Examination of Witnesses (Questions 840-859)
DR STEPHEN
KEEVIL, PROFESSOR
COLIN BLAKEMORE
AND PROFESSOR
RAY DOLAN
17 MAY 2006
Q840 Bob Spink: Professor
Blakemore, were you forceful enough and proactive enough once
you became aware to raise the concerns of the MR community about
this Directive.
Professor Blakemore: To some extent,
I delegated the responsibility of presenting the MRC's view to
individuals who are more expert than I am in this area—which
I think was entirely appropriate. But when I became aware that
the report of the committee that I had chaired was being cited
as evidence I certainly went to some effort to consult my colleagues
who had been involved in that committee as to their views on that
process. The outcome of that was quite a strong letter summarising
our opinions and expressing concern about the way in which our
report had been interpreted. The brief of the committee I chaired
was to speculate—to speculate—about the possible levels
of field strength at which there were detectable interactions
with the human body, particularly the nervous system, but without
a clear instruction to think about or comment on potential hazards
associated with such effects. We did identify a couple of areas
where we thought there was reasonably robust evidence for defining
the threshold for interaction, but, as we have said in our letter
to HSE, on reflection afterwards we could see no clear evidence
that those limits, those determinable limits, indicate a hazard.
There are two areas of uncertainty—and the word "uncertainty"
has been used a lot in the discussion. One is the uncertainty
about the extent to which measurements of detectable effects at
one part in the spectrum can legitimately be extrapolated to others.
I will cite, for instance, the clear evidence that very low frequency
fields can induce phosphenes (that is, apparent flashes of light
caused by direct activation of the retina). We know that those
effects occur over a very narrow frequency band and they fall
off very quickly above about 20 Hz. If cells in the retina can
be affected by low field strengths like that, then it is conceivable
that neurons in the brain could be affected by similar field strengths,
and there is less certain evidence—some evidence but less
certain—that that occurs. There was an assumption (because
of the electrical characteristics of groups of nerve cells) that
such effects, if they occurred, would extend over a large frequency
range. That turns out not to be true on the basis of current evidence
from John Jeffreys, who is an expert in this field who provided
some of the strongest evidence of such effects. They too are limited
to a narrow frequency band. That is one area of uncertainty about
extrapolation of data to determine the thresholds of interaction.
The second area of uncertainty concerns speculation about the
possible effects on the body above those thresholds. Robert tried
to raise the dreaded question of mobile phones. It is worth comparing
this present situation with that considered by Stewart.[2]
If there had been clear enough evidence—as there is now
for effects at the low frequency part of the spectrum—of
interaction with the body at very low-strength radio frequency
fields, then it would have been very difficult, following the
same arguments, for ICNIRP and NRBP not to adopt those extremely
low levels, which probably would have stopped radio frequency
telecommunication technology. It was only because of the uncertainty
of being able to establish a clearly agreed threshold that there
were not similar, inappropriate, extremely cautious limits for
radio frequencies.
Q841 Chairman: If that
seems so obvious to all, how have we got to this point in time,
where we are within a short period of adopting this particular
Directive that is going to have significant impact, without a
body of evidence to support it? How have you all allowed it to
happen? We rely on you.
Professor Dolan: One of the answers
to that is the failure of adequate consultation.
Q842 Chairman: By the
HSE or by whom?
Professor Dolan: At the point
where the European legislation was being drafted, I guess national
agencies have to take responsibility for appropriate consultation
as to the likely impact of the Directive.
Q843 Bob Spink: For the
record, could I ask Professor Blakemore to say when MRC was originally
contacted by HSE. Are you satisfied that HSE are taking full account
of your concerns?
Professor Blakemore: I believe
we were first contacted in September of last year. I think HSE
is now taking very seriously the growing swell of concern. I have
some sympathy with HSE's position because they are not responsible,
of course, for writing the Directive, only for implementing it.
They are struggling, I think genuinely, to see how a very difficult
situation could be retrieved in the face of a Directive which
is very difficult to change.
