Aug 28 2015

French Court Awards Disability for Electromagnetic Hypersensitivity

A French court recently awarded a disability allowance ($912 per month for three years) to Marine Richard based upon her claim that she has EHS (electromagnetic hypersensitivity). This is a concerning development because EHS is likely not a real disease. The situation, however, is a bit more nuanced than it may at first appear.

EHS and Non-Specific Symptoms

First for some background on EHS (or Idiopathic Environmental Intolerance attributed to electromagnetic fields, IEI-EMF, as it is now called in the scientific literature) – sufferers claim that they are sensitive to electromagnetic fields and that these fields cause symptoms such as headaches, dizziness, nausea, fatigue, tingling sensation, or palpitations. In one case series of EHS specifically subjects reported:

The most frequently reported symptoms from exposure to smart meters were (1) insomnia, (2) headaches, (3) tinnitus, (4) fatigue, (5) cognitive disturbances, (6) dysesthesias (abnormal sensation), and (7) dizziness. The effects of these symptoms on people’s lives were significant.

This list of symptoms may seem familiar to anyone with a medical background. They are all considered to be common, subjective, and non-specific symptoms. Sometimes we refer to such symptoms as the “symptoms of life,” because most people will have them at some point, even if they are completely healthy.

Vague and/or nonspecific symptoms such as these are often a challenge for both patients and medical professionals. Because they are non-specific they don’t point to any one disease or even one category of disease. They can be caused by a long list of actual diseases. They can also be lifestyle symptoms, associated with things like poor sleep, being overweight or inactive, or overusing caffeine.

They can also be a manifestation of an underlying mood disorder, such as anxiety or depression. Sometimes a mood disorder might exaggerate baseline symptoms of life, or cause what is called hypervigilance – paying attention to every little daily symptom. These everyday symptoms then provoke further anxiety and depression, resulting in a vicious cycle.

The challenge for the healthcare professional is to ferret out any significant underlying medical condition. Because the symptoms are non-specific this can involve a fairly thorough medical workup. At some point, though, it is reasonable to conclude that any serious underlying condition has been ruled out. Then the challenge becomes shifting focus to addressing the symptoms and improving the quality of life, rather than continuing on an endless hunt for an elusive diagnosis that may not exist.

This is all challenging enough, but in addition there are an increasing number of “alternative” practitioners whose livelihood consists mainly of throwing a monkey wrench into this whole process. They are like sirens luring vulnerable patients who are struggling to deal with non-specific symptoms toward the rocky shores of the fake diagnosis.

Imagine if after a thorough workup your physician is trying to convince you that any serious disease has been ruled out and perhaps we need to focus on your sleep and your anxiety, then a naturopath or fringe doctor tells you that they have magically diagnosed your problem as being something very specific and treatable (what you have been looking for the whole time). The allure of that fake diagnosis would be great.

Often patients in this situation are diagnosed with chronic Lyme disease, something called “Wilson’s syndrome,” low thyroid, candida hypersensitivity, multiple chemical sensitivity, food allergies, non-celiac gluten sensitivity, or electromagnetic hypersensitivity.

Whatever is going on with patients who claim to suffer from EHS we can say with a high degree of scientific confidence that it is not being caused by electromagnetic fields. A 2010 systematic review of provocative studies found:

An extensive literature search identified 15 new experiments. Including studies reported in our earlier review, 46 blind or double-blind provocation studies in all, involving 1175 IEI-EMF volunteers, have tested whether exposure to electromagnetic fields is responsible for triggering symptoms in IEI-EMF. No robust evidence could be found to support this theory. However, the studies included in the review did support the role of the nocebo effect in triggering acute symptoms in IEI-EMF sufferers. Despite the conviction of IEI-EMF sufferers that their symptoms are triggered by exposure to electromagnetic fields, repeated experiments have been unable to replicate this phenomenon under controlled conditions.

This is a consistent and robust result. People who self-identify as having EHS cannot actually tell when they are exposed to an EMF – the electromagnetic field itself is not causing the symptoms.

The French Court Decision

Does all this mean that the judge who ruled to give Marine Richard a disability allowance based upon her EHS diagnosis was wrong? Perhaps, but there is a nuance here I would like to explore.

According to reports, the court “stopped short of recognising EHS as an illness.” What I think this means is that the court recognized that Richard is disabled by her symptoms, and that is sufficient to treat her as disabled, even while it remains agnostic toward the cause of her symptoms.

This is actually not unreasonable and is common practice. Courts are not the place to sort out complex medical science. The challenge that courts face is that they are often tasked to dispense justice in the absence of a clear scientific answer or in the face on an ongoing controversy.

Often courts will err on the side of perceived victims or those in need, while not explicitly endorsing their claims. The vaccine court in the US operates this way. They grant compensation to families of children who may have had a vaccine side effect. They give a wide benefit of the doubt to the families, and essentially grant compensation even with the acknowledged lack of a scientific conclusion that vaccines can cause the alleged injury.

