________________________________________________________________

Please, send us only one response for each self aid group
1. Concerning self aid group(s)1.a Is your group the only one dealing with "electrosensitivity" in your conutry?
0
Yes
0
No
0
I don«t know
1.b If "No", how many other groups do you know about? ___________
1.c How many members does your group have?

____________

1.d Comments ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix 2:11

2. Concerning the extent of the problem
2.a How many members of your group do experience symptoms or other healthproblems which are related to the use of electrical appliances or proximity to sourcesof electric or magnetic field?
_________________
2.b What is your estimate as to the total number of such "cases" in your country?

0
0
0
0
0

Fewer than 10
Between 10 and 100
Between 100 and 1000
Between 1 000 and 10 000
More than 10 000

2.c To the best of your knowledge, do such cases occur throughout your country, or
0Overall, no specific areain specific areas?
0
In specific area(s)2.d If specific areas, please describe _________________________________________________________________________________________
2.e What is your estimate as to the number of such cases in your country with severe
handicap because of this?
0 Fewer than 100
Between 10 and 100
0
Between 100 and 1000
0
Between 1 000 and 10 0000More than 10 000
2.f Comments_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix 2:12

3. Concerning situations where problems appear
3.a To your knowledge, do most of the cases experience problems due to:__ exposure at work-places__ exposure at home__ exposure outdoors or other non-work situations(Please mark the most common description with "1", the next with "2" and the least
common with "3".)
3.b To your knowledge, for most of the cases, did the problems start at:__ work-places__ at home__ outdoors or other non-work situations(Please mark the most common description with "1", the next with "2" and the least
common with "3".)3.c In the list below, please indicate common sources of problems for the cases. Markwith "1" if very often a reported source, "2" if rather often, "3" if sometimes, "4" ifrather seldom, and "5" if it is very seldom a reported cause.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

broadcasting stations, TV towers or telecommunication
masts
electrical appliances at home (electric clocks, hairdryers,
vacuum cleaners etc)
electric wiring in houses
heavy machinery in industry
induction heaters and plastic welding
light sources (fluorescent tubes or other)
medical equipment such as NMR, diathermy
microwave ovens
mobile phones
power lines or transformer stations
radar stations
railwaysvisual display units or TV sets
electric welding(other, please specify)_____________________________(other, please specify)_____________________________

3.d Comments________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix 2:13

4. Concerning symptoms and related problems
4.a Please list symptoms occurring in cases in your group which are reported inconnection with the use of electrical appliances or proximity to electric or magnetic
field sources. Then mark with a cross in 0 (up to) the 5 most common symptoms.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common
0 is common

4.b In your experience, do individuals who suffer from "electrosensitivity" also reportproblems with:
Multiple chemical sensitivity?
_____________
Allergic reactions?
_____________
Problems with dental alloys (amalgam)?
_____________(Please indicate "most do", "some do", "a few do", "no one does" as appropriate.)
4.c Comments_____________________________________________________________________________________________________________________________________________________________________

Appendix 2:14

5. Concerning consequences for the individuals
5.a Please indicate - based on your perception as to members of your group - thepercentage of each category below that:
Perceive fields or minor symptoms but
do not suffer any consequence in daily life_____________%
Manage life, but have taken some actions
due to the perception of fields or symptoms _____________%Show some impairment of well-being_____________%
Are frequently ill, have to see a doctor more
often than common, or have to change work _____________%Have had to change life conditions entirely_____________%(If you can not give a percentage figure, please give one of the following descriptive
terms; "most", "several", "few" or "none".)5.b Comments_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for your help

Appendix 2:15

Appendix 3. Review of investigations into
possible causal factors for subjective
symptoms related to "electromagnetic
hypersensitivityÓ

Preamble
As described in the introduction, Òelectromagnetic hypersensitivityÓ is aphenomenon where individuals experience adverse effects while using or being in
the vicinity of electric, magnetic or electromagnetic devices. Often, these
attributions are specifically directed to electric and/or magnetic fields emanatingfrom these appliances, even if other factors - both physical and others - have also
been suggested. This attribution to specific factors must not be confused with astatement of an established causality.
In our view, this important caveat is based on both the inability, in single(individual) observations ("case reports"), to identify one out of a number offactors present in a situation as being "responsible" for the reaction, and the
difficulty to separate out a direct causal link from that of a psychosomaticallymediated link without additional information. This latter difficulty is augmented
by the current lack of knowledge concerning a mechanism for interaction between
weak electric or magnetic fields and biological systems.
In the text below, we therefore wish to describe the results of such scientificinvestigations that try to establish or indicate whether there is a link between
certain factors (especially exposure to various electric or magnetic fields) andsymptoms typical of those claiming to be "electromagnetic hypersensitive".
As discussed elsewhere in this report, there are a number of indications that thedesignation "electromagnetic hypersensitivity" does not stand for a homogenous
group which is distinct from other individuals. This is especially evident whenindications from different European countries are compared (see the chapter on
description of Òelectromagnetic hypersensitivityÓ. Furthermore, even within one
country, such as Sweden, indications for heterogeneity of "electromagnetic
hypersensitivity" have appeared (14, 51, 111), see further below. Thus, the selfindication by an individual that he or she is "electromagnetic hypersensitive" does
not appear to be an optimal definition on which to base deliberations, since a/ it
could be a conglomerate of different etiologies, and b/ it may also miss otherindividuals who share the same etiology for certain symptoms with (some)"electromagnetic hypersensitive" individuals, but who may not be aware of - orhave rejected - the "electromagnetic hypersensitivity" label. As will become clear

Appendix 3:1

in the following discussion, a problem is that there are - at present - often no goodalternatives to the self-definition of electromagnetic hypersensitivity".
Nevertheless, it was found prudent to separate the discussion of the etiology of
the relevant symptoms associated with "electromagnetic hypersensitivity" - andthe possible role of electromagnetic phenomena in this etiology - into two parts:· First, the scientific literature was reviewed for studies relating the relevant
symptoms to electric or magnetic fields in the general population. Relevant
situations were - as outlined above - neurasthenic or similar symptoms
appearing in situations with both low and higher frequencies of electric or
magnetic fields. Another situation is that of skin-related symptoms in office
workplaces (where use of visual display units, VDUs, occur). This approach
was taken in order to cover the possibility that the symptom(s) may begenerally related to fields - i.e. in the general or the general working
populations, regardless of any specific "sensitivity".
· Secondly, the possibility of a specific "sensitivity" was examined, by way ofreviewing efforts to identify groups of such individuals, either by specificreference to an exposure, or by other means such as hormone analyses,
personality profiles etc. Attempts to discern factors of importance to symptom
development within such groups or in relation to such "sensitivity" are also
reviewed.
Scientific investigations appearing in peer reviewed papers, technical reports,
conference proceedings etc. were scrutinized for relevant information. Somepapers were excluded from the review, for a variety of reasons: the information
was not considered to be relevant to the issue of "electromagnetic hypersensitivity
or related symptoms"; there was a dearth of information on methods which could
not be rectified by contacts with the researcher(s); the study was not based on wellformulated hypotheses; and - generally - a low quality of the study or the report.
Throughout this text, it should be observed that a statement such as Òan
association between.....Ò should not be inferred to suggest that a causal link has
been established. A verification of a causal link between e.g. an external factor
such as a field exposure and an effect is normally considered to require additional
data than only a statistical association (see e.g. Hill (46) or Rothman (87) for ageneral discussion). Basically, such additional data are largely absent in terms of
the reviewed associations under scrutiny. Furthermore, the terms ÒindicatedÒ orÒsuggestedÒ do - in this text - primarily refer to the presence (or absence) of astatistical association, not to a causal link.

Appendix 3:2

General population-based studies
Aim
This part of the section has the following purposes:· To determine, in studies based on general populations or general working
populations, whether relationships exist between exposure to electric or
magnetic fields in different frequencies and neurasthenic symptoms.
· To determine, in studies based on general working populations in offices wherevisual display units are used, whether relationships exist between exposure toelectric or magnetic fields as they occur in these situations and skin disorders or
symptoms.
The review is not concerned with the possibility that exposure to electric or
magnetic fields is related to the development of diseases such as cancer or
Alzheimer«s disease, as these are not characteristics of Òelectromagnetic
hypersensitivityÒ. It should be recognized, however, that an individual«s worry
and concern about adverse health effects - including such diseases - may be of
relevance to Òelectromagnetic hypersensitivityÒ (see further below).
The term "general" implies (here) that no attempt was made in the design ofthese studies to a priori restrict the study population - or the case group - toindividuals with any special sensitivity. Thus, studies performed on groups ofindividuals specifically selected because of their claim for "electrosenitivity" areexcluded here. Likewise, studies based on selected individuals with some (other)defined individual traits of possible relevance to "electrosenitivity" are also
excluded. They are treated in a separate part of the text below.
In principle, the review will look at both observational (epidemiological) andexperimental studies on humans. It is recognized that a large array of studies haveexamined animal experimental studies. Where appropriate, brief references tosuch studies are mentioned, but in general, the readers are referred elsewhere forsuch information. The motivation for this - beyond the practical fact that thiswould have extended the review considerably - is that a "human" interpretation ofanimal data appear problematic, taking into account both the nature of the effects,
and the possibility of psychosomatic mechanisms.
Neurasthenic symptoms and exposure to low frequency fields
Epidemiological studies on headaches
Relationships between the occurrence of headaches with proximity to overhead
power lines have been investigated in a few epidemiological (observational)
studies. Dowson and colleagues (29) observed a significantly higher occurrence
Appendix 3:3

of headaches and migraines among resident living at a moderate distance from thepower lines (60-80 m) than among those living closer to or among those living
further away from the lines. This study had the advantage of using a validated
headaches questionnaire, but suffered from a low response rate (60%) and limited
analysis of confounding. Furthermore, the absence of a "dose-response" (if "dose"is implied by distance to the power line) further detracts from the credibility of theassociation.
In another residential study (82), the study population was chosen amongresidents in towns adjacent to a powerline, individuals residing close to thepowerline as well as petitioners concerned with the powerline. 545 of these wererandomly selected and were asked about depressive symptoms, headaches,
attitudes and demographic variables - with a 70% response rate. No consistentassociation between proximity to powerlines and headaches (migrain or nonmigraine) were found. In still another paper (70), the investigators failed toindicate differences in migraine or non-migraine headaches in relation to theproximity of a powerline.
In a prospective study (41, hitherto only reported in a conference abstract) on
power line workers, no association between the 6 year incidence of headaches andmeasured levels of magnetic or electric fields were found. Likewise, Broadbent etal. and Gamberale and coworkers (cited by Paneth (78)), failed to findassociations between headache and measured field level.
Overall, the amount of support for an association between proximity to powerlines and/or field levels and headaches or migraine is very limited, even if thelimited number of studies together with the limited methodology in some of thestudies precludes any definite conclusion.
Epidemiological studies on depressive, neurasthenic or similar symptoms
It should be observed that the following studies have used varying endpoint
defintions such as depressive symptoms, depression, neurasthenic symptoms etc,
which makes an overall comparison more difficult.
In the study by Poole and coworkers (82) already referred to, depressive
symptoms were ascertained by a validated telephone interview schedule. Subjects
were classified as living ÓnearÓ or not to a transmission line. An association wasnoted between proximity to power lines and depressive symptoms, with an odds
ratio of 2.8 (1.6-5.1). Although concerns about the transmission line were also
associated with depressive symptoms, confounder analysis (adjustments) for thisand other variables did not reduce the relationship between depressive symptoms
and power line proximity. The study by Dowson et al. (29) also found an
association between depression and power line proximity. Likewise, Perry andcolleagues reported slightly increased magnetic field levels at the door of houses
with cases of depressive symptoms than at houses where non-cases lived (0.23 vs0.21 mT) (Perry et al. 1989, cf Savitz, Boyle et al. (95)). Few details were givenin these latter reports, though, and it should be noted that both studies failed toprovide any substantial report on the impact of possible confounding factors.

Appendix 3:4

In contrast, McMahon et al. (69) failed to find such an association - the odds
ratio was 0.9 (0.5-1.8), comparing those residing on the power line easement withthose one block away. While the reported analysis was based on the proximity
measure, measurements at the front of the house of 60 Hz magnetic fields verified
a difference between the easement (average 0.49 mT) and one block away (0.07mT). It should be noted that this study has been criticized for its choice of study
population - a well-to-do area - which presumably could have caused too limited
contrast within the study population (27). As we see it, however, this objection
would be dependent on the (assumed) presence of other necessary factors for thecausation of depression - a small contrast (apart from the factor under study)
would otherwise be optimal for the study. See further Paneth (78) for a general
discussion on the requirements for epidemiological studies within this field.
In a second paper from the same study (70), they also failed to indicate an
association between proximity to power lines (or measured magnetic fields) andpoor appetite, sleep and concentration problems. Taking these endpoint together(and also including headaches - cf above), the odds ratio between them andproximity to power lines (living on vs off the easement) was 0.85 (0.45-1.62). In
some contrast to this, the association between Óworry about the powerlineÓ andthe health effects was 2.24 (1.15-4.37).
Savitz and coworkers (95) examined the prevalence of depression among
electrical workers. Overall, no real tendency of increased risk for "electrical" vs"non-electrical" workers was found. Among electricians, however, increased odds
ratios were noted, especially for "trouble concentrating", where an odds ratio of
2.2 (1.0-5.2) was found when comparing electricians with non-electrical workers.
The authors caution against drawing too strong conclusions from the findings, due
to a/ the absence of exposure information beyound job title (they note thatelectricians "are not the group most certain to have elevated EMF exposure"(related to the general problem of using job titles as surrogates for exposure), b/
that other occupational factors (e.g. solvent exposure) were not adjusted for, andshould be considered "as an alternative explanation for the associations seen forelectricians", and c/ the limited statistical power in the analysis of subgroups ofelectrical workers.
Another recent study by Chevalier et al. (26) investigated in a nested casecontrol study at the EDF-GDF (French National Electricity and Gas) company the
association between various factors - both occupational and non-occupational and diagnoses of anxiety or depression. The principal findings of the multivariate
analysis revealed an array of statistically significant factors (p<0.1):· For depression: being a woman, being a supervisor, job changes, parental
problems, difficulties with children, divorced or separated and having had aserious accident or illness.
· For anxiety: being a woman, being a supervisor, having a job not self-chosen,
recent job transfer, job changes, parental problems and being divorced or
separated.

Appendix 3:5

In the multivariate analysis, there were no significant influences of performing
VDU work or being exposed to "electrical risks".
A study of clinical symptoms in two clusters of individuals living near
powerlines in France showed that neurasthenic symptoms appeared in relation to
exposure awareness leading to anxiety. Taking into account confounding factors,
no consistent association between symptoms and living in the proximity topowerline was found (Luis Miro, personal communication).
Some earlier studies on occupational groups by Knave et al. , Broadbent et al. ,Baroncelli et al. and Gamberale et al. (as reported by Paneth (78)) all failed tofind associations between measured or estimated levels of electric or magnetic
fields and various depressive or anxiety symptoms. In a recent study on workers
in the power industry ((41), so far reported only in a conference abstract), theincidences of depression, sleep disturbances, tiredness, tinglings and neuropathy,
dizzines or stomach related stress symptoms were not found to be associated withelectric nor with magnetic field levels. The 9 year incidence of neurasthenic
symptoms (irritation, anxiety, generally worried, fatigued without cause,
restlessnes and lack of concentrations) was, however, associated with exposure tomagnetic field exposures - even if the final analysis was unable to entirely rule out
a confounding effect of solvent exposure and/or workplace worry.
In some contrast to the findings on headaches, there are here some morecredible indications of associations between these types of symptoms and fieldlevels or proxies for field level exposures around power lines (but not fromoccupational settings). On balance, however, there are still too few studies, too
limited methodology in some of the studies, and too varied results for any definite
conclusions to be made concerning depressive or neurasthenic symptoms (asdefined by the various authors).
Epidemiological studies on suicide
Recently, Baris and coworkers reported some indications of an excess risk ofsuicide being related to exposure among blue collar electrical workers (5). Thiswas further examined in a case-control study (6), where adjustments for someother factors (alcohol consumption, socioeconomic scale, marital status andmental disorders) were also performed. Workers exposed to median levels of
accumulated electric field exposures had a risk ratio of 2.8 (0.9-8.1) compared tothose with lower exposure. Among highly exposed workers, the risk ratio was
lower (1.8; 0.4-8.5). No excess risks were found in association with magnetic
fields or pulsed electromagnetic fields, nor with current exposure to any fields.
Long term exposure was the parameter primarily indicated by the authors, but
results were similar when based on current exposure (for the year in which suicide
occurred). The authors caution against drawing any causal conclusions from thisstudy, because of various possible sources of bias within the study (incomplete
case ascertainment, exposure misclassification, lack of adjustments for all
relevant confounders, and limited sample size). In addition, the lack of a doseresponse relationship should be noted.

