The epidemiology of exposure to electromagnetic fields: an overview of the recent literature

A Critical Review of Randomized Controlled Trials of Static Magnets for Pain Relief

OBJECTIVE

The aim of this review was to establish whether there is evidence for or against the efficacy of static magnets to produce analgesia.

METHODS

A systematic literature review was undertaken of studies that compared the use of static magnets with an appropriate control for the treatment of pain. Study methods, their quality, and outcome were also reviewed.

RESULTS

Overall, 13 of the 21 studies reported a significant analgesic effect due to static magnets. Of the 18 better quality studies with 3 points or more on the quality assessment, 11 were positive and six were negative, and in one there was a non-significant trend towards a positive analgesic effect. In two of the negative studies, there are concerns over adequacy of magnet power for the type of pain, and in the other study of duration of exposure to the magnetic field. If these two studies are excluded on the grounds of inadequate treatment, then 11 out of 15 (73.3%) of the better quality studies demonstrated a positive effect of static magnets in achieving analgesia across a broad range of different types of pain (neuropathic, inflammatory, musculoskeletal, fibromyalgic, rheumatic, and postsurgical).

CONCLUSIONS

The weight of evidence from published, well-conducted controlled trials suggests that static magnetic fields are able to induce analgesia.

A historical perspective of the popular use of electric and magnetic therapy

OBJECTIVES

To review the history of the therapeutic use of static electric and magnetic fields and to understand its implications for current popular and medical acceptance of these and other alternative and complementary therapies.

DATA SOURCES

Comprehensive MEDLINE (1960-2000) and CINAHL (1982-2000) computer literature searches by using key words such as electricity, magnetism, electromagnetic, therapy, medicine, EMF, history of medicine, and fields. Additional references were obtained from the bibliographies of the selected articles. In addition, discussions were held with curators of medical history museums and supplemental searches were made of Internet sources through various search engines.

STUDY SELECTION

Primary references were used whenever possible. In a few instances, secondary references, particularly those requiring translations of early texts, were used.

DATA SYNTHESIS

The use of electric and magnetic forces to treat disease has intrigued the general public and the scientific community since at least the time of the ancient Greeks. The popularity of these therapies has waxed and waned over the millennia, but at all times the popular imagination, often spurred by dynamic and colorful practitioners of pseudoscience, has been more excited than the medical or political establishment. In fact, a pattern seems to reappear. In each era, unsophisticated public acceptance is met first with medical disdain, then with investigation, and, finally, with a failure to find objective evidence of efficacy. This pattern continues today with the public acceptance of magnetic therapy (and alternative and complementary medicine in general) far outstripping acceptance by the medical community.

CONCLUSION

The therapeutic implications of applying electrical and magnetic fields to heal disease have continually captured the popular imagination. Approaches thousands of years apart can be remarkably similar, but, in each era, proof has been lacking and the prevailing medical establishment has remained unconvinced. Interest persists today. Although these agents may have a future role in the healing of human disease, their history and a minimal scientific rationale makes it unlikely that the dichotomy between the hopes of the public and the medical skepticism will disappear.

Carcinogenicity test of 50 Hz sinusoidal magnetic fields in rats

Male and female F344 rats, 48 per exposure group, were sham exposed (Group A) or exposed to 0.5 (Group B) and 5 mT (Group C) magnetic fields for two years. Animals were exposed from 5-109 weeks of age in SPF conditions according to the OECD test guideline No. 451. Average exposure was 22.6 hr/day. No significant differences in body weight and food consumption were observed between the sham and exposed groups. At the end of the exposure period, survival rates of the male rats were 73, 83, and 79%, and those of the females, 77, 79, and 75% for Groups A, B, and C, respectively, with no significant differences between groups. Differential counts of leukocytes were measured at the 52nd, 78th, and 104th weeks of exposure and no significant differences were observed between the exposure groups. All survivors were euthanized on schedule, and all the organs and tissues suspected of tumoral lesions were examined histopathologically. Incidences of mononuclear cell leukemia in the male and the female rats were 5, 4, 4 and 8, 6, 7 for Groups A, B and C, respectively; incidences of malignant lymphoma in the female rats were 0, 1 and 1. Neither significant increases nor acceleration of incidence of leukemia were observed. Incidences of brain and intracranial tumors did not increase in the exposed groups. Incidences of both benign and malignant neoplasms showed no significant difference between the exposed and sham exposed groups with one exception: fibroma of the subcutis in the male rats, which was considered not to be a statistically significant when evaluated with respect to the historical control data in our laboratory.

