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Wednesday, October 28, 2009
Sunday, October 25, 2009
Microdermabrasion May Rejuvenate Aging Skin
From WebMD Health News
Bill Hendrick
October 21, 2009 — Microdermabrasion using a coarse diamond-studded instrument may induce molecular changes in the skin that help rejuvenate it, a new study shows.
The procedure may improve the appearance of wrinkles, acne scars, and other signs of aging, University of Michigan scientists report in the October issue of Archives of Dermatology.
The process involves buffing the skin using grains of diamond or another hard substance, the researchers say.
To change the appearance of skin, the procedure would have to induce the production of collagen, the major structural protein in skin, and it appears to do so, according to the study.
The researchers note that previous studies have shown that microdermabrasion using aluminum oxide may not always stimulate collagen production.
It's not known, the researchers say, whether more aggressive methods -- not involving the destruction of skin tissue -- could trigger collagen production.
Darius J. Karimipour, MD, and colleagues at the University of Michigan, conducted biochemical analysis of skin biopsy specimens before and four hours to 14 days after a microdermabrasion procedure on the aged forearm skin of 40 volunteers.
Twenty-six men and 14 women, ages 50 to 83, took part in the study, each undergoing microdermabrasion with a diamond-studded hand piece of either a coarse-grit or medium-grit abrasiveness.
Microdermabrasion with the coarse-grit hand piece resulted in increased production of a wide array of compounds that are associated with wound healing and skin remodeling, including collagen, compared to untreated forearm skin. These molecular changes weren't seen in participants who received treatments using the medium-grit hand piece, the researchers say.
All participants experienced a mild period of redness that lasted, typically, less than two hours.
"We demonstrate that aggressive non-ablative microdermabrasion (not involving destruction of skin tissue) is an effective procedure to stimulate collagen production in human skin in vivo," the researchers write. "The beneficial molecular responses, with minimal downtime, suggest that aggressive microdermabrasion may be a useful procedure to stimulate remodeling and to improve the appearance of aged human skin."
Further study is needed, they add, to determine if microdermabrasion, performed aggressively, has the capacity to become a worthwhile resurfacing procedure that results in noticeable cosmetic improvement while minimizing" other problems and lifestyle interruptions.
SOURCES:
News release, University of Michigan.
Karimipour, D. Archives of Dermatology, October 2009; vol 145.
Bill Hendrick
October 21, 2009 — Microdermabrasion using a coarse diamond-studded instrument may induce molecular changes in the skin that help rejuvenate it, a new study shows.
The procedure may improve the appearance of wrinkles, acne scars, and other signs of aging, University of Michigan scientists report in the October issue of Archives of Dermatology.
The process involves buffing the skin using grains of diamond or another hard substance, the researchers say.
To change the appearance of skin, the procedure would have to induce the production of collagen, the major structural protein in skin, and it appears to do so, according to the study.
The researchers note that previous studies have shown that microdermabrasion using aluminum oxide may not always stimulate collagen production.
It's not known, the researchers say, whether more aggressive methods -- not involving the destruction of skin tissue -- could trigger collagen production.
Darius J. Karimipour, MD, and colleagues at the University of Michigan, conducted biochemical analysis of skin biopsy specimens before and four hours to 14 days after a microdermabrasion procedure on the aged forearm skin of 40 volunteers.
Twenty-six men and 14 women, ages 50 to 83, took part in the study, each undergoing microdermabrasion with a diamond-studded hand piece of either a coarse-grit or medium-grit abrasiveness.
Microdermabrasion with the coarse-grit hand piece resulted in increased production of a wide array of compounds that are associated with wound healing and skin remodeling, including collagen, compared to untreated forearm skin. These molecular changes weren't seen in participants who received treatments using the medium-grit hand piece, the researchers say.
All participants experienced a mild period of redness that lasted, typically, less than two hours.
"We demonstrate that aggressive non-ablative microdermabrasion (not involving destruction of skin tissue) is an effective procedure to stimulate collagen production in human skin in vivo," the researchers write. "The beneficial molecular responses, with minimal downtime, suggest that aggressive microdermabrasion may be a useful procedure to stimulate remodeling and to improve the appearance of aged human skin."
Further study is needed, they add, to determine if microdermabrasion, performed aggressively, has the capacity to become a worthwhile resurfacing procedure that results in noticeable cosmetic improvement while minimizing" other problems and lifestyle interruptions.
SOURCES:
News release, University of Michigan.
Karimipour, D. Archives of Dermatology, October 2009; vol 145.
Thursday, October 22, 2009
Cell Phones and Brain Cancer -- Jury Still Out
From Medscape Medical News
Roxanne Nelson
October 14, 2009 — Cellular telephones have become an integral part of everyday life; they are now used by an estimated 4 billion people worldwide. But this is a relatively new technology, and there are lingering concerns about health risks, in particular a risk for brain cancer.
A new report suggests that that regular use of cell phones can result in a "significant" risk for brain tumors. But previous studies have been inconsistent. Even so, some European countries have taken precautionary measures, aimed specifically at children.
In the United States, a recent Senate hearing examining the safety of cell phones was inconclusive, saying that although more research is needed, it might be wise to begin taking precautionary measures right now. The National Cancer Institute also said that additional research is needed.
In this special feature, Medscape Oncology presents the views of experts from both sides of the case.
The new report, "Cellphones and Brain Tumors: 15 Reasons for Concern. Science, Spin and the Truth Behind Interphone," was released in August by the International Electromagnetic Field (EMF) Collaborative, a group that includes Powerwatch and the Radiation Research Trust in the United Kingdom, and the EMR Policy Institute, ElectromagneticHealth.org, and The Peoples Initiative Foundation in the United States.
More than 40 scientists and officials from 14 countries endorsed the report, which concluded that:
Studies that are independent of the telecom industry consistently show there is a "significant" risk for brain tumors from cell phone use.
