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No Cancer Link With Cell Phone Towers

June 24, 2010 (London, United Kingdom) — There is no association between a pregnant mother's proximity to a cell phone tower and early childhood cancers, according to results of the largest study of its kind to date.

Paul Elliott, MD, PhD, professor of epidemiology and public health medicine from Imperial College, London, United Kingdom, led the research. The paper was published online June 22 in BMJ.

"We found no pattern to suggest that the children of mums living near a [cell phone tower] during pregnancy had a greater risk of developing cancer than those who lived elsewhere," Dr. Elliot told Medscape Oncology.

He added that unlike previous studies of associations between cancer and cell phone towers, this study used larger numbers of cases so was not subject to the selection and reporting biases seen with smaller sample sizes.

Case–Control Study

In this British study, data on nearly 1400 children younger than 4 years were drawn from the national cancer registry. All case subjects had leukemia or tumors of the central nervous system or brain from 1999 and 2001. Each child with cancer was matched with 3 control subjects for sex and date of birth from the national birth register.

The distance between registered address at time of birth and the nearest of 81,781 cell towers was assessed for each case. Likewise, total power output across all towers within 700 meters (765 yards) of the cell tower was recorded. The researchers then computed modeled power density at each birth address for towers within 1400 meters (1531 yards). Exposure beyond 1400 meters was considered to be at background levels.

This information was correlated with the incidence of cancers of the brain and central nervous system, leukemia, and non-Hodgkin's lymphomas, and all cancers combined.

In their paper, the authors acknowledge that despite low levels of exposure from cell phone towers, there are theoretical concerns about the effects on children because of the relatively greater dose (per kg body mass), the potentially greater susceptibility of children than of adults, and the potential effects of lifelong cumulative exposure to radiofrequency electromagnetic fields.

Only cancers with a short latency period, typically within the first 4 years of life, were investigated. In addition, the study was restricted to exposure of children in utero, although the authors state that postnatal exposure might be relevant to the incidence of early childhood cancers.

"We only looked at estimated exposures during the fetal period and were unable to look at exposure patterns for the children after birth. This is clearly a limitation and it would have been good to look at data after birth, if they had been available. However, our findings do not suggest any link between early childhood cancers and [cell phone tower] exposure," added Dr. Elliott.

Encourage Patients Not to Worry

In an accompanying editorial, John Bithell, MA, DPhil, honorary research fellow at the Childhood Cancer Research Group, University of Oxford, United Kingdom, points out that of the 3 surrogates of exposure considered in the study, the most convincing is the modeled power density at varying distances from the nearest tower. "This is probably the best measure used in an epidemiological study to date."

However, he adds that individual exposure could still vary substantially according to building design, lifestyle, and migration, so the prospects for good estimates of individual exposure are poor.

Based on these results, he concludes that the medical profession should encourage their patients not to worry about harm caused by proximity to cell phone towers. "The epidemiological evidence is also supported by experimental evidence, which has so far failed to show any biological effects — in vivo or in vitro — that might lead us to worry about the impact on health," concluded Dr. Bithell.

However, Sam Milham, Jr. MD, MPH, former chronic disease epidemiologist at the Washington State Department of Health and clinical associate professor at the University of Washington, School of Public Health, Seattle, believes the study used the wrong metric.

"All cell towers operate on direct current, which is changed from the grid alternating current (AC) by switching power supplies. These interrupt the AC current and create high-voltage transients, which get back into the grid. The transients are a potent carcinogen," he explained.

Dr. Milham, who was approached by Medscape Oncology for comment, is currently investigating a cluster of cancers in school teachers in Palm Springs, California. He explained the relation between distance from tower, transient levels, and cancer cases.

"It has a cell tower 20 feet from a classroom wing. The transient levels in the classrooms are inversely related to distance from the tower base, and the cancer cases are found to be overrepresented in the rooms near the tower. This is a close-in phenomenon. I also find very high transient levels in firehouses and businesses near cell towers."

