Characteristics of perceived electromagnetic hypersensitivity in the general population

Unveiling the biological effects of radio-frequency and extremely-low frequency electromagnetic fields on the central nervous system performance

Introduction

Radiofrequency electromagnetic radiation (RF-EMR) and extremely low-frequency electromagnetic fields (ELF-EMF) have emerged as noteworthy sources of environmental pollution in the contemporary era. The potential biological impacts of RF-EMR and ELF-EMF exposure on human organs, particularly the central nervous system (CNS), have garnered considerable attention in numerous research studies.

Methods

This article presents a comprehensive yet summarized review of the research on the explicit/implicit effects of RF-EMR and ELF-EMF exposure on CNS performance.

Results

Exposure to RF-EMR can potentially exert adverse effects on the performance of CNS by inducing changes in the permeability of the blood-brain barrier (BBB), neurotransmitter levels, calcium channel regulation, myelin protein structure, the antioxidant defense system, and metabolic processes. However, it is noteworthy that certain reports have suggested that RF-EMR exposure may confer cognitive benefits for various conditions and disorders. ELF-EMF exposure has been associated with the enhancement of CNS performance, marked by improved memory retention, enhanced learning ability, and potential mitigation of neurodegenerative diseases. Nevertheless, it is essential to acknowledge that ELF-EMF exposure has also been linked to the induction of anxiety states, oxidative stress, and alterations in hormonal regulation. Moreover, ELF-EMR exposure alters hippocampal function, notch signaling pathways, the antioxidant defense system, and synaptic activities.

Conclusion

The RF-EMR and ELF-EMF exposures exhibit both beneficial and adverse effects. Nevertheless, the precise conditions and circumstances under which detrimental or beneficial effects manifest (either individually or simultaneously) remain uncertain.

Modern health worries and annoyance from environmental factors are largely unrelated to smoking, alcohol consumption, and physical activity

OBJECTIVE

Modern health worries, as well as environmental annoyance from chemical agents, noise, and electromagnetic exposure are associated with symptom reporting and marked affective-behavioural changes. As promotion and protection of health is a primary characteristic of these conditions, it can be expected that they will be related to less risk behaviour (smoking and alcohol consumption) and more health behaviour (physical activity), both cross-sectionally and longitudinally.

METHODS

Hypotheses were tested in a sample of 2336 individuals participating in T1 and T2 data collection (3 years apart) of the Västerbotten Environmental Health Study, Sweden. Health-related behaviours were assessed using single self-report questions. Smoking was measured on a binary (yes-or-no) scale; frequency of alcohol consumption and physical activity was measured on a 5-point and a 4-point scale, respectively.

RESULTS

Modern health worries showed no cross-sectional association with the three behaviours, whereas annoyance was typically inversely, very weakly, related to smoking and alcohol consumption. Physical activity was significantly positively associated only with chemical annoyance. None of the variables significantly predicted change of behaviours at T2 after controlling for the respective T1 value and demographic variables.

CONCLUSIONS

Individuals with high levels of modern health worries and annoyance from various environmental agents are not clearly characterized by a healthier lifestyle. Perhaps they focus on the alleviation of their existing symptoms; alternatively, somatic symptom distress decreases their cognitive-affective resources necessary for a long-term life style change.

Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population

Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.

Did a nocebo effect contribute to the rise in special education enrollment following the Flint, Michigan water crisis?

Background

Exposure to waterborne lead during the Flint Water Crisis during April 2014-October 2015 is believed to have caused increased special education enrollment in Flint children.

Method

This retrospective population-based cohort study utilized de-identified data for children under six years of age who had their blood lead tested during 2011 to 2019, and special education outcomes data for children enrolled in public schools for corresponding academic years (2011-12 to 2019-20) in Flint, Detroit (control city) and the State of Michigan. Trends in the following crisis-related covariates were also evaluated: waterborne contaminants, poverty, nutrition, city governance, school district policies, negative community expectations, media coverage and social media interactions.

