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Guideline of the Austrian Medical Association ( ) for the diagnosis and treatment of EMFrelated health problems and illnesses (EMF syndrome)Consensus paper of the Austrian Medical Association’s EMF Working Group ( AG-EMF)
Adopted at the meeting of environmental medicine officers of the Regional Medical Association´s and the Austrian Medical Association on 3rd March 2012 in Vienna.
There has been a sharp rise in unspecific, often stress-associated health problems that increasingly present physicians with the challenge of complex differential diagnosis.
A cause that has been accorded little attention so far is increasing electrosmog exposure at home, at work and during leisure activities, occurring in addition to chronic stress in personal and working life. It correlates with an overall situation of chronic stress that can lead to burnout can physicians respond to this development?
The Austrian Medical Association has developed a guideline for differential diagnosis and potential treatment of unspecific stress-related health problems associated with electrosmog. Its core element is a patient questionnaire consisting of
a general assessment of stress symptoms and a specific assessment of electrosmog exposure.
The guideline is intended as an aid in diagnosing and treating EMF-related health problems.
Many people are increasingly exposed, to various degrees, to a combination of low and high frequency electric fields (EF), magnetic fields (MF) and electromagnetic
fields (EMF) of different signal patterns, intensities and technical applications for varying periods of time, colloquially referred to as electrosmog.
Physicians are often confronted with unspecific complaints without clearly identifiable causes (Huss and Röösli 2006). It has been suspected that environmental conditions such as increasing exposure of the population to radio waves, emanating
e.g. from cordless phones, mobile phone base stations, cell phones, GPRS, UMTS, data cards for laptop and notebook computers and wireless LAN (WLAN), but also exposure to electric and magnetic fields emanating from power lines, devices and equipment, may play a causal role (Blake Levitt and Lai 2010). For the medical profession, this raises new challenges in diagnosis and treatment. A central issue for the causal attribution of symptoms is the assessment of variation in health problems
depending on time and location, which is particularly relevant for environmental causes such as EMF exposure.
Austria is currently rolling out the fourth generation of mobile telephony (LTE), as well as smart metering (for electricity, gas and water consumption), resulting in additional EMF exposure of the population.
New radio technologies and applications have been introduced without certainty about their health effects, raising new challenges for medicine. For instance, the issues of so-called non-thermal effects and potential long-term effects of low-dose
exposure were hardly investigated at all prior to introduction. Some patients suspect a link between EMF exposure and their health problems. Moreover, physicians are increasingly confronted with health problems with unidentified causes. Pursuing an evidence-based treatment strategy in this context is a challenge for differential diagnosis.
In Austria, there are no democratically legitimized limits to protect the general population from EMF exposure. The recommendations of the WHO, compiled by the
International Commission on Non-Ionizing Radiation Protection (ICNIRP 1998), are based on a thermal model. These recommendations were adopted by the EU in its
Council Recommendation of 1999 (EU-Ratsempfehlung 1999) and by Austria in its pre-standard ÖVE/ÖNORM E 8850:2006 02 01 (ÖNORM 2006) without taking into account long-term non-thermal effects.
In August 2007, the BioInitiative, an international group of experts, published a comprehensive report calling for preventive measures against EMF exposure based on the scientific evidence available (BioInitiative 2007). Consequently, the European
Environment Agency compared electrosmog to other environmental hazards such as asbestos or benzene (EEA 2007).
In April 2009, a resolution of the European Parliament called for a review of the EMF limits in the EU Council Recommendation of 1999, which was based on the guidelines of the ICNIRP, with reference to the BioInitiative Report (EU Parliament
In May 2011, the Parliamentary Assembly of the Council of Europe adopted the report “The potential dangers of electromagnetic fields and their effect on the environment” (PACE 2011). The report calls for a number of measures to protect
humans and the environment, especially from high-frequency electromagnetic fields.
One of the recommendations is to “take all reasonable measures to reduce exposure to electromagnetic fields, especially to radio frequencies from mobile phones, and particularly the exposure to children and young people who seem to be most at risk
from head tumours”.
