Defectos Interphone

Interphone Studies To Date
An Examination of Poor Study Design Resulting in an UNDER-ESTIMATION of the Risk of Brain Tumors
L. Lloyd Morgan BEMS, San Diego, 12 June 2008
L. Lloyd Morgan [bilovsky@aol.com]
Methodology
What If There Is No Risk of Brain Tumors?
ORs <1.0 would be ~equal ORs>1.0
Think coin tossing
OR=1.0 are excluded
~5% of ORs would be significant

ORs <1.0 would be ~equal ORs>1.0
Calculate ratio: OR<1.0/OR>1.0

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

L. Lloyd Morgan [bilovsky@aol.com] 2
Methodology
Calculate 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)
Results
Percent Significant Findings By Category
Expectation: ~5%
25%
20%
15%
10%
~ expected
5%
Based on 7 Findings 0%
0% All Years Hours Call # "Regular" Years Ipsi Years Contra
Min per Day
Categories
Results
Ratio (OR<1.0/OR>1.0): Exposures: >10 Year and <10 Year
Ratio
5.0
p=3.6 x 10-22
4.0
3.0
2.0
p=0.16
~ Expected ratio if no risk
1.0
0.0
>10 year
Longest Exposure Lowest Ratio
<10 year
Results
Ratio by Category
Ratio
8 7 6 5 4 3 2 1 0
All Call # Hours Years "Regular" Years Contra Min per Day Years Ipsi
p=6.0x10-07
Non-significant Near-significant
p=6.1x10-06 p=1.2x10-20 p=1.1x10-07 p=0.0011 p=0.0097 p=0.16 p=0.097
Categories
Highest Exposure Lowest Ratio
Results
Ratio by Brain Tumor Type
Ratio
6 5
p=1.2x10-20 p=6.0x10-10
p=8.2x10-9
4 3 2 1 0 All Acoustic Neuroma Glioma Meningioma

p=2.9x10-5
Interphone Protocol Design Flaws

Flaw 1: Selection Bias
Participating controls use cellphones more than nonparticipating 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 are unexposed

Unexposed tumors treated as exposed Plume volume small relative to brain volume
Well know since 1994 (4 previous papers)
Underestimates risk
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:
~15% of brains volume
50-60% (wt. av.=53%) 12-25% (wt. av.=19%)
Ipsilateral cerebellum:
~5% of brains volume
62-85% of absorbed radiation is in ~20% of the brains volume

Plume decreases rapid with depth (actual exposed brains volume: <20%, perhaps 15%)
Flaw 2 Absorbed Radiation Decreases Rapidly w Depth

Relative Absorbed Radation and Penetration Depth in Temporal Lobe % Absorbed Radiation
Relative to Max Absorbed Radiation
60%
900 MHz European Phones (worst case)
50% 40% 30% 20% 10% 0%

15-24
Source: Cardis et al 2008
800-900 MHz Japanese Phones
25-34
35-44
45-54
55-64
65-74
75-84
Depth (mm)
10

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 or more
If definition of regular smoker were used, would a risk of lung cancer be found?
Definition of regular user underestimates risk

Flaws 3 and 4 Latency Time and the Definition of Regular Users

UK Subscribers by Year
Millions
60 50 40 30
>5 year latency 15% User-years
20
>10 year latency 2% User-years
<5 year latency 85% User-Year
10 0
1 2 3 4 5 6 7 15 14 13 12 11 10 9
8 8
9 7
10
11
12
13
14
Years from Eligibility Date (Latency Time)

1 16 0 Wt. Ave. Eligibility Date 2002.5

15
12

Flaw 5: Young adults and children excluded
Children and young adults at greater risk than adults
Interphone Protocol: 30-59 years
Some studies reduce minimum age to 20 years
Underestimates risk
13
Flaw 5 Young Adults and Children Excluded

Sweden: Cellphone Rad.
OR
Korea: Cellphone Rad.

