6. defectos interphone

8/12/2019 6. Defectos Interphone

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L. Lloyd Morgan [[email protected]] 1

Interphone Studies To Date

An Examination of Poor Study Design

Resulting in an UNDER-ESTIMATIONof the Risk of Brain Tumors

L. Lloyd MorganBEMS, San Diego, 12 June 2008


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MethodologyWhat If There Is No Risk of Brain Tumors?

ORs 1.0

Think coin tossing

OR=1.0 are excluded

~5% of ORs would be significant ORs 1.0

Calculate ratio: OR1.0

13 Interphone brain tumor studies to date

Exclude 2 overlapping studies and recent (Schlehofer) study

Analysis restricted to 10 Interphone brain tumor studies

Calculate binomial p-values


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MethodologyCalculate Ratio by Categories by Studies

How to have statistically independent categories? Compare between studies, not within studies

Categories

Brain Tumors

All

Acoustic Neuroma Glioma

Meningioma

Years of use (Years)

Cumulative hours of use (Hours)

Cumulative number of calls (Call #) Regular cellphone use (Regular)

Years of ipsilateral cellphone use (Years Ipsi)

Years of contralateral cellphone use (Yrs Contra)

Minutes of cellphone use per day (Min/Day)


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ResultsPercent Significant Findings By Category

Expectation: ~5%

0%

5%

10%

15%

20%

25%

All Years Hours Call # "Regular" Years Ipsi Years

Contra

Min per

Day

Categories

~ expected

Based

on 7

Findings

0%


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Results

Ratio by Category

0

1

2

3

4

5

6

7

8

All Call # Hours Years "Regular" Years

Contra

Min per

Day

Years

Ipsi

Categories

Ratio

p=1.2x10-20

p=6.0x10-07

p=6.1x10-06

p=1.1x10-07

p=0.0011 p=0.0097p=0.16

p=0.097

Highest

Exposure

LowestRatio

Non-significant

Near-significant


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ResultsRatio by Brain Tumor Type

0

1

2

3

4

5

6

All Acoustic

Neuroma

Glioma Meningioma

Ratio

p=1.2x10-20

p=2.9x10-5

p=6.0x10-10

p=8.2x10-9


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Interphone Protocol Design Flaws

Flaw 1: Selection Bias Participating controls use cellphones more than non-

participating controls

Weighted average control participation rate: 59%

Lon 2004: 20% control refused; 34% used, 59% did not use Underestimates risk

Flaw 2: Tumors outside the radiation plume areunexposed

Unexposed tumors treated as exposed

Plume volume small relative to brain volume Well know since 1994 (4 previous papers)

Underestimates risk


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Flaw 2

Tumors Outside Radiation Plume Are Unexposed

Radiation plumes volume is small % of brains volume

Ipsilateral: exposed Contralateral: unexposed Absorbed radiation decreases rapidly with plume penetration depth

Half-way to the brains mid-line, >90% of energy is absorbed

Percentage of absorbed cellphone radiation Ipsilateral temporal lobe: 50-60% (wt. av.=53%)

~15% of brains volume

Ipsilateral cerebellum: 12-25% (wt. av.=19%)

~5% of brains volume

62-85% of absorbed radiation is in ~20% of thebrains volume

Plume decreases rapid with depth (actual exposedbrains volume:


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Flaw 2

Absorbed Radiation Decreases Rapidly w Depth

Relative Absorbed Radation and Penetration

Depth in Temporal Lobe

0%

10%

20%

30%

40%

50%

60%

15-24 25-34 35-44 45-54 55-64 65-74 75-84

Depth (mm)

% Absorbed Radiation

Relative to Max

Absorbed Radiation

900 MHz European Phones (worst case)

800-900 MHz Japanese Phones

Source: Cardis et al 2008


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Flaw 3: Latency time Known latency times

Ionizing radiation & brain tumor: 20-40 years

Smoking & lung cancer: ~30 years

Asbestos & mesothelioma: 20-40+ years

Short latency times underestimates risk

Flaw 4:Definition of regular user

Regular user: At least once a week for 6 months ormore

If definition of regular smoker were used, would a risk oflung cancer be found?

Definition of regular user underestimates risk


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Flaws 3 and 4

Latency Time and the Definition of Regular Users

UK Subscribers by Year

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8 9 10 1 1 1 2 13 1 4 1 5 16

Years from Eligibility Date

(Latency Time)

Millions

0Wt. Ave.

Eligibility

Date

2002.5

123456789101112131415

5 year latency

15% User-years

>10 year latency

2% User-years


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Flaw 5: Young adults and children

excluded

Children and young adults at greater risk thanadults

Interphone Protocol: 30-59 years

Some studies reduce minimum age to 20 years

Underestimates risk


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Flaw 5

Young AdultsandChildrenExcluded

0

1

2

3

4

20-29 years 30-39 years 40-49 years 50-59 years

Age Range

OR

P


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Flaw 6: Comparison cellphone radiated

power: higher vs lower

Analog Vs Digital phones No longer possible

Rural Vs Urban users

Underestimates risk


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Flaw 7: Cordless phone, walkie-talkie, Ham, andproximity to TV & radio transmitters

Treated as unexposed

Underestimation of risk

Flaw 8: Exclusion of brain tumor types

Includes only acoustic neuroma, glioma & meningioma

Other brain tumor types are excluded

For example lymphoma and neuroepithelial brain tumors

Underestimates risk

Flaw 9: Exclusion of brain tumor cases becauseof death

Underestimates risk of most deadly brain tumors


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Interphone Protocol Design

Flaws Flaw 10: Recall bias

Light users underestimate use

Heavy users overestimate use

Result: Large underestimation of risk


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How to Resolve Flaws

Increase diagnosis eligibility time

Nine Interphone studies: weighted-average 2.6 years

Hardell et al. eligibility time: 6 years

Lower age range to


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Conflict-of-Interest Cellphone Industry

Interphone funding is inadequate to resolve flaws More funding, greater potential of substantial revenue

loss

Researchers conflict-of-interest

(unconscious?)