Modelling induced currents in biological cells exposed to low-frequency magnetic fields

Interactions of low-frequency magnetic fields with biological systems have been a subject of intense scientific inquiry and public concern. Most research has been done at powerline frequencies of 50 Hz or 60 Hz. One of the key questions related to interactions of low-frequency magnetic fields with biological systems is which parameters of the exposure field are responsible for observed effects. Knowledge of the induced electric field and current in various experimental in vitro systems is important for this purpose. The 3D impedance method is used in this research to model spatial patterns of induced electric fields and current in two preparations of cells. A cell monolayer with a random distribution of cells and a confluent monolayer of cells with gap junctions are considered; because of the limitations of the computational method, biological cells are represented by cubes rather than more realistic shapes (e.g. spheres). The random model indicates that for higher cell densities the pattern of the induced current flow has a limited dependence on the size and shape of the container in which the cells are placed, it depends mostly on the actual cell placement. Gap junctions, not surprisingly, are shown to increase the current density, but only if their resistance is sufficiently low. The highest current density occurs in the gaps.

Environmental health research: setting an agenda by spinning our wheels or climbing the mountain?

This paper examines the nature and characteristics of research in environmental health, viewed as the effects of the environment on human health. It is argued that most of this work has been predicated on an epidemiological approach which has yielded significant (if sometimes equivocal) findings about exposure-outcome relationships. This discussion, however, concentrates on the limited and somewhat partial view of theory implied in this perspective. It advocates instead a broad-based approach to theory as the basis for understanding significant portions of the social world. It posits, as illustrations, several social theories and with examples tries to show how environmental health research might be different.

[Cancer mortality among electricity utility workers in a the state of Sao Paulo, Brazil]

A number of epidemiologic studies have observed an association between exposure to 50-60 Hz electromagnetic fields and the development of specific types of cancer. In Brazil, a preliminary report from a study of electricity facility workers in Rio de Janeiro (RJ) has mentioned relatively similar results. An exploratory analysis of death certificates obtained from a sample of electricity workers in S. Paulo was made. Data was analysed by using the Proportional Mortality Ratio (PMR) and the Proportional Cancer Mortality Ratio (PCMR). A slightly elevated all-sites cancer mortality was observed among these workers (PMR 1.11; 95% CI 0.91-1.35). Site specific analysis has shown a statistically significant higher mortality of laryngeal cancer (PCMR 2.04; 95% CI 1.05-4.20). An excess of deaths was also seen for cancers of the buccal cavity/pharynx, prostate, bladder, brain and Hodgkin's disease, although the results lacked statistical significance. When analysed by categories of estimated exposure to magnetic fields, an excess of deaths from bladder cancer (PCMR 4.17; 95% CI 1.35-9.72), neoplasms of the brain (PCMR 7.7; 95% CI 1.02-9.65) and Hodgkin's disease (PCMR 5.55; 95% CI 1.14-16.21) was observed in the group with probably higher exposure to EMF. A comparison of cancer mortality between these workers and petrochemical employees has shown a higher PCMR for larynx tumours (PCMR 3.51; 95% CI 3.02-15.51) and bladder cancer (PCMR 7.53; 95% CI 3.02-15.51). For brain tumours, however, a PCMR of 0.74 (95% CI 0.27-1.61) was noted. Although restrictions related to sample size in the study and the lack of information about known confounders must be considered, the results of this study do not fully disagree with others previously mentioned in the literature.

Risk of childhood leukemia in areas passed by high power lines

There has been an emerging concern about possible health risks posed by exposure to extremely low frequency electromagnetic fields (EMF). The incidence of childhood leukemia near high-power transmission lines has only rarely been investigated. A total of 67 cases of childhood leukemia (aged 0-14 years) were reported to the Cancer Registration Center in Taiwan between 1979 and 1988 from the five districts in the Taipei Metropolitan Area, where at least one elementary school campus is passed over by a high power transmission line (69-345 KV). The standardized incidence ratio (SIR) of childhood leukemia in the five districts was found to be significantly elevated (SIR = 1.49, 95% confidence interval: 1.16-1.91). Younger children seemed more susceptible to EMF exposure as indicated by the fact that children aged 0-4 years in two of the five districts showed significantly elevated SIRs compared to older ones. The unusually high SIRs for children of age 5-9 and 10-14 years in one of these districts (SIR = 4.38 and 3.68 respectively) deserves further investigation.