The EMF exposure limits advocated by industry and used by governments are based on a false premise that a cell phone's electromagnetic radiation has no biological effects except for heating.
The danger of brain tumors from cell phone use is highest in children, and the younger a child is when he/she starts using a cell phone, the higher the risk.
"We have had zero reaction from the industry about the paper," Lloyd Morgan, a retired electronics engineer, an active member of several international science organizations, and the report's lead author, told Medscape Oncology. "What they're doing is a nonresponse response; they haven't challenged anything in it."
This report has intensified a controversy that has been brewing for nearly 2 decades and still remains largely unresolved. Approximately 30 epidemiologic studies have attempted to evaluate a possible association between cell phone use and the risk for brain and salivary gland tumors. There have also been a number of experimental studies involving cell cultures and animal models.
Results, however, have been inconclusive or even contradictory. But studies independent of industry funding have more consistently found higher risks for brain tumors when exposure was 10 or more years, explained Mr. Morgan, adding that "even some industry-funded studies show that there is a connection between cell phone use and the risk of brain tumors."
Interphone Results Flawed
The issue of cell phone safety was to have been settled once and for all by the huge 13-nation industry-funded Interphone study, which was begun nearly 10 years ago. Even though data collection was completed in 2004, the results have still not been published. The European Parliament has called the delay "deplorable," and has demanded an explanation for it. Although the combined results have not yet been released, 14 Interphone studies (11 single country and 3 multicountry studies) with partial results have been published.
"Results of Interphone have been delayed by about 4 years," said Elizabeth Barris, founder of the nonprofit People's Initiative Foundation and coauthor of the new report, in an interview. "It was supposed to be released this September. We wanted to make sure that our report was released before Interphone. We wanted to bring attention to the issue, including the fact that Interphone has been delayed for so long."
With only 4 exceptions, the industry-funded Interphone studies found no increased risk for brain tumors from cell phone use, explained Mr. Morgan. In contrast, a series of Swedish studies, led by Lennart Hardell, MD, PhD, from the Department of Oncology, Orebro Medical Center, in Sweden, which were independent of industry funding, reported numerous findings of significantly increased brain tumor risk from cell phone and cordless phone use.
As you review these studies, you begin to get strong evidence of extremely improbable results.
An analysis of the results from the Interphone studies suggests that the use of a cell phone actually protects the user from a brain tumor, or that the studies had serious design flaws. "In any one study, you can see this incredibly skewing toward protection," said Mr. Morgan. "As you review these studies, you begin to get strong evidence of extremely improbable results."
In fact, Mr. Morgan and his coauthors identified 11 flaws in the Interphone studies: selection bias, insufficient latency time, definition of "regular" cell phone use, exclusion of young adults and children, no investigation of brain tumor risk from cell phones radiating higher power levels in rural areas, exclusion of exposure to other transmitting sources, exclusion of some brain tumor types, exclusion of tumors outside the cell phone radiation plume, exclusion of brain tumor cases because of death or illness, recall accuracy of cell phone use, and funding bias.
"Almost all flaws caused an underestimation of risk," he said, "and for exposure under 10 years, they found protection for cell phones."
The Cellular Telecommunications Industry Association (CTIA), the wireless association's industry trade group, has not specifically responded to the new report, according to Mr. Morgan. However, John Walls, vice president of public affairs at CTIA, told Medscape Oncology that "since we are not a scientific organization, with respect to the matter of health effects associated with wireless base stations and the use of wireless devices, CTIA and the wireless industry have always been guided by science and the views of impartial health organizations."
Peer-reviewed scientific evidence has overwhelmingly indicated that wireless devices do not pose a public health risk, Mr. Walls said. "In addition, there is no known mechanism for microwave energy within the limits established by the [Federal Communications Commission] to cause any adverse health effects," he said. "That is why the leading global heath organizations, such as the American Cancer Society, the National Cancer Institute, the World Health Organization, and the US Food and Drug Administration, all have concurred that wireless devices are not a public health risk."
Initial Red Flags
In the United States, the possible connection between tumors and cell phone use became highly publicized in 1993, when Florida resident David Reynard appeared on the popular television show Larry King Live and blamed cell phones for causing his wife's lethal brain tumor. Mr. Reynard filed a lawsuit against the manufacturer; he ultimately lost the case, but dozens of other lawsuits followed in its wake, along with numerous scientific studies that attempted to find or disprove a link. Most of the lawsuits have been dismissed, and thus far, none have gone to trial.
But the subject was picked up by the media, and scientists and experts argued publicly on opposing sides of the issue. Reports in the popular media prompted Congressional hearings on the safety of cell phone use, and during those sessions, it became clear that cell phones had not been tested for "safety prior to going into commerce," said George Carlo, PhD, MS, JD, during a 2008 radio interview with CFRO, a co-op radio station based in Vancouver, British Columbia. "Because the food and drug industry had not required that testing, Congress asked the industry to fill in those data gaps."
The industry invested $28.5 million and launched the first telecommunications industry-backed studies to investigate possible health risks stemming from cell phone use. Dr. Carlo, who is a Fellow of the American College of Epidemiology and has served on the faculty of several medical schools, headed the Wireless Technology Research program, which ran from 1993 to 1999. It was the largest program in the world to look at the potential dangers of cell phone use and electromagnetic radiation.
"In the middle of 1998, we began to have some of our long-term studies completed and it became clear that we were seeing things that no one expected," said Dr. Carlo. "We found that cell phone radiation caused leakage in the blood–brain barrier, it caused genetic damage in the form of disruption of normal DNA repair, and it caused more than a doubling of the risk of rare neuroepithelial tumors."
"After 6 years," he continued, "we found that cell radiation caused an increased risk of acoustic neuromas."
During the time these Wireless Technology Research studies were being carried out, the use of cell phones mushroomed. In 1993, there were 15 million cell phone users in North America; by 1999, there were more than 100 million.
