On radar and radio exposure and cancer in the military setting.

INTRODUCTION: In 2018, we reported a case series of 47 patients diagnosed with cancer following several years of exposure to high-intensity whole-body radiofrequency radiation (RFR) using the parameter of percentage frequency (PF). Consistent high and statistically significant PFs of hematolymphoid (HL) cancers were found in this group and in four previous reports on RFR-exposed groups in Belgium, Poland and Israel together with increased all-cancers rates. In this paper we report a new series of 46 young cancer patients who were exposed during military service to such radiation. MATERIALS AND METHODS: The new group of patients comprises Israeli soldiers previously exposed to occupational RFR. The patients were self-selected to enroll in the research in cooperation with an NGO assisting patients with administrative counseling and legal and social services. The new group of patients was studied with respect to distribution (proportion) of cancer types using the method of PF. When possible, cancer risk ratios (RR) were estimated too. The results are compared to those of other occupational groups in three countries. RESULTS: Median age at diagnosis was 23 years; duration of exposure was between 1 and 3 years and the latencies were short, median 4.6 years. The PF of HL cancers was 41.3%, 95% CI (27%-57%), versus 22.7% expected in non-exposed subjects matched for age and gender profiles, p = 0.003; 19 out of the 46 patients had HL cancers. The PF of Hodgkin lymphoma cancers was 21.7%, 95%CI (11%-36%), versus 11.6% expected, p = 0.033. For a subgroup of 6 patients, the number of soldiers in the units was known, and we were able estimate approximately the overall cancer risk ratio (RR) after 8 years as being 8.0 with 95% CI (2.9, 17), p < 0.002, with only 0.75 cases expected from the Cancer Registry data. In this subgroup, there were 3 HL cancer cases and 3 non-HL cases. Sarcoma PF was higher than expected, 7 out of the 46 patients were diagnosed with sarcoma, PF = 15.2%, 95%CI (6.3%-28.9%), p = 0.04 versus the expected PF of 7%. CONCLUSION: The HL PF was high and consistent with previous reports. Epidemiological studies on excess risk for HL and other cancers, brain tumors in cellphone users, and experimental studies on RFR and carcinogenicity strongly point to a cause-effect relationship. It is mandatory to reduce the RFR exposure of all personnel to that of the typical community levels, including the peak level of radar pulses. Radiation protection, safety instructions, cancer risk warnings and quantitative data on individual exposure together with regular medical monitoring must be instituted for all personnel exposed to such risks. The findings from our study add to the growing body of evidence underscoring the gross inadequacy of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) thermal standards. Based on our findings and on the previous accumulated research, we endorse the recommendations to reclassify RFR exposure as a human carcinogen, International Agency for Research on Cancer (IARC) group 1.

Radio frequency radiation-related cancer: assessing causation in the occupational/military setting.

BACKGROUND AND AIM: We reexamine whether radio frequency radiation (RFR) in the occupational and military settings is a human carcinogen. METHODS: We extended an analysis of an already-reported case series of patients with cancer previously exposed to whole-body prolonged RFR, mainly from communication equipment and radar. We focused on hematolymphatic (HL) cancers. We used analysis by percentage frequency (PF) of a cancer type, which is the proportion of a specific cancer type relative to the total number of cancer cases. We also examined and analyzed the published data on three other cohort studies from similar military settings from different countries. RESULTS: The PF of HL cancers in the case series was very high, at 40% with only 23% expected for the series age and gender profile, confidence interval CI95%: 26-56%, p<0.01, 19 out of 47 patients had HL cancers. We also found high PF for multiple primaries. As for the three other cohort studies: In the Polish military sector, the PF of HL cancers was 36% in the exposed population as compared to 12% in the unexposed population, p<0.001. In a small group of employees exposed to RFR in Israeli defense industry, the PF of HL cancers was 60% versus 17% expected for the group age and gender profile, p<0.05. In Belgian radar battalions the HL PF was 8.3% versus 1.4% in the control battalions as shown in a causes of deaths study and HL cancer mortality rate ratio was 7.2 and statistically significant. Similar findings were reported on radio amateurs and Korean war technicians. Elevated risk ratios were previously reported in most of the above studies. CONCLUSIONS: The consistent association of RFR and highly elevated HL cancer risk in the four groups spread over three countries, operating different RFR equipment types and analyzed by different research protocols, suggests a cause-effect relationship between RFR and HL cancers in military/occupational settings. While complete measurements of RFR exposures were not available and rough exposure assessments from patients interviews and from partial exposure data were used instead, we have demonstrated increased HL cancers in occupational groups with relatively high RFR exposures. Our findings, combined with other studies, indicate that exposures incurred in the military settings evaluated here significantly increased the risk of HL cancers. Accordingly, the RFR military exposures in these occupations should be substantially reduced and further efforts should be undertaken to monitor and measure those exposures and to follow cohorts exposed to RFR for cancers and other health effects. Overall, the epidemiological studies on excess risk for HL and other cancers together with brain tumors in cellphone users and experimental studies on RFR and carcinogenicity make a coherent case for a cause-effect relationship and classifying RFR exposure as a human carcinogen (IARC group 1).