Results

Between 2011 and 2019, including the 2014-15 crisis period, the incidence of elevated blood lead in Flint children (≥ 5µg/dL) was always at least 47% lower than in the control city of Detroit (p < .0001) and was also never significantly higher than that for all children tested in Michigan (p = 0.33). Nonetheless, special education enrollment in Flint spiked relative to Detroit and Michigan (p < .0001). There is actually an inverse relationship between childhood blood lead and special education enrollment in Flint.

Conclusion

This study failed to confirm any positive association between actual childhood blood lead levels and special education enrollment in Flint. Negative psychological effects associated with media predictions of brain damage could have created a self-fulfilling prophecy via a nocebo effect. The findings demonstrate a need for improved media coverage of complex events like the Flint Water Crisis.

Influence of Fe3O4 and Carbon Black on the Enhanced Electromagnetic Interference (EMI) Shielding Effectiveness in the Epoxy Resin Matrix

The present study aims to investigate the shielding properties of the electromagnetic interference of polymer nanocomposites with different weight percentages of magnetite nanoparticles and cost-effective carbon black nanoparticle (CBN) on different thicknesses. X-ray diffraction test, Raman spectroscopy, the scanning electron microscopy, and the transmission electron microscope analysis were used for investigating the crystallographic structure, morphology and microstructure of the material. The nanocomposites were successfully prepared using a simple mixing and casting. Their shielding efficiency was measured by a vector network analyzer (VNA) in the frequency range of 8.2 ~ 12.4 GHz. The maximum total shielding efficiency was 36.6 dB at 8.2 GHz for a weight percentage of 15% Fe₃O₄ composite and 50% CBN (0.7 mm thickness). The results showed that with an increase of nanocomposite thickness, there is a shift of absorption shielding efficiency peak toward a higher frequency. In addition, nanocomposites had the greatest shielding effectiveness in the low-frequency range. It was found that the proper combination of electrical and magnetic losses causes excellent wave absorption. These findings indicated that epoxy resin with a combination of optimal weight percentage of magnetite and carbon black nanoparticle can be used as a suitable shielding in low thickness.

Physiological changes and symptoms associated with short-term exposure to electromagnetic fields: a randomized crossover provocation study

BACKGROUND

The biological association between electromagnetic fields (EMF) and idiopathic environmental intolerance attributed to EMF (IEI-EMF) has not been established. To assess the physiological changes and symptoms associated with exposure to EMF, we conducted a randomized crossover provocation study.

METHODS

We recruited 58 individuals with IEI-EMF (IEI-EMF group) and 92 individuals without IEI-EMF (control group). In a controlled environment, all participants received EMF signals mimicking those from mobile phone base stations in a randomized sequence under the blinded condition. During the course, participants reported their symptoms and whether they perceived EMF, and we monitored their physiological parameters, including blood pressure (BP), heart rate (HR), and HR variability.

RESULTS

The IEI-EMF and control groups reported similar frequencies of symptoms during both the provocation and sham sessions. No participant could accurately identify the provocation. In both groups, physiological parameters were similar between the two sessions. The control group, but not the IEI-EMF group, had elevated HR when they perceived EMF exposure.

CONCLUSIONS

No symptoms or changes in physiological parameters were found to be associated with short-term exposure to EMF, and no participant could accurately detect the presence of EMF. Moreover, the participants in the control group, but not those in the IEI-EMF group, had elevated HR when they perceived EMF.

Psychological models of development of idiopathic environmental intolerances: Evidence from longitudinal population-based data

The origin of idiopathic environmental intolerances (IEIs) is an open question. According to the psychological approaches, various top-down factors play a dominant role in the development of IEIs. The general psychopathology model assumes a propensity towards mental ill-health (negative affectivity) increases the probability of developing IEIs. The attribution model emphasizes the importance of mistaken attribution of experienced somatic symptoms; thus, more symptoms should lead to more IEIs. Finally, the nocebo model highlights the role of expectations in the development of IEIs. In this case, worries about the harmful effects of environmental factors are assumed to evoke IEIs. We estimated cross-lagged panel models with latent variables based on longitudinal data obtained at two time points (six years apart) from a large near-representative community sample to test the hypothesized associations. Indicators of chemical intolerance, electromagnetic hypersensitivity, and sound sensitivity fit well under a common latent factor of IEIs. This factor, in turn, showed considerable temporal stability. However, whereas a positive association was found between IEIs and increased somatic symptoms and modern health worries six years later, the changes therein could not be predicted as hypothesized by the three psychological models. We discuss the implications of these results, as well as methodological aspects in the measurement and prediction of change in IEIs.

