What the History of Epidemiology and Toxicology Teach

What the History of Epidemiology and Toxicology Teach Us About Understanding Cell Phone Risks Devra Davis, Ph. D. MPH Porto Allegre, Brasil May 19, 2009

Caveat Emptor

International Congress of Scientific and Social Campaign Against Cancer held in Brussels in 1936

Known Cancer Causes -Chapter 2 International Congress of Scientific and Social Campaign Against Cancer, 1936 • • • Hormones X-Radiation Solar radiation Coal tars/ soots Benzene Cobalt-uranium mining

Clarence Cook Little headed the American Cancer Society until 1954, when the geneticist became the founding Director of the Scientific Advisory Board of the Tobacco Industry Research Council.

Chapter 7: Saving Cigarettes

The Secret Ingredient in Kent Cigarettes? ? ? Crocidolite Asbestos

Cell Phone Science Follows Tobacco Playbook • Raise doubts about experimental findings • Fund and develop studies • “War Gaming” of challenging results

Changing Cell Phone Patterns phones per 1000 users Region US 1990 2005 127 683 946 Western 60 Europe Asia 7. 1 930 1008 230 379 World 123 319 2. 1

Use among 1, 600 13 -to-15 -year-olds in Belgium, Katholieke University Leuven • almost 60% of students (ages 13 -15) used cell phones to talk or text message after turning their lights out at bedtime. • teens who used their cell phone more than once a week after lights-out were five times more likely than those who never did so to indicate fatigue and sleep difficulties.

Cell Signals Penetrate the Brains of Children More than Adults With Permission of Om P. Gandhi

[Gandhi and Kang, 2002]

SAR in plane of antenna feed point Adult 10 year old 5 year old Bit-Babik et al. “Simulation of Exposure and SAR Estimation for Adult and Child Heads Exposed to RF Energy from Portable Communication Devices” Radiation Research 163, 580 -590 (2005)

French Telecom Estimate of Differential Absorption of Radiofrequency with Age Wiart et al Phys Med Biol 2008; 53: 368

Marketing Cell Phones For Children glow. Phone Gift Package glow. Phone everything active kids and parents need to keep in touch during their increasingly busy days. The glow. Phone features a full color screen, built in games, customizable ringtones and wallpapers also has a flashlight. $74. 98 Show Color:

Marketing to Five Year Olds

Pew Center Estimates on Children’s cell phone patterns • 63% of teenagers age 12 -17 have cell phones • Girls age 15 -17 most likely to have them (79 percent). • 55% of teens with cell phones use them to talk daily. 60% of teens with cell phones send text messages daily. 54% of kids age 8 -12 are expected to have a cell phone in the next three years. Sources: Pew Internet & American Life Project report “Teens and Social Media” and the Center on Media and Child Health, 2008

Changing Use of Cell Phones in U. S. Children/Young Adults 2008 • • 20% of seven year olds 40 -60% of middle school children Changing use patterns The average cell phone call in 2003 lasted 2. 87 minutes, and the average monthly bill was $49. 91. • Growing marketing to children

Changing Patterns of Cell Phone Use in Teenagers • No students had their own mobile phones 20 years ago • 2008 more than three-fourths of all teens age 15 -17 possess cell phones

Special Packaging for Children

Cell phone use among children Children are a sensitive population: For most tumors and a large number of carcinogens there is an inverse association between age at exposure and development of the disease. Children can experience a long latency period between exposure and development of the disease. Sadetzki, 2009

MOBI-KIDS “Risk of brain cancer from exposure to radiofrequency fields in childhood and adolescence” [Collaborative Project of the Seventh Framework Programme Theme Environment (including climate change) – 2009 -2014] Childhood brain cancer from exposure to radiofrequency fields in childhood and adolescence • Collaborative Project. • EC grant – topic of call: Health impacts of exposure to RF fields in childhood and adolescence (ENV. 2008. 1. 2. 1. 1. )

FRANCE, DECEMBER 2008

(Vriheid M, Occup Environ Med 2006) Detailed data on cell phone use (duration & frequency of calls, side of use, use while moving, use of handset and handheld devices, use in urban & rural areas) r=0. 7

“Based on the largest number of benign PGT patients reported to date, our results suggest an association between cellular phone use and PGTs”. This research was funded by The Israel Cancer Association

Cellular phone use & the risk of benign & malignant Parotid Gland Tumors – a nationwide case-control study Consistent elevated risks were shown in complementary analyses restricted to conditions that may yield higher levels of exposure: After 5 y of cellphone use, an increase of 34% was observed in the risk to develop a tumor, in the same side of the head where the cell phone was held. For ipsilateral use, an excess risk of about 50% was observed in the highest category of use. An excess risk was found among cell phones heavy users in rural areas characterized by a relatively small number of antennas. (Sadetzki S, Am J Epidemiol 2008)

INTERPHONE study: % of cellphone heavy users (upper quintile) by center Sadetzki Interphone upper quintile=735 h Israel upper quintile=1324 h Interphone upper quintile=12800 Israel upper quintile=25328 calls

Hardell metanalysis, 2008

Interphone Summary

Interphone Release, October 8, 2008 • No increased risk meningioma, parotid gland tumors • Doubled risk of gliomas in Denmark, France, Germany, Japan with 10 yrs of use • Some increase in acoustic neuroma

Acoustic Neuroma Meta-analysis Han et al. , 2009 • Cell phone use for at least 10 years had a 2. 4 -fold of acoustic neuroma (95% CI = 1. 1 -5. 3)

Need for Industry Records for independent evaluation • reduce recall bias and increase statistical power • conduct retrospective analyses of first adopters & typical SAR with geocoding • evaluate impacts on children and teenagers • advise regarding engineering redesign

Existing Studies Biased Toward Null • • Insufficient latency time. The time between exposure and diagnosis of a brain tumor, similar to smoking and lung cancer could be several decades. "Regular" cellphone use is defined as once a week for 6 months or more. Would you expect to find lung cancer in a smoker who had smoked for once a week for 6 months or more? No young adults or children included. Because their brains are more susceptible, they are likely to be vulnerable.