Lower Cancer Rates Among Druze Compared to Arab and Jewish Populations in Israel, 1999-2009.

The Druze are a small ethnic minority in Israel amounting to about 130,000 residents (or 1.7 % of the total population of the country). Unlike other population groups, the Druze strive to keep their own traditions and marry mainly inside their own community. During the last decade, cancer morbidity among both Jews and Arabs in Israel has been increasing, while data on the Druze are little known and have not been analyzed and compared to other population groups to date. To compare cancer morbidity rates among Druze, Arabs and Jews in Israel during 1999-2009, gender-specific and age-standardized incidence rates of all site cancers and specific cancers of three population groups (Jews, Arabs and Druze) were received from the Israel National Cancer Registry for the period 1999-2009. Based on these rates, periodical incidence rates were calculated and mutually compared across the groups stratified by gender. As the analysis shows, the Druze had significantly lower cancer rates compared to both Arabs and Jews. Thus, for all site cancers, there were significantly higher cancer rates in Jewish males versus Druze males (RR = 1.39, 95 % CI = 1.16-1.65) and in Jewish females versus Druze females (RR = 1.53, 95 % CI = 1.27-1.85), but not statistically significant for Arab males versus Druze males (RR = 1.12 95 % CI = 0.93-1.35). Lung cancer rates in Arab males were also higher compared to Druze males (RR = 1.84, 95 % CI = 1.13-3.00). Jewish males had statistically significant higher rates of prostate cancer compared to Druze males (RR = 2.47, 95 % CI = 1.55-3.91). For thyroid and colon cancers, risks were not significantly different at the 95 % CI level; however, the risks were significantly different at the 90 % CI level (RR = 3.62, 90 % CI 1.20-11.02 and RR = 1.69, 90 % CI = 1.03-2.77, respectively). Jewish females had significantly higher rates of invasive breast cancer (RR = 2.25, 95 % CI = 1.55-3.25), in situ cervical cancer (RR = 4.01, 95 % CI = 1.27-12.66) and lung cancer (RR = 3.22, 95 % CI = 1.12-9.24) compared to Druze females. We thus observed lower cancer rates among Druze versus Arab and Jewish populations in Israel. A reason for these differences may be due to different nutritional habits. Druze still keep a less processed nutritional lifestyle, than is common in industrial society. There may also be other reasons that have not been identified yet.

Urinary organophosphate metabolite levels in Palestinian pregnant women: results of the Middle East Regional Cooperation Project.

