STATE OF CONNECTICUT Connecticut Behavioral Health Partnership Department of Children and Families ADDENDUM # 1 Department of Social Services Request for Applications The State of Connecticut Behavioral Health Partnership, through the Departments of Children and Families and Social Services is issuing the following addendum to the Enhanced Care Clinics Request for Applications. The Department's responses to the three (3) questions that were submitted by applicants in accordance with the terms of the ECC RFA are set forth herein as an addendum to this RFA.
Electrosensitivity - electro-smog and chemistryFEB - The Swedish Association for the ElectroSensitive 1996
No human being has yet lived his/her entire life surrounded by
computers and mobile telephones.
Based on bioelectrochemistry, life on earth developed over millions of years. Gradually replacing most alternative energy sources, artificial electricity is only about 120 years old. New applications are continuously found and now there are no electro-smog-free areas on the earth. Radiation from radar, antennae, satellites and radioactivity reaches everywhere. Electric equipment disturbs other electric equipment, and much money is invested to protect machines from each other. Are we less sensitive than machines or will electromagnetic overload damage our tissues as it does electronic equipment? Can technology itself solve the problems it has created, or will we have to change our life styles or perish? Alternating currents
Varying in strength with climate and localization, electric and magnetic fields are naturally present. During a thunderstorm, for example, very strong electric fields are created and in times of sun-spot activity, increased magnetic fields have been measured. The earth is a large magnet with a positive (north) and a negative (south) pole, making it possible for birds to orientate. Alternating current, quickly changing direction, is used in the public network. Natural alternating fields are rare and usually weak. When the first public electric network was introduced in New York in 1882, it was based on direct current (12V) which resembles natural electricity. Direct current is still used in specific applications. Fields and frequencies
Radiation is transmission of energy. Ionizing radiation, such as X-rays and radioactivity, is strong enough to break down atoms. Non-ionizing radiation, such as electrostatic, electric and magnetic fields and electromagnetic waves, emitted from all electric equipment, is now also accused of having adverse effects. Health risks have been related to microwaves (from satellite television, mobile telephones, radar and microwave ovens) and radiofrequent waves emitted from radio stations, but also as by-products in many other types of electric equipment, where high frequencies are used. High frequent fields are also emitted from battery-driven equipment, such as lap-top computers. In general, the exposure diminishes with the distance to the Electric and magnetic fields are abbreviated EMF*. Electrostatic fields do not penetrate the body and electric fields are relatively easy to shield. Magnetic fields, however, are capable of penetrating humans as well as buildings In 1965, the Federal Radiation Control, USA, made a statement about ionizing radiation: "the level at which biological injury will occur is unknown". Is there a safe level of EMF exposure? * the flux density, magnetic induction is measured in Tesla - T, T or nanotesla, nT Early warnings
In the 1930's, operators of short-wave equipment, such as strong transmitters, reported symptoms6), such as headaches, dizzyness, nausea and lack of concentration (called radar- or microwave disease by the Russians), and so did hospital personnel where short-wave treatment was used. Radio amateurs working with non-shielded equipment experienced the same problems in the 1950's. In Soviet studies of substation operators certain effects on health were reported in the 60's3). In 1964, a Russian researcher, Kholodov, reported cell death in areas of the brain in rabbits exposed to EMF. A number of cancer alarms, involving children living in the vicinity of high currency power cables, came from USA and the Soviet Union in the 1970's. A Danish study showed an increased risk of male breast cancer in male telecommunication engineers6) and an occupational EMF exposure female breast cancer link has been suggested3)6). Cancer has also been related to mobile (cellular) telephones and fluorescent light.(malign melanoma)6). Many studies were performed on professions with high exposure to electromagnetic fields. In a not yet published study, the Swedish National Institute of Occupational Health (Floderus et al) investigated the general cancer statistics of 2,4 million employees in different professions and found an 80 % higher cancer risk in the most electrically exposed groups, such as electricians, technical engineers, kitchen personnel, machine and motor mechanics and seamstresses. Many different types of cancer were represented. It has been shown in laboratory tests that magnetic fields around 1 T encourage cancer cells to divide10) , and work day average field strengths of 0,2-0,4 T appear to be the level above which there could be an increased risk3). Birth defects
