Rheum with a View

COULD CELL PHONES CAUSE CANCER HEART DISEASE, OR EVEN ARTHRITIS?*

Aren’t you worried about this?! Don’t you lose sleep over this?! Do you even understand the literature?

The reports on a link between cell phones and cancer or other diseases is clear confusing to me, so I attempted to meticulously critique review the entire world selected literature on this topic and get to the truth. I began by discarding the articles from sources like Popular Mechanics and, somewhat reluctantly, The National Enquirer (there was a diet there I wanted to read about and some pictures I wanted to look at …). That left me with the fascinating piece and accompanying editorial in JAMA not too long ago, an intellectually stimulating distillation and exposition from the effete scientifically authoritative New York Times Sunday Magazine, and a couple of other related recent articles.^1-3 And then, to be sure I got it right, I checked the Rheumatology Morning Wire, the Journal of Irreproducible Results World Health Organization, the book “I Was Abducted by Aliens”, and the American Cancer Society website.

I guess this is the place for modest disclaimers. I hate, er, dislike, er, am not of those who believe in, er, don’t really have a cell phone. Now that I’m no longer a program director, division chief, or department chair, and have a very limited consultative practice, there are few, if any, true emergencies or urgencies. I am almost always near phones and computers and can be reached (except when I run). In fact, I bought a cell phone as we departed New Jersey for California, thinking it might be necessary during our cross-country trip (it wasn’t) and then during my driving on Los Angeles freeways (it still wasn’t). It seemed to have gotten misplaced. Maybe one of my grandchildren has it; actually I think the dogs ate it.

Ringing in the Truth

So, let me tell you what I learned. For free. The Cell Phone Diet works by (Sorry, my references seem to be getting mixed up here.) Do you know how many mobile phones there are? This year, there are 5.3 billion (77% of the world’s population). Even 60% of rural Africans have mobile phones now. Laid end-to-end, they might eradicate malaria It was estimated that last year, 91% of Americans used cell phones, accounting for 1.12 trillion minutes and 5 billion text messages per day. Yes, I know how valuable SmartPhones have become in patient care; I purchased them for my faculty at Saint Barnabas, insisted that our hospitalists have and use them, and encouraged my residents and voluntary staff to use them (I wasn’t able to buy them for everybody). Indeed ,there’s an interesting editorial about some aspects of this.⁴ Cell phones are ubiquitous. They have clearly transformed communications, social relationships and interactions, perhaps societies, and certainly medicine and patient care.

Everybody knows that cell phones are a source of death rays nonionizing electromagnetic radiation in the radio frequency range. They may affect tissues (apparently nearly 1,700 scientific papers have been published about this; I plan to systematically and carefully have not reviewed them). I came across one paper that documented statistically significantly less bone mineral density and bone mineral content at the hip, femoral neck, and trochanter over which the cell phone was carried, compared with controls; the decrement in bone density correlated with the number of hours the phone was carried.⁵ These data obviously prove that cell phones cause arthritis, cancer, heart disease, and world famine. Er… These interesting data require independent confirmation in more extensive, better controlled, better randomized studies examining more and different individuals, different cell phones, carriers, and taking into account roaming and lost connections. These really are observations worth noting as they indeed suggest biologic effects with possible clinical relevance.

The experiments reported last February in JAMA were elegant.¹ The investigators clearly demonstrated that cell phones cause arthritis, cancer, heart disease, and world famine found in a randomized crossover trial that 50 minutes of cell phone exposure was associated with small but statistically significant increases in glucose metabolism (measured by positron emission tomography scanning) in the region of the brain closest to the phone antenna, showing that the human brain is affected by the radiofrequency-modulated electromagnetic fields of cell phones. The color figures are neat and, to me, the difference displayed is obvious. Thus these fields will either cause or cure arthritis, or have no effect Speculation about mechanism(s) or biological or clinical implications remain just that, conjectural.²