Source of funds is known in spite of Firewall

Honest, but

Dont bite the hand that feeds you

90 significant protectiveresults

Ignored by authors (no commentary in the text)


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Potential Brain Tumor Risk

30-year Latency

Poisson Distribution Calculation

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Years Since First Exposure

Risk

1985

1st Use

1995

10 Yrs2005

20 Yrs

2015

30 Yrs

0.002%

4%

55%

97%


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Potential Public Health Risk

Potential Brain Tumor Cases From Use of a Cellphone

Assuming a 30-Year Latency Time and 10% of Users1

Diagnosed with a Brain Tumor

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

Potential Cases

of Brain Tumors

per Year

0

50

100

150

200

250

300

350

400

450

Cellphone

Subscribers

millions

Year 2004

44,447 Dx

~3,600 from

cellphone use

Year 2019

1,590,5131Based on 10% of long-term smokers are diagnosed with lung cancer

Source Cellphone Subscribers: CTIA

Source brain tumor diagnosed in 2004: CBTRUS


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Conclusions Interphone resultssubstantiallyunderestimate the risk of

brain tumors Great majority of results have OR10 yearsof use

Significant risk found for >10 years andipsilateral use

Without design flaws Odds Ratios would increasesubstantially

Cellphone industrys conflict-of-interest is obvious

Government: ignores potential epidemic (see no evil)

Public health impact is enormous

Industry independent studies are required


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I Pray Im Wrong!


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Now What?Based on CBTRUS Incidence Data

Window closed for case-control studies

No unexposed cases remain

Cohort studies

Unable to know users of company owed cellphones

Unable to interview cellphone users

Requires enormous numbers

1,000,000 user-years will find (assuming cellphones do not increase

risk)

~6 acoustic neuromas

~54 gliomas

~45 meningiomas

Requires ~1 billion user-years to analyze by

Gender, SES, Years of use ,Exposed tumors only

Requires 30 year cohort study


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Flaw 11: Recall bias Interview cases immediately after diagnosis and 6 months

after surgery Improved memory and cognition 6 months after surgery

Flaw 12: Observational bias

Interviewer not blinded with face-to-face interviews

Mailed questionnaires provide blindness

Supplement by phone as necessary

Flaw 13: Too few cases for statistical power

Nine Interphone Brain Tumor Studies: Use for >10 years Average 18 cases per study

At minimum requires 2-fold more cases and controls forsufficient statistical power


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Design Changes to Resolve Flaws

Treat unexposed tumors as unexposed Tumors outside radiation plume

Data was available, but to date not used, or even discussed

Too few cases?

Treat RF/MW exposures and exposed Cordless phone, walkie-talkie radios, Ham transmitters

Overweight rural users or increase eligibility time

Compare risk of brain tumor with rural and urban users Requires sufficient number of cases and controls

Use questionnaires not face-to-face interviews


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Reporting regular use

Do not publish regular use data

At minimum report regular use for >5 years,

or >10 years

Assumes >3-fold increase in case eligibility range Latency time: initiation or promotion?

Some researchers assume cellphone can only be

promoters

What is evidence for initiation vs promotion?

Follow cases & controls for a longer period


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Increase eligibility time to 9 years (for

sufficient statistical power)

>3-fold increase in cases and controls Publish results every 3 years

Provides longer latency time

Resolves whether cellphones use initiates or

promotes tumors


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Flaw 2


900 MHz European Phone: Depth by Structure

0%

10%

20%

30%

40%

50%

60%

15-24 25-34 35-44 45-54 55-64 65-74 75-84Depth (mm)

Relative

SAR

Temporal Frontal Parietal Occipital Cerebellum

50% 19%Total Raditaion Absobed by Structure

9% 5% 12%


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Flaw 5

Children Excluded

Ionizing Radiation ExampleExcess Relative Risk (ERR) per Gray (Gy)

Malignant Brain Tumors

by Age from Ionizing Radiation Exposure

47%

224%

356%

0%

100%

200%

300%

400%


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Flaw 5Young Adults Excluded

Korean Cellphone Study

0

1

2

3

4


Age Range

OR

P


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Flaw 5Young Adults Excluded

Swedish Cellphone Study

Increased Risk of Brain Tumor

0

1

2

3

4

5

6

7

8


Analog cellphone Cordless phone

OR

Source: Hardell et al.Arch Environ Health. 2004 Mar;59(3):132-7.

Fl 2


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L Lloyd Morgan [bilovsky@aol com] 33

Flaw 2


Source: http://serendip.brynmawr.edu/bb/kinser/Glossary.html

~10.4

~5.6 cm

Surface area ~162 cm2

Ipsilateral temporal lobesvolume to

total brains volume ~15%

Worst case: ~62% of ipsilateral radiation

is absorbed in ~20% of brain

Ipsilateral cerebellums volume to total

volume ~5%

6. defectos interphone

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