"We went back to the industry and suggested that they issue warnings, but they promptly said no," Dr. Carlo said in the interview. "Those of us running the research program knew we had an ethical responsibility to go public with those findings, and we did go public, independent of the industry and independent of the government agencies that were overseeing the work."
In 2001, Dr. Carlo coauthored a book entitled Cell Phones. Invisible Hazards in the Wireless Age: An Insider's Alarming Discoveries, which discussed the findings.
I don't think they ever really expected to find that cell phones were dangerous.
Dr. Carlo felt that part of the reason for the refusal to issue warnings was that the telecommunications industry was not prepared for the results of the research. "I don't think they ever really expected to find that cell phones were dangerous, and when we presented our findings, they were ill prepared for them. They also didn't want to compromise their industry."
As for the lack of action on the part of government regulatory agencies, Dr. Carlo pointed out that agencies in the United States and Canada did not require any premarket testing of cell phones. "The only legal jurisdiction step that they had available in 1999 was to ban cell phones. And from a political point of view, banning cell phones would not be an easy thing to do, especially since our findings were the first ones of their type," he said.
These were "red flags of risk"; there weren't enough data at the time to actually prove that the risk was real, Dr. Carlo emphasized. "That is not the case now; there has been confirmatory evidence. But in 1999, regulatory agencies did not have the scientific evidence to be able to sustain the types of legal challenges that would have come from the industry had they tried to ban cell phones."
Trail of Research
Much of the more recent research on the safety of cell phones has not specifically found a health risk; however, researchers have pointed out the limitations of their studies and left the door open. Part of the problem in assessing the potential connection between brain tumors and cell phone use is the relatively short period of time that the devices have been heavily in use in a large population and the long latency period for many tumors.
A National Cancer Institute study published in 2001, for example, did not support the hypothesis that the use of cell phones caused brain tumors, but the researchers noted that a limitation of their work was that they did not assess risks after a potential induction period of more than several years or among people with very high levels of daily or cumulative use (N Engl J Med. 2001;344:79-86).
A 2009 review from researchers at the Karolinska Institutet in Stockholm, Sweden, reported that studies published to date do not demonstrate an increased risk after approximately 10 years of use for any brain tumor or other head tumor (Epidemiology. 2009;20:639-652). Thus far, data do not suggest a causal association between cell phone use and fast-growing tumors, but they note that for slow-growing tumors, such as meningioma and acoustic neuroma, "the absence of association reported thus far is less conclusive because the observation period has been too short."
Another recent review, the third in a series of updates to an original report issued by the Royal Society of Canada, concluded that although there is no clear evidence of adverse health effects associated with radiofrequency fields during the period from 2004 to 2007, continued research is recommended to address specific areas of concern, including the use of cell phones by children (J Toxicol Environ Health B Crit Rev. 2009;12:250-288).
The Interphone studies to date have largely reported negative results, finding no association between tumors and cell phone use. One study did not find a link between an increased risk for malignant or benign parotid gland tumors and exposure to radiofrequency electromagnetic fields, but the authors concluded that cell phones "have not been used long enough to exclude their possible carcinogenic effect after long-term use, and more epidemiologic studies including long-term users are clearly warranted" (Am J Epidemiol. 2006;164:637-643).
However, the results of an Israeli Interphone study suggest a positive association between cell phone use and the development of parotid gland tumors (Am J Epidemiol. 2008;167:457-467). The authors noted that this was a single study, and therefore did not provide enough evidence to assume causality. They recommend additional investigations of this association, with longer latency periods and large numbers of heavy users, to confirm the findings. "Until more evidence becomes available, we believe that the precautionary approach currently adopted by most scientific committees and applied by many governments should continue to be used," they wrote.
Some of the strongest evidence supporting a link between brain tumors and cell phone use comes from a series of Swedish studies, led by Dr. Hardell. Overall, the reserachers found that risk increased with the number of cumulative hours of use, higher radiated power, and length of cell phone use. They also reported that younger users had a higher risk. In fact, the highest risk was among people who were younger than 20 years at the time of first use (Int J Oncol. 2006;28:509-518; Int Arch Occup Environ Health. 2006;79:630-639; Arch Environ Health. 2004;59:132-137; Pathophysiology. 2009;16:113-122).
A meta-analysis that incorporated 11 long-term epidemiologic studies in this field also reported a link between cell phone use and brain tumors. Using a cell phone for 10 years or longer was positively associated with the development of an ipsilateral brain tumor; in fact, it doubled the risk (Surg Neurol. 2009;72:205-214).
Melange of Reactions
As in the literature, there is no consensus among physicians and scientists about the severity of risk, or even if it exists. On its Web site, the National Cancer Institute notes that although a consistent link has not been demonstrated between cell phone use and cancer, "scientists feel that additional research is needed before firm conclusions can be drawn." Likewise, the American Cancer Society points out that although the weight of the evidence has shown no association between cell phone use and brain cancer, information on the potential health effects of very long-term use, or use in children, is not available.
Sam Milham, Jr. MD, MPH, former chronic disease epidemiologist at the Washington State Department of Health and clinical associate professor at the University of Washington School of Public Health in Seattle, has published several critiques on cell phones and health risks. "I personally think there is a real risk, and have felt this way even before the studies were published, based on animal work," he told Medscape Oncology.
Dr. Milham contends that all of the negative studies have been seriously flawed. "The fact that same-sided tumors with long latency are showing increased risks is bad news, since brain tumors have very long latencies," he said. "The same-sided risks are very important since dose is important. The most worrisome fact is the number of people who are being exposed."
Putting a cell phone against your head is like putting one side of your head against a microwave oven.
"Putting a cell phone against your head is like putting one side of your head against a microwave oven," he added.
Last year, Ronald B. Herberman, MD, director of the University of Pittsburgh Cancer Institute and UPMC Cancer Centers in Pennsylvania, sent a memo to faculty and staff advising them to limit cell phone use based on his interpretation of recent research. In 2008, he testified before a Congressional Subcommittee on the subject of tumors and cell phones, and urged more independent and definitive research.