Beginning with the animal research of Prof. Delgado, Spain, more than 20 years of research have clearly demonstrated that the foetus can be affected by low EMF. Two recent Finnish studies show that low-frequency fields from high radiation computer screens increase the risk of miscarriage 2-3,5 times. A fivefold higher risk of EPL (early pregnancy loss) was found in women living in houses with stronger magnetic fields than 0,6 /tesla6). A number of companies such as United Airlines reported miscarriages in up to 50 % of their female office employees6)10). Women worldwide demanded reassignment to non-VDT work during pregnancy, a requirement accepted in Sweden6). Swedish research has recently demonstrated chromosome changes in the cells of amniotic fluid on exposure to magnetic fields, which if unhealed can lead to cancer, such as leukemia or spontaneous abortions3)6)5)). The Visual Display Terminal (VDT)
As early as the 1880's, Hollerith, the founder of IBM, constructed the first computer-like machine where a battery effect was achieved by combining a tray filled with mercury with pins of a dissimilar metal. When the liquid and the solid metals touched, the electric circuit was completed. The device was capable of picking and reprinting information from pre-registered cards11). Based on the same principle, the first cathode ray tube (CRT) had selenium in one end and metals in the other. Selenium was later replaced by caesium. During the second World War, cataracts in operators of radarscopes with CRTs were reported11). The CRT is used as a picture tube in all equipment with a visual display. Due to the radiation*, including leakage of X-rays* (limit value USA 0,5 mR/h), TV watchers were recommended to stay at a respectable distance from the apparatus, which, however, is very difficult when using a personal computer (PC). The old slogan "power to the people" gets a new meaning here. The first PC was introduced by IBM in 1978. Non-flickering computer screens, developed in the early 80's, emit more high-frequency fields than previous screens. The first complaints of adverse effects came at the end of the 70's. Alarm reports on electrically injured subjects now come from more than 25 countries. *near ultraviolet (UV), near infrared (IR), radio frequent, extremely low frequency (ELF) and ultrasonic radiation. ** a federal survey found that one in 12 computer monitors was leaking enough X-rays to expose the operator to the equivalent of one chest X-ray every day. Many symptoms
At first, the symptoms are mainly localized to the skin, but later dizziness, headaches, exhaustion, lack of concentration, oblivion, muscle and skeletal pains, stomach aches, palpitations, weakening of hands and joints, cramps and fainting also develop. It has been suggested that the so-called Repetitive Strain Syndrome*** (RSI) is also connected to VDT exposure9). A joint US-Finnish study team found a strong occupational link between EMF exposure and Alzheimer's (VDT-News, Sept/Oct, '94). The long-term effects are emphasized and the problems are not limited to VDTs. Obliged to avoid all electrical equipment and sometimes daylight, some extremely sensitive patients hide from civilization. In the 90's, support groups for electro-smog victims were organized (see page 27). The Swedish group with 1800 members is probably the largest. The Swedish Union of Clerical and Technical Employees in Industry has (1995), as the first union in the world, decided officially to take sides with the electrically sensitive (ES) patients (see sep. address). The NCRP (Nuclear Control and Radiation Protection) in the USA recommends new EMF limit values - 0,2 T for day nurseries, schools, etc.(1995) Cross-scientific controversy