"The BMJ study's high-dose group, by distance, was under 612 meters [669 yards]. If they can show me that the case–control risks were similar for residences less than 100 and 200 meters [109 and 218 yards, respectively] from the tower, I'll accept their findings," Dr. Milham said.

The study was funded through the UK Mobile Telecommunications Health Research (MTHR) Programme, an independent body set up to provide funding for research into the possible health effects of mobile telecommunications. The MTHR is jointly funded by the UK Department of Health and the mobile telecommunications industry. Dr. Elliott and Dr. Milham have disclosed no relevant financial relationships. Dr. Bithell reports a beneficial interest in shares in Vodafone Group not exceeding £3000 in value.

How Does the San Francisco Syncope Rule Perform in Canada?

How Does the San Francisco Syncope Rule Perform in Canada?
The rule had a sensitivity of 90% for predicting serious outcomes at 30 days

Patients with syncope often are admitted to the hospital despite negative
emergency department (ED) evaluations. The San Francisco Syncope Rule was
developed to identify syncope patients who are at sufficiently low risk for
serious outcomes to be safely discharged home after ED evaluation. The rule
classifies patients as high risk if they have histories of congestive heart
failure, hematocrit <30%,>
or triage systolic blood pressure <90>
to have 96% and 98% sensitivity for predicting serious outcomes at 7 days
and 30 days, respectively, but has not performed as well in subsequent
validation studies in the U.S. and Australia, where sensitivities ranged
from 74% to 90% (JW Emerg Med Sep 19 2008 and JW Emerg Med Jun 8 2007).

To evaluate performance of the rule in Canada, researchers retrospectively
applied the rule to 505 patients who presented to a single tertiary care
hospital with syncope during an 18-month period. Serious outcomes were
defined as death, myocardial infarction, arrhythmia, pulmonary embolism,
stroke, subarachnoid hemorrhage, significant bleeding, any procedural
intervention to treat a related cause of syncope, any condition causing or
likely to cause a return emergency visit, and hospitalization for a related
event. Overall, 9.7% of patients had serious outcomes within 30 days. The
rule had a sensitivity of 90% for predicting these outcomes.

Comment: The results of this study are consistent with those from other
validation studies. The San Francisco Syncope Rule will likely need to be
improved and then validated before it is adopted in practice. Until then,
clinical judgment should continue to guide treatment and disposition.

— Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine

SOUTH AFRICAN DOCTOR INVENTS FEMALE CONDOMS WITH "TEETH" TO FIGHT RAPE

South African doctor invents female condoms with 'teeth' to fight rape

Dr. Sonnet Ehlers was on call one night four decades ago when a devastated rape victim walked in. Her eyes were lifeless; she was like a breathing corpse. "She looked at me and said, 'If only I had teeth down there,'" recalled Ehlers, who was a 20-year-old medical researcher at the time. "I promised her I'd do something to help people like her one day." Forty years later, Rape-aXe was born. Ehlers is distributing the female condoms in the various South African cities where the World Cup soccer games are taking place. The woman inserts the latex condom like a tampon. Jagged rows of teeth-like hooks line its inside and attach on a man's penis during penetration, Ehlers said.

Once it lodges, only a doctor can remove it -- a procedure Ehlers hopes will be done with authorities on standby to make an arrest. "It hurts, he cannot pee and walk when it's on," she said. "If he tries to remove it, it will clasp even tighter... however, it doesn't break the skin, and there's no danger of fluid exposure." Ehlers said she sold her house and car to launch the project, and she planned to distribute 30,000 free devices under supervision during the World Cup period. "I consulted engineers, gynecologists and psychologists to help in the design and make sure it was safe," she said.

After the trial period, they'll be available for about $2 a piece. She hopes the women will report back to her. "The ideal situation would be for a woman to wear this when she's going out on some kind of blind date ... or to an area she's not comfortable with," she said. The mother of two daughters said she visited prisons and talked to convicted rapists to find out whether such a device would have made them rethink their actions. Some said it would have, Ehlers said.

