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Issue

Vol 133 No 1519: 31 July 2020

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Issue Summary

Article
SUMMARY

Challenges for the future: the gastroenterology specialist workforce in New Zealand

Rosemary Stamm, Kristina Aluzaite, Malcolm Arnold, Thomas Caspritz, Campbell White, Michael Schultz

New Zealand has among the highest rates of colorectal cancer and inflammatory bowel disease in the world. We studied the capacity of and demand faced by the current gastroenterology specialist workforce in the country. We found that New Zealand has a lower specialist gastroenterologist number per population and older workforce compared with other comparable western countries. This means our gastroenterology workforce may struggle to meet the growing gastroenterology healthcare needs of the population. We also found that four of the 20 district health boards had no gastroenterologists, creating healthcare access issues for patients living in these regions.

Article
SUMMARY

Atrial fibrillation in acute coronary syndrome: patient characteristics and appropriate utilisation of anti-thrombotic therapy in New Zealand (ANZACS-QI 39)

Charles Yao-Cheng Ho, Mildred Lee, Chris Nunn, Jonathon White, Andrew J Kerr, on behalf of the ANZACS-QI investigators

One out of seven patients who present with a heart attack has an irregular abnormal heart rhythm called atrial fibrillation which is associated with increased stroke risk. Use of combinations of blood thinners in this group of patients are inconsistent in current New Zealand practice. About half who have increased risk of stroke are discharged without stronger blood thinners called anti-coagulants, whereas those with low stroke risk appear to be over-treated. National action needs to be taken to implement a consensus guideline.

Viewpoint
SUMMARY

New Zealand’s ‘Cannabis Legalisation and Regulation Bill’: an evidence-based assessment and critique of essential regulatory components towards policy outcomes | OPEN ACCESS

Benedikt Fischer, Dimitri Daldegan-Bueno

New Zealand will hold a referendum in September 2020 on whether to make cannabis use, production and retail distribution legal by policy (‘legalisation’), mainly to improve public health, safety and justice. The proposed policy framework has been defined in the recent Cannabis Legalisation and Regulation Bill, including key regulations. Our paper, based on applicable science, reviewed overall 10 essential regulation components of the Bill, including those stipulating: age of legal use and access; places of use; legal production, retail distribution and products available; ‘home-growing’; new and remaining penalties; and research and monitoring. We find that while the Bill appears overall well-developed, several of the critical regulation elements are questionable, or may not serve the declared policy objectives as well as possible in their current form. These elements should be reconsidered, and revised, ideally before a possible cannabis legalisation policy is rolled out.

Article
SUMMARY

Hip abductor tendon tears—a survey of New Zealand orthopaedic surgeons

Mark F Zhu, David S Musson, Jacob T Munro

The hip abductor tendons form a crucial part of the hip joint and are responsible for stability and function during daily activities such as standing from a chair, walking and running. This study surveyed New Zealand’s orthopaedic surgeons to ascertain how often they diagnosed hip abductor tendon tears and the surgical repairs used in treatment. Ninety percent of the surveyed surgeons had diagnosed this problem and there was a reported need for new materials to help improve surgical repair.

Article
SUMMARY

Chronic hepatitis B infection—an unmet medical need in New Zealand 35 years after universal neonatal vaccination

Erin Horsfall, Ed Gane, Ahmad Anwar, Chris Moyes, Alex Lampen-Smith, Susan Hay, Chris Cunningham

In 1988, New Zealand became the second country in the world to introduce universal neonatal vaccination for HBV. Despite this, more than 30 years later 90,000 adult New Zealanders have chronic HBV infection, many of whom will die or need transplants for liver cancer or liver failure. Rates of diagnosis and monitoring are low, reflecting the barriers caused by high levels of socioeconomic deprivation in those Māori and Pacific Island communities who carry the highest burden of this disease. Almost all HBV-related liver cancers and liver transplants are prevented by earlier diagnosis, monitoring and treatment.