Appendix 3:6

Earlier studies on suicide in association with field levels, electrical occupations
or proximity to power lines have given mixed results. The limited methodology inthese other studies should be kept in mind, though. In two different publications,
598 suicide cases were found to have higher estimated (84) or measured (79)electric or magnetic field levels. In contrast, neither Baris and Armstrong (4) nor
McDowell (67) found any relationships between suicide and electrical job titles orvicinity to power lines, respectively.
Again, studies are too few, too often with limitations in their methodology andhave too varied results - even within the recent and more adequately designed
positive study by Baris et al. - for any affirmative conclusions about suicide in
relation to electric or magnetic fields to be made.
Experimental studies on melatonin secretion and EMF
In a recent review, Lambrozo and coworkers (60) summarized the current knowledge concerning animal or human experiments with melatonin and EMF
exposure regimens:· Electric 50/60 Hz fields have been shown to reduce pineal melatonin synthesis
or increase the melatonin degradation in four studies on rodents, but failure tofind such effects have also been reported in one study. Levels varied between 2
and 65 kV/m.
· For magnetic field experiments with rodents, a number of studies have also
indicated a decrease in night time melatonin in rodents, after various exposure
regimens using levels from 0.02 to 100 mT. In a few studies, a lack of such
responses was reported. In both the electric and magnetic field studies, lack of
dose-response relationships (with dose = exposure level) were noted in some ofthe positive studies.
· Data on non-rodent mammals are very scarce, and - in the two studies
performed - essentially non-positive.
· Human data are, again, very limited. Two groups have investigated thispossibility, with mixed results (see however further below).
In addition and subsequent to this review, Graham and coworkers (39, 40) andSelmaoui et al. (96) reported failures to find overall changes in nocturnal
melatonin related to night time magnetic field exposures among both women andmen. (Part of the first of these studies was previously reported, but then as partly
positive. This was included in the review by Lambrozo above.) These studies all
examined nightime exposure and its possible effect on nightime melatoninchanges. David and coworkers (unpublished, presented to the group in MŸnchen,
November 1996) investigated also the effect of daytime exposure during day - andcould find no effect of magnetic field exposure on melatonin regardless of thetime of the day.
Another study investigated effects on circadian rhythm of electric field
exposure among human volunteer isolated from any cues as to the diurnal lightvariations. Small (up to 5%) variations in the circadian rhythm were noted in thisAppendix 3:7

isolated situation (Sulzman et al., cited by Paneth (78)). The clinical or health
implication of this finding is however unclear.
Other experimental studies on neurological and related functions and low
frequency fields
A number of other endpoints such as EEG, ECG and reaction times have beenstudied in the laboratory, both with animal and human subjects. Experiments onhumans are briefly reviewed here - the briefness is motivated by the difficulty ininterpreting the findings in terms of adverse health outcomes. For a review ofanimal experimental studies, we refer to other reviews.
Bell and coworkers (7) exposed patients and volunteers to 7.8 mT static and 60
Hz magnetic fields, and recorded increased EEG (electroencephalogram) activity
in the frequency range 1-18.5 Hz. The static and 60 Hz fields appeared to act
independently. Similar results were noted by Lyskov et al. (65). who found anincreased a (7.6-13.9 Hz) and b (14.2-20 Hz) but decreased d (1.5-3.9 Hz)
activity after exposure to continuous or intermittent 45 Hz, 1260 mT magnetic
fields. Cook and coworkers (28) found changes in auditory (but not visually)
evoked potential after 9 kV/m and 20 mT 60 Hz electric and magnetic field
exposures. In a series of experiments by Ruppe and coworkers (88), volunteers
were exposed to strong 50 Hz magnetic field levels of up to 2 mT for 10 minutedurations. No effects on EEG readings were noted.
In three studies, effects on electrocardiograms and pulse rates were
investigated. In the study by Cook et al. (28) already referred to, a decrease inheart rates was noted. An interaction with the order of expoure/sham sessions was
also observed; the heart rate decrease was only found if the first and the lastsession was "exposed", not when exposure occurred in the intermediate sessions.
Closer scrutiny also revealed that the difference in heart rate was due to changes
primarily in the sham sessions; in the morning, a decrease in the heart rate over
the three hours was noted in both exposed and sham situations, while in theafternoon, this pattern was again observed for the exposed, but not for the shamsubjects. In our opinion, these results lead themelves to various interpretations and it is not clear whether there is in fact only an order effect or an order +exposure effect, or - if an exposure effect exist - if it should be considered harmful
or beneficial.
Using somewhat lower exposure levels (3-4 kV/m and 1-7 mT), Korpinen andPartanen (56) failed to note any changes in the pulse rate due to exposure. Some
autonomic function tests being related to the cardiovasvular system (orthostatic
tests, Valsalva maneuver and deep breathing) were also evaluated by the sameauthors (57), again without observing an effect related to EMF. However, someweakness in the protocol and execution of the study were identified. In theexperiments by Ruppe and coworkers (88) (see above), no effects on ECG, pulse
rates or changes in body temperatures were noted.
Reduced number of errors but similar reaction times in tests performed duringexposure vs sham were noted in the study by Cook and coworkers (28). In

Appendix 3:8

contrast, neither Lyskov et al. (65) nor Podd and coworkers (81) reported effectsof strong magnetic fields (1260 mT, 1100 mT) on reaction times. It should be
noted, however, that Podd et al. used quasi-static frequencies (0.1-0.2 Hz) andvery short exposure durations. Cook et al. (28) also summarized earlier studies onreaction time, they describe the results as "inconsistent". After strong but short
exposure regiments (2 mT, 10 minutes), some psychological tests indicated a
reduction of mental performance (88), although the statistical significance of theresults were unclear.
Summary - low frequency fields
Overall, the hypothesis of increased risks of various neurasthenic symptoms being
related to environmental or occupational exposure to low frequency electric or
magnetic fields is - at present - not supported by strong or consistentepidemiological findings. This lack of overall support is partly due to theinconsistency of the findings, the limited methodology in some of the studies andalso to the limited number of studies performed. The best case - primarily in termsof need of future research - appear to be made by environmental exposure to
fields from power lines and depressive disorders. For this situation, however, it is- based on available data - difficult to separate (presumed) effects due to thephysical presence of the fields from those dependent on psychosomaticmechanisms.
The use of such surrogates for EMF exposure as proximity to power lines etc.
has been critizised, as several unidentified confounders (such as traffic density,urban location of houses etc.) may interfere with the interpretation of the results(Valberg 1996). In some of the more recent studies, measurements of EMF
exposures have been conducted. It can be observed, however, that the inclusion ofdata based on measurements have generally not resulted in stronger associations
with the effects. This lack of further substantiation of the association when better
exposure assessments are made, can be interpreted in several ways, though,among them;· a lack of a ÒtrueÒ relationships with the fields, where some other factor(s)(ÒconfoundersÒ) may be responsible for the association seen.
· the choice of an inappropriate exposure parameter or field desriptor - which
again points to the absence of information on a possible causal mechanism
Considerable attention has been given the possibility that psychosomaticmechanisms may be involved here. Some supporting data from the reviewed
studies were found by Poole et al. (82), by McMahan (70) and the cluster
investigation reported by Miro, as already described and briefly discussed above.
It should be noted, however, that - again - a causal link between EMF worry ande.g. depressive symptoms can not be considered as established, it remains apossibility in these cross-sectional studies that the effect may have caused
increased concern and worry. As a general remark, the current inability toformulate a relevant mechanism or pathway for a "direct" effect tends to favour
the credibility of a psychosomatic mechanism. It may be counter-argued,
Appendix 3:9

however, that the results of the study by Poole et al. (82), where adjustments
were made for attitudes and anxiety, would speak against the psychosomaticmechanism. Better knowledge about socioeconomic variations close to andfurther away from powerlines as well as further investigations into the impact of
attitudes etc. appear warranted.
The most consistent human experimental results appear to come from investigations of EEG activity changes caused by EMF«s. While these indications domotivate further investigations, a few points are worth mentioning; a/ theexposure levels were high (8 - 1260 mT), b/ the interpretation of these changes
appear unclear - in our opinion, they indicate a biological effect, but notnecessarily an adverse effect and c/ effects have not been consistently found by all
investigators. This latter point is augmented by the observation that while effects
on brain potentials were noted in a few studies, they did apparently not result in
reduced reaction times - as measured in two of them. Few other reliable effects
were noted in the reviewed experimental studies on humans. The key issue of
whether melatonin secretion or circadian rhythms are influenced by EMF«s can
not be answered by current data, studies on rodent give some support for the idea,
but data from non-rodent or from human subjects have hirtherto failed to do so.
For both observational and experimental studies on possible effects of low
frequency, low level electric or magnetic fields, this area suffers from the generalinability to describe possible mechanisms or biological pathways linking an
exposure parameter to the investigated effect(s), and the concommitantuncertainity as to the correct exposure index (average, peak, short or long term
exposure, electric or magnetic field component etc.). Several hypotheticalbiological pathways have been proposed, but none have been firmly established.
As discussed by e.g. Paneth (78), Savitz et al. (95), Sobel and coworkers (100)and others, two primary contenders for such a role of interest to these outcomesare calcium efflux across the cell membrane, and changes in melatonin secretion.
As further argued by Paneth (78), the latter hypothesized pathway (decreased
secretion of melatonin caused by electric or magnetic field exposure) would havethe advantage of a/ being more selective toward the types of effects reported here,
and b/ being directly testable on whole animal or human subjects. (It should be
noted that such a pathway (EMF -> melatonin secretion changes -> disorders),
does not describe a "mechanism" in the sense that the "dose" can be identified. In
our opinion, the term "mechanism" should refer to knowledge about the physicalinteraction process. Nevertheless, a firm indication of such a pathway may
enhance the design of further studies where a relevant definition of "dose" could
be achieved.)
In conclusion, while results exist that clearly motivate further research into thepossibility of adverse neurasthenic or neurological reactions to low frequency
fields, current knowledge is unable to strongly support this possibility. This is inpart due to the inconsistent and partly contradictory result obtained, and in partdue to the current inability to determine the relevant exposure parameters (if any).

Appendix 3:10

Neurasthenic symptoms and exposure to radiofrequency fields
In a limited number of studies, neurasthenic or similar symptoms were
investigated in relation to radiofrequency field exposures. Both observational(epidemiological) studies in occupational and general public/residential settings
have been performed, as well as some experimental studies on humans. (For areview of experimental studies on animals, see WHO (118), or McKinlay,
Andersen et al. (68).
Occupational studies
In the 1960-ies and 70-ies, various neurasthenic symptoms and symptoms offunctional disturbances of the nervous and the cardiovascular systems werereported in Soviet and Eastern European literature among military personnel andother workers chronically exposed to RF. In some studies, ECG or EEG
abnormalities were also observed (38, 106, 117, 118). Based on this, the termÓmicrowave sicknessÓ or Óneurotic syndromeÓ was coined. The exposures wererarely estimated - with exception of one study (99), where exposure levels were
given from dozens to hundreds of V/m. These studies are, however, not easily
evaluated because of several drawbacks (vague description of cases, lack ofadequate control groups, poor statistical analyses etc., 118). Some other earlier
epidemiological studies reported failure in finding - in exposed groups or groups
assumed to be exposed - any significant excess of "neurotic syndrome" (97), ECG(97), hospital admission rates due to mental, psychoneurotic or personality
disorders (86) and clinical neurological or psychometric findings (73). For further
review, see Bergqvist (17).
Among plastic welders with high documented exposures to RF, increased
occurrences of paresthesia (numbness) of the hands were found (22, 54). Bothstudies were small, and adjustments for possible confounders were generally not
performed, nevertheless the results should be regarded with some interest, asthese two studies are at least partly based on actual measurements, and theseclearly indicated excessive exposure levels - well above those recommended e.g.
by IRPA (30). In one of these studies (54), a non-significant excess ofneurasthenic symptoms was found, whereas headaches or tiredness were notreported more often by the exposed. The other study by Bini et al. (22) found no
significant associations between central nervous system findings and exposure (nodetails given, though).
An excess of self-reported heart problems was in another study found among
male physiotherapists using RF (shortwave or microwave) diathermy equipment(42). Self-reports of both disease and exposure (use vs non-use) as well as a low
participation rate (58%) do detract from the credibility of the association, though.
In an unpublished study (Luis Miro, personal communication), 105 exposed
microwave workers and 62 controls were been examined. The exposure wasreported as chronic occupational exposure (exposed all day to about 0.1 W/m2),
No clinical problems nor subjective complaints were noted among the controls. In
contrast, some 63% of the exposed workers had some complaint, which was
Appendix 3:11

identified as neurasthenic syndrome (headache, fatigue, heart palpation, vertigo,
thermoregulatory disorder, nausea and behaviour modifications) in 30%. In 8.6%,
this condition was serious enough to justify treatment. Furthermore, afterinvestigating hematological functions, most (87%) of the exposed but only 3% of
the unexposed presented a significant increase in osmotic globular resistance.
Residential exposure to RF fields
Various adverse health outcomes were investigated - in response to resident«spetitions - in the vicinity of a shortwave transmitter based in Schwarzenburg near
Berne, Switzerland (1). The broadcast consists of active periods with shorter (15min) inactive periods for direction changes. Three zones (A, B and C) were
defined around the transmitter at increasing distances, C being several km away.
Exposure to RF signals (6-22 MHz) was measured, and indicated increasinglevels in the C - B - A series. At C, levels were similar to background level (0.08mA/m), while at A, the median level during broadcast was 1.6 mA/m (but still
considerably lower than the IRPA guidelines of 73 mA/m). 100-150 individuals
from each zone took part in at least one of the several investigations.
Socioeconomic status or attitudes varied across the zones, and were accordingly
adjusted for in the analysis.
Difficulty in sleeping was more prevalent closer to the transmitter, and did
exhibit a relationship with measured field levels: Increasing field levels from 1 to
10 mA/m was related to an odds ratio of 3.2 (1.8-5.5). Weakness, nervosity etc
were apparently secondary to this difficulty in maintaining sleep. Experiments
were performed, with changes in the transmitter (shut down or directionalchanges); individual«s diary notation of sleeping difficulty correlated with thesechanges. However, attempts to indicate a melatonin mechanism for thisrelationship failed. The authors were - in their own conclusions - not able to fully
differentiate between a direct biophysical relationship, a stress-mediated one or a
psychosomatic relationship.
These results do - in our opinion - merit further study. There are some aspectsof the study, that makes it difficult to evaluate the outcome, though:· This study was based on a petition - presumably because of an existing
problem. Thus, it can be seen as a cluster investigation. This comment isprimarily relevant for the cross-sectional part of the study, where it will
decrease the generalizability of the results. The experimental part is presumably
less affected, unless the selection process (choosing this particular site) haveresulted in a particularly sensitive population being studied. Then, while
conclusions about the experimental observations per se may still be valid,inference as to the commonality of such reactions should perhaps not be made.
· Some design aspects are not clear, such as the impact of a rather limited
response rate, some details of the analysis, and the full confirmation ofexperimental blindness.
· The use of melatonin levels as a possible intermediate in the pathway between
RF exposure and sleep problem appear - to us - not well based in the literature.