A survey on electromagnetic hypersensitivity: the example from Poland

Idiopathic environmental intolerance attributed to electromagnetic field (IEI-EMF) called electromagnetic hypersensitivity or electrosensitivity appeared in Polish society awareness due to a considerable change made at the end of 2019 in Polish telecommunication laws. The aims of the project were to access the prevalence of IEI-EMF in Poland and to define a reliable methodology to study this phenomenon. The first step was the internet survey performed at the end of 2018. The IEI-EMF prevalence estimated at the level of 39.7% suggested considerable bias affecting the results. The faults of the first approach were analysed and then a second study stage was performed as a telephone survey at the end of 2020. The latter survey allowed estimating the prevalence of IEI-EMF as less than 1.8%. These discrepancies in the results of both surveys were connected to the medium used in the first survey (Internet) indirectly causing that the group pooled was not representative. The second pitfall was the definition of the criteria used for an electrosensitive person classification. This is why the IEI-EMF prevalence was investigated in the second stage with the use of numerous criteria. The application of different criteria allowed for essential conclusions concerning the appropriate methodology for such kinds of studies. Corrections of the methodology before the second survey allowed reliable results consistent with the results obtained in similar studies performed in other countries. Our findings also show that the IEI-EMF frequency reports presented in the literature have to be treated carefully and with some dose of scepticism.

Effects of Lifestyle and Environmental Factors on the Risk of Acute Myeloid Leukemia: Result of a Hospital-based Case-Control Study

Background: Acute myeloid leukemia (AML) is a common malignancy in adults. A vast variety of environmental and lifestyle factors play a role in AML incidence. This study aimed to assess the factors related to AML.

Study design: A case-control study.

Methods: This case-control study was performed on 137 AML cases during 2018-2021 at Beheshti Hospital in Hamadan, Iran, and 137 gender/age-matched controls. A questionnaire including 12 items was used to obtain information about lifestyle and environmental factors. A univariate and multiple variate logistic regression was used to estimate the odds ratios (OR), and a 95% confidence interval (CI) was used to investigate the relationship between the studied variables and the incidence of AML.

Results: Based on findings, 62 (45.3%) out of the 137 leukemic cases were male and 75 (4.7%) were females. A statistically significant increased risk for AML was found with regard to prior usage of cytotoxic agents (OR: 8.00, 95% CI: 1.01, 63.9, P=0.050), family history of malignancies (OR: 3.62, 95% CI: 1.65, 7.92, P=0.001), exposure to electrical power (OR: 3.22, 95% CI: 1.52, 6.81, P=0.002), and history of mental diseases (OR: 8.50, 95% CI: 3.64, 19.80, P=0.001). It was found that the AML incidence had no association with age, gender, radiation therapy, cigarette smoking, prior chemotherapy, congenital disorders, exposure to chemical agents, history of infectious mononucleosis, exercise, and blood transfusion (P>0.05).

Conclusion: The current results suggested that cytotoxic agents, family history of malignancy, mental disorders, and exposure to electrical power could play a role in AML incidence.

The Biocompatibility of Wireless Power Charging System on Human Neural Cells

The progress in technology and science leads to the invention and use of many electrical devices in the daily lives of humans. In addition to that, people have been easily exposed to increased newly generated artificial electromagnetic waves. Exponential use of modern electronic devices has automatically led to increase in electromagnetic wave exposure. Therefore, we constructed the prototype of wireless power charging system to study the biocompatibility of electromagnetic field (EMF) generated by this system on various human cell lines. There are many studies indicating the negative bio-effect of EMF on various types of cells, such as induction of apoptosis. From the other point of view, these effects could rather be beneficial in the way, that they could eliminate the progress of various diseases or disorders. For that reason, we compared the impact of EMF (87 kHz, 0.3–1.2 mT, 30 min) on human normal as well as cancer cell lines based on morphological and cellular level. Our results suggested that EMF generated by wireless power charging systems does not have any detrimental effect on cell morphology, viability and cytoskeletal structures of human neural cells.