Article
SUMMARY

Appropriateness of trimethoprim as empiric treatment for cystitis in 15–55 year-old women: an audit

James E Ussher, Gary N McAuliffe, Juliet A Elvy, TRIME auditors, Arlo Upton

Uncomplicated urinary tract infections are commonly treated with the antibiotic trimethoprim and, consistent with current guidelines, a urine sample is not routinely sent to the laboratory for testing. Among the samples they do receive, laboratories have seen increasing rates of resistance to trimethoprim in the bacteria that most commonly causes urinary tract infections, raising the question as to whether trimethoprim remains an appropriate up-front treatment for uncomplicated urinary tract infection. In this audit, urine samples from patients with uncomplicated urinary tract infection were sent to the laboratory to determine whether bacteria causing the infection were resistant to antibiotics. High rates of resistance to trimethoprim were seen, suggesting that alternative antibiotics should be considered for the up-front treatment of uncomplicated urinary tract infections.

Article
SUMMARY

Preventing acute kidney injury: assessing awareness to temporarily discontinue ‘at-risk’ medicines during acute illness in a New Zealand cohort

Dianne Vicary, Colin Hutchison, Trudi Aspden

This research set out to determine patients’ awareness of temporarily stopping medicines during acute illness, and the actions they would undertake when acutely unwell. We asked people who were collecting their prescriptions from a participating community pharmacy to complete a written questionnaire. We asked them what would they do with their medicines if they became acutely unwell. Then we asked them if they could recall a health professional advising them to temporarily stop some of their medicines when they were acutely unwell; and if they did remember receiving such advice, which of their medicines they would temporarily stop when they were acutely unwell.

Article
SUMMARY

An understanding of discordant SARS-CoV-2 test results: an examination of the data from a central Auckland laboratory | OPEN ACCESS

Shivani Fox-Lewis, Sharmini Muttaiyah, Fahimeh Rahnama, Gary McAuliffe, Sally Roberts

This study reviewed the SARS-CoV-2 PCR (polymerase chain reaction) results from 1 February to 13 April on samples from hospital and community patients conducted at a central Auckland laboratory. In total 20,089 tests were done in this time, of which nine were from patients who tested negative first and then positive. The reasons for the initial negative test include testing before the onset of symptoms and testing late in the course of the illness. If a person with significant risk factors for SARS-CoV-2 (eg, overseas travel or close contact with a case) tests negative, they should have repeat testing performed.

Viewpoint
SUMMARY

Is there a syndrome caused by radiofrequency electromagnetic fields?

Mark Elwood

Some people feel that many symptoms—such as fatigue, sleep problems, anxiety, headache and many others—can be caused by radiofrequency (RF) electromagnetic fields from cell phones or transmitters. This article examines the scientific evidence assessing this. There is a lot. Many studies are very simple—just asking if people have symptoms and if they are exposed to RF. Many of these show associations, but they are very weak studies. The best studies are tests of immediate effects in ‘double blind’ experimental conditions—these show that actual RF exposure does not cause symptoms, but the belief that there is RF exposure (even if there isn’t) and that it’s harmful—can cause symptoms. For longer term effects, much more extensive studies taking several years are being done: these are now giving results and so far show no real effects. The symptoms are real, and people may be quite ill: but the cause seems not to be RF exposure.

Article
SUMMARY

Age-related differences in SARS-CoV-2 testing in the Northern Region of New Zealand | OPEN ACCESS

Aakash V Chhibber, Sharmini Muttaiyah, Gary McAuliffe, Shivani Fox-Lewis, Mary De Almeida, Matthew Blakiston, Veronica Playle, Andrew Fox-Lewis, Sally Roberts

We reviewed the testing in the Northern Region of New Zealand during the early stages of the COVID-19 pandemic. This was a laboratory-based study that focused on the age differences in SARS-CoV-2 testing, trying to better understand if children had a low burden of disease or were under-represented in testing (and therefore had low numbers of cases). We calculated testing rates and positivity rates by age and showed that although children <10 years had less tests, there was very little disease in this age group. The interpretation of testing and positivity rate for the 10–14-year-old age group is less straightforward and requires more research to fully understand.

Article
SUMMARY

Falls risk factor assessment and secondary prevention in the older old

Katherine Bloomfield, Marcus Lau, Martin J Connolly

Falls are very common in older adults and can cause significant harm. Previous scientific studies have clearly demonstrated many important risk factors and prevention strategies that can help reduce the risks of older adults falling, for example, stopping or reducing certain medications that increase the risk of falling, and by promoting exercises that have shown to improve strength and balance. This study of the very old admitted to hospital at Waitemata District Health Board (DHB) showed that many of these issues are not addressed during admission, and that very few of these patients are referred to Older Adult specialists who are experts in falls prevention and management. Patients in this study were discharged from hospital on a concerning number of medications. Approximately 20% had died within six months of discharge, and twice that were readmitted back to hospital in that period of time, many with further falls. The manuscript discusses possible ways to improve this quality care gap that exists at Waitemata DHB.