Chairman: We are looking forward to their
response.
Bob Spink: Were any of the panel amazed
to read the evidence we received from the Director General last
week—or is that not in the formal evidence—that if
the Directive has gone wrong they will ignore it?
Chairman: That is not in the formal evidence.
Bob Spink: And they will not take infractory
proceedings—
Chairman: That is not in the formal evidence.
Bob Spink: —because they might
well consider that it is wrong.
Chairman: That is not in the formal evidence.
Bob Spink: I am sorry. Did I get that
on the record, though?
Chairman: I do not think we can ask you
for comment on what is a private view of the Commissioner.
Q844 Bob Spink: I apologise,
Chairman.
Professor Blakemore: It is a very
encouraging private view.
Dr Harris: It is not private any more
though.
Chairman: At that point we will move
on. I have lost control of this Committee!
Q845 Dr Harris: Professor
Blakemore, would you agree with the following assertion that it
is not possible at present to say that exposure to radio frequency
regulation, even at levels below national guidelines, is totally
without potential adverse health guidance, and that gaps in knowledge
are sufficient to justify a precautionary approach?
Professor Blakemore: I think you
might be quoting from a sentence that I played a part in writing.
Q846 Dr Harris: Would
you agree with that?
Professor Blakemore: I certainly
would agree with it.
Q847 Dr Harris: Would
you then agree with the statement that: as a precautionary approach,
the ICNIRP guidelines for public exposure be adopted for use in
the UK?
Professor Blakemore: Yes. I did
agree with that. You are quoting, of course, from the Stewart
Report, the report of the Independent Expert Group on Mobile Phones.
Q848 Dr Harris: Of which
you were a member.
Professor Blakemore: Of which
I was a member. That recommendation of course was made in the
knowledge that to adopt ICNIRP guidelines for radio frequency
radiation would not impede mobile frequency telecommunications
technology. What it would do would be to send a signal that we
should be aware of the concerns, employing the precautionary principle,
and not race ahead with technology which would push exposure levels
up further.
Dr Harris: I would question that—and
I want go too far down this path—because if you try to get
a signal in North Oxford you will find it difficult because mobile
phone masts have been resisted by people in North Oxford on the
basis of the Stewart Report. I will show you my postbags and—
Chairman: Dr Harris, I do not want to
get on to mobile phones. I want to keep specifically to MRI.
Q849 Dr Harris: I would
question your analysis, therefore, that the Stewart Report and
your coverage of it, particularly in its reference to the precautionary
principle, has not impeded the ability to use that technology.
Professor Blakemore: The implementation
of ICNIRP guidelines has certainly not impeded the technology.
The public unfortunately go beyond the logic of the explicit limits
of exposure stated by ICNIRP in their concern about mobile phone
masts. We all know that.
Q850 Dr Harris: To what
extent would you say the Directive with which you disagree has
been based on the precautionary principle? Is that part of the
problem, would you say, whether you agree it is the right version
of the precautionary principle or not?
Professor Blakemore: I think we
are seeing now that the intransigence—and I use that word
advisedly—of the Commission, in considering the concerns
that have been expressed, goes far beyond the precautionary principle.
In the Commission's document on precautionary principle, which
I think was published in 2000, its interpretation of the precautionary
principle is as follows: "Where action is deemed necessary,
measures based on the precautionary principles should be inter
alia proportional to the level of protection, based on an
examination of the potential benefits and costs of action or lack
of action and subject to review in the light of new scientific
data." I think we have seen those principles infringed in
the discussions around the issue of the Physical Agents Directive.
Dr Keevil: I absolutely agree.
One of the issues we have is the way in which the status of pieces
of evidence has somehow sort of grown out of all proportion through
the process. If you look at the ICNIRP guidance, it is a review
of all the literature and it says, "There are uncertainties.