However, many experts are not convinced that there is a link. Currently, there is no evidence that cell phones cause brain cancer, said John Moulder, PhD, professor and director of radiation biology at the Medical College of Wisconsin in Milwaukee.
"The published data have rather consistently shown the absence of evidence for a human health hazard," he told Medscape Oncology. "Conclusive cancer epidemiology requires long follow-up time and accurate exposure assessment. The exposure assessment in this field has been very weak, as it depends on peoples' memories of how they were using mobile phones 10 or more years ago."
He emphasized that the studies based on what side of the head people used their phones are particularly weak, since most people use them on both sides, at least some of the time.
"Until we can find a way to measure actual exposure over long periods of time, the epidemiology will never be conclusive," he added.
Dr. Moulder pointed out a number of flaws in the new report. "The authors seem to have combed the literature for reports that support their concerns, and have ignored everything that would contradict their views," he said. "A scientific risk assessment needs to looks at all the evidence."
Although the report states that cell phone radiation has been shown to cause the blood–brain barrier to leak, Dr. Moulder noted that only 1 group has found that effect. "Other groups have been unable to replicate the effect."
Part of the problem with this research is that it is nearly impossible to prove that something doesn't cause cancer. "The closest you can come is to repeatedly try to show that it does and repeatedly fail," he said.
The Road Ahead
On the heels of the release of the new cell phone report, a Senate hearing on the health effects of cell phone use was held in September, and chaired by Sen. Tom Harkin (D-Iowa). The take-away message from expert testimony was that more and better research is needed to determine if there is a risk to human health. And nearly all of the researchers and scientists who spoke at the hearing advocated a precautionary approach in the meantime.
We just don't know what the answer is.
"We just don't know what the answer is," said Sen. Arlen Specter (D-Pennsylvania) during the hearing. "Precautions are not a bad idea. They may not be a good idea, but they are not a bad idea. And the issue of children is something we should look at a little more closely."
Several countries, including Israel, France, and Finland, and the United Kingdom have decided not to wait for additional data; instead, they have issued warnings about the use of cell phones and advise taking precautionary measures, especially for children. New legislation in France, for example, will ban advertising of cell phones that is directed to children younger than 12 years of age and the sale of cell phones designed for children younger than 6 years. In addition, France will introduce new limits for radiation from the phones and require cell phones to be sold with earphones.
Realistically, it is going to be difficult to change behaviors now that cell phones are so entrenched in daily use, explained Mr. Morgan. "In some parts of the world, it is nearly impossible to get a land-line telephone, so cell phones are the only option."
Cell phones can be made safer, and the technology to do so exists right now. For example, said Mr. Morgan, "you can get a 10,000-fold reduction in exposure simply by keeping the phone 6 inches away from the head."
There are also steps that can be taken right now to make cell phones safer to use, he said. These include using a wired headset (not a wireless headset such as a Bluetooth), using speaker-phone mode, or sending text messages; keeping the phone away from the body when not in use; avoiding use in a moving car, train, or bus, or in rural areas at some distance from a cell tower, because any of these uses will increase the power of the cell phone's radiation; and keeping the cell phone turned off until you need to use it.
The authors also recommend using a corded land-line phone whenever possible, instead of a wireless phone, and to avoid cell phones when inside buildings, particularly with steel structures. Since children face a greater health risk, they should not be allowed to sleep with a cell phone under their pillows or at the bedside, said Mr. Morgan. Ideally, those younger than 18 years should not use a cell phone at all, except for emergencies.
Roxanne Nelson
October 14, 2009 — Cellular telephones have become an integral part of everyday life; they are now used by an estimated 4 billion people worldwide. But this is a relatively new technology, and there are lingering concerns about health risks, in particular a risk for brain cancer.
A new report suggests that that regular use of cell phones can result in a "significant" risk for brain tumors. But previous studies have been inconsistent. Even so, some European countries have taken precautionary measures, aimed specifically at children.
In the United States, a recent Senate hearing examining the safety of cell phones was inconclusive, saying that although more research is needed, it might be wise to begin taking precautionary measures right now. The National Cancer Institute also said that additional research is needed.
In this special feature, Medscape Oncology presents the views of experts from both sides of the case.
The new report, "Cellphones and Brain Tumors: 15 Reasons for Concern. Science, Spin and the Truth Behind Interphone," was released in August by the International Electromagnetic Field (EMF) Collaborative, a group that includes Powerwatch and the Radiation Research Trust in the United Kingdom, and the EMR Policy Institute, ElectromagneticHealth.org, and The Peoples Initiative Foundation in the United States.
More than 40 scientists and officials from 14 countries endorsed the report, which concluded that:
Studies that are independent of the telecom industry consistently show there is a "significant" risk for brain tumors from cell phone use.
The EMF exposure limits advocated by industry and used by governments are based on a false premise that a cell phone's electromagnetic radiation has no biological effects except for heating.
The danger of brain tumors from cell phone use is highest in children, and the younger a child is when he/she starts using a cell phone, the higher the risk.
"We have had zero reaction from the industry about the paper," Lloyd Morgan, a retired electronics engineer, an active member of several international science organizations, and the report's lead author, told Medscape Oncology. "What they're doing is a nonresponse response; they haven't challenged anything in it."
This report has intensified a controversy that has been brewing for nearly 2 decades and still remains largely unresolved. Approximately 30 epidemiologic studies have attempted to evaluate a possible association between cell phone use and the risk for brain and salivary gland tumors. There have also been a number of experimental studies involving cell cultures and animal models.
Results, however, have been inconclusive or even contradictory. But studies independent of industry funding have more consistently found higher risks for brain tumors when exposure was 10 or more years, explained Mr. Morgan, adding that "even some industry-funded studies show that there is a connection between cell phone use and the risk of brain tumors."