ALL ARTICLES
SUMMARY
Editorial
Vol 133 No 1519: 31 July 2020

Has the present government delivered the health policy that it promised before it was elected?

Frank Frizelle

The health issue of today is clearly the COVID-19 pandemic and the New Zealand response. At the time of writing most New Zealanders will rightly feel proud of our response to the pandemic and the effect of this response on the ability of our health system to function as it does.

Article
Vol 133 No 1519: 31 July 2020

Challenges for the future: the gastroenterology specialist workforce in New Zealand

Rosemary Stamm, Kristina Aluzaite, Malcolm Arnold, Thomas Caspritz, Campbell White, Michael Schultz

New Zealand’s healthcare system is funded by government garnered taxes and offers a comprehensive set of free core health services to all New Zealanders as well as those who live in New Zealand and hold a residency or work visa.

Article
Vol 133 No 1519: 31 July 2020

Atrial fibrillation in acute coronary syndrome: patient characteristics and appropriate utilisation of anti-thrombotic therapy in New Zealand (ANZACS-QI 39)

Charles Yao-Cheng Ho, Mildred Lee, Chris Nunn, Jonathon White, Andrew J Kerr, on behalf of the ANZACS-QI investigators

Atrial fibrillation (AF), the most commonly encountered clinical arrhythmia, often coexists with acute coronary syndrome (ACS).

Article
Vol 133 No 1519: 31 July 2020

Hip abductor tendon tears—a survey of New Zealand orthopaedic surgeons

Mark F Zhu, David S Musson, Jacob T Munro

Hip abductor tendon tears are a common cause of greater trochanteric pain syndrome, affecting up to 20% of those over the age of 50.

Article
Vol 133 No 1519: 31 July 2020

Chronic hepatitis B infection—an unmet medical need in New Zealand 35 years after universal neonatal vaccination

Erin Horsfall, Ed Gane, Ahmad Anwar, Chris Moyes, Alex Lampen-Smith, Susan Hay, Chris Cunningham

Chronic hepatitis B virus (HBV) infection is a recognised global health priority and in 2016 the World Health Organisation (WHO) adopted the first-ever global hepatitis strategy to eliminate viral hepatitis as a public health threat by 2030.

Article
Vol 133 No 1519: 31 July 2020

Appropriateness of trimethoprim as empiric treatment for cystitis in 15–55 year-old women: an audit

James E Ussher, Gary N McAuliffe, Juliet A Elvy, TRIME auditors, Arlo Upton

Cystitis is a common presentation in primary care. Uncomplicated cystitis is defined as occurring in females with a normal urinary tract.

Article
Vol 133 No 1519: 31 July 2020

Preventing acute kidney injury: assessing awareness to temporarily discontinue ‘at-risk’ medicines during acute illness in a New Zealand cohort

Dianne Vicary, Colin Hutchison, Trudi Aspden

Acute kidney injury (AKI) is an increasingly common clinical problem affecting kidney structure and function, and is defined as an abrupt onset of renal dysfunction ranging from minor loss of function to organ failure.

Article
Vol 133 No 1519: 31 July 2020

An understanding of discordant SARS-CoV-2 test results: an examination of the data from a central Auckland laboratory | OPEN ACCESS

Shivani Fox-Lewis, Sharmini Muttaiyah, Fahimeh Rahnama, Gary McAuliffe, Sally Roberts

SARS-CoV-2 is the causative agent of Coronavirus Disease 2019 (COVID-19). The SARS-CoV-2 pandemic has infected over seven million people worldwide (data accessed on 8 June), with 1,504 cases in New Zealand.

Article
Vol 133 No 1519: 31 July 2020

Age-related differences in SARS-CoV-2 testing in the Northern Region of New Zealand | OPEN ACCESS

Aakash V Chhibber, Sharmini Muttaiyah, Gary McAuliffe, Shivani Fox-Lewis, Mary De Almeida, Matthew Blakiston, Veronica Playle, Andrew Fox-Lewis, Sally Roberts

New Zealand’s first case of coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed on 28 February 2020 at Auckland City Hospital in an adult who had recently travelled overseas.