Methodological Critiques • Cellphones used in rural areas radiate more power than in urban areas. Studies have not included rural users. • Cordless phones are similar to cellphones yet cordless phones users are treated as unexposed. • People who die before they can be interviewed are excluded. This underestimates risks of most deadly brain tumors. • • Interviews conducted in hospital after surgery • Recall bias (imperfect memory). An Interphone study, using billing records, has shown that light users underestimate their use and heavy user overestimates their use.

Cell Phone Studies Industry Effect No Effect Total Funded 25 52 77 (42%) (32%) Non-Industry- 105(58%) Funded Total 74 (70%) 99 (54%) (68%) 31 (30%) 83 (46%) 182 Odds ratio=0. 2 c 2 = 24. 36 (p<. 001) an industry funded study is 1/5 as likely to report a positive finding compared to an independent one. (1/29/04) Source: Lai and Richter

Biological Plausibility • Alters heat shock proteins • Increases permeability of blood, brain barrier • Epigenetic effects on methylation and DNA repair • Some thermal effects

Ethical Questions? ? • Apparent release of peer review to attorneys engaged in litigation

Department of Health “Mobile phones & Health” Leaflet (October 2006 ) • If you use a mobile phone, you can choose to minimize your exposure to radio waves. – keep your calls short – consider relative SAR values when buying a new phone. • Radio waves above a certain level can cause heating effects to the body. International guidelines have been set to keep exposure to radio waves below that level. • The UK has a ban on handheld cell phone use while driving.

U. K. Advice (continued) • For children and young people (under the age of 16), the UK Chief Medical Officers strongly advise: – use mobile phones for essential purposes only – keep all calls short - talking for long periods prolongs exposure and should be discouraged • The UK CMOs recommend that if parents want to reduce potential risks to children they should restrict children’s use of mobile phones.

FRANCE, DECEMBER 2008

The Israeli Ministry of Health – Recommendations for cell phone use (July 2008) “In general, the Israeli Ministry of Health embraces the guidelines published by most international entities, which recommend following the precautionary principle in relation to mobile phone use. Accordingly, the Israeli Ministry of Health recommends the following: ” Use of a speaker/hands free device or earphones. Reducing the number and duration of cell phone calls is another simple way of decreasing the exposure. In areas where the reception is weak, the exposure level increases. Therefore, one should talk less in these areas. It is highly recommended that the precautionary rules be followed by children, who are in general, more sensitive to develop cancer following exposure to carcinogenic factors. While driving, it is best to speak as little as possible and, in any case, to follow regulation B 28. http//: www. health. gov. il/pages/default. asp? Page. Id=4408&cat. Id=838&maincat=46

Center for Environmental Oncology University of Pittsburgh Cancer Institute – Recommendations for cell phone use (July 2008) “Precautionary Principle” Use of a speaker/hands free device or earphones. Reducing the number and duration of cell phone calls is another simple way of decreasing the exposure. In areas where the reception is weak, the exposure level increases. Therefore, one should talk less in these areas. It is highly recommended that the precautionary rules be followed by children, who are in general, more sensitive to develop cancer following exposure to carcinogenic factors. http//: www. health. gov. il/pages/default. asp? Page. Id=4408&cat. Id=838&maincat=46

UK, Department of Health “Mobile phones & Health” Leaflet (October 2006 ) Gaps in scientific knowledge led the Stewart Group to recommend a precautionary approach to the use of mobile phones and base stations.

French Government Proposed Restrictions on Cell Phones, January, 2009 • Ban advertising to children under 12 • Ban design of phones to be used by those under six. • Handsets must be sold with phones • City of Lyon official advertising campaign to discourage the use of the phones by children.

Finnish Authorities Warn of Cell Phone Risks to Children and Those with Pacemakers • Use text messages rather than calls • Use hands-free devices, with phone kept away from the body, • Avoid talking in an area with low connectivity • Disruption of pacemakers is usually harmless, but can increase heart beat

Finnish Authorities Warn of Cell Phone Risks to Children “Although research to date, has not demonstrated health effects from mobile phone’s radiation, precaution is recommended for children as all of the effects are not known. ”

Many governments advise against children using cell phones: • • • England France Germany Israel Finland Bangalore, India

Nick Naylor—Moral Flexibility

Truth is Stranger Than Fiction • “Gentlemen, practice these words in front of the mirror: Although we are constantly exploring the subject, currently there is no direct evidence that links cell phone usage to brain cancer. ”

For more information visit: • • preventingcancernow. org ewg. org thesimplebody. com devradavis. com

Center for Environmental Oncology Leadership and Staff • Ronald B. Herberman, MD, Director of UPCI Cancer Centers • Devra Lee Davis, Ph. D. MPH, Director • Maryann Donovan, MPH, Ph. D, Scientific Director • Evelyn Talbott, Ph. D, Epidemiology • Joel Weissfeld, MD, Epidemiology • Monica Han, Ph. D, Post-Doctoral Fellow • Steven Bodnar, MS, Greening/Community Assessment • Mary Platt, MBA, Center Administrator

Martin Luther King, Jr. • • Cowardice asks the question, “Is it safe? ” Expediency asks the questions, “Is it politic? ” But Conscience asks the question: “Is it right? ” And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must do it because Conscience tells him it is right. ”

www. preventingcancernow. org www. devradavis. com www. thesimplebody. com