The purpose of the study was to measure urinary organophosphate (OP) metabolites in Palestinian pregnant women, and to compare levels with those in pregnant women in Jerusalem and women from the general population in Israel. We measured six dialkyl phosphates in urine samples collected from 148 pregnant women from the West Bank area. Median total dimethyl phosphate (DM(total)) levels were significantly lower in Palestinian women compared to Jerusalem pregnant women and women in Israel (p = 0.041). In Palestinian women reporting that their place of residence was near an agricultural field, DM(total) levels were significantly higher (p = 0.037). Lower urinary excretion of dimethyl phosphate pesticide metabolites in Palestinian women compared to Israeli women may result from lower consumption of fruits and vegetables in the Palestinian population. Our findings highlight differences in OP pesticide exposure in populations with close geographical proximity but with differences in culture, diet, lifestyle, and regulatory oversight of pesticides.

Trauma care and case fatality during a period of frequent, violent terror attacks and thereafter.

BACKGROUND: From September 1999 through January 2004 during the second Intifada (al-Aqsa), there were frequent terror attacks in Jerusalem. We assessed the effects on case fatality of introducing a specialized, intensified approach to trauma care at the Hebrew University-Hadassah Hospital Shock Trauma Unit (HHSTU) and other level I Israeli trauma units. This approach included close senior supervision of prehospital triage, transport, and all surgical procedures and longer hospital stays despite high patient-staff ratios and low hospital budgets. Care for lower income patients also was subsidized. METHODS: We tracked case fatality rates (CFRs) initially during a period of terror attacks (1999-2003) in 8,127 patients (190 deaths) at HHSTU in subgroups categorized by age, injury circumstances, and injury severity scores (ISSs). Our comparisons were four other Israeli level I trauma centers (n = 2,000 patients), and 51 level I U.S. trauma centers (n = 265,902 patients; 15,237 deaths). Detailed HHSTU follow-up continued to 2010. RESULTS: Five-year HHSTU CFR (2.62 %) was less than half that in 51 U.S. centers (5.73 %). CFR progressively decreased; in contrast to a rising trend in the US for all age groups, injury types, and ISS groupings, including gunshot wounds (GSW). Patients with ISS > 25 accounted for 170 (89 %) of the 190 deaths in HHSTU. Forty-one lives were saved notionally based on U.S. CFRs within this group. However, far more lives were saved from reductions in low CFRs in large numbers of patients with ISS < 25. CFRs in HHSTU and other Israeli trauma units decreased more through the decade to 1.9 % up to 2010. CONCLUSIONS: Sustained reductions in trauma unit CFRs followed introduction of a specialized, intensified approach to trauma care.

Scientific panel on electromagnetic field health risks: consensus points, recommendations, and rationales.

In November, 2009, a scientific panel met in Seletun, Norway, for three days of intensive discussion on existing scientific evidence and public health implications of the unprecedented global exposures to artificial electromagnetic fields (EMF). EMF exposures (static to 300 GHz) result from the use of electric power and from wireless telecommunications technologies for voice and data transmission, energy, security, military and radar use in weather and transportation. The Scientific Panel recognizes that the body of evidence on EMF requires a new approach to protection of public health; the growth and development of the fetus, and of children; and argues for strong preventative actions. New, biologically-based public exposure standards are urgently needed to protect public health worldwide.

Long-term effects of repealing the national maximum speed limit in the United States.

OBJECTIVES: We examined the long-term effects of the 1995 repeal of federal speed limit controls on road fatalities and injuries in fatal crashes. METHODS: We used a Poisson mixed-regression model to assess changes in the number of fatalities and injuries in fatal crashes between 1995 and 2005 on rural interstates, where all US states have raised speed limits since the repeal, as well as on urban interstates and noninterstate roads, where many states have raised speed limits. RESULTS: We found a 3.2% increase in road fatalities attributable to the raised speed limits on all road types in the United States. The highest increases were on rural interstates (9.1%) and urban interstates (4.0%). We estimated that 12 545 deaths (95% confidence interval [CI] = 8739, 16 352) and 36 583 injuries in fatal crashes (95% CI = 29 322, 43 844) were attributable to increases in speed limits across the United States. CONCLUSIONS: Reduced speed limits and improved enforcement with speed camera networks could immediately reduce speeds and save lives, in addition to reducing gas consumption, cutting emissions of air pollutants, saving valuable years of productivity, and reducing the cost of motor vehicle crashes.