In other words, if you happen to have a seizure following a vaccine, the court is not going to spend its time trying to sort out whether or not the vaccine actually caused the seizure. They will just grant you compensation.

The downside of this policy is that people will often interpret the court’s action as if it is endorsing the causative claim, even when it explicitly is not.

A more troubling situation I won’t get into extensively here is when the issue is not one of public compensation but one of liability. For example, when companies are sued because their product allegedly caused an illness, even before the science is in. Here I do not think that courts are justified in simply erring on the side of the alleged victim, even though they will often do that.

There are many examples of this, including the alleged association of silicone implants and autoimmune disease. While the data was still preliminary courts awarded a multi-billion dollar class action settlement against Dow Corning, forcing them into bankruptcy protection for nine years and the removal of silicone breast implants from the market. However, when the science was finally in, it turns out there is no increased risk of autoimmune disease from silicone implants.

Conclusion

In the end it is important to have the science right so that we can best approach difficult situations such as those who feel their life is being destroyed by EHS. It is extremely helpful to know scientifically that electromagnetic fields are not causing their symptoms.

This, however, does not mean that they are not sick or at least have a disorder. It’s just probably not what they think it is. In some cases it is possible that patients who become convinced they have EHS have another identifiable illness, which is being missed because they are pursuing a false diagnosis.

In many cases, however, the cause(s) may be as vague as the symptoms. There may be a number of lifestyle and mood factors contributing to the symptoms in a self-reinforcing manner. We don’t really have a good non-judgmental name for this situation, which is unfortunate. We need a label that describes the syndrome without implying a cause, especially one that is probably not true.

In any case, it is important to recognize that these non-specific symptoms, when severe, can be debilitating. As physicians we take this approach all the time, and then try to address the debility. I have no problems with courts taking the same approach, if that is how their laws are construed.

It is important to recognize, however, that concluding that “compensation is appropriate” (often the wording used by the vaccine court) is not the same as endorsing an alleged cause.

Unfortunately, however, that is how it is often taken, especially by proponents.

12 responses so far

12 Responses to “French Court Awards Disability for Electromagnetic Hypersensitivity”

  1. idoubtiton 28 Aug 2015 at 10:50 am

    This French case was noted in the Doubtful News comments yesterday regarding the recent story about parents suing a school over wifi exposure.

    http://doubtfulnews.com/2015/08/parents-complain-about-wifi-in-school-ill-sue-ya/

    The parents of the child want the Massachusetts school to accommodate their wish for a weaker wifi signal. However, the school’s wifi signal is below the federal standards. Their recourse then is a legal one. They claim to have several doctors to support the claim that EHS (EMS) is real. If this does go to court, will it be a battle of expert witnesses?

    Meanwhile, the kid in the middle doesn’t seem to be receiving the resolution he might need.

  2. MikeLewinskion 28 Aug 2015 at 11:08 am

    For names, how about Non-specific Dysphoria or Somatic Dysphoria? In this particular case, Nocebo-Induced Dysphoria. I know that dysphoria doesn’t quite capture it, so maybe there’s a related term that is less about emotions.

    There’s mention of an attempted overdose on placebo in the NYT story Beware the Nocebo:

    In one remarkable case, a participant in an antidepressant drug trial was given placebo tablets — and then swallowed 26 of them in a suicide attempt. Even though the tablets were harmless, the participant’s blood pressure dropped perilously low.

    Are those literally sugar pills? Is there still a straightforward physiological explanation in reach?

    I agree that awarding the woman disability was probably a good thing for her sake, even if it means other people take the ruling the wrong way.

  3. goldmund52on 28 Aug 2015 at 2:41 pm

    I particularly appreciate the strong acknowledgment that patients with these non-specific symptom syndromes have real symptoms that cause real impairment. Acknowledging the impairment caused by these syndromes is the first step in establishing a therapeutic relationship; you don’t want to be a nocebo by invalidating the symptoms as psychological. *

    Having said that, IMO, the appropriate treatment for these syndromes is rarely compensated disability. The job of the treating physician is to maintain or rehabilitate function in these patients. Without writing a whole treatise here, I quote the following from Gordon Waddell’s UK commissioned, evidence-based review, Is Work Good for Your Health and Well Being?. “In summary, there is a strong theoretical case, supported by a great deal of background evidence, that work and paid employment are generally beneficial for physical and mental health and well-being.” I don’t know any of the details of this French case, other than that she was 39 years old. But there is a pretty good chance that this judge has harmed this woman by validating these nonspecific symptoms as disabling—learned helplessness. The great majority of people who are on full-time compensated disability for 3 years will never go back to work.