Appendix 3:12

It should preferably have been used as a possible confounder - but then thatwould have made it necessary to evaluate all participants for melatonin levels.
Notwithstanding these limitations, further investigations into this possibility
appear warranted. Currently, it is - in our opinion - not posible to draw any
general conclusions from this single study.
The US Embassy in Moscow was intermittently irradiated between 1963 and1975 by an RF source of a few GHz, resulting in exposure levels of some 0.05-0.2
W/m2 . An extensive survey of adverse health problems among the Embassy
personnel and dependents living at the Embassy. Although various healthoutcomes among individuals were detected, including some with neurasthenic
symptoms, no health outcomes was, in the final analysis, judged to be linked tothe exposure (64).
Mobile phone users
In some countries, anecdotal reports have appeared that describe various
symptoms such as headaches, feeling of warmth etc in some individuals whenusing mobile phones. Results of studies on this phenomenon have - so far - beenvery limited (47), but some research activities on this are currently ongoing.
Another general concern being expressed is that of exposure due to mobile telecommunication base stations. To our knowledge, studies related to these latter
situations have not been performed.
It should be noted that while public exposure to base stations appear negligible,
thermal exposure from hand-held mobile phones ("cellular phones") could insome extreme circumstances be of the same order as - or possibly also exceed current basic limits or safety standards. Major difficulties exist, however, in theascertainment of the exposure in these situations, because of uncertainties inmeasuring and/or calculating the relevant dosimetric quantity . See further Kuster
and Balzano (58).
Other observations in humans
Cutaneous perception (primarily as heat or pain) is possible at high exposurelevels to frequencies in the order of a few GHz; auditory effects (Ómicrowave
hearingÓ), and effects of contact or induced currents, exceeding stimulating
thresholds of excitable tissues, have been experimentally observed (118). Some ofthese effects can be considered ÓphysiologicalÓ rather than ÓadverseÓ, andfurthermore, they appear as a consequence of short term exposure to RF levels
much higher than commonly occurring occupational or environmental levels. Tencases of complaints allegedly associated with RF field exposures have beencollected in a French data base, but without possibility to establish a link with RF
exposure (Miro, personal communication).
An overexposure to high levels of RF of a few GHz frequency can apparently
induce neurasthenic symptoms and also EEG abnormalities (106, 118). Headache,fatigue, heart palpations anxiety, memory loss, insomnia, hyperhydrosis and othersubjective symptoms were reported, mainly in subjects overexposed during
Appendix 3:13

maintenance of radar or military systems; in a few subjects EEG abnormalities
were also found (106). Even if in some cases the exposure was not estimated, it
can be concluded that in most instances, such effects have been reported fromexposure situations where the levels are a few to several orders of magnitude
higher than current guidelines (e.g. by ICNIRP), and are considered to be due tothermal interactions of RF fields with the body (118). As a consequence, theseobservations can not be applied to chronic low level RF exposure, which is under
scrutiny here.
In two recent experimental studies, some effects on EEG pattern and on sleep
parameters (shortened sleep latency, decreased REM sleep) (66) and on the EEG
alpha activity (110) have been reported after exposure to pulsed fields frommobile phones or similar sources. The exposure ranged from 0.5 W/m 2 (900 MHz
pulse-modulated at 217 Hz (66)) to less than 0.01 W/m 2 (150 MHz pulsemodulated at 217 Hz; (110). In another experiment, exposure to 1 W/m2 of 2.45
Ghz continuous fields did not result in any noticeable effects on nervous system
functions, where exposure to 10 W/m2 did influence some perception test results(71).
Summary - radiofrequency fields
For high RF exposures after accidental overexposures (capable of causing
substantial thermal effects), various neurological and neurasthenic effects havebeen described, as well as other medically well defined conditions. Numbness ofthe hands does also appear to be a reasonably well documented effect ofmoderately high RF exposures - appearing among plastic welders exposed tolevels above current guidelines. No other neurological or neurasthenic effects of
RF exposures at moderately high levels could be verified.
The main concern here, however, is with low level RF exposures - i.e. below
those causing thermal interactions with the body, and below the expoure limits set
by various national and international guidelines or standards. Epidemiological andexperimental studies that investigate the possibility of neurasthenic effects of such
low level RF exposures are limited. The sleep problems reported around a Swiss
shortwave transmitter motivates some further comments here, however, as theinvestigators made considerable efforts to exclude a psychosomatic mechanism.
This report - as well as some indications from the study reported by Miro (seeabove) motivates further research, but the data is at present not sufficient toestablish neither the reliance of the adverse effect (neurasthenic symptom ordifficulty in sleeping) on mechanisms other than psychosomatic ones nor indeed
its general existence. The various problems anecdotally reported by mobile phoneusers (headaches etc.) and the few experimental studies on nerve system
functions, sleep effect etc. do also point to the need for further scientificinvestigations.
At the same time, the paucity of studies with good exposure assessment andsophisticated analyses does at the same time make it impossible to fully dismiss
the suggestion of neurasthenic effects of low level RF exposures on the basis ofthese studies. The plausibility of the hypothesis is also partly reduced due to the
Appendix 3:14

inability - at present - to describe and verify mechanisms that could elicit abiological response of RF exposures below those relevant for thermal interactions.
In some contrast, it is possible to formulate a psychosomatic mechanism ofinteraction - but of course then only for situations where the individual is aware of
the exposure.
As was the case for low frequency fields, the current (limited) scientificknowledge is unable to strongly support the suggestion that low level RF fields
would cause neurasthenic effects. A few observations and reports are worthy offurther investigations, though.
Skin symptoms among VDU users
Description of skin complaints or disorders among VDU users
The first reports of facial, throat or hand skin problems among VDU users
appeared - to our knowledge - from the UK (Rycroft 1984 cf Stenberg 102),
followed by some Norwegian reports (25, 72, 107). The first Swedish reports
were published in the middle or late eighties (9, 63, 113), although unpublishedcase descriptions had appeared earlier. Since then, most published studies havebeen performed in Sweden, even if case reports have also appeared in othercountries, e.g. USA (36, 37) and Japan (Matsunaga et al. 1988, cf Stenberg 102).
It should be noted, however, that reports have also appeared that indicate a lack ofÓVDU-related dermatosesÓ or ÓVDU-related dermatological problems in somecountries; e.g. from Italy, where 736 VDU workers seen at the Institute ofOccupational Medicine in Milano, without reporting any such cases (80).
Descriptions of these cases often emphasized unspecific symptoms similar to
those of various skin disorders such as rosacea (pain, itching, burning), with mild
objective signs (rashes, redness, sometimes describable as a non-specificerythema) but with more pronounced or intense symptoms (16) (9). It is also
noteworthy that in the cohort study by Bergqvist and Wahlberg (20), 25% were
given a diagnosis of a skin disorder, while only 19% of the same cohort did reportskin symptoms at the same day - but prior to visiting the dermatologist. (And, as
indicated below, with only a minor overlap.) A major reason for these discrepancies probably lies in the observations that most (86%) of the diagnosed skindisorders were judged to be mild, with the remainder of moderate severity (20).
Generally, these skin symptoms appear transient, often being reduced afterwork or over weekends (16). In a 5 year follow-up study by Eriksson and coworkers (33), 63% of the skin problems present at the onset disappeared during
the study time. The occurrence of changes in work situations or the "electricalenvironment" were more common among those who remained as cases thanamong those who recovered - the full interpretation of this is, however, unclear;both ineffective measures and measures directed to more severe (but lessresponsive) cases could be involved. Of 201 cases examined by Berg (9), 75%
were followed up 8 months later. For 14% the problems had ceased, while 52%

Appendix 3:15

reported less severe problems and 28% had similar skin complaints. For 6%, theproblems had increased. Most (87%) had continued their work at the VDUs.
It must be emphasized, however, that this description of mild skin problems
that often resolve without remedial actions - while common - does not apply to allindividuals concerned. A smaller group describe their health problems as intense
and with major social consequences, and their problems are also described asincreasing if remedial actions are not taken. For example, in the study by Berg (9)on referred patients, 5 individuals (3% of the follow up) had markedly different
symptoms (but few objective signs), and had declared themselves as"hypersensitive to electricity" - had quit the VDU work and described serious
consequences in their daily life.
The research experience gained on such more severely afflicted individuals are
discussed in a separate section below.
Comparisons of self-reported symptoms and objective signs or diagnosed skindisorders have given varied results. According to Berg (10), a fairly goodcorrelation was noted between self-reported skin complaints amd clinicaldiagnoses (depending on both signs and symptoms) - about 87% of the skincomplaint statuses were confirmed by the diagnoses. However, the correlation
was rather poor between skin complaints and current signs (46% confirmation). In
another cohort study by Bergqvist and Wahlberg (20), the correspondence between skin symptoms and diagnoses was rather poor, with only 33% of thosereporting symptom were given a diagnosis. (It should be noted that the clinicalcriteria for rosacea was different in these two studies, Berg et al. used a muchbroader definition.)
From case reports, a high degree of one-sidedness of symptoms (at the side of
the face turned to the VDU) have often been noted (9). When examining this in acohort (i.e. when individuals were not self-selected), no such unilaterality wasobserved (13); while many had unilateral rashes, they were at least as common on
the side not turned towards the VDU. A reasonable explanation for the unilaterality towards the VDU in case reports appears to be that of a selection process,individuals with mild/modest skin rashes at the "wrong" side of the face will
perhaps not approach a dermatologist for "VDU-related skin problems".
Epidemiological investigation into relationships with VDU work
In Sweden, a number of epidemiological studies have been performed concerning
skin problems and VDU work. In most of these studies, skin symptoms andcomplaints were more common among those performing VDU work than among
those who did not (13, 20, 52, 74, 103). Most but not all of these studies also
performed some adjustment analysis for confounding factors. For example,
comparing those working at least 20 hrs/week for at least 5 years resulted in a risk
ratio of 3.0 (1.2-7.1) according to Berg and coworkers (13). Similar results - anodds ratio of 2.5 (1.1-5.6) for those having worked at least 2.5 man-years - werenoted by Bergqvist and Wahlberg (20). Both studies used both a retrospective
definition of exposure ("at least 5 years" or "man-years" of VDU work), and a
retrospective recall of skin rashes (in the last 2 years, in the last 12 months,
Appendix 3:16

respectively). When asking about current symptoms, only individuals with shorter
VDU work duration (<2.5 man-years) indicated a (non-significant) excess odds
ratio (2.0; 0.7-5.5) (20). A possible - but in no way definite - interpretation could
be that this reflect a transient effect of VDU work, problems appear mostcommonly at the beginning of VDU work, and then partly disappear. (Compare
the description above.) In a longitudinal study, the incidence of reporting skin
symptom did not correlate with VDU use vs no VDU use (the risk ratio was 1.2;
0.6-2.3), but did weakly correlate with the intensity of VDU use (>30 hrs/week vs<20 hrs/week, risk ratio=1.9; 0.9-3.8) (19). (The study by Bergqvist andWahlberg is a cross-sectional part of this longitudinal study.) In a third crosssectional study by Stenberg and coworkers (101) on office workers in northern
Sweden, VDU work was associated with skin symptoms in a dose-responsemanner (dose = daily VDU work duration); for 0-1 hr/day, the odds ratio was 1.2(1.0-1.5), for 1-4 hr/day, the odds ratio was 1.9 (1.6-2.2) and for >4 hr/day, theodds ratio was 2.4 (2.0-2.9). These odds ratios were adjusted for other factors(gender, asthma and psychosocial conditions). This large questionnaire study
formed the basis for additional investigations, see further below.
In other countries, a few similar studies have been performed as well, withvaried results. In some early questionnaire studies from the US with low response
rates and limited analysis, one reported an association between symptoms and
VDU use (Murray 1981, cf Bergqvist (16) and Stenberg (102), while the other did
not (Frank 1983, cf Bergqvist (16) and Stenberg (102). A more recent UK study(23) failed to find a statistically significant association; The odds ratio (calculated
by us) comparing VDU and non-VDU users where 1.3 (0.9-1.9). For more
specific symptoms or signs, odds ratios varied between 1.1 and 1.7 - none being
significant. The low response rate (41%) and the limited analysis should be taken
into account.
In a large Italian study (24), both women and men reported significantly higher
prevalences of skin disorders and facial rashes when the duration of VDU work
exceed 2 hours/day. The odds ratio (calculated by us) was 2.2 (1.6-2.9) for skindisorders and 2.7 (2.3-3.2) for facial rashes. These associations varied somewhat
with both age and gender. For example, among women, the odds ratio for facial
rash was reduced to 1.4 (1.1-1.7). If a symptom frequency score was used, theassociations decreased somewhat, which the authors interpreted as a failure toverify the association between VDU work and facial skin "as have otherepidemiological studies...in norther European countries". It may conceivably also
reflect the mild type of skin reactions presumably involved. Furthermore, it wasnoticable that the prevalences of skin rashes and disorders were generally much
lower in this Italian study (0.5 - 7%) than among the Swedish studies (see above).
To what degree this reflects reality or different manner of ascertainment is notpossible to determine. For further discussions of international comparisons of thisissue, see also a review by Stenberg (102).
As already indicated, evaluations of skin symptoms, signs and diagnosed skindisorders can be seen as more or less independent processes. For skin signs, Berg

Appendix 3:17

et al. (13) reported a small nonsignificant association with VDU work. Bergqvist
and Wahlberg (20) found subtantial increases in the occurrence of non-specificerythema with VDU work, but the limited number of cases again resulted in thisexcess being statistically non-significant (see further below).
For diagnosed skin disorders overall, the results have been varied, with Bergand coworkers (13) finding an excess (the relative risk was reported to be 1.4; 1.11.8 for those working at least 20 hrs/week at a VDU for at least 5 years). In
contrast, Bergqvist and Wahlberg (20) did not find such excesses (their odds ratio
was 0.9; 0.4-2.2 for those having worked at least 2.5 man-years). For specificdiagnoses, however, the correspondence appear greater, both studies noted anincreased occurrence of seborrhoeic eczema with increaed VDU use. This isconsistent also with the results of some other Swedish studies (63, 104) (Note thatthe study by LidŽn and Wahlberg is based on the same study population as
Bergqvist and Wahlberg (20), but 6 years previously.)
Overall, an excess occurrence of subjectively reported skin symptoms orcomplaints is apparently found among VDU users, whereas a relationship with
objective signs or diagnosed skin disorders appear less clear - a case can probably
be made for seborrhoeic eczema, and possibly for non-specific erythema. Most but perhaps not all - of the cases can be described as mild, and many often appear
to improve or disappear even without any remedial action being taken. It should
be noted that most of the evidence and indications on which these conclusions are
based come from Swedish and some Norwegian studies. The information
available on studies from other countries than Sweden and Norway appear limited
and have produced varied results, even if it can be argued that three out of fourstudies have at least indicated an excess of problems among VDU users vs nonusers. The limited number of non-Swedish publications are perhaps attributable tothe more limited attention given this topic in other countries. For example, in theconference series Work With Display Units, which has been held four times(1986, 1989, 1992 and 1994), the dominant presentation on this topic has
generally been Swedish).
Relationships between skin problems and electrostatic or low frequency electricor magnetic fields
These fields have been in the center of interest ever since the discussion
concerning skin complaints during VDU work commenced at around 1980.
Several investigations have explicitly or implicitly studied the possibility thatelectrostatic charges on the VDU and/or the operator might influence theoccurrence of skin problems. As originally proposed by Cato Olsen (25), thehypothesis would be that increases in the electrostatic field at the VDU work
station, or increases in the electrostatic charge of the operators, would increase thefacial deposition of small air particles, which in turn might lead to adverse
reactions. In an early Swedish study (63), some limited additional support for thishypothesis appeared, but with the emphasis on the operator«s charge, not theelectrostatic charge of the VDU. Subsequent Swedish studies did not, however,substantiate this; In the study by Sandstršm et al. the odds ratios for various bodyAppendix 3:18

potentials varied between 1.2 (0.6-2.8) and 1.4 (0.7-3.1) (93), while the study by
Bergqvist and Wahlberg resulted in an odds ratio of 0.6 (0.3-1.2) for highly
charged operators. Neither could the use of grounded filters be shown to reduce
the skin problems (21). More recently, two Norwegian intervention studies have,
however, somewhat reopened this hypotheses, by indicating a/ that changes in the
grounding of an external filter (which affects both electrostatic and low frequency
electric fields from the VDU) affected the frequency of tinglings of the skin (77),and b/ efforts to reduce low frequency electric fields as well as electrostatic
charges on both the operator and the VDU did reduce the occurrence of skin
symptoms - but only in locales with high airborne dust levels (98).
In two Swedish studies, explicit measurements of exposure to low frequency
electric or magnetic fields at the VDU work station have been performed without finding any definite relationship between these fields and the skincomplaints (21, 91, 93, 101) after adjustment for other factors, nor with objective
signs or diagnosed skin disorders (20, 21). While some excess odds ratios were
found between the accumulated exposure (over the years) to line frequency
electric and magnetic field, these excesses were shown to be related primarily tothe duration of VDU work, not the field levels involved (21). Likewise, an excess
odds ratio for ELF magnetic fields (2.7; 1.0-6.9) (93) was reduced after
adjustments for other factors (101).
A firmer statistical association was found, however, between electric fields inother parts of the office and the skin complaints in the study by Sandstršm andcolleagues (91, 93, 101). The interpretation of this finding is not straightforward,
though. If cases of skin problems increase with increasing VDU work (thus,
presumably, staying at the VDU work station), then what mechanism(s) relate thisto fields in other parts of the room, but not to those at the VDU work station? One
way would be the recognition that measurements of electric fields are extremely
difficult and give quite variable results, and that the two parameters measured(VDU vs other places in the room) should be seen as samples of the general level
only, and not predictive of specific sites. On balance, this finding is interesting,but can not - in our opinion - be seen as definitive.
Koh and coworkers compared users of CRT (cathode ray tube) and PD (plasma
display) VDU users, where the former are generally assumed to cause higher
exposure levels - no significant difference was found (53). Likewise, Berg et al.
failed to associate their increased VDU work skin rashes with any VDU type or
use of filters etc (13).
In summary, the evidence for or indications of an involvement of various
electric or magnetic fields on VDU-related skin problems appear weak to almost
non-existent. The possible exception is - in our view - actually the first formulated
hypothesis, where increased electrostatic charge on (primarily) the operator would
increase the deposition of airborne particles, with possible skin-relatedconsequences. If this is indeed the case, then it appears difficult to study, since itwould be very situation specific and due to a/ the composition (chemically) of theairborne dust, and b/ the sensitivity of the individual to this dust. This might