Interphone Results Flawed
The issue of cell phone safety was to have been settled once and for all by the huge 13-nation industry-funded Interphone study, which was begun nearly 10 years ago. Even though data collection was completed in 2004, the results have still not been published. The European Parliament has called the delay "deplorable," and has demanded an explanation for it. Although the combined results have not yet been released, 14 Interphone studies (11 single country and 3 multicountry studies) with partial results have been published.
"Results of Interphone have been delayed by about 4 years," said Elizabeth Barris, founder of the nonprofit People's Initiative Foundation and coauthor of the new report, in an interview. "It was supposed to be released this September. We wanted to make sure that our report was released before Interphone. We wanted to bring attention to the issue, including the fact that Interphone has been delayed for so long."
With only 4 exceptions, the industry-funded Interphone studies found no increased risk for brain tumors from cell phone use, explained Mr. Morgan. In contrast, a series of Swedish studies, led by Lennart Hardell, MD, PhD, from the Department of Oncology, Orebro Medical Center, in Sweden, which were independent of industry funding, reported numerous findings of significantly increased brain tumor risk from cell phone and cordless phone use.
As you review these studies, you begin to get strong evidence of extremely improbable results.
An analysis of the results from the Interphone studies suggests that the use of a cell phone actually protects the user from a brain tumor, or that the studies had serious design flaws. "In any one study, you can see this incredibly skewing toward protection," said Mr. Morgan. "As you review these studies, you begin to get strong evidence of extremely improbable results."
In fact, Mr. Morgan and his coauthors identified 11 flaws in the Interphone studies: selection bias, insufficient latency time, definition of "regular" cell phone use, exclusion of young adults and children, no investigation of brain tumor risk from cell phones radiating higher power levels in rural areas, exclusion of exposure to other transmitting sources, exclusion of some brain tumor types, exclusion of tumors outside the cell phone radiation plume, exclusion of brain tumor cases because of death or illness, recall accuracy of cell phone use, and funding bias.
"Almost all flaws caused an underestimation of risk," he said, "and for exposure under 10 years, they found protection for cell phones."
The Cellular Telecommunications Industry Association (CTIA), the wireless association's industry trade group, has not specifically responded to the new report, according to Mr. Morgan. However, John Walls, vice president of public affairs at CTIA, told Medscape Oncology that "since we are not a scientific organization, with respect to the matter of health effects associated with wireless base stations and the use of wireless devices, CTIA and the wireless industry have always been guided by science and the views of impartial health organizations."
Peer-reviewed scientific evidence has overwhelmingly indicated that wireless devices do not pose a public health risk, Mr. Walls said. "In addition, there is no known mechanism for microwave energy within the limits established by the [Federal Communications Commission] to cause any adverse health effects," he said. "That is why the leading global heath organizations, such as the American Cancer Society, the National Cancer Institute, the World Health Organization, and the US Food and Drug Administration, all have concurred that wireless devices are not a public health risk."
Initial Red Flags
In the United States, the possible connection between tumors and cell phone use became highly publicized in 1993, when Florida resident David Reynard appeared on the popular television show Larry King Live and blamed cell phones for causing his wife's lethal brain tumor. Mr. Reynard filed a lawsuit against the manufacturer; he ultimately lost the case, but dozens of other lawsuits followed in its wake, along with numerous scientific studies that attempted to find or disprove a link. Most of the lawsuits have been dismissed, and thus far, none have gone to trial.
But the subject was picked up by the media, and scientists and experts argued publicly on opposing sides of the issue. Reports in the popular media prompted Congressional hearings on the safety of cell phone use, and during those sessions, it became clear that cell phones had not been tested for "safety prior to going into commerce," said George Carlo, PhD, MS, JD, during a 2008 radio interview with CFRO, a co-op radio station based in Vancouver, British Columbia. "Because the food and drug industry had not required that testing, Congress asked the industry to fill in those data gaps."
The industry invested $28.5 million and launched the first telecommunications industry-backed studies to investigate possible health risks stemming from cell phone use. Dr. Carlo, who is a Fellow of the American College of Epidemiology and has served on the faculty of several medical schools, headed the Wireless Technology Research program, which ran from 1993 to 1999. It was the largest program in the world to look at the potential dangers of cell phone use and electromagnetic radiation.
"In the middle of 1998, we began to have some of our long-term studies completed and it became clear that we were seeing things that no one expected," said Dr. Carlo. "We found that cell phone radiation caused leakage in the blood–brain barrier, it caused genetic damage in the form of disruption of normal DNA repair, and it caused more than a doubling of the risk of rare neuroepithelial tumors."
"After 6 years," he continued, "we found that cell radiation caused an increased risk of acoustic neuromas."
During the time these Wireless Technology Research studies were being carried out, the use of cell phones mushroomed. In 1993, there were 15 million cell phone users in North America; by 1999, there were more than 100 million.
"We went back to the industry and suggested that they issue warnings, but they promptly said no," Dr. Carlo said in the interview. "Those of us running the research program knew we had an ethical responsibility to go public with those findings, and we did go public, independent of the industry and independent of the government agencies that were overseeing the work."
In 2001, Dr. Carlo coauthored a book entitled Cell Phones. Invisible Hazards in the Wireless Age: An Insider's Alarming Discoveries, which discussed the findings.
I don't think they ever really expected to find that cell phones were dangerous.
Dr. Carlo felt that part of the reason for the refusal to issue warnings was that the telecommunications industry was not prepared for the results of the research. "I don't think they ever really expected to find that cell phones were dangerous, and when we presented our findings, they were ill prepared for them. They also didn't want to compromise their industry."
As for the lack of action on the part of government regulatory agencies, Dr. Carlo pointed out that agencies in the United States and Canada did not require any premarket testing of cell phones. "The only legal jurisdiction step that they had available in 1999 was to ban cell phones. And from a political point of view, banning cell phones would not be an easy thing to do, especially since our findings were the first ones of their type," he said.