To be able to determine whether relatively weak fields could affect biological systems knowledge of physics, electrical laws, biology, medicine as well as clinical experience was required. At the end of the 80's, the problem of electro-smog developed into a political and economic controversy5). According to one side, there could be no such damaging influence on human systems from weak EMF. Instead other factors such as chemicals, stress, and personality were investigated, involving disciplines such as chemistry, psychology and sociology. The other side claimed that even if it was, at present state of knowledge, impossible to explain this complicated phenomenon, it was scientifically evident that there was some kind of a connection between electrical equipment and health problems. The debate intensified. New projects were initiated and international congresses arranged. Although the right to life and bodily safety should apply to this group of patients in a constitutional state, the victims seldom received any recognition for their complaints and most law suits failed. Politically and economically uncomfortable, many ES patients end up in mental hospitals. Concerned about their personnel, however, the Social Health and Welfare Board, Sweden, however, reconstructed their own electrical system for health preventive reasons. Other companies, have done the same; Ellemtel, Volvo, Bofors, SKF and SAS to mention a few. The computer operators of the JAS-plane (defence airplane) project have been guaranteed an EMF-free house6). So-called low-radiation screens also provoke reactions in many patients. Nokia Monitor has their aim set on a zero-radiation screen. Since it cannot be excluded that the increasing fields could be potentially dangerous to living organisms, many researchers from both camps now regard the problem as "multifactorial"5). Biologically possible
The genetic code is the same for all life, except for mitochondria*. The behavioural pattern of honey bees is seriously disturbed on exposure of low EMF (Smith 1989, Harm 1982). After extensive barn electrification, some American cows developed "anorexia"11). Structural and functional changes in nerve cells in the brains of rabbits exposed to electric fields have been documented. The number of mitochondria were reduced and 500-1200 lamellar bodies/cell were found. This normally only happens under exceptional pathological conditions. The animals became very slow7). Extremely weak currents (1 microA) caused a 30 % reduction in the uptake of the amino acid proline, a central component in connective tissue (MacLeod et al 1987). Effects of magnetic radiation of the nucleic acids of the cells have been reported (see Liboff et al 1984). The electrochemical cell
According to the German researcher, Dr. U.Warnke Ph.D at the University of Saarlandes, the formation of the fuel of the cell (ATP) is affected by EMF, causing energy deficiency (can also be caused by other exposures or deficiencies)10). Our cellular information exchange system is based on weak electrical impulses. The effect of the cell is maximally 70-80 mV. In this microcosmos, each molecule and electron has its own place and energy field (Warnke 1993). Radiation travels. It is emitted from objects with high potential and is absorbed by those of low energy (here the human). The cell's internal and external system of information exchange is disturbed, causing a biological chain reaction, including increased cell division (Adey 1986). Many of the functions of the cell are controlled by calcium and other minerals crossing the cell membranes7). Exposed to a magnetic field, the cell's calcium level is increased within two minutes10). The liberation of calcium from nerve tissue has been shown to increase under EMF exposure. Frequency-dependent, the effect is maximized at 16 Hz (Bawin & Adey 1976), but nothing happens at 5 Hz. The secretion of cellular products such as neuropeptides (see page ) and hormones is dependent on calcium, which is also essential for a number of intracellular reactions7). Resent research in Umeå, Sweden, has mapped the mechanism behind the calcium liberation. A cellular protein, CD45, is "responsible" for the cellular reactivity to EMF. Melatonin
Sensitive to radiation and light, the hormone melatonin, is formed in the pineal gland. Some frequencies (> 0,4 T) contribute to diminished melatonin production**). Due to the delayed effect it takes 2,5 weeks of low EMF (light, UHF) exposure for the production to diminish to under the limit value10). Melatonin regulates hormones, important for our well-being, such as serotonin, dopamine, noradrenaline, prolactin (stress hormone), and the sleep-hormone somatotropin. Deficiencies can cause insomnia as well as depression (Ferrier et al, 1982, Lewy 1983). Melatonin also controls our immune system (Maestroni et al. 1986) and it can inhibit the growth of breast cancer (Cohen et al. 1988), prostate cancer (Philo/Berkowitz 1988), ovary cancer (Leone et al. 1988) and melanome (Narita/Kudo 1985) Long-term deficiencies can lead to an increased incidence of cancer (Blask 1984; Reiter 1988), fertility changes (Reiter 1980) and prolonged feeling of jet lag (Arendt 1988). It takes about 3-14 days for the pineal gland to recuperate after ceased exposure to EMF10). *: minor organelle, incorporated in the cytoplasm of the cell, in humans as well as animals and plants. It has its own DNA. At an early stage in evolution, the mitochondria used to be separate organisms. They are the energy providers of the cell. ** 0,01W/cm2 is enough for this to happen and a 100 % reduction is achieved at 0,5 W/cm2 (Brainard et al. 1983). Chemicals