Article
Vol 133 No 1519: 31 July 2020

Falls risk factor assessment and secondary prevention in the older old

Katherine Bloomfield, Marcus Lau, Martin J Connolly

Falls are common in older adults with half of community-dwelling people aged 80 years and over experiencing a fall in one year.

Viewpoint
Vol 133 No 1519: 31 July 2020

New Zealand’s ‘Cannabis Legalisation and Regulation Bill’: an evidence-based assessment and critique of essential regulatory components towards policy outcomes | OPEN ACCESS

Benedikt Fischer, Dimitri Daldegan-Bueno

New Zealand features relatively high cannabis use rates in global comparison, while presently considering fundamental reform of its present, prohibition-based cannabis control approach towards legalisation of cannabis use and supply.

Viewpoint
Vol 133 No 1519: 31 July 2020

Is there a syndrome caused by radiofrequency electromagnetic fields?

Mark Elwood

It is claimed that exposure to radiofrequency fields (RF) produces a ‘microwave syndrome’, characterised by ‘sleep disturbance/insomnia, headache, depression/depressive symptoms, fatigue/tiredness, dysesthesia, concentration/attention dysfunction, memory changes, dizziness, irritability, loss of appetite/body weight, restlessness/anxiety, nausea, skin burning/tingling/dermographism and EEG changes’.

Clinical Correspondence
Vol 133 No 1519: 31 July 2020

Two cases of episcleral tattooing presenting to the acute ophthalmic clinic

Michael TM Wang, Zak J Prime, Helen V Danesh-Meyer, Jennifer P Craig

Episcleral tattooing is a form of body modification, involving subconjunctival injection of pigment for cosmetic purposes.

Clinical Correspondence
Vol 133 No 1519: 31 July 2020

Frontal sinus post-traumatic mucocele secondary to a cactus spine

Depak Patel, John Clarkson, Satya Amirapu

Forty-eight year-old gentlemen presented to our otolaryngology clinic with a six-month history of a cystic swelling over his right forehead with unilateral clear nasal fluid expressed with pressure over the mass.

Letter
Vol 133 No 1519: 31 July 2020

Health effects on IQ of fluoride

Bruce Spittle

Although the 2014 report, Health effects of water fluoridation: a review of the scientific evidence, found that water fluoridation did not adversely affect brain development, it recommended that a similar review should be repeated if a large well-designed study was published that appeared likely to have shifted the balance of health benefit vs health risk.

Letter
Vol 133 No 1519: 31 July 2020

Slipping under the radar: worsened health outcomes in semi-urban areas of New Zealand

Lukas Marek, Jesse Wiki, Malcolm Campbell, Simon Kingham, Clive Sabel, Melanie Tomintz, Matthew Hobbs

Persistent inequities in health outcomes, morbidity and mortality exist between urban and rural regions, an area of research that has received a significant amount of attention both nationally and internationally.

Letter
Vol 133 No 1519: 31 July 2020

Management of short supply oral contraceptives

Caryn Thomas, Rhiannon Braund, Helen Paterson

PHARMAC is tasked with, among other things, the challenge of providing continuity of supply of funded medicines for our relatively small country, and stands behind the nature of the sole supply contracts resulting in fewer supply issues compared to most other countries.

Letter
Vol 133 No 1519: 31 July 2020

Provision of primary care in managed isolation and quarantine facilities during the COVID-19 pandemic: lessons learned from Christchurch, New Zealand | OPEN ACCESS

Ibrahim S Al-Busaidi, Miriam Martin

The COVID-19 pandemic has presented health systems in New Zealand and across the world with new challenges across the different levels of care delivery.

Letter
Vol 133 No 1519: 31 July 2020

Medical assistance in dying: a response

David Robins

I read with interest the 26 June article by Winnington and McLeod regarding medical assistance in dying, MAID, in relation to the proposed legislation in New Zealand.

100 Years Ago in the NZMJ
Vol 133 No 1519: 31 July 2020

The Influence of Francis Bacon on Medical Science

Sir Joshua Reynolds said, in speaking of Art, there was only one name, and that name was Michael Angelo. In Medicine there is a name that held a compelling and magic sway for centuries, and that name is Hippocrates.