Electromagnetic pollution alert: Microwave radiation and absorption in human organs and tissues

Electromagnetic radiation from communication and electronic devices, networks, systems and base stations has drawn concern due to excessive global usage with increasing power and operating frequency level. Numerous previous researches only focus on how the radiation from certain frequency ranges of particular devices could harm specific human organs and tissues, resulting in distinct symptoms. In this research, electromagnetic propagation and properties in 14 human organs and tissues were analyzed and investigated based on the organs and tissues' electromagnetic and mechanical parameters, and chemical composition. Counting the organs and tissues as electromagnetic materials, their permittivity and conductivity, computed by a 4-Cole-Cole mode, directly respective to the operating frequency, are interrelated to wave behavior and hence influence the organs' response. Tests were conducted in 1 GHz to 105 GHz system settings, covering most microwave frequency uses: 2.4 GHz of 4G-LTE, Wi-Fi, Bluetooth, ZigBee and the 5G ranges: 28 GHz of 5G-mmW and 95 GHz of 5G-IoT. Trial human organs and tissues were placed in the wave propagation direction of 2.4 GHz and 28 GHz dipole antennas, and a waveguide port operating from 95 to 105 GHz. The quantitative data on the effects of 5G penetration and dissipation within human tissues are presented. The absorbance in all organs and tissues is significantly higher as frequency increases. As the wave enters the organ-tissue model, the wavelength is shortened due to the high organ-tissue permittivity. Skin-Bone-Brain layer simulation results demonstrate that both electric and magnetic fields vanish before passing the brain layer at all three focal frequencies of 2.4 GHz, 28 GHz and 100 GHz.

Which sources of electromagnetic field are of the highest concern for electrosensitive individuals? - Questionnaire study with a literature review

The primary goal of the study was to identify sources of electromagnetic field (EMF) which are attributed to negative health outcomes by a general population of electrohypersensitive (EHS) individuals. Secondary goal was to investigate the differences in indicated sources in subgroups distinguished based on gender, sex, place of living, place of work and the distance between place of living and the nearest mobile phone base station (MPBS). The cross-sectional study aiming to describe and analyze the population of EHS subjects was performed using a web-based questionnaire. The full survey consisted of 32 questions and concerned participants' baseline characteristics and details on sensitivity to electronic devices. Participants were regarded as EHS if they answered "yes" to the question "Do the electric/electronic/telecommunication devices negatively affect your well-being?" and indicated at least one device which in their opinion had such an impact. We identified 408 EHS subjects, out of which 288 (70.73%) were females and 120 (29.27%) were males. Phones, especially mobile devices, were attributed to negative health outcomes by the highest number of subjects (309, 75.74% and 267, 65.44% for phones and mobile phones, respectively). Additional subgroup analysis indicated that older participants and participants who live closer to MPBS more often complained of physical symptoms attributed to MPBS impact (p = .02 and p < .01, respectively). Phones, especially mobile devices, are the most important source of EMF influencing EHS subjects. People who self-reported living closer to MPBS and older individuals seem to be remarkably more concerned about MPBS health impact.

Understanding and Preventing Health Concerns About Emerging Mobile Health Technologies