Also in May 2011, a group of experts at the International Agency for Research on Cancer, an agency of the WHO, classified radiofrequency electromagnetic fields as possibly carcinogenic (Group 2B) for humans (IARC 2011).
A representative telephone survey (n=2048, age >14 years) carried out in 2004 in
Switzerland yielded a frequency of 5% (95% CI 4-6%) for a self-attributed “diagnosis” of electrosensitivity (Schreier et al. 2006).
In another survey carried out in Switzerland, in 2001, 394 respondents attributed specific health problems to EMF exposure. Among others, the following symptoms were reported as occurring frequently: sleep problems (58%), headaches (41%),
nervousness (19%), fatigue (18%) and difficulty concentrating (16%). The respondents listed mobile phone base stations (74%), cell phones (36%), cordless phones (29%) and high-voltage lines (27%) as causes. Two thirds of respondents had taken measures to reduce their symptoms, the most frequent measure being to avoid exposure. Remarkably, only 13% had consulted their physicians (Röösli et al. 2004).
While a 2006 study by Regel et al. described no exposure effects, two provocation studies on exposure of “electrosensitive” individuals and control subjects to mobile phone base station signals (GSM, UMTS or both) found a significant decline in wellbeing after UMTS exposure in the individuals reporting sensitivity (Zwamborn et al.
2003, Eltiti et al. 2007). Analysis of the data available on exposure of people living near mobile phone base stations has yielded clear indications of adverse health effects (Santini et al. 2002, Navarro et al. 2003, Hutter et al. 2006, Abdel-Rassoul et al.
2007, Blettner et al. 2008).
Based on the scientific literature on interactions of EMF with biological systems, several mechanisms of interaction are possible. A plausible mechanism at the intracellular and intercellular level, for instance, is interaction via the formation of
free radicals or oxidative and nitrosative stress (Friedmann et al. 2007, Simkó 2007, Pall 2007, Bedard and Krause 2007, Pacher et al. 2007, Desai et al. 2009). It centres on the increased formation of peroxynitrite (ONOO-) from a reaction of nitrogen
monoxide (NO) with superoxide (O2-). Due to its relatively long half-life, peroxynitrite damages a large number of essential metabolic processes and cell components.
This approach can serve as a plausible explanation of many of the health problems, symptoms and their progression observed in the context of EMF exposure. There are increasing indications that EMF syndrome (EMFS) should be counted among multisystem disorders (Pall 2007) such as Chronic Fatigue Syndrome (CFS), Multiple Chemical Sensitivity (MCS), fibromyalgia (FM) and Post Traumatic Stress Disorder
In Sweden, EMF syndrome is designated as electrohypersensitivity (EHS), considered a physical impairment and recognized as a disability. With reference to UN Resolution 48/96, Annex, of 20 December 1993 (UN 1993), local governments grant support to individuals with EHS. Employees with EHS have a right to support from their employers so as to enable them to work despite this impairment. Some hospitals in Sweden provide rooms with low EMF exposure.
The Austrian Medical Association considers it its duty and its mission to provide members of the medical profession with a compilation of the current state of the scientific and political debate from a medical perspective and with specific
recommendations for action in this first guideline. The guideline can only be improved by suggestions, criticism and amendments. Due to the rapid development of various technologies, the recommendations need to be adapted on an ongoing
basis. We therefore invite all medical professionals to send contributions to the next edition of the guideline to the following email address: firstname.lastname@example.org
What to keep in mind when dealing with patients and EMF
In the case of unspecific health problems (see patient questionnaire) for which no clearly identifiable cause can be found, EMF exposure should in principle be taken
into consideration as a potential cause, especially if the patient suspects that it may be the cause.
How to proceed if EMF-related health problems are suspected
The recommended approach to diagnosis and treatment is intended as an aid and should, of course, be modified as each individual case requires.
1. History of health problems and EMF exposure
2. Examination and findings
3. Measurement of EMF exposure
4. Prevention or reduction of EMF exposure