Article
SUMMARY

Challenges for the future: the gastroenterology specialist workforce in New Zealand

Rosemary Stamm, Kristina Aluzaite, Malcolm Arnold, Thomas Caspritz, Campbell White, Michael Schultz

New Zealand has among the highest rates of colorectal cancer and inflammatory bowel disease in the world. We studied the capacity of and demand faced by the current gastroenterology specialist workforce in the country. We found that New Zealand has a lower specialist gastroenterologist number per population and older workforce compared with other comparable western countries. This means our gastroenterology workforce may struggle to meet the growing gastroenterology healthcare needs of the population. We also found that four of the 20 district health boards had no gastroenterologists, creating healthcare access issues for patients living in these regions.

Article
SUMMARY

Atrial fibrillation in acute coronary syndrome: patient characteristics and appropriate utilisation of anti-thrombotic therapy in New Zealand (ANZACS-QI 39)

Charles Yao-Cheng Ho, Mildred Lee, Chris Nunn, Jonathon White, Andrew J Kerr, on behalf of the ANZACS-QI investigators

One out of seven patients who present with a heart attack has an irregular abnormal heart rhythm called atrial fibrillation which is associated with increased stroke risk. Use of combinations of blood thinners in this group of patients are inconsistent in current New Zealand practice. About half who have increased risk of stroke are discharged without stronger blood thinners called anti-coagulants, whereas those with low stroke risk appear to be over-treated. National action needs to be taken to implement a consensus guideline.

Article
SUMMARY

Hip abductor tendon tears—a survey of New Zealand orthopaedic surgeons

Mark F Zhu, David S Musson, Jacob T Munro

The hip abductor tendons form a crucial part of the hip joint and are responsible for stability and function during daily activities such as standing from a chair, walking and running. This study surveyed New Zealand’s orthopaedic surgeons to ascertain how often they diagnosed hip abductor tendon tears and the surgical repairs used in treatment. Ninety percent of the surveyed surgeons had diagnosed this problem and there was a reported need for new materials to help improve surgical repair.

Article
SUMMARY

Chronic hepatitis B infection—an unmet medical need in New Zealand 35 years after universal neonatal vaccination

Erin Horsfall, Ed Gane, Ahmad Anwar, Chris Moyes, Alex Lampen-Smith, Susan Hay, Chris Cunningham

In 1988, New Zealand became the second country in the world to introduce universal neonatal vaccination for HBV. Despite this, more than 30 years later 90,000 adult New Zealanders have chronic HBV infection, many of whom will die or need transplants for liver cancer or liver failure. Rates of diagnosis and monitoring are low, reflecting the barriers caused by high levels of socioeconomic deprivation in those Māori and Pacific Island communities who carry the highest burden of this disease. Almost all HBV-related liver cancers and liver transplants are prevented by earlier diagnosis, monitoring and treatment.

Article
SUMMARY

Appropriateness of trimethoprim as empiric treatment for cystitis in 15–55 year-old women: an audit

James E Ussher, Gary N McAuliffe, Juliet A Elvy, TRIME auditors, Arlo Upton

Uncomplicated urinary tract infections are commonly treated with the antibiotic trimethoprim and, consistent with current guidelines, a urine sample is not routinely sent to the laboratory for testing. Among the samples they do receive, laboratories have seen increasing rates of resistance to trimethoprim in the bacteria that most commonly causes urinary tract infections, raising the question as to whether trimethoprim remains an appropriate up-front treatment for uncomplicated urinary tract infection. In this audit, urine samples from patients with uncomplicated urinary tract infection were sent to the laboratory to determine whether bacteria causing the infection were resistant to antibiotics. High rates of resistance to trimethoprim were seen, suggesting that alternative antibiotics should be considered for the up-front treatment of uncomplicated urinary tract infections.

Article
SUMMARY

Preventing acute kidney injury: assessing awareness to temporarily discontinue ‘at-risk’ medicines during acute illness in a New Zealand cohort

Dianne Vicary, Colin Hutchison, Trudi Aspden

This research set out to determine patients’ awareness of temporarily stopping medicines during acute illness, and the actions they would undertake when acutely unwell. We asked people who were collecting their prescriptions from a participating community pharmacy to complete a written questionnaire. We asked them what would they do with their medicines if they became acutely unwell. Then we asked them if they could recall a health professional advising them to temporarily stop some of their medicines when they were acutely unwell; and if they did remember receiving such advice, which of their medicines they would temporarily stop when they were acutely unwell.