These were "red flags of risk"; there weren't enough data at the time to actually prove that the risk was real, Dr. Carlo emphasized. "That is not the case now; there has been confirmatory evidence. But in 1999, regulatory agencies did not have the scientific evidence to be able to sustain the types of legal challenges that would have come from the industry had they tried to ban cell phones."
Trail of Research
Much of the more recent research on the safety of cell phones has not specifically found a health risk; however, researchers have pointed out the limitations of their studies and left the door open. Part of the problem in assessing the potential connection between brain tumors and cell phone use is the relatively short period of time that the devices have been heavily in use in a large population and the long latency period for many tumors.
A National Cancer Institute study published in 2001, for example, did not support the hypothesis that the use of cell phones caused brain tumors, but the researchers noted that a limitation of their work was that they did not assess risks after a potential induction period of more than several years or among people with very high levels of daily or cumulative use (N Engl J Med. 2001;344:79-86).
A 2009 review from researchers at the Karolinska Institutet in Stockholm, Sweden, reported that studies published to date do not demonstrate an increased risk after approximately 10 years of use for any brain tumor or other head tumor (Epidemiology. 2009;20:639-652). Thus far, data do not suggest a causal association between cell phone use and fast-growing tumors, but they note that for slow-growing tumors, such as meningioma and acoustic neuroma, "the absence of association reported thus far is less conclusive because the observation period has been too short."
Another recent review, the third in a series of updates to an original report issued by the Royal Society of Canada, concluded that although there is no clear evidence of adverse health effects associated with radiofrequency fields during the period from 2004 to 2007, continued research is recommended to address specific areas of concern, including the use of cell phones by children (J Toxicol Environ Health B Crit Rev. 2009;12:250-288).
The Interphone studies to date have largely reported negative results, finding no association between tumors and cell phone use. One study did not find a link between an increased risk for malignant or benign parotid gland tumors and exposure to radiofrequency electromagnetic fields, but the authors concluded that cell phones "have not been used long enough to exclude their possible carcinogenic effect after long-term use, and more epidemiologic studies including long-term users are clearly warranted" (Am J Epidemiol. 2006;164:637-643).
However, the results of an Israeli Interphone study suggest a positive association between cell phone use and the development of parotid gland tumors (Am J Epidemiol. 2008;167:457-467). The authors noted that this was a single study, and therefore did not provide enough evidence to assume causality. They recommend additional investigations of this association, with longer latency periods and large numbers of heavy users, to confirm the findings. "Until more evidence becomes available, we believe that the precautionary approach currently adopted by most scientific committees and applied by many governments should continue to be used," they wrote.
Some of the strongest evidence supporting a link between brain tumors and cell phone use comes from a series of Swedish studies, led by Dr. Hardell. Overall, the reserachers found that risk increased with the number of cumulative hours of use, higher radiated power, and length of cell phone use. They also reported that younger users had a higher risk. In fact, the highest risk was among people who were younger than 20 years at the time of first use (Int J Oncol. 2006;28:509-518; Int Arch Occup Environ Health. 2006;79:630-639; Arch Environ Health. 2004;59:132-137; Pathophysiology. 2009;16:113-122).
A meta-analysis that incorporated 11 long-term epidemiologic studies in this field also reported a link between cell phone use and brain tumors. Using a cell phone for 10 years or longer was positively associated with the development of an ipsilateral brain tumor; in fact, it doubled the risk (Surg Neurol. 2009;72:205-214).
Melange of Reactions
As in the literature, there is no consensus among physicians and scientists about the severity of risk, or even if it exists. On its Web site, the National Cancer Institute notes that although a consistent link has not been demonstrated between cell phone use and cancer, "scientists feel that additional research is needed before firm conclusions can be drawn." Likewise, the American Cancer Society points out that although the weight of the evidence has shown no association between cell phone use and brain cancer, information on the potential health effects of very long-term use, or use in children, is not available.
Sam Milham, Jr. MD, MPH, former chronic disease epidemiologist at the Washington State Department of Health and clinical associate professor at the University of Washington School of Public Health in Seattle, has published several critiques on cell phones and health risks. "I personally think there is a real risk, and have felt this way even before the studies were published, based on animal work," he told Medscape Oncology.
Dr. Milham contends that all of the negative studies have been seriously flawed. "The fact that same-sided tumors with long latency are showing increased risks is bad news, since brain tumors have very long latencies," he said. "The same-sided risks are very important since dose is important. The most worrisome fact is the number of people who are being exposed."
Putting a cell phone against your head is like putting one side of your head against a microwave oven.
"Putting a cell phone against your head is like putting one side of your head against a microwave oven," he added.
Last year, Ronald B. Herberman, MD, director of the University of Pittsburgh Cancer Institute and UPMC Cancer Centers in Pennsylvania, sent a memo to faculty and staff advising them to limit cell phone use based on his interpretation of recent research. In 2008, he testified before a Congressional Subcommittee on the subject of tumors and cell phones, and urged more independent and definitive research.
However, many experts are not convinced that there is a link. Currently, there is no evidence that cell phones cause brain cancer, said John Moulder, PhD, professor and director of radiation biology at the Medical College of Wisconsin in Milwaukee.
"The published data have rather consistently shown the absence of evidence for a human health hazard," he told Medscape Oncology. "Conclusive cancer epidemiology requires long follow-up time and accurate exposure assessment. The exposure assessment in this field has been very weak, as it depends on peoples' memories of how they were using mobile phones 10 or more years ago."
He emphasized that the studies based on what side of the head people used their phones are particularly weak, since most people use them on both sides, at least some of the time.
"Until we can find a way to measure actual exposure over long periods of time, the epidemiology will never be conclusive," he added.
Dr. Moulder pointed out a number of flaws in the new report. "The authors seem to have combed the literature for reports that support their concerns, and have ignored everything that would contradict their views," he said. "A scientific risk assessment needs to looks at all the evidence."
