From the journal Reviews on Environmental Health.
Published online by De Gruyter -15july2024.
A critical appraisal of the WHO 2024 systematic review of the effects of RF-EMF exposure on tinnitus, migraine/headache, and non-specific symptoms.
by John W. Frank , Ronald L. Melnick and Joel M. Moskowitz.
Abstract
The World Health Organization (WHO) in 2012 initiated an expert consultation about research on the health effects of radio-frequency electromagnetic fields (RF-EMF) for a WHO monograph that was last updated in 1993. The project was abandoned over concerns about the quality of the commissioned review papers. The WHO restarted the project in 2019 by commissioning 10 systematic reviews (SRs) of the research on RF-EMF exposure and adverse biological and health outcomes in laboratory animals, cell cultures, and human populations. The second of these SRs, published in 2024, addresses human observational studies of RF-EMF exposure and non-specific symptoms, including tinnitus, migraine/headache, and sleep disturbance. The present commentary is a critical appraisal of the scientific quality of this SR (SR7) employing criteria developed by the Oxford Centre for Evidence-Based Medicine. Based upon our review, we call for a retraction of SR7 and an impartial investigation by unconflicted experts of the currently available evidence and future research priorities.
One further consideration, in assessing the potential of the SR by Röösli et al. [3] for bias, is the affiliations and funding sources of the authors, which are only partly declared in their paper, compared to those documented in publicly available sources. This worrisome under-declaration of potential conflicts of interest is demonstrated by contrasting the statement of such potential conflicts at the end of this SR (first quotation below) with the statement of funding from the institution with which Röösli et al. [3] are associated (second quotation below):
- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Martin Röösli’s research is entirely funded by public or not-for-profit foundations. He has served as advisor to a number of national and international public advisory and research steering groups concerning the potential health effects of exposure to nonionizing radiation, including the World Health Organization, the International Agency for Research on Cancer, the International Commission on Non-Ionizing Radiation Protection, the Swiss Government (member of the working group “mobile phone and radiation” and chair of the expert group BERENIS), the German Radiation Protection Commission (member of the committee Non-ionizing Radiation (A6) and member of the working group 5G (A630)) and the Independent Expert Group of the Swedish Radiation Safety Authority.
This statement does not reflect the true extent of the relationships with telecommunications firms of Röösli et al. [3] and their home institution (Swiss Research Foundation for Electricity and Mobile Communication – FSM), which are described in that Foundation’s 2022 Annual Report as follows [38]:
- Organization and financing: the Research Foundation is sponsored by the ETH Zurich, and the companies Cellnex, Ericsson, Sunrise, Swisscom, and Swissgrid. Institutionally, the FSM is supported by the Swiss Federal Offices of Public Health (FOPH), Communications (OFCOM), Environment (FOEN), and Energy (SFOE), as well as by the Federal Inspectorate for Heavy Current Installations (ESTI). In addition, the following NGOs support the Foundation: the Swiss Academy of Engineering Sciences (SATW), Swiss Consumer Forum (KF), the Swiss Heritage Society (SHS), the Swiss Cancer League, Ingenieur Hospital Schweiz, the Swiss Electricity Industry Association (VSE), the Swiss Telecommunications Association (ASUT), Suissedigital, Electrosuisse, Swico, the Swiss Conferences of Cantonal Ministers for Construction, Planning and the Environment (BPUK), and for Energy (EnDK).
These potential conflicts of interest are of great concern. There are many aspects of both systematic reviews and meta-analysis which – despite the use of widely recommended tools such as the OHAT Risk of Bias scale and GRADE scheme for assessing strength of evidence – involve inherently subjective decisions. Such subjectivity inevitably leads to significant variation across such reviews, even when precisely the same primary studies are being assessed [17, 39]. This potential for subjectivity requires clear cut independence of such reviews’ co-authors from any and all influences which might lead to bias related to conflicts of interest.
Conclusions
To summarize, the way in which any epidemiologically unsophisticated reader is likely to be misled by this SR is clear. It appears to conclude unequivocally that the body of scientific evidence reviewed supports the safety of current (e.g. ICNIRP-based) population exposure limits for RF-EMF [10]. We reiterate that, on the contrary, this body of evidence is not adequate to either support or refute the safety of current exposure limits – largely due to the very small number and low methodological quality of the relevant primary studies to date, and the fundamental inappropriateness of meta-analysis for the handful of very heterogeneous primary studies identified by Röösli et al. [3] for each of the exposure/outcome combinations analysed.
We therefore call for a retraction of the SR by Röösli et al., and an impartial international investigation, by unconflicted experts, of both the currently available evidence base on these issues, as well as related research priorities for the future. That investigation should particularly address, above and beyond the topic of priority health outcomes to be researched (which was already assessed in the international expert consultation by WHO in 2018) [2] the need for improved methods of accurately measuring RF-EMF exposures, suitable for large human observational studies in the general population – the Achilles heel of the current literature.
Corresponding author:
Joel M. Moskowitz, PhD, School of Public Health, University of California, Berkeley, CA 94720, USA, E-mail: jmm(@)berkeley.edu – On behalf of the International Commission on the Biological Effects of Electromagnetic Fields (ICBE-EMF).
Frank, John W., Melnick, Ronald L. and Moskowitz, Joel M.. “A critical appraisal of the WHO 2024 systematic review of the effects of RF-EMF exposure on tinnitus, migraine/headache, and non-specific symptoms” Reviews on Environmental Health, 2024. https://doi.org/10.1515/reveh-2024-0069
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