Appendix 3:19

explain the failure in some major studies - which did find excess VDU-relatedskin problems - to find any support for this hypothesis. However, it may then also
be argued whether such a situation-specific hypothesis - even if true - is capableof explaining more than a smaller part of the VDU-related skin problems.
Relationships between VDU-related skin problems and some other factors
In the study by Bergqvist and Wahlberg (20), a low relative humidity and skin
type were together associated with seborrhoeic eczema; individuals with skin type
1 and 2 who had worked with an average relative humidity below 30% during thepreceeding week had an odds ratio of 8.3 (2.5-28) of being given the diagnosis
seborrhoeic eczema. This finding appeared to be independent of VDU work, but
the occurrence of a low relative humidity was more common in locales where
VDUs were placed. The authors tentatively ascribed the earlier reported findingsof associations between seborrhoeic eczema and VDU work (20, 63) to low
relative humidity as an alternative explanation.
In an intervention study, a high air temperature (above some 23 oC) increased
the reporting of various skin symptoms (especially among men) (49). Further
limited support for such associations can be found in the seasonality of some skinproblems, e.g. for seborrhoeic eczema (104). In contrast, no real associations withhumidity or air temperature was found by Sandstršm and coworkers (91, 93), but
the fact that the climate factors and skin problems were not ascertained in thesame time periods may be a possible explanation for this non-positive finding.
Overall, VDU-specific studies have given some limited indications that a low
relative humidity and/or a high indoor air temperature is conducive to certain skinailments. If so, and if some observations are correct that put these findings asbasically independent of VDU work (but mixed because of common occurrenceof these problems in VDU localities), then some of the skin problems ascribed to
VDU work situations may in actuality be involved in the "indoor air problems"
also discussed.
A high workload was shown in two studies (20, 101) to be associated with skin
symptoms. In e.g. the former, an odds ratio of 3.7 (1.3-10.3) was found, after
adjustments for other factors. In the latter, a relationship was also noted between
workload and the objective sign of nonspecific erythema. This latter relationshipwas noted among VDU users only, though (20). Likewise, NorbŠck andcoworkers (74) also noted some fairly strong - but uncertain - relationships
between dermal problems and various psychosocial factors.
In this part of the review, no effort was made to describe the totality ofscientific evidence connecting indoor air climate or stress factors with skinproblems - the review is limited to studies which specifically have investigatedthese associations in VDU situations. Generally, a fairly large body of evidence
connect these factors with skin problems - evidence obtained in other situations.
The studies reviewed here are - in our opinion - sufficient to indicate thatgenerally accepted factors for skin complaints such as low relative humidity/highindoor air temperature or stress are operating also in VDU work situations, and toAppendix 3:20

at least suggest that these may actually be major explanatory factors for the noted
association between VDU work and skin ailments.
Summary - VDU work and skin problems
In summary, while skin symptoms appear to be associated with VDU work, thisappears less certain for skin disorders. Regarding objective signs, no conclusion
appear possible. Some results suggest that "normal" explanations for these
problems such as a low relative humidity or a high air temperature, as well as
stress situations, may be major explanatory facors for these skin problems also in
VDU work situations. In contrast, suggestions of electric or magnetic field
involvement are very scant to nonexistant. One possibility could, however, be
static charges leading to a higher facial deposition of skin irritants.
These conclusions are almost exclusively derived from Swedish and a few
Norwegian studies. The degree by which they are applicable to skin problems
among VDU users also in other countries is not clear - nor is indeed theoccurrence of the problem there. It is conceivable that major effect modifiers suchas the prevalence of low relative humidity situations or differences in skin types
etc. may play a role in causing large scale regional differences.
Finally, it should be reemphasized that these skin problems - often of mild andtransient character - should not be mixed with the less common occurrence ofindividuals with more severe health problem being attributed to various "electricalsources". See further next section.

Reactions among individuals with possible special sensitivity
In the section above, data concerning associations between various but often
rather common symptoms and electric or magnetic fields were examined. It was
found that the evidence for such associations - although some indications needing
further investigations do exist - was rather meagre. For these studies, study
populations were normally recruited among the general population, and theevaluation was based on statistical methods. It is thus conceivable, that if a higher
sensitivity to a specific factor exist among a small group of individuals, then thesestudies reviewed above may be incapable of detecting associations between thefactor such as field exposure and symptom in such (hypothetically) few sensitive
individuals. To overcome this possible problem, studies are warranted thatspecifically look at such sensitive individuals, but in order to do so, they must ofcourse first be identified.
Aim
This section examines the evidence for the existence of groups with special
sensitivity that could be of relevance to "electrical sensitivity". Such sensitivity
could be defined around a self-declaration of sensitivity, an explicitly measured
sensitivity to an external factor, a type of reaction, an individual/constitutional
Appendix 3:21

factor or a personal trait. When reviewing such different bases for "sensitivity",
other data pertinent for the particular type of sensitivity (if any) are also
discussed.
Groups defined by self-definition, symptoms and/or attribution
The simplest and ostensibly most straightforward approach would be to identify
an individual as "electromagnetic hypersensitive" based on his/ her own appraisal.
It can be shown, however, that this approach does have serious drawbacks interms of scientifically valid methodology: Such a definition of effect will involve
also an appreciation of the exposure - and if that is related to the real exposure,false positive results may be obtained when examining the possible association
between "electromagnetic hypersensitivity" and the exposure. However, in theabsence of the individual being able to determine his/her "exposure" situation, thisself-definition approach may still be valid.
Several attempts have been made to describe typical symptoms of individuals
claiming to be "electromagnetic hypersensitive". Symptoms have also - in a few
instances - been used to define possible subgroups. In an early case series description of 32 seriously afflicted individuals (51), they were differentiated as to:¥ Individuals with symptoms dominated by skin problems. This subgroupreported their problems primarily in terms of VDUs or VDU work, and could
be described as having a fairly good prognosis - various efforts to improve thesituation appeared to work for many of them.
¥ Individuals with symptoms dominated by neurasthenic problem (but often alsowith skin problems). This subgroup attributed their problems to a range ofelectrical appliances (including VDUs), and their situation did not seem torespond as well to remedial actions.
Bergdahl and coworkers (14) differentiated a group of 20 individuals according
to their own attribution of their problems; a/ the "VG" group - only to VDUs andfluorescent tubes or b/ the "EG" group - to a wide range of electrical devices.
When symptoms were ascertained, the results were found to be similar to thosegiven by Knave et al. above, as the VG group reported primarily skin symptoms,
while the EG group also reported a number of neurasthenic symptoms (dizziness,headaches, concentration problems, heart palpitations etc.). (See further below fora psychological profile of these individuals.)
In another recent study based on questionnaires (111), 111 individuals who
were all still actively employed (although some were on sick-leave for various
reasons) declared themselves as "electromagnetic hypersensitive". Based on their
symptoms, they were divided into four groups:¥ 67 individuals (60% of the case group) who considered themselves"electromagnetic hypersensitive", each individual reported, however, few if any
skin or neurasthenic symptoms,

Appendix 3:22

¥ 26 cases (24%) reported several skin symptoms,¥ 9 cases (8%) reported several neurasthenic symptoms, while¥ 9 cases (8%) reported both several skin and neurasthenic symptoms.
It should be noted that a number of individuals who did not consider themselves
as "electromagnetic hypersensitive" were also found in all subgroups. One
obvious possibility is to use symptom-based groups as the basis for further
investigations, regardless of self-declaration of "electromagnetic hypersensitivity". A few cautionary comments are warranted, though. First, this might
miss - as previously argued - a (hypothetical) special groups which otherwise
might be "drowned" in others. Possibly reinforcing this, it was noticed that within this study - there were differences between e.g. the skin subgroup derived
from the cases and from the non-cases (111). Furthermore, this strictly symptom
based approach has actually already been reviewed (see the section on skinproblems above).
Eriksson (32), reporting on the same study as Sandstršm, Stenberg andcoworkers, noted that during the 5-year follow-up period, individuals who, in
addition to having skin symptoms, also reported other symptoms (general or
mucosal) had a higher risk of still having skin symptoms five years later. Thisfinding appear to be consistent with the retrospective information obtained from
Knave et al. (above) - a better prognosis for individuals with (primarily or only)
skin symptoms.
Thus, care should be taken for the heterogeneity of those calling themselves"electromagnetic hypersensitive". Data above, which are all from Sweden, do
clearly indicate this - at least for the Swedish situation. Tentatively, a VDU/skinoriented group could be differentiated from other group(s) with a more diverse
attribution and with a higher occurrence of (also) neurasthenic symptoms. It
should be emphasized that this more diverse attribution (at least in Sweden) still
includes VDUs. For example, in a study reported in 1988 by Berg on 201 referredpatients for suspected VDU-related skin problems (9), 5 individuals (2.5%)
declared themselves sensitive to electricity ("electric allergy"), they were
described as having different symptoms, and reported limitations of their daily
life. (See further below.)
Individual and possibly predisposing factors
Hormonal levels and stress mediated reactions
Arnetz and coworkers (3, 11) examined 47 office workers with VDU associatedskin symptoms (19 cases) or 28 healthy controls, and found that the cases differedfrom the controls during actual work with VDUs but not during leisure days (bothsituations were apparently in the same locales, so as to keep the "electromagnetic
environment" constant). The following differences were found:· Higher hormone levels (prolactin and thyroxine) among the cases than thecontrols, but only during a working day. A similar decrease was found forAppendix 3:23

testosterone. These changes were also associated with increased levels of stressamong the cases.
· Higher levels of estradiol among the cases than controls, both during work andleisure periods. This was, according to the authors, possibly related to itching
behaviour, and could presumably be explained by the effect of estradiol on
vasodilation.
· No differences in adrenalin, noradrenalin, cortisol or growth hormone levels.
The authors concluded that "physiological differences" were found between
subjects with and without VDU-related skin complaints, and they discussed thesefindings primarily in consequences in terms of occupational stress reactions, not
as a reaction the EMF levels - as they were the same or similar for both situations.
In the provocation study of Andersson et al. (2), no relationships between prolactin or cortisol and the electric or magnetic field exposures were found. Twostudies (briefly reported in conference abstracts) on general populations offersome further comments: (109) could not find any association between ELF
electric or magnetic field exposures and cortisol or prolactin levels in men, while
Graham and coworkers (39) noted changes in estradiol and prolactin, but not in
cortisol levels in women (neither report give details, however).
Another noteworthy observation obtained in a few provocation studies (seebelow) is that while guessing that the fields were on were related to increased
discomfort occurrence in the subjects, the actual fields were not (2, 45). One
difficulty in interpreting these observations is that it is unclear whether the
discomforts then influenced the guesses that the fields were on, or whether the
belief in the fields being on influenced the perception of symptoms. A possibility
in this is some sort of "vicious circle", where such processes may reinforce eachother.
Based on these findings, Arnetz and colleagues suggested that "manyemployees working with computers suffer from occupational strain. This resultsin physiological changes characterized by elevated metabolism and increased
dermal blood-flow. This response acts as an unconditioned stimulus. Once theconditioned response has been learned, the psychophysiological response iselicited purely by the conditioned stimulus, i.e. the VDU-environment." (3).
Similar arguments for the amplification of an early (physiological) effect havealso been forwarded by Leitgeb (61), who investigated the possibility that aphysical factor (electric current perception) could trigger a situation (see below),
and also suggested a role for e.g. media-driven awareness in this process. Further
arguments for this have been forwarded by David and colleagues (34, 85). The
reader is also referred to the section on risk perception, as well as to the earlier
comments on a possible (psychosomatic) link between worry and adverse healtheffects in the vicinity of powerlines.
For a few investigations into melatonin levels, see below.

Appendix 3:24

Personality inventories and psychological profiles
In the study by Bergdahl and coworkers (14), where cases were separated into a"VDU" (VG) and an "electrical appliances" (EG) group depending on their
attribution of their problems (see above), both groups were compared to acontrol/healthy group as to various psychological profiles. While the VG grouponly deviated from the control group in terms of higher somatic anxiety andmuscular tension, the EG group deviated in several scores from the Karolinska
Scale of Personality (socialization, somatic anxiety, muscular tension,
psychasthenia), and various psychological function scales (e.g. difficulty in taking
initiative) as well as items best described as symptoms (e.g. difficulty inconcentration). (Similar observations have been made by Ruppe, personalcommunication.)
In another (unpublished) report by Edvardsson (31), job satisfaction among agroup of individuals with VDU work related skin problems was ascertained, andwas found to be slighty higher than an external control group. Most (83%)
described themselves having active but not stressful jobs. Disease behaviour inthis group was characterized as excessive disease conviction, emphasis on
somatic perception of the disease and denial of family or economic problems, butalso low levels of anxiety - all in comparison with a primary care patient group.
Although interesting, it must be pointed out that a/ both of these studies are
small, b/ that they are both cross-sectional in design, and c/ that the study by
Edvardsson did not report any analysis of confounder factors. In the study by
Bergdahl et al. , some items describing differences between the EG and thecontrol group appear to us to be akin to neurasthenic symptoms. Thus, if a groupis defined by symptoms, then finding an excess of such symptoms should not beinterpreted as an item describing possible causality. Other items in the Bergdahl
study are of more central interest, especially social behaviour, lack of initiativeand feeling of inferiority. Again, however, conclusions are difficult, since it could
also be argued that such behaviour could be a result of the problem, notnecessarily a cause of them. On balance, these studies point to an interesting set ofdescriptors, but further work concerning their possible role in the origin of the"electromagnetic hypersensitivity" are warranted before any such conclusions
should be made.
Dermatological or histopathological findings
Skin biopsies were taken on three early cases of skin problems during VDU work
(two men 25 years old and one woman 50 years old), and revealed increased
vasculation of the skin, signs of inflammatory processes and - in microscopic
examination - signs of actinic elastosis. The author discussed these findings interms of ultraviolet radiation, ionizing radiation and "unknown factors" (59). The
hypothetical connection to UV or ionizing radiation was rebutted in a comment
from the Swedish National Radiation Protection Institute, as these factors havebeen measured in VDU work situations in general and around the VDU units usedby one of the three cases referred to above, and found to be negligible (8). The
influence of an operator«s electrostatic charge on radon daughter deposition was
Appendix 3:25

also investigated, and was found to be slightly increased in one study (35) but notin another (15). Even in the positive finding, the increase in normal officesituations was too small to be considered relevant (8). Also the interpretation of
the actinic elastosis finding as unusual has been challenged: it was pointed outthat in other investigations of normal individuals in these age groups, suchfindings were not uncommon. In one early study, 87% of the 20-29 year old and100% of the 50-59 year old individuals examined exhibited such changes (50).
Subsequently, a histopathological investigation of 83 VDU users with skincomplaints and 51 gender and age-matched dermatological out-patients without
VDU work has been published (12). The occurrences were similar for'telangiectases', 'degenerative changes in elastic fibres' and 'sebaceous glands' and(non-significantly) less common among the VDU workers for 'inflammatory
infiltrates', 'hydropic egeneration of basal cells' and 'occurrence of demodex
folliculorum'. When separating the subjects into subgroups depending on whether
objective signs were present or not, it was found that the VDU workers with skincomplaints and objective signs had significantly fewer findings of marked
telangiectases than non-VDU workers with objective signs (p<0.001). VDU
workers with skin complaints had more mast cells (moderate and marked degree)
than the non-VDU workers - but the differences, which was found both among
those with and without objective signs, failed to be statistically significant. Twoout of a total of four individuals who reported themselves as "electromagnetic
hypersensitive" were among those with a marked increase in mast cells (12).
Examining in two patients with self-defined "electromagnetic hypersensitivity"
the possible effects of a TV set session, a high proportion of mast cells were
found prior to the open-field exposure, and they were also found to have a highnumber of somastostatin immunoreactive dendritic cells. After the TV sessions,the number of mast cells were unchanged, but no somastostatin immunoreactive
dendritic cells could be found (48). The authors emphasized that this should befurther examined, but also stressed the extremely small number of individuals
examined. In summary, this material is at present too small and unclear for any
conclusions to be made.
Overall, limited evidence is currently available concerning possible dermatological or histopathological differences between VDU users with skinproblems and other individuals. The finding of an increased number of mast cells
is interesting, but a/ this has only (so far) been examined in one study, wherechance was not ruled out as an explanation, b/ it did not appear to be specific for
those with a more serious symptomatology who had declared themselves"electromagnetic hypersensitive", and c/ it is not clear whether this change - ifsubstantiated by more investigations - should be regarded as an individual trait
possibly enabling certain reactions, as a consequence of exposure or as a findingof no specific etiological interest by itself.
Skin temperature readings
In one provocation study (116), cases of "electromagnetic hypersensitive"
individuals had a much more varied facial skin temperature than controls (cases:
Appendix 3:26