Electro-sensitive patients in Australia report having developed their EMF-symptoms after exposure to pesticides1). There is a basic duality between chemical structure and frequencies4). British researchers found that atomic radiation and chemicals induce similar effects. In some types of medical treatment, chemicals are used to increase the effects of radiation. Prof. Adey from USA studied the effects of EMF for 30 years. He emphasizes the combination effects. Some chemicals can be activated from EMF with the same frequency as in power cables. When the metal housing in computers was replaced by plastic components, the previous shielding was not regarded as necessary. The result was more radiation and increased emission of chemicals, 6)11). 50,000 new chemicals are introduced every year. The limit values are usually set for one substance at a time, without consideration of combination effects. Electrical devices such as TV screens contain chemicals such as fire retardant, emitted when the apparatus is in use (=warm). In 1990 IBM measured an emission of up to 50 chemicals from their screens, all of them, of course, under the limit value for each chemical6). In the semi-conductor industry in Silicon Valley, many odd chemicals and metals such as arsenic, iridium and gallium are used. Gases, silanes, boran and chlorine, are formed. Working in "clean", dust-free, sterile rooms, the employees suffered from inexplicable symptoms of disease6). The increased use of the toxic metal Beryllium in computers and other electric equipment is another health hazard3). Oxidative stress and metals
Metals conduct electricity. Copper, for example, is used in electrical wires. Metal exposure is not necessary for electromagnetic fields to have biological effects, but it can increase the process. Some life-essential metals and trace elements are always present in our bodies in small quantities. (The presence of ferromagnetic materials support the idea that we have a basic ability to sense weak magnetic fields4)). Lately the exposure to and absorption of larger "unwanted" quantities of sometimes toxic heavy metals, such as mercury, lead and cadmium has increased. The keyboard in older metallic computers was earthed to the chassis of the visual display and electricity was drained into wall sockets and on to the building's ground. With the new plastic housing all-in-one VDTs, the electricity is instead earthed through the "metallic" human, overloading the central nervous system, causing backaches, swelling and sore skin around the ankles and feet11). Due to its unpaired electron, electro-sensitivity is a basic property of a free radical. It is known that some metals enhance biological effects by producing more reactive radicals. Iron overload produces photosensitivity and enhances radiation and free radical effects3). Other metals, which enhance radiation (ionizing) effects include mercury, copper, platinum, chromium, ruthenium, cobalt, cadmium, vanadium, silver and arsenic. It cannot be excluded that these metals can also enhance EMF effects3). Some English patients claim that they are able to listen to the radio through their fillings. Dental amalgam consists of 50 % mercury combined with silver, tin and copper. Metals are released from dental amalgam by mechanical corrosion, heat and/or electric currents between dissimilar metals, facilitated by an electrolyte, here saliva. Commissioned to find out why divers working with under-water welding constantly lost their amalgam fillings, T. Örtendahl and P. Högstedt, at the Chalmers University of Technology in Gothenburg, Sweden, found that EMF-exposure more than doubled the mercury release from amalgam (2,6 average value)2). New dental amalgam blocks of 3 different types (DAB Fine Alloy, high-copper ANA 2000 and Dispersalloy) were exposed to 4 different computer screens (Ericsson DMU 3715-002, Ericsson DMU 3715-005, IBM 8503-002, IBM 8513 type 5157 and Macintosh Plus. The IBM screens, however, did not show any increased liberation of mercury. The reason for this is unknown, and it made no difference whether the screen was of a so-called "low-radiation" type, compensated to diminish the magnetic fields. The alternation of the magnetic fields probably determines how much mercury is liberated. Amalgam has a complex