Although the report states that cell phone radiation has been shown to cause the blood–brain barrier to leak, Dr. Moulder noted that only 1 group has found that effect. "Other groups have been unable to replicate the effect."
Part of the problem with this research is that it is nearly impossible to prove that something doesn't cause cancer. "The closest you can come is to repeatedly try to show that it does and repeatedly fail," he said.
The Road Ahead
On the heels of the release of the new cell phone report, a Senate hearing on the health effects of cell phone use was held in September, and chaired by Sen. Tom Harkin (D-Iowa). The take-away message from expert testimony was that more and better research is needed to determine if there is a risk to human health. And nearly all of the researchers and scientists who spoke at the hearing advocated a precautionary approach in the meantime.
We just don't know what the answer is.
"We just don't know what the answer is," said Sen. Arlen Specter (D-Pennsylvania) during the hearing. "Precautions are not a bad idea. They may not be a good idea, but they are not a bad idea. And the issue of children is something we should look at a little more closely."
Several countries, including Israel, France, and Finland, and the United Kingdom have decided not to wait for additional data; instead, they have issued warnings about the use of cell phones and advise taking precautionary measures, especially for children. New legislation in France, for example, will ban advertising of cell phones that is directed to children younger than 12 years of age and the sale of cell phones designed for children younger than 6 years. In addition, France will introduce new limits for radiation from the phones and require cell phones to be sold with earphones.
Realistically, it is going to be difficult to change behaviors now that cell phones are so entrenched in daily use, explained Mr. Morgan. "In some parts of the world, it is nearly impossible to get a land-line telephone, so cell phones are the only option."
Cell phones can be made safer, and the technology to do so exists right now. For example, said Mr. Morgan, "you can get a 10,000-fold reduction in exposure simply by keeping the phone 6 inches away from the head."
There are also steps that can be taken right now to make cell phones safer to use, he said. These include using a wired headset (not a wireless headset such as a Bluetooth), using speaker-phone mode, or sending text messages; keeping the phone away from the body when not in use; avoiding use in a moving car, train, or bus, or in rural areas at some distance from a cell tower, because any of these uses will increase the power of the cell phone's radiation; and keeping the cell phone turned off until you need to use it.
The authors also recommend using a corded land-line phone whenever possible, instead of a wireless phone, and to avoid cell phones when inside buildings, particularly with steel structures. Since children face a greater health risk, they should not be allowed to sleep with a cell phone under their pillows or at the bedside, said Mr. Morgan. Ideally, those younger than 18 years should not use a cell phone at all, except for emergencies.
Wednesday, October 7, 2009
Passive Smoking Linked to Loss of Genetic Protection Against Respiratory Illness
From Reuters Health Information
NEW YORK (Reuters Health) May 12 - Investigators at the University of Southern California in Los Angeles report evidence that second-hand exposure to tobacco smoke negates the protection against respiratory illness afforded by the glutathione S-transferase P1 (GSTP1) variants.
The study, by Dr. Frank D. Gilliland and colleagues, involved 1132 Hispanic and non-Hispanic fourth-grade children in the Children's Health Study and is published in the May issue of Pediatrics.
The investigators assessed tobacco smoke exposure, respiratory-related school absences and status of four GSTP1 single-nucleotide polymorphisms, which account for 93% of the variation across the locus.
Three of the four SNPs were associated with a decreased risk of respiratory illness. However, "the protective effect of GSTP1 variants was lost among individuals exposed to in utero and secondhand tobacco smoke," Dr. Gilliland and colleagues report.
"The paradigm of loss of genetic protection among those exposed to tobacco smoke has clinical and public health implications that warrant broader consideration in research and practice," the team concludes.
Pediatrics 2009;123:1344-1351.
NEW YORK (Reuters Health) May 12 - Investigators at the University of Southern California in Los Angeles report evidence that second-hand exposure to tobacco smoke negates the protection against respiratory illness afforded by the glutathione S-transferase P1 (GSTP1) variants.
The study, by Dr. Frank D. Gilliland and colleagues, involved 1132 Hispanic and non-Hispanic fourth-grade children in the Children's Health Study and is published in the May issue of Pediatrics.
The investigators assessed tobacco smoke exposure, respiratory-related school absences and status of four GSTP1 single-nucleotide polymorphisms, which account for 93% of the variation across the locus.
Three of the four SNPs were associated with a decreased risk of respiratory illness. However, "the protective effect of GSTP1 variants was lost among individuals exposed to in utero and secondhand tobacco smoke," Dr. Gilliland and colleagues report.
"The paradigm of loss of genetic protection among those exposed to tobacco smoke has clinical and public health implications that warrant broader consideration in research and practice," the team concludes.
Pediatrics 2009;123:1344-1351.
Friday, October 2, 2009
Surgical Mask May Be Comparable to N95 Respirator in Halting Flu Transmission
From Medscape Medical News
Laurie Barclay, MD
October 1, 2009 — Use of a surgical mask may not be inferior to the N95 respirator in halting influenza transmission in healthcare workers, according to the results of a noninferiority, randomized controlled trial published online October 1 and to be published in the November 4 print issue of the Journal of the American Medical Association.
"Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse," write Mark Loeb, MD, MSc, from McMaster University in Hamilton, Ontario, Canada, and colleagues. "Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance."
The goal of this study was to compare the surgical mask with the N95 respirator in protecting healthcare workers from influenza infection.
At 8 tertiary-care Ontario hospitals during the 2008 to 2009 influenza season, 446 nurses in emergency departments, medical units, and pediatric units were randomly assigned to use either a fit-tested N95 respirator or a surgical mask when caring for patients with febrile respiratory illness. Laboratory-confirmed influenza, measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers, was the main study endpoint.
Surgical mask efficacy was defined as being noninferior to the N95 respirator, with noninferiority defined as the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) greater than −9%.