Article
SUMMARY

An understanding of discordant SARS-CoV-2 test results: an examination of the data from a central Auckland laboratory | OPEN ACCESS

Shivani Fox-Lewis, Sharmini Muttaiyah, Fahimeh Rahnama, Gary McAuliffe, Sally Roberts

This study reviewed the SARS-CoV-2 PCR (polymerase chain reaction) results from 1 February to 13 April on samples from hospital and community patients conducted at a central Auckland laboratory. In total 20,089 tests were done in this time, of which nine were from patients who tested negative first and then positive. The reasons for the initial negative test include testing before the onset of symptoms and testing late in the course of the illness. If a person with significant risk factors for SARS-CoV-2 (eg, overseas travel or close contact with a case) tests negative, they should have repeat testing performed.

Article
SUMMARY

Age-related differences in SARS-CoV-2 testing in the Northern Region of New Zealand | OPEN ACCESS

Aakash V Chhibber, Sharmini Muttaiyah, Gary McAuliffe, Shivani Fox-Lewis, Mary De Almeida, Matthew Blakiston, Veronica Playle, Andrew Fox-Lewis, Sally Roberts

We reviewed the testing in the Northern Region of New Zealand during the early stages of the COVID-19 pandemic. This was a laboratory-based study that focused on the age differences in SARS-CoV-2 testing, trying to better understand if children had a low burden of disease or were under-represented in testing (and therefore had low numbers of cases). We calculated testing rates and positivity rates by age and showed that although children <10 years had less tests, there was very little disease in this age group. The interpretation of testing and positivity rate for the 10–14-year-old age group is less straightforward and requires more research to fully understand.

Article
SUMMARY

Falls risk factor assessment and secondary prevention in the older old

Katherine Bloomfield, Marcus Lau, Martin J Connolly

Falls are very common in older adults and can cause significant harm. Previous scientific studies have clearly demonstrated many important risk factors and prevention strategies that can help reduce the risks of older adults falling, for example, stopping or reducing certain medications that increase the risk of falling, and by promoting exercises that have shown to improve strength and balance. This study of the very old admitted to hospital at Waitemata District Health Board (DHB) showed that many of these issues are not addressed during admission, and that very few of these patients are referred to Older Adult specialists who are experts in falls prevention and management. Patients in this study were discharged from hospital on a concerning number of medications. Approximately 20% had died within six months of discharge, and twice that were readmitted back to hospital in that period of time, many with further falls. The manuscript discusses possible ways to improve this quality care gap that exists at Waitemata DHB.

Viewpoint
SUMMARY

New Zealand’s ‘Cannabis Legalisation and Regulation Bill’: an evidence-based assessment and critique of essential regulatory components towards policy outcomes | OPEN ACCESS

Benedikt Fischer, Dimitri Daldegan-Bueno

New Zealand will hold a referendum in September 2020 on whether to make cannabis use, production and retail distribution legal by policy (‘legalisation’), mainly to improve public health, safety and justice. The proposed policy framework has been defined in the recent Cannabis Legalisation and Regulation Bill, including key regulations. Our paper, based on applicable science, reviewed overall 10 essential regulation components of the Bill, including those stipulating: age of legal use and access; places of use; legal production, retail distribution and products available; ‘home-growing’; new and remaining penalties; and research and monitoring. We find that while the Bill appears overall well-developed, several of the critical regulation elements are questionable, or may not serve the declared policy objectives as well as possible in their current form. These elements should be reconsidered, and revised, ideally before a possible cannabis legalisation policy is rolled out.

Viewpoint
SUMMARY

Is there a syndrome caused by radiofrequency electromagnetic fields?

Mark Elwood

Some people feel that many symptoms—such as fatigue, sleep problems, anxiety, headache and many others—can be caused by radiofrequency (RF) electromagnetic fields from cell phones or transmitters. This article examines the scientific evidence assessing this. There is a lot. Many studies are very simple—just asking if people have symptoms and if they are exposed to RF. Many of these show associations, but they are very weak studies. The best studies are tests of immediate effects in ‘double blind’ experimental conditions—these show that actual RF exposure does not cause symptoms, but the belief that there is RF exposure (even if there isn’t) and that it’s harmful—can cause symptoms. For longer term effects, much more extensive studies taking several years are being done: these are now giving results and so far show no real effects. The symptoms are real, and people may be quite ill: but the cause seems not to be RF exposure.

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