structure and it can not be excluded that it reacts to certain combinations of field strength and frequencies. More knowledge about the factors involved is required to know exactly why and what is happening. In an attempt to calm the readers, Örtendahl and Högstedt, in their documentation, finally emphasize that more mercury is dissolved from amalgam fillings during chewing than in front of the VDT. However, it's not that we do one thing or the other - we usually do both, sometimes even simultaneously. In the investigation, amalgam blocks - not fillings -.were investigated, which means there was no saliva or any biologically active component, that could increase the effects, present. It is possible that other equipment, such as mobile telephones, where some of the radio waves go through the head, has the same effect on the dissolution of mercury from amalgam. According to Dr. Scheingraber (biologist, mineralist and dentist), Germany10), there are indications that simultaneous exposure to heavy metals and EMF could increase the effects with a synergetic factor of 5-10. With electron ron micrographs, the Norwegian scientist, Wedberg, showed that sulphur is excreted from the bodies of VDT users. If the protective enzyme PSH (phosphate, sulphur and hydrogen) is destroyed, the cell cannot repair itself or combat radiation11). Since sulphur binds with mercury, it cannot be excluded that this could also diminish the body's defence to mercury from dental amalgam. Selective and/or positive sensitivities
Some patients exclusively react to particular equipment and certain frequencies. Sensitivities may also suddenly change frequency and/or be intensified during certain periods of time, sometimes in connection with other exposures. Some women feel that the level of sensitivity is affected by the menstruation cycle. According to Dr. Rea, Texas, USA, who has treated 500 ES patients, American patients feel better in Europe and vice versa. This, he thinks, is because Europe uses 50 Hz and America 60 Hz in the public networks. Fractures can be treated with frequencies of 20 Hz. Limited EMF exposure can also have an anti-inflammatory effect. The efficiency of time-regulated low EMF treatment (20-80 Hz, 1-2mv/cm, 10 min/times/days) of patients previously exposed to radiactive irradiation was demonstrated by Prof. Markarov, Russia3). Exposure to pulsed fields of about 24 Hz for 1 hour/day can stimulate growth in plants10). (Maybe that caused the rumour in the USA that basket-ball players could be "grown" with similar techniques). Dr. Monroe, England, found that electrosensitive patients usually have an individual "zero-frequency" where all the symptoms disappear. It can be found by testing the patient with an oscilloscope, an instrument used to generate electromagnetic fields of different frequencies. This frequency can be used to treat the patient3)4). The chicken and the egg
Emphasizing the nature of the damage, the way they see it, some of the support groups (for chemicals, amalgam as well as electro-smog) call themselves "injured". Due to this "cumulative overload", further exposure of patients to EMF during provocation tests, etc., is regarded as unethical, and so is exposure of children to EMF. Terms like sensitivity or allergy*) are also used. "Hypersensitivity" clearly indicates that, reacting to a basically harmless exposure, the patient is to "blame" for the condition (Compare "radioactive irradiation" where you never hear of hypersensitivity or allergy!) The scientists Brown (1982) and Alexander (1957), said that "the effects of radiation show up in human population as a large number of similar illnesses". Referring to the simultaneous appearance of the two syndromes, Ergotec, USA, suggests that amalgam-poisoning is caused by VDT radiation9). However, many amalgam patients never used a VDT, and the patients of today are usually the second or third generation of victims The amalgam density is high in Sweden. 10-25 % of the 16,000 organized amalgam-patients are also electrically sensitive. Depending on the way of amalgam removal and/or previous EMF-exposure, some patients develop ES in connection with amalgam replacement, others get rid of it. ES is usually regarded as one of the many symptoms triggered by amalgam-poisoning, and the most difficult to "cure"3). (why if it is just one of the symptoms?) Dr. Marija M. Hughes, American scientist and a "survivor" of severe ES is one of the few American patients who won a legal battle3) against her employer. She feels that her one and only (now removed) amalgam filling had nothing at all to do with her ES. Dr. M. Hanson, science director of the Swedish Association of Dental Mercury Patients, puts it this way: "a number of syndromes such as neurasthenia, chronic fatigue syndrome, fibromyalgia, chemical sensitivity, amalgam poisoning and electro-sensitivity are interrelated, identical or overlapping. Many of the symptoms of these disorders (with individual variations) are the same. This, together with known effects of EMF, heavy metals and chemicals and the result of therapies indicates that very basic biochemical and biophysical processes are disturbed, such as the calcium balance, etc." 3) *) From a strictly immunological point of view, it has not been scientifically established that 'electro-sensitivity' is an 'allergy', however, according to many scientists, it is possible . Medical treatment