Incitement, genocide, genocidal terror, and the upstream role of indoctrination: can epidemiologic models predict and prevent?

We apply the models and tools of epidemiology and public health to propose a unified field theory showing the role of ideologies, indoctrination, and incitement, in genocide, genocidal terror, and terror by groups or individuals. We examine the effects of indoctrination and incitement as exposures and risks in relation to genocide and genocidal terror. Incitement has been recognized as a trigger to these outcomes but indoctrination is upstream to incitement. Population-wide exposure to indoctrination increases susceptibility to the effects of incitement. These relationships have been seen in all major genocides and genocidal terror in the late twentieth and twenty-first centuries. There is some insight into the relationship between ideology, incitement, and genocidal acts of violence from the so-called localized genocides in Bosnia, Rwanda, Darfur, Syria, and most recently, among the Rohingya in Myanmar. There is a need to recognize the upstream role of ideologies of hate in order to determine the degree to which indoctrination posed, and continues to pose, a contributing factor. Epidemiologic models, such as the iceberg model of exposure and disease and the concept of "sick individuals" and "sick populations," guide our understanding of the content and spread of indoctrination and incitement and can provide essential insights for prevention. The hateful indoctrination and ideologies behind genocidal violence must be countered and replaced by positive ideologies and role models that emphasize respect for life and human dignity for all.

Malthusian pressures, genocide, and ecocide.

Historical models postulate that genocide cannot occur without the ideology and decisions of its authoritarian perpetrators and the indifference of bystanders. These models do not address genocidal risks from ecocide. Study objectives were to assess 1) the role of Malthusian pressures in recent genocides, 2) the role of ecocide and ecologic abuse in creating these pressures, and 3) strategies for prevention and deterrence. Analysis of reports, demographic studies, and time trends in recent genocides and recent ecocidal events from ecologic abuse suggests that Malthusian pressures and zero-sum rivalries over water, arable land, or natural resources by themselves do not lead to genocide. Such pressures may have exacerbated the political and socioeconomic predictors in Rwanda and Darfur, but not in former Yugoslavia. However, collapse of socioeconomic and governmental infrastructures following genocide can leave behind massive sustained damage to carrying capacity and sustainability. Surviving victims, if they return to their environments, will remain at risk for persecution. Ecocide--the large-scale destruction, depletion, or contamination of natural ecosystems--can result in widespread damage to health, survival, fertility, reproduction, and sustenance, and forced flight. International early warning and effective response systems are needed to deter or prevent political decisions to carry out genocide. Such systems must include long-term measures to resolve zero-sum conflicts over environmental resources and to prevent toxic risks to vulnerable populations and destruction of habitat by deliberate or wanton ecologic abuse, which itself should be redefined as a crime against humanity.

Childhood lead exposure in the palestinian authority, Israel, and Jordan: results from the Middle Eastern regional cooperation project, 1996-2000.

In the Middle East, the major sources of lead exposure have been leaded gasoline, lead-contaminated flour from traditional stone mills, focal exposures from small battery plants and smelters, and kohl (blue color) in cosmetics. In 1998-2000, we measured blood lead (PbB) levels in children 2-6 years of age in Israel, Jordan, and the Palestinian Authority (n = 1478), using a fingerstick method. Mean (peak; percentage > 10 microg/dL) PbB levels in Israel (n = 317) , the West Bank (n = 344), Jordan (n = 382) , and Gaza (n = 435) were 3.2 microg/dL (18.2 ; 2.2%) , 4.2 microg/dL (25.7; 5.2%), 3.2 microg/dL (39.3; < 1%) , and 8.6 microg/dL (> 80.0; 17.2%), respectively. High levels in Gaza were all among children living near a battery factory. The findings, taken together with data on time trends in lead emissions and in PbB in children in previous years, indicate the benefits from phasing out of leaded gasoline but state the case for further reductions and investigation of hot spots. The project demonstrated the benefits of regional cooperation in planning and carrying out a jointly designed project.