Of 478 nurses evaluated for eligibility from September 23 to December 8, 2008, 446 nurses were enrolled and randomized, with 225 assigned to use surgical masks and 221 to use N95 respirators. In the surgical mask group, influenza infection occurred in 50 nurses (23.6%) compared with 48 (22.9%) in the N95 respirator group (absolute risk difference, −0.73%; 95% CI, −8.8% to 7.3%; P = .86, with the lower confidence limit being inside the noninferiority limit of −9%). Noninferiority of the surgical mask was also shown for influenza A (H1N1).
"Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza," the study authors write. "Our findings apply to routine care in the health care setting. They should not be generalized to settings where there is a high risk for aerosolization, such as intubation or bronchoscopy, where use of an N95 respirator would be prudent."
Study limitations include the inability to determine compliance for all participants, that audits were conducted only on medical and pediatric units and not in the emergency department, the inability to account for the effect of indirect contact, and the inability to determine whether participants acquired influenza from hospital or community exposure.
"In routine health care settings, particularly where the availability of N95 respirators is limited, surgical masks appear to be non-inferior to N95 respirators for protecting health care workers against influenza," the study authors conclude.
In an accompanying editorial, Arjun Srinivasan, MD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and Trish M. Perl, MD, MSc, from the School of Medicine and Bloomberg School of Public Health at Johns Hopkins University in Baltimore, Maryland, note that appropriately designed and worn N95 respirators protect wearers from small-particle exposure.
For most patient care, the World Health Organization and the Society for Healthcare Epidemiology of America recommend the use of surgical masks, whereas the Centers for Disease Control and Prevention and the Institute of Medicine recommend wearing N95 respirators when caring for patients infected with H1N1 influenza.
"That this study is, to our knowledge, the first and only published randomized trial assessing respiratory protection for preventing influenza transmission is a sad commentary on the state of research in this area," Dr. Srinivasan and Dr. Perl write. "Uncovering the truth and identifying the most appropriate way to protect health care personnel will require that other investigators build on this study. Ultimately, accumulating a body of evidence on this topic will provide much-needed answers."
They also stress the importance of other measures to prevent influenza transmission, including vaccination and hand hygiene.
"While the debate over the role of respiratory protection in preventing influenza transmission will continue, neither the ongoing discussion nor the need for more research should excuse anyone from failing to implement other measures that are known to protect patients and HCP from influenza," they conclude.
The Public Health Agency of Canada supported this study. The study authors and editorialists have disclosed no relevant financial relationships.
JAMA. Published online October 1, 2009. Study, Editorial
Laurie Barclay, MD
October 1, 2009 — Use of a surgical mask may not be inferior to the N95 respirator in halting influenza transmission in healthcare workers, according to the results of a noninferiority, randomized controlled trial published online October 1 and to be published in the November 4 print issue of the Journal of the American Medical Association.
"Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse," write Mark Loeb, MD, MSc, from McMaster University in Hamilton, Ontario, Canada, and colleagues. "Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance."
The goal of this study was to compare the surgical mask with the N95 respirator in protecting healthcare workers from influenza infection.
At 8 tertiary-care Ontario hospitals during the 2008 to 2009 influenza season, 446 nurses in emergency departments, medical units, and pediatric units were randomly assigned to use either a fit-tested N95 respirator or a surgical mask when caring for patients with febrile respiratory illness. Laboratory-confirmed influenza, measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers, was the main study endpoint.
Surgical mask efficacy was defined as being noninferior to the N95 respirator, with noninferiority defined as the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) greater than −9%.
Of 478 nurses evaluated for eligibility from September 23 to December 8, 2008, 446 nurses were enrolled and randomized, with 225 assigned to use surgical masks and 221 to use N95 respirators. In the surgical mask group, influenza infection occurred in 50 nurses (23.6%) compared with 48 (22.9%) in the N95 respirator group (absolute risk difference, −0.73%; 95% CI, −8.8% to 7.3%; P = .86, with the lower confidence limit being inside the noninferiority limit of −9%). Noninferiority of the surgical mask was also shown for influenza A (H1N1).
"Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza," the study authors write. "Our findings apply to routine care in the health care setting. They should not be generalized to settings where there is a high risk for aerosolization, such as intubation or bronchoscopy, where use of an N95 respirator would be prudent."
Study limitations include the inability to determine compliance for all participants, that audits were conducted only on medical and pediatric units and not in the emergency department, the inability to account for the effect of indirect contact, and the inability to determine whether participants acquired influenza from hospital or community exposure.
"In routine health care settings, particularly where the availability of N95 respirators is limited, surgical masks appear to be non-inferior to N95 respirators for protecting health care workers against influenza," the study authors conclude.
In an accompanying editorial, Arjun Srinivasan, MD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and Trish M. Perl, MD, MSc, from the School of Medicine and Bloomberg School of Public Health at Johns Hopkins University in Baltimore, Maryland, note that appropriately designed and worn N95 respirators protect wearers from small-particle exposure.
For most patient care, the World Health Organization and the Society for Healthcare Epidemiology of America recommend the use of surgical masks, whereas the Centers for Disease Control and Prevention and the Institute of Medicine recommend wearing N95 respirators when caring for patients infected with H1N1 influenza.
"That this study is, to our knowledge, the first and only published randomized trial assessing respiratory protection for preventing influenza transmission is a sad commentary on the state of research in this area," Dr. Srinivasan and Dr. Perl write. "Uncovering the truth and identifying the most appropriate way to protect health care personnel will require that other investigators build on this study. Ultimately, accumulating a body of evidence on this topic will provide much-needed answers."
They also stress the importance of other measures to prevent influenza transmission, including vaccination and hand hygiene.
"While the debate over the role of respiratory protection in preventing influenza transmission will continue, neither the ongoing discussion nor the need for more research should excuse anyone from failing to implement other measures that are known to protect patients and HCP from influenza," they conclude.
The Public Health Agency of Canada supported this study. The study authors and editorialists have disclosed no relevant financial relationships.
JAMA. Published online October 1, 2009. Study, Editorial
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