1.4 oC difference between the two facial sides compared to 0.8 oC in controls neither being related to the electric field exposure tested in the study). They
discussed this in terms of "differences in vegetative system function" withpossible consequences in terms of skin blood flow and sweat secretion.
Reactions in terms of skin temperature and some other physiologicalparameters were also investigated in some other provocation studies, e.g. thestudy by Hamnerius and coworkers (43), without finding any relationships.
Sensitivity and reactions to external factors
Sensitivity to electromagnetic fields or currents
The observation that "electromagnetic hypersensitive" individuals report their
symptoms in situations where modest exposure to electric or magnetic fields
occur, while other individuals do not report such reactions, motivates a closer
look at the possibility of special sensitivity to these fields.
In the literature, the degree of sensitivity to electric fields and induced currents
has been fairly well documented. An external field of some 10-15 kV/m isconsidered normally sufficient for perception, while about 5% of the population
may perceive fields at some 3-5 kV/m (75, 118). Annoyance reactions in terms oftinglings etc may require slightly higher levels of normally some 20 kV/m. (30,75). Calculations by Korniewicz (55) have suggested somewhat lower perception
threshold levels (1.6 kV/m) - presumably under "ideal" conditions. For contact
currents, i.e. currents mediated by a metallic object in the ambient electric field,
threshold values are substantially lower, the WHO document (118) presents datafrom Chatterjee et al. (1986) where field levels in the order of 10-100 V/m were
sufficient for perception (at 10 kHz), rising about one order of magnitude forhigher frequency fields. Data are also presented that suggest a large individual
variability, the 0.5% most sensitive population may react to currents half to one
magnitude lower than the "average" person (118).
Considering the levels of electric fields in some relevant situations, and thelarge degree of individual variability that exist in perception, it is notinconceivable that this perception phenomenon might occur in some situations ina smaller part of the population, e.g. around high voltage power lines (75). Suchperception phenomena in office situations around VDUs appear morequestionable, however, where electric field levels are often found to be in the 10
to 100 V/m range (21, 92).
In a series of experiments, Leitgeb and coworkers (61, 62) have investigated thevariation in electric current sensitivity, and indicated that the distribution of thismeasurable sensitivity in the population is bimodal, and with women having athreshold some 30% lower than men. It can also be seen clearly that there is acertain percentage of persons with a considerably lower threshold which may beinterpreted as a prerequisite for - but not as a sign of Òelectromagnetic
hypersensitivityÓ. Additionally the tested persons have been asked before the test

Appendix 3:27

to grade their ÒsensibilityÓ. It turned out that for the men being tested, there was
not a very good correlation between their subjective evaluation of ÒsensibilityÓ
with the measurements, but that this correlation was better among the women.
Provocation studies with EMF«s
Provocation studies have been carried out on individuals with skin complaints
during VDU work as well as on individuals with Òelectromagnetic hypersensitivityÓ, mostly in Sweden and Norway (2, 43-45, 77, 94, 115-116) but with afew studies also from other countries (83, 114). A tabulation of their basic designand outcome is given in table 1. A few additional studies are ongoing.
Furthermore, provocation studies have in some instances been used as part of the
medical handling of individuals, see e.g. Hellbom (45), Sandstršm, Stenberg et al.
(94) or Toomingas (108). This latter aspect is not covered here, though.
In addition to the studies listed in table 1, unpublished data from an ongoingstudy by David and coworkers was reported to the project group in MŸnchen in
November 1996: 9 individuals with "electromagnetic hypersensitivity" were notable to guess more than random whether they were exposed or not - and the same
was true for a control group.
In the way of an example, the study by Andersson and coworkers (2) is
described in more detail. The inclusion criteria (substantial symptoms, reacted in
an open challenge within 30 minutes to the actual VDU, etc) were met by 17 of
35 candidate, 16 of whom participated in the study. The double blind sessions infrom of a VDU (4-8 sessions, each being either "on" or "off") had a 30 minuteduration. Guesses if the fields were "on" or "off", a VAS scale symptom
ascertainment, and blood hormonal levels were endpoint under study. The
following results were obtained:· Participants could not guess better than random whether the fields (the VDU)
were "on" or "off".
· No relationships were found between hormonal levels such as prolactin andcortisol)and the "on"/"off" status.
· Symptoms changes were related to the guesses as to whether the fields were"on", not the actual fields.
The overall evaluation by the authors of these studies were that these studies
fail to demonstrate an ability by these individuals - as a group - to detect fields,
and an association between symptoms developing during the test sessions and thefields involved. In some studies, e.g. the ones by Hamnerius, Agrup et al. (43),
Sandstršm et al. (94) and Wennberg et al. (115, 116), some individuals were able
to guess correctly in one session, but were generally unable to verify this whenretested.

Appendix 3:28

Table 1. Provocation studies with EMF«s and selected individuals
Study

Recruitment
Exposure situation
Outcome parameter
1)
Recruited among patients with VDU work related skin problems
Hamnerius et al. 30 skin/VDU
Fields created (ELF, Field detection,(43)
patients
VLF, RF), 1 h/skin measures andsessionsymptom reporting

Results

Inability to detect
fields. Symptoms or
measurements not
related to fields

Oftedal et al.
(77)

20 skin/VDU
cases 1)

Real work situ-ations, VDUs andgrounded filters(on/off)

Reporting of skinproblems whenusing these VDUs

Weak association
with filter being
grounded vs not

Sandstršm et al.
(94)

22 skin/VDU
patients (1 nonVDU case)

Fields created (ELF, Reporting of facial
VLF). Varying
skin problems
durations

8 cases reacted
more for certain
fields, but not
reproducibly

Swanbeck et al.
(105)

30 skin/VDU
patients

Different VDUs
(electrostatic and
VLF magnetic
fields) 3 h/ session

Reported skinproblems

Recruited among cases of declared "electromagnetic hypersensitivity"
Andersson et al. 16 cases ofReal VDU (on/ off), Field detection and(2)"electromagnetic 30 min/ session
symptom reporting
hypersensitivity". Positive open
challenge

No differences
between these
VDUs. Reactions
also when VDUs
switched off
Inability to detect
fields. Symptoms
not related to fields

Hamnerius et al.
(44)

7 cases ofShielded VDUs =>"electromagnetic magnetic field
hypersensitivity" changes,
1 h/session

Field detection,skin measures andsymptom reporting

No secure differences exposure vsshield situations

Hellbom, (45)

6 cases ofReal VDU (on/ off), Field detection and"electromagnetic 30 min/ session
symptom reporting
hypersensitivity". Positive
open challenge

Inability to detect
fields. Symptoms
not related to fields

Wennberg et al.
(115, 116)

25 cases ofFields created (ELF, Field detection,"electromagnetic VLF). Short resymptom reporting
hypersensitivity" curring exposures

No relation symptom and fields. 3
cases detected
fields, but not
reproducibly

Appendix 3:29

Table 1. (continued)
Study

Recruitment
Exposure situation
Outcome parameter Results
1)
Recruited among individuals with multiple chemical sensitivity who also reported sensitivity to
EMF«sRea, et al. (83) 100 MCS andMagnetic fields
Symptoms and
16 individuals did"electromagnetic created by coil,
physiologicalreproducible react
hypersensitivity" several chal-lenges parameters
to certain frequencies
cases 2)
Wang et al.
(114).

19 MCS andMagnetic fields"electromagnetic created by coil,
hypersensitivity" several challenges
cases 2)Symptoms andphysiologicalparameters

No relation
symptoms andfields whenchallenged

Notes for table 1:
1) These are based on best available information - but categories are difficult to separate (at leastin the Swedish studies) and may have changed over time. In some studies, control groups werealso included.
2) MCS=multiple chemical sensitivity. These individuals reported both MCS and"electromagnetic hypersensitivity". The study by Wang et al. also included individuals with MCS
but not with "electromagnetic hypersensitivity".

In two studies, positive findings were obtained. In the first, a provocation/intervention study by Oftedal and collagues (77), grounding - in a double blind
manner - an external filter (with conductive coating) did significantly reduce theseverity of the skin symptom "tingling or pricking sensation" (p=0.03). The effecton other symptoms were negligible. The mere presence of an ungrounded filter
did reduce the electrostatic fields only - and this was also associated with areduction in the same symptom. Thus, the authors discuss whether the observed
effects were related to the static field or the time-dependent (ELF or VLF) fields,
but were unable - due to the small number of individuals involved - to clarify this.
In conclusion, they summarize by noting that the "results weakly support the
hypothesis that skin symptoms can be reduced by a reduction of electric fields",
but also that "relatively weak tendencies were shown in this study, and few
persons were participating. Therefore, more studies are required to confirm or
deny the role of electric fields". Recently, in a conference abstract, the sameinvestigators reported a failure to replicate these findings, though (76).
In the other study by Rea et al. (83), 100 subjects apparently recruited amongindividuals with MCS (multiple chemical sensitivity) who complained of being
sensitive to EMF were challenged by 21 active challenges (magnetic fields atvarying frequences between 0.1 Hz and 5 MHz) and 5 sham challenges. 25
individuals reported at least a 20% change in the number or intensity of symptoms
were retested, and 16 (64%) of these again reported positive reactions. The
symptoms and the frequency at which these individuals reacted differed. For
neurological/neurasthenic symptoms, essentially all frequences were found to bepositive for several of the 16 successful subjects. Subsequent to the appearance of
this report, critique has been levelled at the experimental procedures (field levels
Appendix 3:30

reported, assurance of blindness etc.; (18)). The authors reply corrected some but
not all of these questions. Other aspects of this study has also been discussed,
including the variability in the responses (different symptoms etc). It should be
noted that another study aimed at reproducing these findings, but under "morerealistic non-controlled environments" (114) failed to do so.
The ability of all these studies to be able to detect sensitive individuals has also
been discussed, and therefore the non-positive studies ability to really indicate anabsence of an effect has been questioned. This discussion has centered around a/
recruitment of testees, b/ correct test situations and c/ disturbances by otherfactors.
It has been argued that by indavertently choosing the wrong individuals(individuals not able to react under these conditions or in the often short durationof the session), the tests might be unable to find a positive effect (even if there isone) and/or make it difficult to generalize the findings. Thus, inclusion criteria are
critical. Most studies have been based on individuals who themselves claim toreact quickly (within the prescribed test sxession duration). Furthermore, a few
studies have verified this by actually testing the individuals in an "open" session,i.e. by requiring that the individuals report a reaction under the experimental
conditions when they are aware of the fields/VDU being "on". The failure - inthese two studies (2, 45) - to detect the fields in the subsequent double blindsession among individuals who reported reactions when knowing the exposure
diminish, in our opinion, this counterargument of using the wrong individuals.
The same argument is valid against the second objection - that of incorrect test
situation (wrong fields etc). It does remain a possibility that a psychosomaticallymediated reaction is so strong that it overwhelms any reaction "directly" due tothe fields.
In table 1, all provocation studies are separated according to the source
population from which the testees were derived, as we think this is important interms of the discussed inhomogeneity of "electromagnetic hypersensitivity". Itshould be noted, however, that the delineation between skin/VDU cases and"electromagnetic hypersensitive" individuals (in the Swedish studies) is difficult,in part due to limited information, and in part due to the possible variations over
the years in these designations. In general, cases of both skin/VDU problems and"electromagnetic hypersensitivity" were obtained through sources that - in our
opinion - would ensure that the testees had severe problems, this being used here
as a proxy for "electromagnetic hypersensitivity" or "individuals with a special
sensitivity". Severity of problems were also included as a specific inclusion
criteria in some of the studies, e.g. the one by Andersson et al. (2). The study by
Oftedal and coworkers (77) is not clear on this point, however, since the primary
selection was by questionnaire, and there is no information on subsequent
restrictions based on severity - severity was an investigated variable in theanalysis. Thus, it might be arguable that this study should in actuality be placed in
the previous section - i.e. being considered together with other information on
normal skin reaction in VDU work situations.

Appendix 3:31

An overall evaluation of these provocation studies does - in our opinion -resultin a general inability to demonstrate an effect, in that· "electromagnetic hypersensitive" individuals have not been shown to be able todetect electric or magnetic fields at levels consistent with those situations where
they do react, and· "electromagnetic hypersensitive" individuals do react in these provocation
studies, but these reactions have not been shown to be related to the fields. In a
few studies, they do appear to be related to the belief that the field is "on".
In reference to radiofrequency fields - and to mobile phone use situations - abrief mention should be made of one study, where one of 7 individuals could
identify whether a mobile phone was ÓonÓ or not (47). The author did howeverstate that these results do not at present allow any conclusions - the indicationneeds to be followed up. So far, we are not aware of any larger study that has
examined this possibility.
Expoure to light or light modulation ("flickering light") and melatonin findings
The observation that a common attribution in at least the VDU related cases of"electric sensitivity" in Northern Europe is to sources of light and especiallymodulated ("flickering") light such a VDUs and fluorescent tubes, have motivatedsome groups to examine the possibility of an increased sensitivity to light
modulation among these individuals.
Both Wibom et al. (119) and Sandstršm and coworkers (89, 90) recruited
individuals claiming to be "electromagnetic hypersensitive" as well as healthy
controls, and exposed them to variations in light modulation. Whereas Sandstršm
used an artificial situation mimicking the light modulation of a VDU, Wibom
used variations in light modulations from fluorescent tubes. Both noted anincreased sensitivity among those claiming to be "electromagnetic hypersensitive"
compared to the controls. These differences were noted both subjectively andaccording to EEG and VEP measurements (EEG=electroencephalogram, VEP=
visually evoked potentials.) For the study by Wibom et al. , subject were recruited
based on their subjective attribution of their problems also to fluorescent tubes.
In a recent conference proceeding, Wadman and coworkers (112) did not findany differences in night urine melatonin between those claiming "electromagnetic
hypersensitivity" and those who did not. They found, however, an increased levelof melatonin - and a strong light influence on it - in a small subgroup ofindividuals with both skin and neurasthenic symptoms (112). Preliminary data on
urine melatonin levels from David and coworkers (presented to the group in
November 1996), suggested a/ that there was no difference among healthy
individuals in field free and in a 100 mT 50 Hz magnetic field, and b/ that there
was no difference between healthy individuals and individuals with"electromagnetic hypersensitivity" when both were tested in a field-free environment. The preliminary presentations of these data, together with the small numberof individuals involved in the "positive" subgroup (above) warrant caution ininterpretation, though.
Appendix 3:32

A few studies have thus suggested that selected groups of individuals who
claim to be "electromagnetic hypersensitive" are more sensitive to light
modulations ("flickering light") than normal subjects. Two preliminary reports
have also appeared that suggest that "electromagnetic hypersensitive" individuals- as a group - do not have urinary melatonin levels that differ from healthy
controls. In one of them, however, a difference was found in a subgroup definedby having both skin and neurasthenic symptoms. It could be argued that further
investigations into light, light modulation and/or melatonin levels should consider
specific subgroups of "electromagnetic hypersensitives". At present, the limited
amount of data offer no firm conclusions - beyond observing that other physicalfactors than EMFs might be of interest.
Summary - individuals with possible special sensitivity
Attempts to identify individuals with a special sensitivity of possible relevance to"electromagnetic hypersensitivity" appear rather fragmented. Likewise, successful
and definite identification of causal factors for symptoms among such individuals
have not been made. Some preliminary and detailed observations are available,
though:On identification and terminology
To identify individuals on their claim for "electromagnetic hypersensitivity",
while a cause of some problems in etiological research, would have utility inhandling situations. There are indications, however, that "electromagnetic
hypersensitive" individuals should not be treated as a homogenous group. Thus,
subsequent identification of subgroups - currently based on symptoms and/or
attributions - appear valid for both research efforts and for medical handling. A
basic distinction appear to be relevant between individuals with skin symptoms
who attribute them to VDU work situations, and individuals with (primarily)
neurasthenic symptoms who attribute them to a variety of situations. It is possiblethat the first of these two groups (the skin/VDU) is found also in other countries
than Sweden, but is not described there as "electromagnetic hypersensitivityÓ.
Throughout this document, the term "electromagnetic hypersensitivity" (whenplaced within citation marks) is used in the current, loosely defined way. Further
discussions on an international or at least inter-European level on this topic
would, however, benefit from a common and perhaps more strict terminology. We
therefore suggest that the skin/VDU situation is described as such (e.g. "skinsymptoms occurring in VDU work situations") and that the term "electromagnetic
hypersensitivity" is not used to cover these situations and these individuals. In
principle, we would prefer a similar restraint also for the second situation - calling
it e.g. "neurasthenic symptoms in the vicinity of electrical appliances" (although
we recognize that this could be difficult in some countries). If so, then the termelectromagnetic hypersensitivity could be restricted to situations - andinvestigations - that specifically address a sensitivity to electric or magnetic fields
or electric currents.
Appendix 3:33