Excessive and disproportionate advertising in peer-reviewed journals.

The International Committee of Medical Journal Editors (ICMJE) has outlined ethical guidelines concerning the advertising practices of peer-reviewed journals that briefly discuss issues of excessive and disproportionate advertising. The authors evaluated these guidelines using quantitative data, assessing the types and frequencies of advertising in 2001 print issues of NEJM and JAMA, two principal members of ICMJE. Advertising ratios (ratio of advertisements to editorial content) were near unity in NEJM and 0.30 in JAMA, compared with reported ratios of 0.15 among low-circulation specialty science journals and 0.80 among high-circulation consumer magazines. In both journals, five corporations placed more than 50% of all display advertisements. The findings suggest a dissonance between the ethical guidelines and the de facto advertising practices of arguably the two most important member journals of the ICMJE. There is a need to define and apply standards for excessive and disproportionate advertising.

FIOH-sponsored newsletter misrepresents asbestos hazards in Zimbabwe.

The Finnish Institute of Occupational Health (FIOH) has received support from the World Health Organization (WHO) and the International Labor Office (ILO) to publish the African Newsletter on Occupational Health and Safety. The African Newsletter on Occupational Health and Safety should not be a medium for industry propaganda, or the source of misinformation among the workers of Africa. Instead, FIOH should provide the same level of scientific information in Africa that it does in Finland and other developed countries.

Can external signs of trauma guide management?: Lessons learned from suicide bombing attacks in Israel.

BACKGROUND: Following a suicide bombing attack, scores of victims suffering from a combination of blast injury, penetrating injury, and burns are brought to local hospitals. OBJECTIVE: To identify external signs of trauma that would assist medical crews in recognizing blast lung injury (BLI) and effectively triaging salvageable and nonsalvageable victims. DESIGN: Retrospective analysis of all 15 suicide bombing attacks that occurred in Israel from April 1994 to August 1997. SETTING: National survey. PATIENTS: One hundred fifty-three victims died and 798 were injured as a result of 15 attacks. Medical records were reviewed for external signs of trauma, such as burns and penetrating injuries, and the presence of BLI. Main Outcome Measure The odds ratio for BLI and death. RESULTS: Three settings were targeted: buses, semiconfined spaces, and open spaces. Sixty survivors (7.5%) suffered from BLI, which was more common in buses (37 of 260) than semiconfined spaces (14 of 279) and open spaces (9 of 259) (P<.001). Victims with BLI were more likely to suffer from penetrating injury to the head or torso, burns covering more than 10% of the body surface area, and skull fractures (odds ratios, 4, 11.6, and 55.8, respectively; P<.001). Victims who died at the scene were more likely to suffer from burns, open fractures, and amputations in comparison with survivors (odds ratios, 6.5, 18.6, and 50.1, respectively; P<.001). CONCLUSIONS: Following a suicide bombing attack, external signs of trauma should be used to triage victims to the appropriate level of care both at the scene and in the hospital. Triage of salvageable and nonsalvageable victims should take into account the presence of amputations, burns, and open fractures.

Death and injury from motor vehicle crashes: a tale of two countries.