Reproductive and teratologic effects of electromagnetic fields

The reproductive risks of electromagnetic fields (EMF) were evaluated based on an extensive review of the scientific literature pertaining to human epidemiologic studies, secular trend data, in vivo animal studies and in vitro studies, and biologic plausibility. The epidemiologic studies involving the reproductive effects of EMF exposures to human populations have included populations exposed to: (1) video display terminals (VDTs), and (2) power lines and household appliances. The clinical use of diagnostic MRI (magnetic resonance imaging) has been increasing, but there are few reports or studies of pregnant women or individuals of reproductive age who have been exposed to MRI, and whose reproductive performance has been evaluated. The population that has been studied most frequently are women exposed to VDTs, but their EMF exposures are extremely low and frequently are at the level of the ambient EMF in a house or office. The results of epidemiologic studies involving VDTs are generally negative for the reproductive effects that have been studied. Based on the number of studies, the exposure levels, and the fairly consistent results, it can be argued that VDT epidemiologic studies should no longer be given priority. There have been fewer studies concerned with the reproductive risks of power lines, electric substations, and home appliances. In some publications, positive findings for reproductive risks were reported, but the more consistent findings indicate that EMF, even at these higher exposures, do not generate a measurable increase in reproductive failures in the human population. When compared to other fields of human epidemiology, it is obvious that these studies have many difficulties. Exposures are rarely determined. Studies frequently involve small sample sizes and the investigators rarely have a combined expertise in EMF physics, engineering, and reproductive biology. Because of the allegation that there may be particular windows of frequency, wave shape, and intensity that may be deleterious, it is impossible to disregard low frequency EMF exposures as having no deleterious reproductive effects. Yet the epidemiologic data that are available would point in that direction. Secular trend data analysis of birth defect incidence data indicate that increasing generation of electric power during this century is not associated with a concomitant rise in the incidence of birth defects. There are over 70 EMF research projects dealing with animal and in vitro studies that are concerned with some aspect of reproduction and growth. Unfortunately, a large proportion of the embryology studies utilized the chick embryo and evaluated the presence or absence of teratogenesis after 48 to 52 hours of development.(ABSTRACT TRUNCATED AT 400 WORDS)

Birth defects and high voltage power lines: an exploratory study based on registry data

This is an exploratory study on birth defects in municipalities through which overhead high voltage power lines (HVPL) pass. It was aimed to test the association between maternal residencial proximity to HVPL and congenital anomalies through a case-control study based on data from the Central-East France Registry of Congenital Malformations. Each of the 1688 malformed infants identified through the register was matched with two randomly selected controls in the same maternal age group of the general population. No excess of any specific type of malformation was observed in infants exposed to HVPL. An inverse association was even found between maternal residence in municipalities with potentially high exposure to electromagnetic fields from overhead power lines and congenital anomalies of all types. This was accounted for by low numbers of exposed infants with two types of malformations: skeletal defects and cardiac defects. Difficulties in interpretation of data are addressed and limitations of the study are discussed. If an inverse association were upheld in further work, a possible mechanism might be that exposure to electromagnetic fields may increase the risk of spontaneous abortion of fetuses with anomalies.

Effects of 60 Hz electric and magnetic fields on the development of the rat cerebellum