On individual, predisposing factors
In one study, certain hormone levels differed between individuals with"electromagnetic hypersensitivity" and others, both constitutionally (for estradiol)and during VDU work (for prolactin and thyroxine) - but not in relation to EMF
levels. A few other investigations have reported differences between "electromagnetic hypersensitives" and others in terms of personality or disease behaviour.
These and some other indications suggest that "electromagnetic hypersensitive"
individuals may react differently (more intensively(?)) to various stress situations,
including concern for fields. These limited observations do, however, require
further support before a definite involvement of stress sensitivity in the causationof "electromagnetic hypersensitivity" can be considered established. The main
importance of such further investigations is likely to be the connection between
the results (if verified) and confirmation - or not - of a psychosomatic part in thecausal mecha-nism for "electromagnetic hypersensitivity".
Another individual trait that has been suggested is that of signs of a higher skinreactivity, both in terms of skin temperature variations between "electromagnetic
hypersensitives" and others, and in terms of increased occurrence of mast cells inskin biopsies. Again, these results are however found only in single studies, anddo require further study.
On sensitivity to external physical factors
A large variation in individual sensitivity to induced or contact electric current iswell established. Some indications that extreme groups exist in this sense havebeen forwarded. Its involvement in the process by which some individuals claim
to be "electromagnetic hypersensitive" has not been established, however.
Among some cases of "electromagnetic hypersensitivity", attribution has been
to "electrical" appliances that also emit modulated light (VDUs, fluorescenttubes). Following up on this, a few investigations have indi-cated that some"electromagnetic hypersensitivity" individuals are more sensitive to such light
modulations ("flicker") than healthy controls. Further investigations are in
progress, but whether and to what degree such sensitivity could explain some
subgroups of "electromagnetic hypersensitivity" is currently unknown.
On reactions to electric and magnetic fields
In some countries (Germany, Norway, Sweden, the UK and the US), provocations
studies of various electric or magnetic field exposures have been conducted withindividuals claiming "electromagnetic hypersensitivity". The recruitment methods, inclusion criteria, provocation design and endpoint under study have allvaried in these 12 studies - covering totally 284 "electromagnetic hypersensitive"
individuals as well as control persons in some of them. In one study, weakindications of reactions to electric/electrostatic fields in terms of tingling or
pricking sensations were made, while in another, various symptom did appear
after exposure to magnetic fields at varying frequencies (0.1 Hz to 5 MHz). The
results in the other 9 of these 11 studies were an inability to a/ detect fields and/orb/ to react to them in terms of symptoms. Taken overall, provocation studies toAppendix 3:34

date have not been able to verify a direct link between (mainly) low frequency
fields and problems of "electromagnetic hypersensitivity" that is independent ofawareness of the fields. For fields of higher frequencies, the limited number ofstudies performed enable no conclusions to be made.

Appendix 3:35

References
1.

2.

3.

4.
5.
6.

7.
8.
9.
10.

11.
12.
13.
14.
15.

16.
17.
18.
19.

Altpeter N. Study on health effects of the shortwave transmitter station of Schwarzenburg,
Berne, Switzerland (major report). BEW Publication Series No 55, August 1995, Bundesamt
fŸr Energiewirtschaft, 1995.
Andersson B, Berg M, Arnetz BB, Melin L, Langlet I, LidŽn S. A cognitive-behavioral
treatment of patients suffering from "electric hypersensitivity". J Occup Environ Med
1996;38:752-758.
Arnetz B, Berg M, LidŽn S. Job stress, VDU-work and skin symptoms. In: Luczak H, ‚akir
A, ‚akir G, ed. Work with Display Units «92 - Selected Proceedings of the 3rd International
Conference WWDU «92, Berlin, Germany. Amsterdam: Elsevier Science Publ, B.V, 1993:
59-63.
Baris D, Armstrong B. Suicide among electric utility workers in England and Wales. Br J Ind
Med 1990;47:788-792.
Baris D, Armstrong BG. A mortality study of electrical utility workers in QuŽbec. Occup
Environ Med 1996;53:25-31.
Baris D, Armstrong BG, Deadman J, ThŽriault G. A case cohort study of suicide in relation
to exposure to electric and magnetic fields among electrical utility workers. Occup Environ
Med 1996;53:17-24.
Bell GB, Marino AA, Chesson AL. Alterations in brain electrical activity caused by magnetic
fields: detecting the detection process. Electroencephal Clin Neuroptahol 1992;83:389-397.
Bengtsson G. StrŒlskyddsinstitutets kommentar om strŒlning och bildskŠrmar (Comments by
the Radiation Protection Board on radiation and VDTs, in Swedish). LŠkartidn 1986;83:61.
Berg M. Skin problems in workers using visual display terminals. A study of 201 patients.
Cont Derm 1988;19:335-341.
Berg M. Evaluation of a Questionnaire used in Dermatological Epidemiology. Discrepancy
between Self-reported Symptoms and Objective Signs. Acta Derm Venereol (Stockh)
1991;71, Suppl 156:13-17.
Berg M, Arnetz B, LidŽn S, Eneroth P, Kallner A. Techno-Stress. A PsychophysiologicalStudy of Employees with VDU-Associated Skin Complaints. J Occup Med 1992;34:698-701.
Berg M, Hedblad M-A, Erhardt K. Facial Skin Complaints and Work at Visual Display
Units. A Histopathological Study. Acta Derm Venereol (Stockh) 1990;70:216-220.
Berg M, LidŽn S, Axelson O. Facial skin complaints and work at visual display units. An
epidemiologic study of office employees. J Am Acad Derm 1990;22:621-625.
Bergdahl J. Psychologic aspects of patients with symptoms presumed to be caused byelectricity or visual display units. Acta Odontol Scand 1995;53:304-310.
Bergman H, Axelson O. BildskŠrmar och radonmiljš - radondšttrarna dras till bildskŠrmen,
inte till operatšren? (Visual display units and radon environment - radon daughters attracted
to the screen, not to the operators?, in Swedish). LŠkartidn 1986;83:678-679.
Bergqvist U. Video display terminals and health. Scand J Work Environ Health 1984;10:187.
Bergqvist U. Review of epidemiological studies. In: Kuster N, Balzano Q, Lin JC, ed. Mobile
Communications Safety. London: Chapman & Hall, 1996: 147-170.
Bergqvist U, FranzŽn O. Letters to the Editor: Electromagnetic field sensitivity. Electro- andMagnetobiology 1993;12:v-vii.
Bergqvist U, Knave B, Voss M, Wibom R. A longitudinal study of VDT work and health. Int
J Hum Comp Interact 1992;4:197-219.

Appendix 3:36

20. Bergqvist U, Wahlberg J. Skin symptoms and disease during work with visual display
terminals. Cont Derm 1994;30:197-204.
21. Bergqvist U, Wahlberg JE. Skin diseases, symptoms and complaints at VDU work investigating the impact of electric and magnetic fields. In: Luczak H, ‚akir A, ‚akir G, ed.
Work with Display Units «92 - Selected Proceedings of the 3rd International Conference
WWDU «92, Berlin, Germany. Amsterdam: Elsevier Science Publ, B.V, 1993: 64-69.
22. Bini M, Checcucci A, Ignesti A, et al. Exposure of workers to intense RF electric fields thatleak from plastic sealers. J Microwave Power 1986;33-40.
23. Carmichael AJ, Roberts DL. Visual display units and facial rashes. Cont Derm 1992;26:6364.
24. Castellino N, Mattei O. Psychosomatic symptoms. Boll Ocul 1989;68:19-24.
25. Cato Olsen W. Electric field enhanced aerosol exposure in visual display unit environments.
CMI Report No 803604-1, The Chr. Michelsen Institute, 1981.
26. Chevalier A, Bonenfant S, Picot M-C, Chastang J-F, Luce D. Occupational factors of anxiety
and depressive disorders in the French National Electricity and Gas Company. J Occup
Environ Med 1996;38:1098-1107.
27. Clarke K, Leo E. Re: "Depressive symptomatology in women and residential proximity tohigh-voltage transmission lines". Am J Epidemiol 1995;142:1248-1249.
28. Cook MR, Graham C, Cohen HD, Gerkovich MM. A Replication Study of Human Exposure
to 60-Hz Fields: Effects on Neurobehavioral Measures. Bioelectromagn 1992;13:261-285.
29. Dowson DI, Lewith GT, Campbell M, Mullee MA, Brewster LA. Overhead high-voltage
cables and recurrent headache and depressions. The Practitioner 1988;323:435-436.
30. Duchene AS, Lakey JRA, Repacholi MH. IRPA Guidelines on Protection Against NonIonizing Radiation. New York: Pergamon Press, 1990:1-111.
31. Edvardsson T. VDU workers with skin symptoms. Work and behavioural aspects. Department
of Applied Psychology, University of Uppsala, Uppsala, Sweden 1991
32. Eriksson N. The psychosocial work environment and illness among office workers.
Department of Sociology, University of UmeŒ, UmeŒ, Sweden 1996.
33. Eriksson N, Hššg J, Stenberg B, Sandstršm M. Facial skin symptoms in office workers. A
five year follow-up study. In: Grieco A, Molteni G, Piccoli B, Occhipinti E, ed. Work with
Display Units 94. Selected Papers of the Fourth International Scientific Conference on Work
with Display Units. Milan, Italy. Amsterdam: Elsevier Science B V, 1995: 357-362.
34. Fachner J, Rei§enweber J, David E. Is there electromagnetic hypersensitivity? In: Simunic D,
ed. COST 244 meeting on Electromagnetic Hypersensitivity. Graz: COST 244, European
Union, DG XIII/72/95, 1994: 30-40.
35. Falk R, Nyblom L. Radondšttrar och bildskŠrmsarbete. Resultat av en fšrstudie (Radondaughters and VDT work. Results from a pilot study, in Swedish). SSI-rapport 86-02,
National Radiation Protection Board, Stockholm, Sweden, 1986.
36. Feldman LR, Eaglestein WH, Johnson RB. Terminal illness. J Am Acad Derm 1985;12:366.
37. Fisher AA. "Terminal" Dermatitis Due to Computers (Visual Display Units). Cutis
1986;37:153-154.
38. Gordon ZV. Voprosy Gigieny Truda i Biologiceskogo Dejstvija Elektromagnitnych Polej
Sverchvysckich Castot (German translation: Fragen der Arbeitshygien und der biologische
Wirkung Elektromagnetischer Mikrowellenfelder, p 33-43: Klinisch-hygienische
GenenŸberstellung der Arbeitsbedingungen und des Gesundheitszustandes der Arbeiter, die
mit Mikrowellenstrahlungsquellen in BerŸhrung kommen). Leningrad: The "Medicina"
Publishing Company, 1966.
39. Graham C, Cook MR, Gibertini M, Riffle DW. EMF effects on hormonal and immune
function in women. The 1996 Annual Review of Research on Biological Effects of Electricand Magnetic Fields from the Generation, Delivery & Use of Electricity. November 19-21.
San Antonio, Texas: W/L Associates, Ltd, Frederick, Md, 1996: 84.
Appendix 3:37

40. Graham C, Cook MR, Rifle DW, Gerkovich MM, Cohen HD. Nocturnal melatonin levels inhuman volunteers exposed to intermittent 60 Hz magnetic fields. Bioelectromagn
1996;17:263-273.
41. Hagman M, Tšrnqvist S, Bergqvist U, Knave B. A prospective study among power industry
workers. Incidence of symptoms from the nervous system. (More details reported in EMF
Health & Safety Digest, Nov-Dec 1996 p 15). The Annual Review of Research on Biological
Effects of Electric and Magnetic Fields from the Generation, Delivery & use of Electricity.
San Antonio, Texas, USA: W/L Associates Ltd, Frederick, Md, 1996: 91.
42. Hamburger S, Logue JN, Silverman PM. Occupational exposure to non-ionizing radiation
and an association with heart disease: an exploratory study. J Chron Dis 1983;36:791-802.
43. Hamnerius Y, Agrup G, Galt S, Nilsson R, Sandblom J, Lindgren R. Double-blind
provocation study of hypersensitivity reactions associated with exposure to electromagnetic
fields from VDUs. Preliminary short version. In: Ramel C, ed. Seminarium omelšverkŠnslighet (Symposium on hypersensitivity to electricity). KVA report 1993:2.
Stockholm, Sweden: Royal Swedish Academy of Science, 1993: 67-72.
44. Hamnerius Y, Sjšberg P. Investigation of provoked hypersensitivity reactions from theelectric and magnetic fields of a video display unit. In: Simunic D, ed. COST 244 meeting on
Electromagnetic Hypersensitivity. Graz: COST 244, 1994: 44-45.
45. Hellbom M. Provokationsfšrsšk med elšverkŠnsliga personer. Effekterna av information om
fšrekomst av elektriska och magnetiska fŠlt. (Provocation attempt with individuals
hypersensitive to electricity. Effects of information about the presence of electric andmagnetic fields, in Swedish.) Department of Applied Psychology, University of Uppsala,Uppsala, Sweden, 1993
46. Hill AB. The environment and disease: Association or causation? Proc R Soc Med
1965;58:295-300.
47. Johansson O. ElšverkŠnslighet samt šverkŠnslighet mot mobiltelefoner. Resultat frŒn en
dubbelblind provokationsstudie av metodstudiekaraktŠr. (Hypersensitivity to electricity andsensitivity to mobile phones. results from a double blind provocation stody of methodologicalcharacter, in Swedish). Repoirt 2, Department of Experimental Dermatology, Karolinska
Institutet, Stockholm, Sweden, 1995.
48. Johansson O, Hilliges M, Bjšrnhagen V, Hall K. Skin changes in patients claiming to sufferfrom "screen dermatitis": a two-case open-field provocation study. Exp Dermatol
1994;3:234-238.
49. Jorulf L, BarregŒrd L, Hagberg S, Krogstad A-L, Ran A. A longitudinal study of symptoms
in office VDU-work at different room temperatures. A preliminary report. In: Luczak H,‚akir A, ‚akir G, ed. Work with Display Units «92 - Selected Proceedings of the 3rdInternational Conference WWDU «92, Berlin, Germany. Amsterdam: Elsevier Science Publ,
B.V, 1993: 54-58.
50. Kligman AM. Early destructive effect of sunlight on human skin. JAMA 1969;210:23772380.
51. Knave B, Bergqvist U, Wibom R. Symptom och subjektiva besvŠr vid "šverkŠnslighet mot
elektricitet" (Symptoms and subjective discomforts at "hypersensitivity to electricity", in
Swedish). National Institute for Working Life, Solna, Sweden, 1989 (1989:4).
52. Knave B, Wibom R, Voss M, Hedstršm L, Bergqvist U. Work with video display terminals
among office employees. I. Subjective symptoms and discomfort. Scand J Work Environ
Health 1985;11:457-466.
53. Koh D, Goh CL, Jeyaratnam J, Kee WC, Ong CN. Dermatological Symptoms Among Visual
Display Unit Operators Using Plasma Display and Cathode Ray Tube Screens. Ann Acad
Med Singapore 1990;19:617-620.
54. Kolmodin-Hedman B, Mild KH, Hagberg M, Jšnsson E, Andersson M-C, Eriksson A. Healthproblems among operators of plastic welding machines and exposure to radiofrequency
electromagnetic fields. Int Arch Occup Environ Health 1988;60:243-247.
Appendix 3:38

55. Korniewicz HR. Skin nerve stimulation caused by low frequency electric field. Polish J
Occup Med Environ Health 1993;6:417-424.
56. Korpinen L, Partanen J. Influence of 50 Hz electric and magnetic fields on the pulse rate ofhuman heart. Bioelectromagn 1994;15:503-512.
57. Korpinen L, Partanen J. The influence of 50 Hz electric and magnetic fields on humancardiovascular autonomic function tests. Electro Magnetobiol 1995;14:135-147.
58. Kuster N, Balzano Q. Experimental and numerical dosimetry. In: Kuster N, Balzano Q, LinJC, ed. Mobile Communications Safety. London: Chapman & Hall, 1996: 13-64.
59. Lagerholm B. BildskŠrmar och hudfšrŠndringar: IngŒende undersškningar motiverade(VDTs and skin changes: Intensive investigations motivated, in Swedish). LŠkartidn
1986;83:60-61.
60. Lambrozo J, Touitou Y, Dab W. Exploring the EMF-Melatonin connection: a review of thepossible effects of 50/60-Hz electric and magnetic fields on melatonin secretion. Int J Occup
Environ 1996;2:37-47.
61. Leitgeb N. Electromagnetic hypersensitivity. Quantitative assessment of an ill-definedproblem. In: Simunic D, ed. COST 244 meeting on Electromagnetic Hypersensitivity. Graz:
COST 244, 1994: 68-74.
62. Leitgeb N. ElektrosensibilitŠt. VEO Journal 1995;1:51-55.
63. LidŽn C, Wahlberg JE. Work with video display terminals among office employees. V.
Dermatologic factors. Scand J Work Environ Health 1985;11:489-493.
64. Lilienfield AM, Tonascia J, Tonascia S, Libauer CA, Cauthen GM. Foreign service healthstatus study - evaluation of health status of foreign service and other employees from selected
eastern European posts. Final report. NTIS, PB-288 163. Department of State, Washington
DC, 1978.
65. Lyskov E, B, Juutilainen J, JousmŠki V, Partanen J, Medvedev S, HŠnninen O. Effects of 45Hz magnetic fields on the functional state of the human brain. Bioelectromagn 1993;14:8795.
66. Mann K, Ršschke J. Effects of pulsed high-frequency electromagnetic fields on human sleep.
Neuropsychobiology 1996;33:41-47.
67. McDowall ME. Mortality of persons resident in the vicinity of electricity transmission
facilities. Br J Cancer 1986;53:271-279.
68. McKinlay AF, Andersen JB, Bernhardt JH, et al. Possible health effects related to the use ofradiotelephones. Proposals for a research programme by a European Commission Expert
Group. Brussels: European Commission, 1996.
69. McMahan S, Ericson J, Meyer J. Depressive symptomatology in women and residential
proximity to high-voltage transmission lines. Am J Epidemiol 1994;139:58-63.
70. McMahan S, Meyer J. Symptom prevalence and worry about high voltage transmission lines.
Env Res 1995;70:114-118.
71. Meister A, Eggert S, Richter J, Ruppe I. Die Wirkung eines hšchstfrequenten
elekromagnetischen Feldes (2,45 GHz) auf Wahrnehmungsprozesse, psychische Leistungund Befinden (Effects of an ultra-high frequency electromagnetic field on perception,
psychic performance and well-being, in German). Z gesamte Hyg 1989;35:203-205.
72. Nilsen A. Facial rash in visual display unit operators. Cont Derm 1982;8:25-28.
73. Nilsson R, Hamnerius Y, Mild KH, et al. Microwave effects on the central nervous system a study of radar mechanics. Health Phys 1989;56:777-779.
74. NorbŠck D, Edling C. Environmental, occupational, and personal factors related to theprevalence of sick building syndrome in the general population. Br J Ind Med 1991;48:451462.
75. NRPB. Board Statement on Restrictions on Human Exposure to Static and Time Varying
Electromagnetic Fields and Radiation. Doc NRPB 1993;4:1-69.