New technologies and innovations have often improved population well-being and societal function; however, these are also often initially accompanied by worry and fear. In some cases, such worries can impede, or even prevent entirely, the adoption of the technology. Mobile health (mHealth), a discipline broadly focused on employing ambulatory technologies to improve the affordability, reach, and effectiveness of health promotion and clinical intervention approaches, offers new innovations and opportunities. Despite emerging evidence supporting mHealth efficacy (eg, for improving health outcomes), some individuals have concerns about mHealth technology that may impede scalability, efficacy, and, ultimately, the public health benefits of mHealth. We present a review and conceptual framework to examine these issues, focusing on three overarching themes: biophysiological, psychological, and societal concerns. There are features of mHealth that lead to worries about the potential negative effects on an individual’s health (eg, due to exposure to electromagnetic or radio waves), despite evidence supporting the safety of these technologies. When present, such beliefs can lead to worry that gives rise to the experience of unpleasant and concerning physical symptoms—the nocebo effect. This may represent an important implementational barrier because of apprehension toward beneficial mHealth products (or features thereof, such as wireless charging, wearable or implantable sensors, etc) and may also have broader ramifications (eg, leading to economic, governmental, and legislative actions). In addition to reviewing evidence on these points, we provide a broad three-step model of implementation research in mHealth that focuses on understanding and preventing health concerns to facilitate the safe and effective scalability of mHealth (and that may be generalizable and applied to similar technologies): (1) evaluating and better discerning public perceptions and misperceptions (and how these may differ between populations), (2) developing theory-based public health communication strategies regarding the safety of mHealth, and (3) disseminating this messaging using evidence-based methods. Collectively, these steps converge on reviewing evidence regarding the potential role of worry and nocebo in mHealth and providing a model for understanding and changing attitudes and preventing unfounded negative perceptions related to mHealth technology.

Electromagnetic hypersensitivity: a critical review of explanatory hypotheses

BACKGROUND

Electromagnetic hypersensitivity (EHS) is a condition defined by the attribution of non-specific symptoms to electromagnetic fields (EMF) of anthropogenic origin. Despite its repercussions on the lives of its sufferers, and its potential to become a significant public health issue, it remains of a contested nature. Different hypotheses have been proposed to explain the origin of symptoms experienced by self-declared EHS persons, which this article aims to review.

METHODS

As EHS is a multi-dimensional problem, and its explanatory hypotheses have far-reaching implications, a broad view was adopted, not restricted to EHS literature but encompassing all relevant bodies of research on related topics. This could only be achieved through a narrative approach. Two strategies were used to identify pertinent references. Concerning EHS, a complete bibliography was extracted from a 2018 report from the French Agency for Food, Environmental and Occupational Health & Safety and updated with more recent studies. Concerning related topics, the appropriate databases were searched. Systematic reviews and expert reports were favored when available.

FINDINGS

Three main explanatory hypotheses appear in the literature: (1) the electromagnetic hypothesis, attributing EHS to EMF exposure; (2) the cognitive hypothesis, assuming that EHS results from false beliefs in EMF harmfulness, promoting nocebo responses to perceived EMF exposure; (3) the attributive hypothesis, conceiving EHS as a coping strategy for pre-existing conditions. These hypotheses are successively assessed, considering both their strengths and limitations, by comparing their theoretical, experimental, and ecological value.

CONCLUSION

No hypothesis proves totally satisfying. Avenues of research are suggested to help decide between them and reach a better understanding of EHS.

Methodological limitations in experimental studies on symptom development in individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) - a systematic review

BACKGROUND

Hypersensitivity to electromagnetic fields (EMF) is a controversial condition. While individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) claim to experience health complaints upon EMF exposure, many experimental studies have found no convincing evidence for a physical relation. The aim of this systematic review was to evaluate methodological limitations in experimental studies on symptom development in IEI-EMF individuals that might have fostered false positive or false negative results. Furthermore, we compared the profiles of these limitations between studies with positive and negative results.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the methodological conduct and reporting. Eligible were blinded experimental studies that exposed individuals with IEI-EMF to different EMF exposure levels and queried the development of symptoms during or after each exposure trial. Strengths and limitations in design, conduct and analysis of individual studies were assessed using a customized rating tool.

RESULTS

Twenty-eight studies met the eligibility criteria and were included in this review. In many studies, both with positive and negative results, we identified methodological limitations that might have either fostered false or masked real effects of exposure. The most common limitations were related to the selection of study participants, the counterbalancing of the exposure sequence and the effectiveness of blinding. Many studies further lacked statistical power estimates. Methodically sound studies indicated that an effect of exposure is unlikely.