    The treatment is easy (not). Establish a therapeutic relationship by ruling out identifiable disease. Coach patient out of the fix-it box mentality into self-management with attention to sleep, mood (mostly anxiety), and physical deconditioning. Teach mindfulness based strategies along the lines of Acceptance and Commitment Therapy. Don’t harm the patient with chronic opioids or benzodiazepines. Tres facile.

    *There could be a whole side discussion here on somatoform disorders. There is a category that is principally psychiatric. This includes somatization disorder by DSM-IV criteria, Munchhausen’s, conversion disorder, hypochondriasis. The much, much larger category is people whose life stressors cause physical symptoms. This is the fibromyalgia, whole body pain, chronic fatigue people. Most of the people with EHS probably have the latter.

  4. Fair Persuasionon 28 Aug 2015 at 10:18 pm

    Just got a ComEd Smart Meter. I’m happy and have no ill effects. Wouldn’t trade my residence for a barn!

  5. Robert Christon 28 Aug 2015 at 11:36 pm

    I used to see this phenomenon a lot in the support group Yahoo groups “sick buildings”. Attitude that mold related illness is well understood in the medical literature. And particularly that it’s caused by mycotoxins. And that if we just sue the owners of homes & businesses with some type of mold issue. Who should know better. That the condition will go away. Which in essence means we need to sue roughly 50% of the owners of properties at some point. Cause I’ve heard from some estimates that about 50% of homes and businesses either have, or have had, or will have at some point some type of potentially health threatening mold issue. And it does prevent the victim from looking for other possible other causes for their symptoms. Having fallen into this trap I can vouch for that. I do believe mold sensitivity is real extremely debilitating, and a lot of these people could possibly do much better if they could get themselves into a home with no mold issues. Not saying mold causes the condition anymore than it “causes” aspergillosis. I suspect we have some kind of weird immune disorder that predisposes us to these symptoms. I would think from a skeptics perspective it’s at least plausible? Not exactly an extraordinary claim. Like some of the other conditions. Living with it for close to 19 years now it’s hard not to be angry that science has not caught up with what many of us strongly suspect to be reality. But because of a lot of the nuances Steve touched on here and in the past. I guess it’s somewhat understandable. These conditions are hard to test for cause they do not turn on and off like a light bulb. I’ve also fell into the trap many times blaming different situations for my ongoing symptoms. It’s hard not to do. With symptoms as profound as the ones we have, very much up and down, what would be extraordinary is if we didn’t do this.

  6. RickKon 29 Aug 2015 at 9:03 am

    Wow, I never realized there was a whole fear community focused on ComEd Smart Meters.

    If that tiny signal was harmful, nobody working in radio broadcasting, working for the military, working on a ship or working in a major city would live past 40.

  7. edwardBeon 29 Aug 2015 at 12:01 pm

    I’ll bet you two bucks that the little guy idoubtit spoke of doesn’t show any aggravation of his symptoms when he is unknowingly exposed to wifi. Just whip out your iPhone and you will see that in metropolitan areas, even small ones, we are all constantly surrounded by wifi networks belonging to businesses and neighbors.

  8. Newcoasteron 29 Aug 2015 at 2:37 pm

    I think I will print this one off for my neighbour around the corner. He is a “No Smart Meters” advocate, and has a small billboard in front of his house posted with letters from the local power utility and his replies, as well as some pseudoscientific articles on the “dangers” of EMF, smart meters and cellphones.

    It’s a bit of an eyesore, but perhaps he won’t notice right away if I post this article on his billboard for a few days.

    Stealth skepticism. 🙂

  9. Lukas Xavieron 29 Aug 2015 at 5:06 pm

    Off-hand thought:
    If a case like this was brought before a court, could the judge demand that a properly blinded trial be conducted to settle the matter?

    E.g. “You say that you’re harmed by wifi signals? Let’s conduct a series of trials and if you can determine whether a signal is present with 75% accuracy or better, I’ll find in favor of your claim. Otherwise, your case is thrown out.”

    Would that sort of thing be legal?

  10. Fair Persuasionon 31 Aug 2015 at 11:44 pm

    The World Health Organization does not recognize this illness as independently verifiable or having any physiological basis. WHO has run tests which show people cannot distinquish levels of WiFi. The French court has been scammed by a reporter. C’est la vie.

  11. RCon 01 Sep 2015 at 1:51 pm

    Fair Persuasion –

    The fact that people can’t distinguish wifi levels doesn’t mean that this person isn’t disabled – it means that they’re not disabled because of wifi. If they can’t work because of some nonspecific anxiety disorder, they still can’t work.

    There’s not necessarily a scam here. The court should be making a decision on whether or not the person is impacted and can’t work – not on whether the person’s understanding of their own condition is correct.

  12. Fair Persuasionon 01 Sep 2015 at 6:46 pm

    The reporter received the maximum term, three years for France’s cash sickness benefit. Should we check back after three years to see the rest of the story for EHS?

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