Appendix 3:39

76. Oftedal G, Nyvang A, Moen B. Long term effects on health complaints by reducing electricfields from VDUs. In: Johnson A, Oftedal G, ed. 5th Nordic Workshop on Biological Effects
of Low Frequency Electromagnetic Fields, StrŒlevernRapport 1997:6. ¯sterŒs: Norwegian
Radiation Protection Authority, 1997: 73-74.
77. Oftedal G, Vistnes AI, Rygge K. Skin symptoms after the reduction of electric fields fromvisual display units. Scand J Work Environ Health 1995;21:335-344.
78. Paneth N. Neurobehavioral Effects of Power-Frequency Electromagnetic Fields. Environ
Health Perspect 1993;101:101-106.
79. Perry FS, Reichmanis M, Marino AA, Becker RO. Environmental power-frequency magnetic
fields and suicide. Health Phys 1981;41:267-277.
80. Pierini F, Piccoli B, Moroni P. Dermatiti in operatori a VDT: Rassegna della letteratura(Dermatitis in VDT operators: a literature review, in Italian). Med Lav 1991;82:451-457.
81. Podd JV, Whittington CJ, Barnes GRG, Page WH, Rapley BI. Do ELF magnetic fields affecthuman reaction time? Bioelectromagn 1995;16:317-323.
82. Poole C, Kavet R, Funch DP, Donelan K, Cherry JM, Dreyer N. Depressive symptoms andheadaches in relation to proximity of residence to an alternating-current transmission line
right-of-way. Am J Epidemiol 1993;137:318-330.
83. Rea WJ, Pan Y, Fenyves EJ, Sujisawa I, Samadi N, Ross GH. Electromagnetic fieldsensitivity. J Bioelectr 1991;10:241-256.
84. Reichmanis M, Perry FS, Marino AA, Becker RO. Relation between suicide and theelectromagnetic field of overhead power lines. Physiol Chem & Physics 1979;11:395-403.
85. Rei§enweber J, David E, Pfotenhauer M. Untersuchungen Ÿber psychologische Aspekte bei
der Wahrnehmung von Magnetophosphenen und Elektrophosphenen (Investigations of
psychological aspects of the perception of magnetophosphenes and electrophosphenes, inGerman). Biomed Technik 1992;37:42-45.
86. Robinette CD, Silverman C, Jablon S. Effects upon health of occupational exposure to
microwave radiation (radar). Am J Epidemiol 1980;112:39-53.
87. Rothman KJ. Modern epidemiology. Boston: Little, Brown and Company, 1986.
88. Ruppe I, Hentschel K, Eggert S, Goltz S. Experimentelle Untersuchungen zur Wirkung von
50-Hz-Magnetfeldern (Schlu§bericht), Fb 11.003. Bundesanstalt fŸr Arbeitsmedizin, 1995.
89. Sandstršm M, Lyskov E, Berglund A, Medvedev S, Hansson Mild K. Neurophysiologicaleffects of flickering light in patients with perceived electrical hypersensitivity. J Occup
Environ Med 1997;39:15-22.
90. Sandstršm M, Lyskov E, Hanson Mild K. Neurophysiological effects of flickering light onpatients with electrical hypersensitivity. In: Simunic D, ed. COST 244 meeting on
Electromagnetic Hypersensitivity. Graz: COST 244, 1994: 88-93.
91. Sandstršm M, Mild HK, Lšnnberg G, Stenberg B, Wall S. Inomhusmiljš och hŠlsa bland
kontorsarbetare i VŠsterbotten. Elektriska och magnetiska fŠlt: en fall - referentstudie blandbildskŠrmsarbetare (The Office Illness Project in Northern Sweden. Electric and magnetic
fields: a case referent study among VDT workers, in Swedish). Undersškningsrapport
1991:12, National Institute of Occupational Health, Solna, Sweden, 1991.
92. Sandstršm M, Mild KH, Stenberg B, Wall S. A survey of electric and magnetic fields among
VDT operators in offices. IEEE Trans Electromagn Compat 1993;35:394-397.
93. Sandstršm M, Mild KH, Stenberg B, Wall S. Skin symptoms among VDT workers andelectromagnetic fields - a case referent study. Indoor Air 1995;5:29-37.
94. Sandstršm M, Stenberg B, Mild KH. Erfarenheter av patientprovokationer med elektriska
och magnetiska fŠlt. (Experience with patient provocations with electric and magnetic fields,
in Swedish). In: Ramel C, ed. Seminarium om elšverkŠnslighet (Symposium on
hypersensitivity to electricity). KVA report 1993:2. Stockholm, Sweden: Royal Swedish
Academy of Science, 1993: 62-66.

Appendix 3:40

95. Savitz DA, Boyle CA, Holmgreen P. Prevalence of depression among electrical workers. Am
J Ind Med 1994;25:165-176.
96. Selmaoui B, Lambrozo J, Touitou Y. Magnetic fields and pineal function in humans:
Evaluation of nocturnal acute exposure to extremely low frequency magnetic fields onserum, melatonin and urinary 6-sulfatoxymelatonin circadian rhythms. Life Sci
1996;58:1539-1549.
97. Siekierzynski M, Czerski P, Milczarek H, et al. Health surveillance of personnel
occupationally exposed to microwaves. II. Functional disturbances. Aerospace Med
1974;45:1143-1145.
98. Skulberg KR, Skyberg K, Eduard W, Goffeng LO, Vistnes AI, Levy F. Inneklima ved
dataskjerm - hjelper antistatbehandling av skjermen? Indoor climate at VDUs - does
antistatic treatment help?, in Norwegian). Report HD-FOU 1069/ FOU, Statens
arbeidsmilj¿institutt, Oslo, Norway 1996.
99. Slepicka J, Slivova A, Pochmon O, Zapletalova E. (cited from Terrana, 1994). Prac Lek
1967;19:5-11.
100. Sobel E, Davanipour Z, Sulkava R, et al. Occupations with exposure to electromagnetic
fields: A possible risk factor for Alzheimer«s disease. Am J Epidemiol 1995;142:515-524.
101. Stenberg B. Office Illness. The Worker, the Work and the Workplace. New Series 399, UmeŒUniversity, UmeŒ, Sweden, 1994.
102. Stenberg B. Skin symptoms and VDT work - reports from three continents. In: Grieco A,
Molteni G, Piccoli B, Occhipinti E, ed. Work with Display Units 94. Selected Papers of the
Fourth International Scientific Conference on Work with Display Units. Milan. Amsterdam:
Elsevier, 1995: 27-32.
103. Stenberg B, Hansson Mild K, Lšnnberg G, Sandstršm M, Sundell J, Wall S. Inomhusmiljš
och hŠlsa bland kontorsarbetare i VŠsterbotten. En enkŠtstudie av upplevd hŠlsa samt
exponeringsfšrhŒllanden i arbete och bostad. (The Office Illness Project in Northern
Sweden. A questionnaire study of perceived health and risk of symptoms related to personal
factors and occupational and residential exposure factors, in Swedish).
Undersškningsrapport 1991:11, National Institute of Occupational Health, UmeŒ, Sweden,
1991.
104. Svensson E, Svensson J. LŒngvarigt bildskŠrmsarbete gav lindriga hudbesvŠr - tendens tillškning vintertid (Prolonged VDU work caused mild skin discomforts - a tendency forincrease during winter, in Swedish). LŠkartidn 1987;84:1843-1845.
105. Swanbeck G, Bleeker T. Skin Problems from Visual Display Units. Provocation of Skin
Symptoms under Experimental Conditions. Acta Derm Venereol (Stockh) 1989;69:46-51.
106. Terrana T. Patologia da radiofrequenze e microonde: rassegna della casistica descritta nella
letteratura internazionale. In: Vecchia P, ed. Atti del Convegno Nazionale Radiazione
Ionizzanti: Effetti Biologici, Sanitari ed Ambientali. Como, Italy: 1994
107. Tj¿nn HH. Report of facial rashes among VDU operators in Norway. HŠlsorisker och
DataskŠrmar. Ergolab, Stockholm, Sweden, 1980.
108. Toomingas A. Provocation of the electromagnetic distress syndrome. Scand J Work Environ
Health 1996;22:457-458.
109. Tšrnqvist S, Eneroth P, Bergqvist U, Hagman M, Knave B. Biochemical Markers andOccupational Exposure in the Power Industry. The Annual Review of Research on Biological
Effects of Electric and Magnetic Fields from the Generation, Delivery & use of Electricity.
San Antonio, Texas, USA: W/L Associates Ltd, Frederick, Md, 1996: 45.
110. von Klitzing I. Low-frequency pulsed electromagnetic fields influence EEG of man. Phys
Med 1995;April/June:77-80.
111. Wadman C, Bergqvist U, Medhage …, Linder G, Knave B. ElšverkŠnslighet - en studie bland
kontorsarbetare (Hypersensitivity to electricity - a study among office workers, in Swedish).
Arbetslivsrapport 1996:5, National Institute for Working Life, Solna, Sweden, 1996.

Appendix 3:41

112. Wadman C, Medhage …, Bergqvist U, et al. Differences in melatonin between Òelectric
hypersensitiveÓ and healthy individuals - a case-control study. Presented at the 25th
International Congress on Occupational Health. Stockholm, 1996: 114.
113. Wahlberg JE. NŒgon specific bildskŠrmsrelaterad hudsjukdom har inte observerats bland 100
undersškta operatšrer. (No specific VDT-related skin disease have been observed among 100
examined operators, in Swedish). LŠkartidn 1986;83:3328-3329.
114. Wang T, Hawkins LH, Rea WJ. Effects of ELF magnetic fields on patients with chemicalsensitivities. In: Simunic D, ed. COST 244 meeting on Electromagnetic Hypersensitivity.
Graz: COST 244, 1994: 123-132.
115. Wennberg A, FranzŽn O, Paulsson L-E. Electromagnetic field provocations of subjects with
"Electric hypersensitivity". In: Simunic D, ed. COST 244 meeting on Electromagnetic
Hypersensitivity. Graz: COST 244, 1994: 133-139.
116. Wennberg A, FranzŽn O, Paulsson LE. Reaktioner vid exponering fšr elektriska ochmagnetiska fŠlt. Provokationer av personer med och utan "elšverkŠnslighet". (Reactions toexposure to electric and magnetic fields - provocations of subjects with "electricalsensitivity", in Swedish). Arbete och HŠlsa 1994;1-19.
117. WHO. Biological Effects and Health Hazards of Microwave Radiation, 15-18 October, 1974.
Warzaw, Poland: The World Health Organisation, The US Department of Health, Educationand Welfare, and The Scientific Council to the Minister of Health and Social Welfare,
Poland, 1974.
118. WHO. Electromagnetic Fields (300 Hz to 300 GHz). Environmental Health Criterai 137,
World Health Organization, Geneva, 1993.
119. Wibom R, NylŽn P, Wennberg A. Flimmer frŒn lysršr. En mšjlig bidragande orsak till
besvŠr vid "elšverkŠnslighet" (Flicker from fluorescent tubes. A possible contributary causeof "hypersensitivity to electricity", in Swedish). Undersškningsrapport 1995:31, National
institute for Working Life, Solna, sweden, 1995.

Appendix 3:42

Appendix 4. Risk perception andcommunication
As stated in the main text of this report, Kunsch (5) listed a number of factors,
within those listed in Table 1 in the main text, which may have relevance in thecase of electromagnetic fields. Here we discuss in more detail these factors,
whose relative importance of each depends on the source, on the exposure
conditions, and mainly on the perception of an individual person. Therefore, noranking of the factors is possible, and their order in the following is completely
arbitrary.
The catastrophic potential should be of minor relevance. No possibility ofaccidents is foreseen even by the general public. However, distorted messages
such as Òelectrical ChernobylÓ in the case of clusters of broadcasting antennas, orof power lines, could create attitudes similar to catastrophic fear.
The different role of familiarity has already been discussed. In addition, it may
be noted that even if people are familiar with electricity, they are not with electricand magnetic fields in se. The fields cannot be seen, on perceived by senses, apartfrom special cases (e.g. hair stimulation by intense electric fields), and thisÒhiddenÓ nature increases the concern, also because of the similarity with ionizing
radiation.
The uncertainty and the lack of understanding of mechanisms and effects are
the focus of public debates and controversies, and consequently are likely to havea great impact also on individual perception of risks.
Whereas the biological and health effects of high intensity fields are wellknown and understood, not even the basic interaction mechanisms underlying
hypothesized effects of low-level exposures have been clearly identified. The
possibility of such effects is still a matter of controversy among scientists, withphysicists in general being more skeptical than biologists and epidemiologists (seee.g. the statement of the American Physical Society (1)). That induces large
uncertainties in the evaluation of risks, further increased by inconsistencies andcontradictions in the scientific findings of biological effects.
People are confused by controversial results and diverging opinions of experts,
and that results in a general lack of credibility in science.
The risk is absolutely uncontrollable by individuals, who in most cases are noteven aware of the exposure. When awareness is possible, as in the case of VDUs
or cellular phones, that does not imply a control of actual exposure and, evenmore, of risks. People in fact do not know Òhow muchÓ they risk, due to theabsence not only of any indication of dose-effect relationships, but also of a clear
concept of ÒdoseÓ.
Exposure to electromagnetic fields is in most cases involuntary. Significant
exceptions are the use of home computers and cellular phones. The perception ofrisks in this cases, with respect to other similar exposures, would warrant further
Appendix 4:1

investigation. In the absence of ad hoc research, the empirical observation of usersof cellular phones, who are concerned with radiation from base stations more thanfrom the portable set (whose exposure is much higher), suggests a relevant role ofthe perception of risks, at least for this source.
As already discussed, effects on children and on future generations play asignificant role in determining the perception of risks from electromagnetic fields,
mainly due to the cancer issue. Also epidemiological and biological findings on
pregnancy disturbances and teratogenic effects probably influence peopleÕs
attitude. That holds true in particular for VDUs and this attitude seems not
modified by most recent studies which do not support the hypothesis of
miscarriages or other effects on pregnancy for such exposures. It has been
observed in fact (5) that the initial information is essential for the attitude of the
public towards new sources of risk, whereas later on the human mind tends toselect the information which supports oneÕs previously formed opinions.
The importance of coverage by the media is obvious and will be discussed in
more detail in the paragraph on risk communication.
The benefits of most technologies involving exposure to electromagnetic fields(electricity, broadcasting, telecommunications) are generally well recognized. The
distribution of risks, on the contrary, may be a matter of controversy. That seems
quite clear for the siting of power lines and base stations for cellular phones. The
attitude is the same which is exhibited in completely different cases, where a
NIMB (Ònot in my backyardÓ) logic prevails. This factor therefore interferes withpersonal stake, in the sense that risks are perceived as higher risks by people
personally exposed.
It may be presumed that the human origin of most electromagnetic pollution isa cause for increased concern. In addition, sources with high visual andenvironmental impact, such as power lines and broadcasting towers, are perceived
as Òhard technologiesÓ, and that is generally an additional reason for fear.
In conclusion, most of the factors identified in previous research on different
agents, activities and habits are likely to contribute to some extent to theperception of risks for electromagnetic fields.
Other subjective attitudes may however be relevant for risk perception. It is
likely in fact that anxiety and discomfort related to inconscious causes (e.g.
psychosocial factors) are projected onto an external, visible source such as anantenna, a power line, or a VDU at the workplace.
The question of the different perception of risks by lay people and by experts
has been addressed by Fremlin(2).
Table 1 shows the different ranking of a number of different activities by four
different groups. The comparison indicates very large differences in risk
perception, in both directions. Nuclear power is considered a threat by the generalpublic much more than by experts, who on the contrary appreciate the risks of Xrays more than lay people.