OR
Increased Risk of Brain Tumor
4
Source: J.W. Choi el al.Case-control Studies on Human Effects of Wireless Phone RF in Korea, BEMS 2006
8 7 6 5 4 3 2 1 0
20-80 years Analog cellphone
P<0.01
Source: Hardell et al. Arch Environ Health. 2004 Mar;59(3):132-7.
20-29 years
20-80 years
20-29 years
0
20-29 years 30-39 years
Age Range
Cordless phone
40-49 years
50-59 years
Israel: Ionizing Radiation

ERR/GY
Excess Relative Risk (ERR) per Gray (Gy) Malignant Brain Tumors by Age from Ionizing Radiation Exposure
400% 356% 300%

Mean estimated dose: 1.5 Gy (range 1.0 to 6.0 Gy)
200%
224%
100%
47% 0% <5 5-9 10+
Age at Exposure
Source: Sadetzki et al., RADIATION RESEARCH 163, 424432 (2005)
14

Flaw 6: Comparison cellphone radiated power: higher vs lower
Analog Vs Digital phones
No longer possible
Rural Vs Urban users Underestimates risk
15

Flaw 7: Cordless phone, walkie-talkie, Ham, and proximity 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 because of death

Underestimates risk of most deadly brain tumors

Flaw 10: Recall bias
Light users underestimate use Heavy users overestimate use Result: Large underestimation of risk
17
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 <15 years Pay controls (and cases?) for participation in study
Do not tell controls what is the purpose of the study
Interview proxies in case of death

Separately report both case and proxy interview results
Treat unexposed tumors as unexposed Etc., Etc., Etc.,

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 protective results
Ignored by authors (no commentary in the text)
Potential Brain Tumor Risk 30-year Latency

Poisson Distribution Calculation
Risk
100%
1985 1st Use 1995 10 Yrs 2005 20 Yrs 2015 30 Yrs
97%
80%
60%
55%
40%
20%
4%
0%
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
0.002%
Years Since First Exposure
20
Potential Public Health Risk

Potential Brain Tumor Cases From Use of a Cellphone Potential Cases Assuming a 30-Year Latency Time and 10% of Users1 of Brain Tumors per Year Diagnosed with a Brain Tumor
1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0
1
Cellphone Subscribers millions 450 400 350
Year 2019 1,590,513
Based on 10% of long-term smokers are diagnosed with lung cancer

Source Cellphone Subscribers: CTIA Source brain tumor diagnosed in 2004: CBTRUS
300 250 200 150
Year 2004 44,447 Dx ~3,600 from cellphone use
100 50 0
19 8 19 5 8 19 6 8 19 7 8 19 8 8 19 9 9 19 0 9 19 1 9 19 2 9 19 3 9 19 4 9 19 5 9 19 6 9 19 7 9 19 8 9 20 9 0 20 0 0 20 1 0 20 2 0 20 3 0 20 4 0 20 5 0 20 6 0 20 7 0 20 8 0 20 9 1 20 0 1 20 1 1 20 2 1 20 3 1 20 4 1 20 5 1 20 6 1 20 7 1 20 8 19
21
Conclusions
Interphone results substantially underestimate the risk of brain tumors
Great majority of results have OR<1.0
Either cellphone use is protective, or the study has major flaws
Ratio is lowest for highest exposures: ipsilateral use or >10 years of use Significant risk found for >10 years and ipsilateral use
Without design flaws Odds Ratios would increase substantially Cellphone industrys conflict-of-interest is obvious Government: ignores potential epidemic (see no evil)
Public health impact is enormous
Industry independent studies are required

I Pray Im Wrong!
23
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


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 for sufficient statistical power
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


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


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
28

900 MHz European Phone: Depth by Structure
Relative SAR
60% 50% 40% 30% 20% 10% 0% 15-24 25-34 35-44 45-54 Depth (mm) 55-64 65-74 75-84
50%
Total Raditaion Absobed by Structure

19% 9% 5% Frontal Parietal Occipital
12%
Temporal
Cerebellum
29
Flaw 5 Children Excluded Ionizing Radiation Example

ERR/GY
Excess Relative Risk (ERR) per Gray (Gy) Malignant Brain Tumors by Age from Ionizing Radiation Exposure
400% 356% 300%

