Editorial: Neurological Illness and National Security: Lessons to Be Learned

Abstract

Editorial: Neurological Illness and National Security: Lessons to Be Learned Relman DA. Neurological Illness and National Security: Lessons to Be Learned. JAMA. Published online March 18, 2024. doi:10.1001/jama.2023.26818 No abstract Excerpt In 2016, a set of troubling neurological symptoms was reported through confidential channels by US government personnel based at the US Embassy in Havana, Cuba. As the number of cases in Havana escalated and then similar cases occurred over the next 5 years in other locations around the globe, efforts to understand this syndrome, now known as anomalous health incidents (AHIs), were hampered by their unusual features, incomplete information, nonstandardized clinical testing, delayed reporting, and the sensitive nature of the circumstances, individuals, and their work. A subset of individuals described the abrupt onset, sometimes in the middle of the night, of a loud, grinding, clicking, buzzing, or high-pitched piercing sound inside the head, occasionally likened to a slide whistle, and a sensation of pressure, sometimes in one ear, on one side of the head, or in the face or chest. Most strikingly, these phenomena often displayed strong location dependence, in that they quickly dissipated when the individuals vacated their initial location, and then returned when the location was revisited. In some cases, this location dependence was reported to occur repeatedly by the same individual or by multiple individuals as they moved away from and then returned within minutes to a specific location, such as part of a room. These abrupt-onset sensory phenomena were followed by a mix of vertigo, dizziness, imbalance, blurry vision, tinnitus, headache, nausea, and cognitive dysfunction, sometimes leading to chronic disability. In this issue of JAMA, Chan et al1 and Pierpaoli et al2 at the National Institutes of Health (NIH) report on an extensive clinical assessment of 86 participants with AHIs and 30 control participants, and on magnetic resonance imaging (MRI) findings of 81 of these participants with AHIs and 48 control participants, respectively. Overall, the authors found few significant differences between participants with AHIs and control participants, and no consistent evidence of brain injury. These findings differ from previous clinical and imaging studies of smaller numbers of cases from Havana and China that found evidence of vestibular, oculomotor, and pupillary abnormalities3,4 and a variety of MRI findings.5 With few differences between cases and controls in the 2 current studies, one might suspect that nothing or nothing serious happened with these cases. This would be ill-advised. Two detailed investigations of AHIs (in which I played a role) found the cases with abrupt-onset, location-dependent sensory phenomena to be unlike any disorder reported in the neurological or general medical literature, and potentially caused by an external mechanism.6-9 The first of these investigations was undertaken by the US National Academy of Sciences in 2019-2020 and the second by a panel of experts on behalf of the US Intelligence Community in 2021-2022. The latter is described in more detail below. Both of these investigations involved experienced clinicians, detailed interviews with many affected individuals, careful reviews of the literature, and informal reviews of some medical records, but not physical examinations or directed testing. After considering a wide variety of possible mechanisms, both studies concluded that some of the cases with abrupt-onset, location-dependent sensory phenomena could be plausibly explained by exposure to directed, pulsed radiofrequency energy, despite important uncertainties. Others have also pointed to pulsed radiofrequency energy as a plausible mechanism.10,11 The US Intelligence Community has discounted this possibility and concluded that reported symptoms were probably the result of “preexisting conditions, conventional illnesses, and environmental factors,” influenced by their assessment that no foreign adversary played a role in these cases.12 While many cases may be explained in this fashion, the evidence that might favor known conditions, illnesses, and factors in some of the cases with abrupt-onset, location-dependent auditory- vestibular phenomena is weak at best.... Open access paper: jamanetwork.com

AI evidence extraction

Main findings

This editorial describes anomalous health incidents (AHIs) characterized in some cases by abrupt-onset, location-dependent sensory phenomena followed by vestibular and cognitive symptoms. It summarizes two NIH reports (86 AHI participants and 30 controls; MRI in 81 AHI participants and 48 controls) as finding few significant differences between AHI participants and controls and no consistent evidence of brain injury. It notes that prior expert investigations concluded some cases could be plausibly explained by exposure to directed, pulsed radiofrequency energy, but with important uncertainties, and that the US Intelligence Community discounted this mechanism.

Outcomes measured

• abrupt-onset auditory/sensory phenomena (loud grinding/clicking/buzzing/high-pitched sound)
• pressure sensation (ear/head/face/chest)
• vertigo
• dizziness
• imbalance
• blurry vision
• tinnitus
• headache
• nausea
• cognitive dysfunction
• MRI findings / evidence of brain injury

Limitations

• Editorial/excerpt; not an original empirical study
• No abstract provided; information is excerpted narrative
• Exposure to directed/pulsed RF energy is discussed as a plausible mechanism with uncertainties; no direct exposure measurements reported
• No frequency, SAR, or exposure duration details provided
• Clinical and imaging findings are summarized secondhand from other studies; detailed methods/results not provided here

Suggested hubs

• who-icnirp (0.2)
  Discusses pulsed radiofrequency energy as a possible mechanism for symptoms, relevant to RF health-risk discourse, though not directly about WHO/ICNIRP guidance.

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    "population": "US government personnel and others reporting anomalous health incidents (AHIs); editorial also references NIH studies with AHI participants and controls",
    "sample_size": null,
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        "Exposure to directed/pulsed RF energy is discussed as a plausible mechanism with uncertainties; no direct exposure measurements reported",
        "No frequency, SAR, or exposure duration details provided",
        "Clinical and imaging findings are summarized secondhand from other studies; detailed methods/results not provided here"
    ],
    "evidence_strength": "insufficient",
    "confidence": 0.66000000000000003108624468950438313186168670654296875,
    "peer_reviewed_likely": "yes",
    "keywords": [
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        "neurological symptoms",
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