CONCLUSION

Overall, the evidence points towards no effect of exposure. If physical effects exist, previous findings suggest that they must be very weak or affect only few individuals with IEI-EMF. Given the evidence that the nocebo effect or medical/mental disorders may explain the symptoms in many individuals with IEI-EMF, additional research is required to identify the various factors that may be important for developing IEI-EMF and for provoking the symptoms. We recommend the identification of subgroups and exploring IEI-EMF in the context of other idiopathic environmental intolerances. If further experimental studies are conducted, they should preferably be performed at the individual level. In particular, to increase the likelihood of detecting hypersensitive individuals, if they exist, we encourage researchers to achieve a high credibility of the results by minimizing sources of risk of bias and imprecision.

Possible Effects of Radiofrequency Electromagnetic Field Exposure on Central Nerve System

Technological advances of mankind, through the development of electrical and communication technologies, have resulted in the exposure to artificial electromagnetic fields (EMF). Technological growth is expected to continue; as such, the amount of EMF exposure will continue to increase steadily. In particular, the use-time of smart phones, that have become a necessity for modern people, is steadily increasing. Social concerns and interest in the impact on the cranial nervous system are increased when considering the area where the mobile phone is used. However, before discussing possible effects of radiofrequency-electromagnetic field (RF-EMF) on the human body, several factors must be investigated about the influence of EMFs at the level of research using in vitro or animal models. Scientific studies on the mechanism of biological effects are also required. It has been found that RF-EMF can induce changes in central nervous system nerve cells, including neuronal cell apoptosis, changes in the function of the nerve myelin and ion channels; furthermore, RF-EMF act as a stress source in living creatures. The possible biological effects of RF-EMF exposure have not yet been proven, and there are insufficient data on biological hazards to provide a clear answer to possible health risks. Therefore, it is necessary to study the biological response to RF-EMF in consideration of the comprehensive exposure with regard to the use of various devices by individuals. In this review, we summarize the possible biological effects of RF-EMF exposure.

Diplomats' Mystery Illness and Pulsed Radiofrequency/Microwave Radiation

Importance: A mystery illness striking U.S. and Canadian diplomats to Cuba (and now China) "has confounded the FBI, the State Department and US intelligence agencies" (Lederman, Weissenstein, & Lee, 2017). Sonic explanations for the so-called health attacks have long dominated media reports, propelled by peculiar sounds heard and auditory symptoms experienced. Sonic mediation was justly rejected by experts. We assessed whether pulsed radiofrequency/microwave radiation (RF/MW) exposure can accommodate reported facts in diplomats, including unusual ones. Observations: (1) Noises: Many diplomats heard chirping, ringing or grinding noises at night during episodes reportedly triggering health problems. Some reported that noises were localized with laser-like precision or said the sounds seemed to follow them (within the territory in which they were perceived). Pulsed RF/MW engenders just these apparent "sounds" via the Frey effect. Perceived "sounds" differ by head dimensions and pulse characteristics and can be perceived as located behind in or above the head. Ability to hear the "sounds" depends on high-frequency hearing and low ambient noise. (2) Signs/symptoms: Hearing loss and tinnitus are prominent in affected diplomats and in RF/MW-affected individuals. Each of the protean symptoms that diplomats report also affect persons reporting symptoms from RF/MW: sleep problems, headaches, and cognitive problems dominate in both groups. Sensations of pressure or vibration figure in each. Both encompass vision, balance, and speech problems and nosebleeds. Brain injury and brain swelling are reported in both. (3) Mechanisms: Oxidative stress provides a documented mechanism of RF/MW injury compatible with reported signs and symptoms; sequelae of endothelial dysfunction (yielding blood flow compromise), membrane damage, blood-brain barrier disruption, mitochondrial injury, apoptosis, and autoimmune triggering afford downstream mechanisms, of varying persistence, that merit investigation. (4) Of note, microwaving of the U.S. embassy in Moscow is historically documented. Conclusions and relevance: Reported facts appear consistent with pulsed RF/MW as the source of injury in affected diplomats. Nondiplomats citing symptoms from RF/MW, often with an inciting pulsed-RF/MW exposure, report compatible health conditions. Under the RF/MW hypothesis, lessons learned for diplomats and for RF/MW-affected civilians may each aid the other.