Let's come up with some numbers to exclude possible effects"
and that sounds to me like a precautionary approach. If you go
back to the definition that you had right at the start of this
inquiry from Sir David King, the precautionary principle being
the idea that a lack of consensus should not prevent action, it
is almost a case study of that: "There's a lack of consensus
but let's have some numbers and let's have some action" but
somehow that has then been taken as concrete limits. The Directive
does not say that it is precautionary, it says, "These are
thresholds for known adverse health effects," so somehow
the status of the evidence has grown and it does not reflect what
ICNIRP perhaps is saying about it.
Q851 Dr Harris: I understand
that, because this started with "no known adverse health
effects", but Professor Blakemore quoted from the 2000 document,
and, if you look at what the European court said in respect of
the beef ban, "Where there is uncertainty as to the existence
or extent of risks to human health, the Commission may take protective
measures without having to wait until the reality or seriousness
of those risks becomes apparent" so everyone who wants to
take a stronger precautionary approach can pick a judicial definition
almost of the precautionary principle. I want to ask Professor
Blakemore, in particular, as someone who has influenced policy
in this area, whether he thinks there is a problem with the precautionary
principle and interpretation of it and a lack of a definition
in it in this area.
Professor Blakemore: I think it
is generally agreed there are serious problems with the precautionary
principle because of the variety of interpretations of it. When
there is variety but the underlying principle is to be cautious,
then usually the most conservative of the interpretations wins
out—and the example you have quoted there is obviously at
the conservative end. The key, though, to all of this is surely
that we should take into account, in our consideration of appropriately
cautious and protective measures, the risks that might be associated
with implementing those measures, but also the loss of the benefits
associated with preventing the use of technology. In the case
of MRI, it is very, very clear: the hazards associated with other
approaches (for instance X-rays or positron emission tomography,
which are in some ways alternatives to MRI) far exceed, on the
basis of known and certain evidence, the risks that might be associated
with MRI.
Q852 Dr Harris: I want
to give you a chance to influence what the Government does. We
have institutions like the HSE and the NRPB and we have people
negotiating at the Commission, we have Ministers in Council, and
the word "precautionary" approach or principle is flying
around, but do you think it would be of value for the UK Government
to do more work on how it is going to apply the precautionary
approach—including the issue you mentioned of risk versus
benefit and identifying the opportunity cost of being too cautious—in
its policy and negotiations?
Professor Blakemore: I think a
serious piece of work on the interpretation of the precautionary
principle would be very helpful.
Q853 Margaret Moran: I
think you have made very clear, Dr Keevil, your view on the response
given by the Commissioners and you are submitting some further
information on it, so I will not go into that. Since my colleague
blew the gaffe on some private discussion which seemed to indicate
that the Directive might be amended, let me make it clear that
there is some difference of view. Let us assume, as we have to,
that the Directive will be implemented within its current timetable.
Given that assumption, what new evidence has been provided to
the Commissioner to persuade him to establish a joint working
group? In other words, what has happened between the point at
which the Directive has been signed and sealed over there and
the different thoughts emerging?
Dr Keevil: That process relates
back to a meeting that I mentioned earlier when I went with a
group representing the radiology and medical physics communities
in Europe to meet with Commissioner Spidla. Ahead of that, we
sent a summary of what we thought the main impacts would be on
clinical practice and research in MRI, and we had what I felt
at the time was a very positive meeting where he responded to
that by saying he would set up this working party, the remit of
which would be to look at the evidence for the claims we were
making to see whether, essentially, they were true. That is a
very valuable step. It is limited in some ways, because, if you
are purely looking at current practice in MR, there is a risk
that you would close off things which might develop in the future.
As Professor Blakemore was saying earlier: research begins to
turn into clinical practice. So it is not necessarily the panacea,
but it was certainly a very positive move and I think that was
because of the initiative that the European MR community took
in setting up a meeting with the Commissioner and presenting that
evidence. What was said in Brussels when this Committee went there
seemed, to some extent, to fly in the face of that, because they
were expressing a great deal of scepticism about that working
party and what it might turn out and obviously had a very entrenched
view of what the outcome was going to be.