Mean estimated dose: 1.5 Gy (range 1.0 to 6.0 Gy)
200%
224%
100% 47% 0% <5 5-9 Age at Exposure 10+
Source: Sadetzki et al., RADIATION RESEARCH 163, 424432 (2005)
30
Flaw 5
OR
Young Adults Excluded Korean Cellphone Study

P<0.01
Source: J.W. Choi el al.Case-control Studies on Human Effects of Wireless Phone RF in Korea, BEMS 2006
0
20-29 years 30-39 years
Age Range
40-49 years
50-59 years
31
Flaw 5
Young Adults Excluded Swedish Cellphone Study
OR
Increased Risk of Brain Tumor
8 7 6 5 4 3 2 1 0
20-80 years Analog cellphone
Source: Hardell et al. Arch Environ Health. 2004 Mar;59(3):132-7.
20-29 years
20-80 years
20-29 years
Cordless phone
32
~5.6 cm
Source: http://serendip.brynmawr.edu/bb/kinser/Glossary.html
~10.4 cm Surface area ~162 cm2
Ipsilateral temporal lobes volume to total brains volume ~15% Ipsilateral cerebellums volume to total volume ~5% Worst case: ~62% of ipsilateral radiation is absorbed in ~20% of brain

Defectos Interphone

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Defectos Interphone

Uploaded by

Copyright:

Available Formats

Interphone Studies To Date

L. Lloyd Morgan [bilovsky@aol.com]

~5% of ORs would be significant

Calculate ratio: OR<1.0/OR>1.0

Calculate binomial p-values

How to have statistically independent categories?

0% All Years Hours Call # "Regular" Years Ipsi Years Contra

Min per Day

p=6.1x10-06 p=1.2x10-20 p=1.1x10-07 p=0.0011 p=0.0097 p=0.16 p=0.097

Highest Exposure Lowest Ratio

L. Lloyd Morgan [bilovsky@aol.com]

4 3 2 1 0 All Acoustic Neuroma Glioma Meningioma

L. Lloyd Morgan [bilovsky@aol.com]

Interphone Protocol Design Flaws

Flaw 2: Tumors outside the radiation plume are unexposed

Flaw 2 Tumors Outside Radiation Plume Are Unexposed

Percentage of absorbed cellphone radiation

50-60% (wt. av.=53%) 12-25% (wt. av.=19%)

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

Flaw 2 Absorbed Radiation Decreases Rapidly w Depth

50% 40% 30% 20% 10% 0%

800-900 MHz Japanese Phones

L. Lloyd Morgan [bilovsky@aol.com]

Interphone Protocol Design Flaws

Short latency times underestimates risk

Flaw 4: Definition of regular user

Definition of regular user underestimates risk

Flaws 3 and 4 Latency Time and the Definition of Regular Users

<5 year latency 85% User-Year

Years from Eligibility Date (Latency Time)

1 16 0 Wt. Ave. Eligibility Date 2002.5

Interphone Protocol Design Flaws

L. Lloyd Morgan [bilovsky@aol.com]

Flaw 5 Young Adults and Children Excluded

Korea: Cellphone Rad.

Increased Risk of Brain Tumor

Israel: Ionizing Radiation

400% 356% 300%

47% 0% <5 5-9 10+

L. Lloyd Morgan [bilovsky@aol.com]

Interphone Protocol Design Flaws

Rural Vs Urban users Underestimates risk

L. Lloyd Morgan [bilovsky@aol.com]

Interphone Protocol Design Flaws

Flaw 8: Exclusion of brain tumor types

Flaw 9: Exclusion of brain tumor cases because of death

Interphone Protocol Design Flaws

L. Lloyd Morgan [bilovsky@aol.com]

How to Resolve Flaws

Interview proxies in case of death

Treat unexposed tumors as unexposed Etc., Etc., Etc.,

Researchers conflict-of-interest (unconscious?)

Potential Brain Tumor Risk 30-year Latency

Years Since First Exposure

L. Lloyd Morgan [bilovsky@aol.com]

Potential Public Health Risk

Cellphone Subscribers millions 450 400 350

Year 2019 1,590,513

Based on 10% of long-term smokers are diagnosed with lung cancer

300 250 200 150

Year 2004 44,447 Dx ~3,600 from cellphone use

L. Lloyd Morgan [bilovsky@aol.com]