Critics say the female condom is not a long-term solution and makes women vulnerable to more violence from men trapped by the device. It's also a form of "enslavement," said Victoria Kajja, a fellow for the Centers for Disease Control and Prevention in the east African country of Uganda. "The fears surrounding the victim, the act of wearing the condom in anticipation of being assaulted all represent enslavement that no woman should be subjected to." Kajja said the device constantly reminds women of their vulnerability. "It not only presents the victim with a false sense of security, but psychological trauma," she added. "It also does not help with the psychological problems that manifest after assaults."

However, its one advantage is it allows justice to be served, she said. Various rights organizations that work in South Africa declined to comment, including Human Rights Watch and Care International. South Africa has one of the highest rape rates in the world, Human Rights Watch says on its website. A 2009 report by the nation's Medical Research Council found that 28 percent of men surveyed had raped a woman or girl, with one in 20 saying they had raped in the past year, according to Human Rights Watch.

In most African countries, rape convictions are not common. Affected women don't get immediate access to medical care, and DNA tests to provide evidence are unaffordable. "Women and girls who experience these violations are denied justice, factors that contribute to the normalization of rape and violence in South African society," Human Rights Watch says.

Women take drastic measures to prevent rape in South Africa, Ehlers said, with some wearing extra tight biker shorts and others inserting razor blades wrapped in sponges in their private parts. Critics have accused her of developing a medieval device to fight rape. "Yes, my device may be a medieval, but it's for a medieval deed that has been around for decades," she said. "I believe something's got to be done ... and this will make some men rethink before they assault a woman."

Jadilah Pasien Pintar! (In Bahasa Indonesia)

Jadilah Pasien Pintar!


Salah satu sebab mengapa orang enggan pergi ke dokter atau rumah sakit, bisa jadi karena persoalan komunikasi. Hal ini diungkapkan guru besar Fakultas Kedokteran Universitas Indonesia, Prof. Daldiyono Hardjodisastro, dalam bukunya yang berjudul Pasien Pintar dan Dokter Bijak.

Dalam buku tersebut diungkapkan, untuk mendapat hasil maksimal dari pertemuan dengan dokter, pasien harus mempersiapkan diri, di antaranya:

* Mengenakan pakaian yang memudahkan dokter melakukan pemeriksaan.

* Mencatat keluhan yang hendak disampaikan ke dokter secara lengkap, kapan dirasakan, dan upaya yang sudah dilakukan untuk mengurangi rasa sakit. Beritahukan pula penyakit yang pernah atau sedang diderita, obat yang sedang diminum, serta jika ada alergi.

* Dari tanya jawab soal keluhan dan pemeriksaan fisik pasien, dokter akan menegakkan diagnosis kemudian memberikan terapi, termasuk resep obat. Pasien berhak mendapat informasi yang jelas mengenai hasil pemeriksaan, menanyakan bila ada yang belum jelas, juga mengambil keputusan untuk menerima atau menolak saran dokter tentang terapi yang akan diberikan. Jika pasien tidak menerima keputusan dokter, ia berhak mencari pendapat kedua (second opinion) dari dokter lain.

* Pasien yang pintar perlu bertanya dan mengetahui obat apa yang diresepkan dokter serta manfaatnya.

* Jika kondisi keuangan tidak memungkinkan, pasien perlu meminta obat generik. Hilangkan persepsi bahwa penyakit harus cepat sembuh. Ingat, pengobatan memerlukan waktu, kesabaran, dan ketekunan. Tak jarang, ada dokter terbawa kemauan pasien yang ingin cepat sembuh, sehingga melakukan berbagai jenis pemeriksaan yang belum tentu diperlukan atau memberi obat berlebihan.