Q854 Margaret Moran: Were
you given any assurances about the composition and remit of the
working party?
Dr Keevil: Assurances might be
putting it too strongly. The Commissioner said that they would
establish a working party to examine the extent to which practice
was affected by the Directive. That was fleshed out as: Would
the Directive restrict the use of MRI and so reduce patient benefit
and would it limit the evolution of the discipline? It was agreed
that would be set up by the Employment Directorate General but
would have input from the MR radiology and scientific MR community
in Europe. Since we came back from that meeting in Brussels, I
have heard no more about that working party, and so it was news
to me that we are going to have a meeting next month. As far as
I am aware, the exact composition has not been determined but
there was an agreement that it would have input from our community.
I came away with the impression—and it is in my notes—that
the community would participate not only in determining the composition
but in determining the mandate of that working group; whereas
there was a very firm view in the evidence that you received last
week that the mandate is set and is quite narrow and it will just
have some sort of advisory role and not be able to really recommend
changes to the Directive in itself. But that may simply be my
misinterpretation.
Q855 Margaret Moran: If
it has that mandate, do you think it will be of any benefit?
Dr Keevil: It then depends on
what notice the Commission takes of the outcome. If, as I would
imagine, it does demonstrate that there is a real impact on MR—and
I think, to a large extent, we have already demonstrated that
impact so it should not be a difficult task—and we present
that evidence to the Commission, it is then a question of what
they do with it. The Commissioner said to us in March that if
the working group did establish that there was an impact on practice,
defined in the way I have described, then he would be open to
changes in the Directive—although he said it would not be
an easy process and may not be successful, because of course it
now has to go back through all the European institutions. So that
was very encouraging.
Q856 Adam Afriyie: To
all intents and purposes, as we know publicly at the moment, the
Directive will be reviewed in 2009. What evidence or research
needs to be undertaken before then on EMF and static fields and
who should fund it?
Dr Keevil: That is a very difficult
question. The research field of EMF interactions with biological
systems is quite a broad one and it is not one in which I am involved.
There are large uncertainties, as I was saying. In some of those
there is work in place already to try to close them down. There
is work at UCL, for example, looking at possible effects of time
varying fields on evoked potential to the brain. That is work
of which I am aware.
Q857 Adam Afriyie: But
you are not at the stage where you have a list of work that would
need to be completed in order to—
Dr Keevil: There are lists of
what the research questions are. Again, this is not really my
field, but some are very broad questions, which are not things,
I would imagine, that are going to be solved in that timeframe.
They are ongoing research questions. There is always going to
be a degree of uncertainty. I think the solution may be more in
recognising that uncertainty. Mainly, to some extent, it is about
ICNIRP recognising the uncertainty and reinforcing the fact that
there is uncertainty in the evidence that has informed their limits.
They are reviewing their guidelines at the moment.
Q858 Adam Afriyie: Professor
Blakemore, if research is identified that will be required for
the review, is MRC prepared to fund it?
Professor Blakemore: We have already
indicated to HSE that we will be prepared to consider funding—preferably
in partnership—in this area, depending, obviously, on the
quality of the proposals that are received. Could I say, just
to extend Stephen's comment, that the biggest and most impressive
experiment has already been done, and that is the fact that some
400 million people have been exposed to MRI scanners with, as
far as I know, no recorded health problems as a consequence.
Q859 Chairman: Or to the
workers.
Professor Blakemore: Nor to the
workers. That is a pretty good starting point. The MRC and others
have identified areas where work could be done and where capacity
exists in this country to do it well. I think this work could
be done quite quickly.
Bob Spink: Could I put on the record
that this has been going on for 34 years now, to my knowledge,
since the first scanners were developed in Radlett by EMI in 1972.
Chairman: That is a comment on the record.
Thank you for the final comment from my colleague Bob Spink. Could
I thank you very much indeed, Professor Dolan, Dr Keevil and Professor
Blakemore.
2 Note by the witness: The Independent Expert
Group on Mobile Phones, chaired by Sir William Stewart. Back
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