OBJECTIVE: To determine why road deaths dropped by 33.9% in the United Kingdom, compared to 6.5% in the United States, between 1990 and 1999. METHODS: Deaths per billion vehicle kilometers traveled (D/BVKM), and case fatality rates (CFR) in the United States and the United Kingdom were tracked. Time trends in CFR can be used to track the direct effects of speed of impact. CFR is a crash-phase outcome that is independent of exposure, and varies approximately to the fourth power of the speed of crash impact. Joinpoint regression analysis was used to analyze changes in time trends of CFR. RESULTS: In the 1990s, the decrease in deaths in the United Kingdom was attributable mostly to the 29.6% drop in the CFR. In the United States, the CFR dropped by only 6.6%. The United Kingdom introduced speed cameras and an array of speed-calming measures. By contrast, in the United States, use of speed cameras was extremely rare, and speed limits and speeds increased in 32 of the 50 states, mostly in 1995 and 1996, after which CFR actually rose (p<.0001). Intercountry differences in time trends in seat belt use, trauma care, vehicle kilometers traveled, congestion, and driving under the influence of alcohol (DUI), along with massive increase in use of higher-risk sports utility vehicles in the United States, did not account for the contrasting trends in deaths through the 1990s. But increases in DUI in the United States after 1997 may have contributed to increases in speed-related crashes. CONCLUSIONS: The reductions in CFR, probably from small drops in speed of impact account for the disproportionately greater drop in death tolls in the United Kingdom compared to the United States. The temporal fit between drops in CFR and deaths following the introduction of speed cameras in the United Kingdom and increases in speed (speed creep), CFR, and deaths in the United States following raised speed limits suggests that diverging changes in speeds of impact accounted mainly for these changes. Use of D/BVKM to correct for exposure concealed the lack of progress after 1990 in the United States, since falling time trends in D/BVKM reflect increases in congestion. If the United States had implemented United Kingdom-type speed control policies and not raised speed limits, there would have been an estimated 6500 to 10,000 (approximately 16% to 25%) fewer road deaths per year during the period following speed-limit increases (1996 to 1999), including many DUI-related deaths. Reductions of up to 50% are now achievable based on newer population-wide strategies for speed control.

Conflicts of interest and scientific integrity.

The encroachment of conflicts of interest on the peer-review process of scientific journals is discussed, with particular reference to a current example. The authors stress the need for transparency of the connections among authors, reviewers, publishers, editors, and sources of funding to prevent erosion of trust in the scientific integrity of such publications.

Cancer risks in naval divers with multiple exposures to carcinogens.

We investigated risks for cancer and the case for a cause-effect relationship in five successive cohorts of naval commando divers (n = 682) with prolonged underwater exposures (skin, gastrointestinal tract, and airways) to many toxic compounds in the Kishon River, Israel's most polluted waterway, from 1948 to 1995. Releases of industrial, ship, and agricultural effluents in the river increased substantially, fish yields decreased, and toxic damage to marine organisms increased. Among the divers (16,343 person-years follow-up from 18 years of age to year 2000), the observed/expected ratio for all tumors was 2.29 (p<0.01). Risks increased in cohorts first diving after 1960 compared to risks in earlier cohorts, notably for hematolymphopoietic, central nervous system, gastrointestinal, and skin cancer; induction periods were often brief. The findings suggest that the increases in risk for cancer and short induction periods resulted from direct contact with and absorption of multiple toxic compounds. Early toxic effects in marine life predicted later risks for cancer in divers.

Ames, pesticides, and cancer revisited.

The case for continuing use of existing levels of pesticides in agriculture, espoused by Bruce Ames, is refuted. Ames' contentions that naturally occurring carcinogens are far more widespread than man-made ones, that pesticides prevent cancer by providing fruits and vegetables at lower costs to the poor, and that animal data on high risks with high doses cannot predict low risks from low doses in humans do not address key issues: 1) fruits and vegetables contain mixtures of carcinogens and anti-carcinogens, and selection effects from human exposures to these mixtures go back more than a million years; 2) exposures from bioconcentrations of biopersistent organochlorines in the food chain create particular risks for meat-eaters, who have higher cancer risks than vegetarians; 3) even low doses from ingestion of produce containing pesticide residues can cause tissue injury, which could itself promote cancer; 4) epidemiologic data show rises in cancer incidences in older people in many countries, major differences in cancer risks between countries, and converging trends in risks for populations migrating to certain countries; 5) studies of pesticide-exposed workers consistently show increased rates of cancers and birth defects and cancers in their offspring; 6) epidemiologic studies based on large databases tend to underestimate risks from environmental causes because of exposure misclassification; 7) exposures to many organochlorines may have pervasive effects on endocrine function; 8) crop yields can be increased with less use of pesticides. Studies demonstrating the latter need replication, and should be supported as part of a coherent government agenda to develop alternative farming methods.