• 27 JUL 09
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    #1101: Cindy Sage comments on Dariusz Leszczynski’s blog (last message)

    The third blog “Between a Rock and a Hard Place” is available at http://rock-and-hard-place.blogspot.com/2009/07/how-reliable-is-epidemiological.html.

    It asks: How reliable is the epidemiological evidence on mobile phones and cancer?

    Friday, July 24, 2009
    Comments by Cindy Sage on 3rd Blog – Between a Rock and A Hard Place Blog


    Several questions and comments:

    1) You say Auvinen profiled ‘all published epidemiological studies to
    date dealing with mobile phones and cancer’ at the BEMS meeting. Did he
    include the Kan et al., (2007) meta-analysis? For brain tumors, it
    reported a pooled OR for long-term users of 10 years and longer (5
    studies) at 1.25 (CI = 1.01-1.54). This is important. The meta-analsis
    EXCLUDED any Hardell et al studies. It still found increased risk of
    brain tumor. J Neurooncol. 2007 July 1:(Epub). Kan P Simonsen SE Lyon
    JL Kestle JR. Division of Pediatric Neurosurgery, Department of
    Neurosurgery, University of Utah, 100 N. Medical Drive, Salt Lake City,
    Utah. john.kestle@hsc.utah.edu

    2) You say Auvinen indicated “the scientific evidence is of
    insufficient quality to reliably draw any health-risk-related estimates.”
    Well, this cannot be true when all the published studies to date with
    data on 10 year and longer latency report increased risk of malignant
    brain tumor. It is enough to say there is early evidence of some risk,
    but the risk cannot yet be quantified precisely. So, it is sufficient
    for early precautionary advice. That should be the signal from the
    evidence to date.

    3) By agreeing with Auvinen’s position that “more case-control studies
    will not improve the situation because of unavoidable biases, and will
    only be a waste of time and money”, are you saying that Hardell et al
    studies are a waste? That they contribute no useful information?

    4) You say that “case-control studies” are of such insufficient quality
    that drawing any health-related conclusions is like ‘flipping-a-coin”.
    In fact, you could and should say also that cohort studies suffer from
    the same methodological deficiencies and are equally or more
    unreliable. There are several published articles reporting the specific
    deficiencies of other types of epidemiological studies, including
    exclusion of heavy users, diluting effects by including improper
    definition of regular user, drawing conclusions from latency periods
    too short to show effects and finding none, concluding there is no
    risk, etc. Deficiencies that have led to ORs consistently under 1
    across many of the published studies indicate something is wrong with
    their research design, or execution.

    5) I think the results of the paper in Epidemiology and the ICNIRP RF
    Review paper do have consistent conclusions (you do not). ICNIRP concludes that “Results of epidemiological studies to date give no consistent or convincing
    evidence of a causal relationship between RF exposure and any adverse
    health effect. On the other hand, these studies have too many
    deficiencies to rule out an association.” A conclusion of the
    Epidemiology paper is “For slow-growing tumors such as meningioma and
    acoustic neuroma, as well as glioma among long-term users, the absence
    of an association reported thus far is inconclusive because the
    observation period has been too short.” It cannot rule out effects
    either. And because the Epidemiology paper omits reference to the Kan
    et al., 2007 finding of increased risk at 10 or more years, excluding
    all the Hardell et al papers, and because it dismisses its own finding
    that combined results of studies with 10 years or more of cell phone
    use show elevated risks as ‘deviant results’, fixing these two glaring
    errors would perhaps require a shift to “there is some evidence” or
    “there is a real risk”.

    6) You conclude that “at this time, any statements suggesting that
    ‘there is a health risk’ or ‘there is no health risk’, based on the
    epidemiological evidence, are premature and not reliabily supported by
    the available science.” Dariusz, you forget that it is not black and
    white, nor are we given only two choices – yes it does, or no it does
    not conclusively cause brain tumors. There is the important middle
    ground which would say “we have some evidence… and that the risks of
    doing nothing with it, of waiting until we know definitively one way or
    the other, will result in decades of unnecessary exposures that could
    have been prevented by some sensible public health cautions based on
    the data showing some risk at 10 years or longer use. There is no
    excuse for demanding an ‘either or” scenario. Thanks for the forum to
    discuss these ideas. You are doing us all a service by providing a place
    for exchange of viewpoints

    Cindy Sage

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