Appendix 4:2

Table 1. Ordering of perceived risk, by experts and by three lay groups, for a selected
number out of 30 activities and technologies in the USA (2).

Motor vehicles
Smoking
Alcohol
X-rays
Police work
Nuclear power

15 experts

40 women

30 students

1
2
3
7
17
20

2
4
6
22
8
1

5
3
7
17
8
1

25 active
club members
3
4
5
24
7
8

Electromagnetic fields are not included in the study; however, empiricalexperience clearly indicates a big difference, the risks is perceived as a more
likely and severe risk by the public as compared to scientists.
The matter is being investigated by the Harvard Center for Risk Analysis. They
reported (4) on the interview of 1,000 Americans about a variety of alleged
hazards in the daily life that had been covered by the media. Interestingly,
respondents were less confident that electromagnetic fields were a hazard thanthey were about nearly all the agents covered by the survey (Table 2). The
striking coincidence of findings on X-rays and electromagnetic fields issuggestive of a tendency by the public to associate (or even confound) the twosources, as pointed out above.
Table 2. Hazard confidence score within the public in the USA adopted from the Harvard
Center for Risk Analysis (4)ITEM
Heavy smoking
Environmental tobacco smoke
Ozone Depletion
Global Warming
Radon
Medical X-rays
Electric and Magnetic Fields

Percent Top Score1
90.0
71.9
63.2
51.4
46.7
38.8
38.3

Mean Score2
9.1
7.7
7.1
6.4
6.2
5.6
5.5

1

Percentage of responses equal to 7 or more on a 10-point scale.

2

Mean score of the 1,000 respondents.

Further research is in progress to investigate how much difference there is
between the public and the scientific community in their perception of risks fromelectromagnetic fields. It has already been reported (3) that also within scientists
the confidence on the existence of health risks from such sources spans over awide range.
The relationship of knowledge and familiarity of risks with their perception has
been the object of a study on power lines performed by Granger Morgan, Slovic
and coworkers (7). They reported a comparison of risk perception for 16 known
or potential hazards through a psychometric representation, i.e. a two dimensional
diagram (Figure 1) where factors 1 and 2 are made up of a combination of factors(see Table 1 in the main text) that seem to go together. Factor 1 Òdread riskÓ

Appendix 4:3

stands for: uncontrollable, dread, consequences fatal, not equitable, catastrophic,
high risk to future generations, not easily reduced, risk increasing, involuntary.
Factor 2 Òunknown riskÓ represents: not observable, unknown to those exposed,
effect delayed, new risk, risks unknown to science. The negative axes denote therespective opposite characteristics.
It is not surprising that risks from power lines, although equally unknown as
those for electric blankets and not far from VDUs and microwave ovens, areperceived as ÒdreadÓ, probably due to involuntarity. In the same study, the authors
found that exposure from power lines and electric blankets were ranked by lay
people among the least risky of the hazards considered. However, the provision of
information on scientific findings on ELF fields, that was initially very limited,
produced a significant shift in the perception of the respondents towards moreÒdread riskÓ. This point is very important for the connection between risk
communication and risk perception. The debates on electromagnetic fields have infact increased over the more than one decade that has passed after the study, and it
is likely that information disseminated by the media has produced a similar shift
in the appraisal of risk by the public in general.
Plastic food container,
fields from electric blankets,
visual display units,
microwave ovens,
caffeineÒUnknownriskÓ

Factor 2

Not a ÒdreadÓ risk
Power lawn mowers,
automobiles, bicyclesÒKnownriskÓ

Fields from large powerlines,
pesticides, diagnostic X-rays,
nuclear reactors

Factor 1
ÒDread riskÓ
Cigarette smoking, large dams,
commercial aviation,
handguns

Figure 1. Location of hazards on two risk-dimensions for 16 known or perceived hazards
Data from Morgan et al. (7)These findings are fairly consistent with a recent study in Norway (6), where asurvey on about 1,000 people shows that approximately two thirds of the sample
consider health effects to be probably due to exposure, and three quarters regard
the fields being more dangerous than they formerly believed.
The Norvegian survey also confirms the importance of voluntarity. Even
though the Norvegian public is well aware of the electromagnetic fields generated
by domestic appliances, the concern is much lower than for power lines (Table 3).

Appendix 4:4

Table 3. Reported anxiety for different sources of radiation and fields in Norway.
Percentage of respondents (adapted from Maerli (6).
SourceRadioactive fallout
Power lines
UV
X raysComputer screensElectric devices
Microwave ovens

Veryfrightened
57
10
8
5
3
3
3

Ratherfrightened
24
19
20
9
7
5
5

A bit
frightened
13
34
42
33
27
26
23

Not
frightened
5
34
27
51
59
64
64

DonÕt
know
1
3
3
2
4
2
5

References
1.
2.
3.
4.
5.
6.
7.

APS. Statement on "Power Line Fields and Public Health. American Physical Society, 1995
Fremling JH. Power production, what are the risks? (2nd ed.) Adam Hilgar, Bristol, New
York, 1989.
HCRA. Workers, EMFs, and cancer. Report vol 3 no 2, Harvard Center for Risk Analysis,
Boston, Mass, 1995.
HCRA. EMFs and childhood cancer. Report vol 4 no 2, Harvard Center for Risk Analysis,
Boston, Mass, 1996.
Kunsch B. Electromagnetic fields and risk perception. In: Simunic D, ed. COST 244 meetingon Electromagnetic Hypersensitivity. Graz: COST 244, 1994: 58-67.
Maerli MB. The Norwegian public«s perception of risk from electromagnetic fields. Radiat
Prot Dosim 1996;68:235-238.
Morgan MG, Slovic P, Nair I, et al. Powerline frequency electric and magnetic fields: A pilot
study of risk perception. Risk Anal 1985;5:139-149.

Appendix 4:5

Appendix 5. Information material
In the following, the addresses contacted in order to ask for information material
as well as the contact letter are included. Furthermore the evaluation sheet used toget a somewhat uniform description of the different information brochures ispresented. Finally, the first and the back page of each evaluated brochure isincluded in the appendix.

Address list of organisations and institutions asked for information material on electromagnetic fields
The following list contains addresses of institutions and organizations in various
European nations. It should be noted that sometimes information is used inneighboring states as well as in the country of origin. Some organisations also
sent information material prepared by other organisations. In the documentarypart of this report the first and last page of each brochure received and evaluatedis to be found. As is evident from the list below, not all institutions replied bysending information brochures.
Austria
Total number of brochures received and evaluated: 3
Addresses referred to:
Verband der ElektrizitŠtswerke …sterreichs
Brahmsplatz 31040 Wien
UnfallverhŸtungsdienst der Allgemeinen Unfallversicherungsanstalt
Adalbert-Stifter Str.65
1201 Wien
Belgium
Total number of brochures received and evaluated: 1
Addresses referred to:
Begacom D5Service MOB
Rue des Palais 421210 Bruxelles

Appendix 5:1

Vlaamse Instelling vor Technologisch Onderzoek
Boerentang 200
2400 Mol
Denmark
Total number of brochures received and evaluated: 3
Addresses referred to:
The National Board of Health
Amaliegade 13
PB 2020
Kopenhagen K
Denmark 1012
Finland
Total number of brochures received and evaluated: 2
Addresses referred to:
Finnish Center for Radiation and Nuclear Safety
POB 1400881 Helsinki
FranceTotal number of brochures received and evaluated: 3
Addresses referred to:
Institut National de Recherche et de Securite
30 rue Olivier-Noyer
75680 Paris Cedex 14
Unipede28 rue Jacques Ibert
75888 Paris Cedex 17
Germany
Total number of brochures received and evaluated: 14
Addresses referred to:
Berufsgenossenschaft der Feinmechanik und Elektrotechnik
Gustav Heinemann Ufer 130
50968 Kšln

Appendix 5:2

Bundesamt fŸr Strahlenschutz, Institut fŸr Strahlenhygiene
IngolstŠdter Landstra§e 185764 Oberschlei§heim
Forschungsgemeinschaft Funk e.V.
Bonn Center, HI 305
53115 Bonn
Informationszentrale der ElektrizitŠtswirtschaft e.V.
Postfach 7005 61
60555 Frankfurt Main
Umweltschutzreferat MŸnchen
Rindermarkt 1080331 MŸnchen
Verbraucherzentrale Niedersachsen e.V.
Herrenstr.14
30159 Hannover
GreeceTotal number of brochures received and evaluated: 0Addresses referred to:
National Center for Scientific Research ÒDemocritosÓ
153 1D AG. Paraskevi Attikis
POB 60228
AthensIreland
Total number of brochures received and evaluated: 2
Addresses referred to:Electrical Supply Board
Lower Fitzwilliam Street
Dublin 2

Appendix 5:3

ItalyTotal number of brochures received and evaluated: 0Addresses referred to:
Istituto di ricerca sulle onde elettromagnetichedel Consiglio Nazionale delle Ricerche
Via Panciatichi 640127 Firenze
Luxembourg
Total number of brochures received and evaluated: 0Addresses referred to:
Ministere de la sante de la securite sociale delÕeducation physique et des sports de la jeunesse
Division de la Radioprotection
Portugal
Total number of brochures received and evaluated: 0Addresses referred to:
Instituto das Communicationes de Portugal
Av. Jose Malhoa
Lote 1683
1000 Lisboa
Higiene e Seguance do Trabalho
Gen. Dir.
Av. da Republica 84
1000 Lisboa
Spain
Total number of brochures received and evaluated: 0Addresses referred to:
Direccion General de Telecommunicaciones
Ministerio de Obras Publicas, Transportes y Medio Ambiente
Placio de Cibeles, s/n 5 a Planta
28014 Madrid

Appendix 5:4

Institudo de Seguridad e Hygiene en el Trabajo
Torrelaguna 73
28027 Madrid
Ministerio de Industria y Energia
Avda Complutense 22
28040 Madrid
SwedenTotal number of brochures received and evaluated: 6
Addresses referred to:
National Board of Occupational Safety and Health
171 84 SolnaElsŠkerhetsverket
Box 1371
11193 Stockholm
ForskningsrŒdsnŠmnden
Box 6710
113 85 Stockholm
Fšreningen fšr El- och BildskŠrmsskadadeBox 151 26
104 65 Stockholm
Switzerland
Total number of brochures received and evaluated: 2
Addresses referred to:
Bundesamt fŸr Umwelt, Wald und Landschaft
3003 Bern
Schweizer Bundesam fÙr Gesundheitswesen
Abteilung Strahlenschutz
Bollwerk 27, Postfach
3003 BernSUVA Schweizerische Unfallversicherungsanstalt
PostfachFluhmattenstr. 1
CH 6002 Luzern

Appendix 5:5

The Netherlands
Total number of brochures received and evaluated: 0Addresses referred to:
Ministry of Welfare, Health and Cultural Affairs
Directorate for Food and Product Safety
PO BOX 3008
United Kingdom
Total number of brochures received and evaluated: 4Addresses referred to:
National Radiological Protection Board
Chilton Didcot
Oxon OX11 OQRElectricity Association Services Limited
30 Milllbank
London SW1P 4RD

Appendix 5:6

Contact letter
The following letter was sent to these organisations.

Dr. Evi Vogel
Institute for Radiation Hygiene
Federal Office of Radiation Protection
85764 Obercleissheim
Germany

8 Aug 1996

Dear ladies and gentlemen,
the European Commission is funding a project on ÒPossible health
implications of subjective symptoms and electromagnetic fieldsÓ. Ten
scientists of six different European countries are about to collect, evaluate, and coordinate knowledge and practical experiences on persons
showing symptoms due to the fields of electric or magnetic devices or
the proximity of other such sources. Within a year a status report will
be prepared and recommendations on actions to be taken will be
included. We expect that information on electric, magnetic, andelectromagnetic fields in general will play a major role. Therefore we
intend to include in our status report also a review on what different
kinds of such information is circulated in different countries. It would
be very helpful if you could send us your information leaflets, if you
have any, and also tell us how videly they are spread.
Thank you very muchYours sincerely(Dr Evi Vogel)

Appendix 5:7

Evaluation checklist
1. General
1.a
1.b
1.c
1.d
1.e
1.f

Titel of brochure:in English:
Editor/Organisation:
Country/Language:
Number of pages:
Year:
Written for whom:

2. Layout
2.a

Is type of language used appropriate for the readers referred to:(1=very much... 4= not at all)2.b
Are comparisons given to explain things?
few
severalmany
interesting examples:
2.c
Pictures/photos :x/y pages(1= very good,....4=very bad, 0= none):mostly amusing
2.d Graphs x/per y pages(1= very good,....4=very bad, 0= none):
2.e Tables/lists
x/y pages
or text inserts (1= very good,....4=very bad, 0= none):
3. Content

3.a
3.b

Compared with length of paper:
1= very good,....4=very bad, 0= none
Is information given on:
nature of EMF:
sources:results of studies (state of the art):
limits:which limits (international, national, self made)Appendix 5:8

3.c

3.d

Is information given on individuals with Òelectromagnetic
hypersensitivityÓ or on psychological effects:
e.g.:
e.g. recommendations:(interesting examples on back side)
Addresses for further information:

4. Argumentation space
4.a

4.b
4.c

(what type of arguments are used, 1= very much ...4= not at all)
Is content of brochure:
an instruction
a warninga persuasiona dialogue
objective/subjective(1= very obj....4=very subj.)
Is there a clear cut between informing and debating:
Are controversies referred to:e.g.

Appendix 5:9

Information brochures from different European countries
The front and back page of brochures from the following nations andorganisations are reproduced on the following pages:· Austria:- UnfallverhŸtungsdienst (UVD) der Allgemeinen Unfallversicherungsanstalt(AUVA), page App 5:11;- Verband der ElektrizitŠtswerke …sterreichs, page App 5:12-13,· Belgium: Vlaamse Instelling voor Technologisch Onderzoek (VITO),
page App 5:14,· Denmark: Sundhedsstyrelsen, page App 5:15-17,· Finland: SŠteilyturvakeskus (STUK), page App 5:18-19,· France: Institut National de Recherche et de SŽcuritŽ (INRS),
page App 5:20-21,· Germany:- Bundesamt fŸr Strahlenschutz (BfS), page App 5:22-25;- Umweltschutzreferat der Landeshaupstadt MŸnchen, page App 5:26;- Informationszentrale der ElektrizitŠtswirtschaft e. V. (IZE),
page App 5:27-29;- Arbeitskreis Schulinformation Energie, page App 5:30;- Forschungsgemeinschaft FUNK, page App 5:31;- Berufsgenossenschaft der Feinmechanik und Elektrotechnik, page App 5:32;- Verbraucher-Zentrale Niedersachsen e.V., page App 5:33;- Wulf-Dietrich Rose/KiWi, page App 5:34;- Info-Blatt ELEKTROSMOG, page App 5:35,· Ireland: Electricity Supply Board, page App 5:36-37,· Sweden:- Arbetarskyddsstyrelsen and other authorities, page App 5:38;- Boverket and other authorities, page App 5:39;- ForskningsrŒdsnŠmnden, page App 5:40;- ElsŠkerhetsverket, page App 5:41;- El- och BildskŠrmsskadades Fšrening, page App 5:42-43,· Switzerland: Bundesamt fŸr Umwelt, Wald und Landschaft (BUWAL),
page App 5:44-45,· United Kingdom:- Electricity Association, page App 5:46-47;- National Radiological Protection Board, page App 5:48-49,· Unipede: Permanent Group on Medical Matters, page App 5:50.

Appendix 5:10