June 19, 2008

Interphone Project: The Cracks Begin To Show

Cardis Endorses Precaution

The divisions within the Interphone project are coming out into the open. As the delay in releasing the final results approaches the three-year mark, the tensions within the study team are no longer much of a secret. It's even becoming clearer who is in which camp —who believes that cell phones present a tumor risk and who thinks the phones are safe.

All this came into focus at last week's Bioelectromagnetics Society (BEMS) annual meeting in San Diego, which featured a panel discussion on cell phones and brain tumors, with special emphasis on the 13-country, $15-plus million Interphone epidemiological study of tumors among users of mobile phones. Near the end of the two-plus-hour session, ex-Motorola staffer Mays Swicord came to the microphone and, with a single word, voiced the question on everyone's mind. "When?" he asked Elisabeth Cardis, the head of Interphone. She replied with what has become her trademark answer: "Soon, I hope." Last March, Cardis left the International Agency for Research in Cancer (IARC) to join the Center for Research in Environmental Epidemiology (CREAL) in Barcelona.

Outside the meeting room, Sweden's Lennart Hardell spoke about the delays at Interphone: "It's not fair to public health to withhold the Interphone results, after all the public paid for most of it." In his BEMS presentation, Hardell concluded that his own studies show a "consistent pattern of increased risk for glioma and acoustic neuroma after ten years." He noted that he believes that a ten-year tumor latency is the "minimum" —that is, the observed risks are likely to grow larger in the years ahead.

Not long after arriving in San Diego, we heard that some progress had been made: A new draft of the final Interphone paper has been completed and was being reviewed by the research teams in all 13 countries. Cardis later confirmed this to Microwave News, but she was quick to add that other "final" versions had circulated in the past. When asked whether she was pleased with this latest draft, Cardis declined to offer an opinion. Maria Feychting, who is leading the Swedish Interphone group, also refused to comment. Germany's Joachim Schüz (now in Denmark) was less reticent. "I am very happy where we are now," he told us. "We are extremely close." No one was yet willing to predict when the final Interphone paper would finally be submitted to a journal for publication.

A three-member committee made up of Finland's Anssi Auvinen, Canada's Jack Siemiatycki and New Zealand's Alistair Woodward assembled the most recent draft of the Interphone paper. The project teams in Canada and New Zealand have not yet revealed their own findings, preferring instead to present their results in the joint 13-country paper. The Finnish group reported its data as part of a joint analysis with those from four other Interphone countries (Denmark, Norway, Sweden and the U.K.). Together they reported an elevated risk for brain tumors and acoustic neuroma among long-term cell-phone users.

Even as a new consensus draft has emerged, the split within the project has become move visible. A number of sources close to the project revealed that Feychting, who served as the chair and moderator of the BEMS session, is firmly in the "there is no risk" group, as are Schüz together with Canada's Dan Krewski and U.K.'s Tony Swerdlow. They argue that any observed associations pointing to an elevated tumor risks are more likely due to biases inherent in the study design. For instance, people may say that they used a cell phone on the side of their head with the tumor, even if this were not the case, in order to rationalize how and why they got the tumor.

The opposing group says that higher tumor risks are showing up and precautionary measures are called for. This faction includes Israel's Siegal Sadetzki and Australia's Bruce Armstrong, who have already made their views public (see our April 28 post).

One insider confided that things have gotten so bad that some members of the Interphone project are no longer talking to each other and this has added to the delay in publishing the final results. "As a result of the animosity between the factions, scientists and the public at large are being denied this important data," that person said. "It's a tragedy to me."

Cardis has been careful not to publicly reveal where she herself stands. That is until this week —immediately after the BEMS meeting— when she endorsed a set of precautionary measures. In an interview published on Monday in Le Monde, arguably France's leading newspaper, Cardis said that she is in general agreement with those who argue against the use of cell phones by children under the age of 12 and in favor of the use of hands-free sets. "In the absence of definitive results and in the light of a number of studies which, though limited, suggest a possible effect of radiofrequency radiation, precautions are important," Cardis told Le Monde. "I am therefore globally in agreement with the idea of restricting the use of children, though I would not go as far as banning mobile phones," Cardis added. (She provided Microwave News with a translation of her comments to Le Monde.)

Cardis was responding to an "Appeal" for caution in the use of mobile phones, issued last Sunday, June 15, by 20 cancer and public health specialists in the Journal du Dimanche, another well-read newspaper. Among the 20 are Henri Pujol, a past president of the La Ligue Nationale Contre le Cancer, the French counterpart to the American Cancer Society, and Annie Sasco, a former head of epidemiology for cancer prevention at IARC. The Appeal received widespread coverage in the French media —so much so that it prompted the French National Academy of Medicine to issue a "clarification" yesterday in an effort to quell the growing public controversy. The academy stated that the results of the Interphone study that had been published so far are "reassuring" and, in a jab at the group of 20, reminded everyone that medicine is not about advertising or marketing.

David Servan-Schreiber, a professor of psychiatry at the University of Pittsburgh and a lecturer at the medical school in Lyon, was the force behind the Appeal. "I gathered a group of experts in order to respond to the questions I was getting every week in my talks and on my Web site," he told Microwave News. Servan-Schreiber criticized the Academy of Medicine for its well-known "aversion to any environmental causes of cancer." "[It's] argument that existing cell phone studies warrant continuing use without precautions just doesn't make sense scientifically. This is all quite appalling," he said.

The group of 20 presented a list of ten recommendations on how to practice precaution. In addition to limiting the use of cell phones by children and endorsing the use of a hands-free set, these include picking a low SAR phone, keeping cell phones away from your body, using a landline whenever possible and favoring text messages over making a call. The full text of the Appeal is available here.