It was some time after this that I learned from my Rheumatology Morning Wire that cell phones cause arthritis, cancer, heart disease, and world famine the World Health Organization said that cell phones cause brain cancer issued a press release labeling cell phones as “possibly carcinogenic.”⁶ This was apparently based on a report from an expert panel of 31 scientists who reviewed the literature, “slated to be published July 1 in The Lancet,” which included “epidemiologic data showing an increased risk among heavy cell phone users of a rare type of brain tumor called a glioma.”⁷ The American Caner Society website warns that cell phones cause arthritis, cancer, heart disease, and world famine nicely summarizes available evidence and then lists the conclusions of expert agencies, noting that the Food and Drug Administration (FDA), Federal Communications Commission (FCC), Centers for Disease Control and Prevention (CDC), National Institute of Environmental Health Sciences (NIEHS), and National Cancer Institute (NCI) all have softer conclusions—“majority of studies … failed to show an association” (FDA); “no scientific evidence …” (FCC); “studies … raised concerns … research … taken together does not indicate a significant association between phone use and health effects” (CDC); “not conclusively lined … more research is needed” (NIEHS); “research has not consistently demonstrated a link … further surveillance is needed before conclusions can be drawn” (NCI).⁸

Let me tell you my thoughts about cell phones and driving, dining, and certain other personal and interpersonal activities. Now I try to turn a bit serious. We have a couple of observations showing that, under some circumstances, cell phones have a biological effect—on bone and brain, in these studies. Some have enough concern about the relationship to gliomas to consider the risk in the 2B category (possible carcinogen).

Am I an alarmist? Am I some wide-eyed, bearded radical? Not at all. Not my style. Do I think we are going to have an epidemic of serious health problems from cell phones? Not really. But stranger things have happened. We used to treat acne with irradiation, ankylosing spondylitis with irradiation, certain pregnant women with diethyl stilbesterol, and anxious patients with thalidomide, all of which led to delayed-onset, unexpected, horrible tragedies. Did you or your parents ever buy a Corvair (which was “unsafe at any speed”)? And I’m sure you can think of other products, or even social or medical trends, introduced only for their “adverse effects to be discovered later.” It’s not impossible.

I really am not a “technophobe” or luddite. In the lab, I participate in some incredibly sophisticated, technologically advanced experiments. I think first I’ll examine the effects of cell phone electromagnetic fields on mediator release in vitro (how much do you want to bet I’ll find something, for some cytokine, in some circumstance?). Then I’ll move on to experimental arthritis in animals (double or nothing?). And next I think I should be ready for fibromyalgia patients in the clinic (this will surely lead to fame and fortune).

My dogs, by the way, seem not to have suffered any ill effects from eating my cell phone.

Don’t call me, I’ll call you.

*Some of the style used in this column, particularly the use of strike-through text for comic effect, was derived from “The Life of Reilly” feature, by Rick Reilly, in Sports Illustrated, particularly that of May 17, 1999.

Dr. Panush is professor of medicine, Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles.

References

1. Volkow ND, Tomasi D, Want G-J, et al. Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011;305:808-81.
2. Lai H, Hardell L. Cell phone radiofrequency radiation exposure and brain glucose metabolism. JAMA. 2011;305:828-829.
3. Mukherjee S. Do cellphones cause brain cancer? New York Times Magazine, April 13, 2011;pp. 29, 32, 34-36, 65.
4. Horwitz LI, Detsky AS. Physician communication in the 21st century: To talk or to text? JAMA. 2011;305:1128-1129.
5. Saravi FD. Asymmetries in hip mineralization in mobile cellular phone users. J Craniofac Surg. 2011;22:706-710.
6. International Agency for Research on Cancer. World Health Organization. IARC classifies radiofrequency electromagnetic fields as possibly carcinogenic to humans. May 31, 2011, pp. 1-6.
7. Rheumatology Morning Wire, June 1, 2011.
8. American Cancer Society. Cellular Phones. Available at www.cancer.org/cancer/cancercauses/othercarcinogens/athome/cellular-phones. Updated May 31, 2011. Accessed July 15, 2011.