Patients who have been exposed for a long time to strong EMFs are the most difficult to rehabilitate, whilst those who suddenly develop ES in connection with other exposures without previous heavy VDT exposure are the easiest to "cure". With varying results and sometimes side-effects, anti-depressive medicines such as Anafranil and Cipramil (earlier relatives of Prozac) have been used to treat ES patients. Working from a different angle, the amino acid tryptophane has the same effect on the neurotransmitter serotonin. Not always effective, it is definitely a milder form of treatment. There are plans to test melatonin on this patient group, although the long-term effects of such supplementation have not been documented. Anti-oxidants and a number of alternative therapies can be helpful (see page 18), but as Dr. Olle Johansson, Sweden, put it: "If I "cure" this patient and put her in front of a VDT again, who will take the blame if she develops cancer within 10-30 years?" Minimizing the exposure
Some of the measures involve long-term planning (new architecture) in the public, work-related and private sector. Tranquil areas, rooms with little exposure and few electric walls can be installed. The electric cabling can be shielded and/or an automatic close-down system can be installed (demand switch). It has been suggested that we should go back to the use of direct current (12 V) in households etc. Stick to your gas stove - if you still have one! Dr. Palm, German physician, recommended (1970) that you unplug the fuse for the bedroom when you sleep (when the light is off, EMF increases). Sleeping with your head close to electric wiring, heating or water pipes (vagabonding currents) should be avoided as well as fluorescent light, electric blankets, non-medical X-ray examinations and other medical treatment involving electricity (some patients developed their ES after MRI scanning). P.S. The above article is intended as a brief introduction to a huge subject, and for the continued debate, your comments, experience or expertise would be most welcome! Read about high frequencies in general and mobile telephones in particular in the next issue! 1) Chemical Crisis, one woman's story. Scribe Publications Australia. ISBN 0-908011-25-3. Can be ordered from ACTA, see page 4. 2) Effekter på dental amalgam orsakade av magnetfält genererade av bildskärmar och elektrisk svetsutrustning. Chalmers Technical Highschool, Avd. för Ortodonti, Odontologiska kliniken, S-413 90 Göteborg 3) Electrical and magnetic hypersensitivity, 2nd Copenhagen Conference, 1995, Jyrki Katajainen, Bengt Knave, ISBN 87-981270-2-0. 4) Electromagnetic Man. Health & Hazard in the electrical environment. Cyril Smith & Simon Best, UK. 1989. ISBN =-460-04698-5. 5) Epidemisk masspsykos eller reell risk? (A sociological study of the controversy surrounding electro-sensitivity). T. Brante, H. Norman. Symposion, Sweden, 1995. ISBN :91-7139-252-1. 6) Fältslaget om de elöverkänsliga, Gunni Nordström, Carl von Schéele, Sweden, 1995. ISBN 91-550-4083-7. 7) Några tankar kring elöverkänslighet och bildskärmsskada, Karolinska Institute. O. Johansson, 1994. ISSN 1400-1611. 8) Occupational exposure to 60-Hz magnetic fields and risk of breast cancer in women (abstract). American Journal of Epidemiology 1995 June 1:141(11):S31 9) Pollution Alert, Ergotec Association, Inc. Bert Dumpè, September 1993-13. lSBN: 0-9622907-2-6. 10) Strom des Lebens Strom des Todes, Electro- und Magnetosmog im Kreuzfeuer. P.C. Mayer-Tasch, B.M. Malunat. ISBN 3-596-12483-2, Germany, Fischer Taschenbuch Verlag GmbH. 1995. 11) X-rayed without consent,, Ergotec Association B. Dumpé. ISBN: 0-9622907-0-X.
The randomized comparative pediatric critical illnessstress-induced immune suppression (CRISIS) prevention trial Joseph A. Carcillo, MD; J. Michael Dean, MD; Richard Holubkov, PhD; John Berger, MD; Kathleen L. Meert, MD;K. J. S. Anand, MBBS, DPhil; Jerry Zimmerman, MD, PhD; Christopher J. L. Newth, MB, ChB; Rick Harrison, MD;Jeri Burr, MS, RN-BC; C. C. R. C. Douglas F. Willson, MD; Carol Nicholson, MD