* Sebaliknya, dokter yang bijak adalah yang mampu berkomunikasi secara efektif dengan pasien. Dokter mau mendengarkan keluhan pasien, menjawab pertanyaan dan menjelaskan situasi pasien, memberi nasihat cukup, serta tidak sekadar memberi resep, sehingga pasien merasa puas.

* Kemampuan berkomunikasi merupakan inti dari pekerjaan dokter. Kepandaian sebenarnya hanya nomor dua. Pasalnya, 60 persen pasien sebenarnya tidak sakit, tetapi mengalami kelainan fungsional. Hanya 40 persen yang benar-benar sakit, itu pun 20 persennya akan sembuh sendiri.

Lalu, bagaimana menghadapi dokter yang tidak komunikatif? Konsultan gastroenterologi-hepatolog

i ini menyarankan untuk meninggalkan ruangan dan segera pindah dokter jika memungkinkan.

Jika Merasa Tak Puas

Pernah dikecewakan oleh pelayanan di rumah sakit? Agar keluhan Anda tersampaikan dengan baik, berikut beberapa caranya:

* Jika mempunyai keluhan, catat dengan jelas tanggal, hari, dan jam kejadian, kalau perlu nama petugas yang memberikan pelayanan. Kemudian Anda dapat menghubungi bagian humas maupun customer service rumah sakit tersebut.

* Ada rumah sakit yang kepala perawatannya bertugas mengurus masalah atau keluhan, sehingga pasien disarankan menghubungi Kepala (Bidang) Perawatan bila merasa tidak puas. Bila masalah belum terpecahkan, tidak tertutup kemungkinan langsung maju ke direktur atau pimpinan rumah sakit.

* Anda dapat menghubungi perwakilan Persatuan Rumah Sakit Seluruh Indonesia setempat. Persi mempunyai kepengurusan di semua wilayah di seluruh provinsi di Indonesia.

* Manfaatkan kotak saran yang ada di setiap rumah sakit untuk mengomunikasikan hal-hal yang dianggap pasien (konsumen) tidak patut dilakukan oleh petugas rumah sakit. Hal ini merupakan masukan positif agar pihak rumah sakit memperbaiki diri. Tanpa masukan dari konsumen, pengelola rumah sakit akan selalu merasa bahwa pelayanan yang diberikan sudah cukup baik. Jadi, masukan atau kritik harusnya diterima sebagai satu mekanisme kontrol dari pengguna jasa rumah sakit.

* Jika merasa tidak puas dengan layanan dokter, konsumen dapat langsung mengklarifikasi dengan dokter yang merawat terlebih dahulu. Termasuk adanya dugaan kesalahan prosedur layanan (obat, dosis, maupun tindakan).

* Sangat tidak dibenarkan bila sewaktu pasien melakukan klarifikasi, dokter tidak melayani dengan baik, misalnya menghindar atau mengaku tidak punya waktu. Seorang dokter yang memberikan layanan kepada pasien sudah terikat satu kontrak, yang dikenal dengan kontrak terapeutik (Prof. Dr. Leenen), sehingga dokter bersangkutan harus memberikan penjelasan atas setiap pertanyaan pasien. Sikap profesional harus dijaga oleh para dokter.

* Pahami hak pasien, salah satunya mendapatkan informasi yang jelas dan benar. Pergunakan hak itu dengan baik, beritahu dokter bahwa Anda berhak mendapatkan informasi yang Anda inginkan. Bila ada yang kurang jelas, misalnya soal pilihan jenis obat (generik atau paten), dosis, tindakan medis, pasien juga memiliki hak bertanya atas kuitansi tagihan rumah sakit bagi penderita rawat inap untuk diklarifikasi hingga jelas benar, juga mengenai penggunaan obat dan peralatan yang harus bayar.

* Mencermati dan meneliti tindakan medis apa saja yang sudah lakukan, apakah sesuai dengan yang seharusnya dibayarkan. Adalah hak pasien untuk mengetahui setiap rupiah yang dikeluarkan untuk membayar biaya rumah sakit.

Red : Kes. Kompas