The effects of extremely low frequency (ELF) electromagnetic (EM) fields on the maturation of the rat cerebellum were studied. Newborn rats were exposed to 60 Hz electric and magnetic fields under three different combinations in a specially constructed apparatus. The pups were irradiated for 7-8 h daily, with a 30-min interruption for nursing. Pups were kept with their mothers for the remainder of the time. After approximately 1, 2, or 3 weeks of exposure, the pups were killed. Control pups were sham exposed. The somatic growth of the irradiated rats did not show any significant difference from sham-exposed controls. At 1 kV/m and 10 gauss exposure, there was a small but statistically significant decrease in cerebellar mass. In rats exposed at 1 kV/m and 10 gauss, DNA and RNA levels were significantly higher than those in sham-exposed controls at 6 and 13 days of age, but at 20 days, these two biochemical constituents were similar in both groups of rats. The ELF-EM treatment had no effect on protein and cerebroside concentrations. In terms of age effects, DNA and RNA exhibited increases from 6 to 13 days of age, and declined from 13 to 20 days. Protein and cerebroside levels exhibited increases during the 6-20-day periods. In rats exposed at 100 kV/m and 1 gauss, the DNA levels were initially less than those of sham-exposed controls at 8 days of age, reached approximately the same levels at 14 days, and then were higher than those of controls at 22 days. There was, therefore, a significant ELF-EM effect as well as a significant interaction between age and ELF-EM exposure. In terms of age effects, DNA levels for both control and exposed animals increased from 8 to 14 days. From 14 to 22 days, DNA levels of exposed rats continued to increase while those of the controls decreased. This age effect was significant. RNA levels in both groups of animals showed increases from 8 to 14 days of age, but the increase was less for the irradiated animals than for the controls. From days 14 to 22, RNA levels for both groups showed a reduction, but the decrease was greater in the irradiated than in control rats. ELF-EM treatment significantly reduced protein levels at 8 days of age, but at 14 to 22 days, protein levels of exposed rats were higher than those of controls.(ABSTRACT TRUNCATED AT 400 WORDS)

Biologic effects of prolonged exposure to ELF electromagnetic fields in rats. I. 50 Hz electric fields

A three-year investigation was conducted on the biological effects of high-intensity electric field exposures of rats for up to 18% of their life span. Two hundred and forty adult male rats, divided into groups of 20 animals each, were exposed at ground potential for 8 h/day at 25-kV/m and 100-kV/m 50-Hz electric fields or were sham exposed for 280, 440, and 1240 h. The corresponding ages at sacrifice were 140, 164, and 315 days. An additional group of 40 rats was investigated under similar experimental conditions after 440 h of exposure at floating potential. Independent of exposure duration, mode of grounding, and field strength, no statistical differences in body weight, morphology, and histology of the liver, heart, mesenteric lymph nodes, and blood variables (hematology and serum chemistry) were found in comparison with sham-exposed animals. Plasma levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (TS) at sacrifice varied widely among experimental animals in the same group but did not differ in exposed compared with sham-exposed rats. A nonsignificant tendency toward a decrease in the testes/body weight ratio was found after 1240 h of exposure. Microscopic examination of a large number of specimens showed no quantitative or qualitative statistical differences in testes alterations either among exposed animals or between exposed and their corresponding sham-exposed groups. We conclude that 50-Hz electric field exposure, even of long duration at very high field strengths, does not induce harmful effects on tissues with high cellular turnover rates and does not impair the reproductive function of rats. Moreover, after exposure, all variables investigated were well within the normal physiological range.

Immobilization osteoporosis in paraplegia

The pathophysiology of osteoporosis as it relates to immobilization or disuse osteoporosis in paraplegics is briefly reviewed. The physiology of bone formation and resorption is discussed, and the influence of piezoelectric forces on bone integrity and the consequences of the loss of this effect in paraplegics is addressed. When bone is stressed, negative charges accumulate on the side from which the stress is applied and positive charges accumulate on the opposite side. Presumably the collagenous component of bone plays the major role in the generation of electrical potentials. Another mechanism important in the generation of electrical potentials is created by liquid planes streaming past solid planes. Diminished forces acting on bone, as in paraplegia, are translated into changes in the activity of bone remodeling units which can be assessed by histomorphic and histoenzymatic techniques. Other biochemical and endocrine consequences of immobilization involve increased serum calcium, decreased serum parathyroid hormone (PTH), and decreased dihydroxy-vitamin D synthesis. Urinary hydroxyproline and calcium excretion are increased, as is stool calcium. The bone loss that follows immobilization may produce an increased susceptibility to fractures involving long bones more than the spinal column, and is due more to decreased bone formation than to accelerated bone resorption. The treatment of immobilization osteoporosis primarily involves early remobilization, but other treatments, including the use of electrical fields and the administration of bisphosphonates, calcitonin, and a growth hormone are being actively investigated.