ARTICLE Communicated by Anne Steinemann

Diplomats’ Mystery Illness and Pulsed

Radiofrequency/Microwave Radiation

Beatrice Alexandra Golomb

[email protected]

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UC San Diego School of Medicine, La Jolla, CA 92093, U.S.A.

Importance: A mystery illness striking U.S. and Canadian diplomats to

Cuba (and now China) “has confounded the FBI, the State Department
and US intelligence agencies” (Lederman, Weissenstein, & Lee, 2017).
Sonic explanations for the so-called health attacks have long dominated
media reports, propelled by peculiar sounds heard and auditory symp-
toms experienced. Sonic mediation was justly rejected by experts. We
assessed whether pulsed radiofrequency/microwave radiation (RF/MW)
exposure can accommodate reported facts in diplomats, including un-
usual ones.
Observations: (1) Noises: Many diplomats heard chirping, ringing or
grinding noises at night during episodes reportedly triggering health
problems. Some reported that noises were localized with laser-like pre-
cision or said the sounds seemed to follow them (within the territory
in which they were perceived). Pulsed RF/MW engenders just these ap-
parent “sounds” via the Frey effect. Perceived “sounds” differ by head
dimensions and pulse characteristics and can be perceived as located be-
hind in or above the head. Ability to hear the “sounds” depends on high-
frequency hearing and low ambient noise. (2) Signs/symptoms: Hearing
loss and tinnitus are prominent in affected diplomats and in RF/MW-
affected individuals. Each of the protean symptoms that diplomats
report also affect persons reporting symptoms from RF/MW: sleep prob-
lems, headaches, and cognitive problems dominate in both groups. Sen-
sations of pressure or vibration figure in each. Both encompass vision,
balance, and speech problems and nosebleeds. Brain injury and brain
swelling are reported in both. (3) Mechanisms: Oxidative stress pro-
vides a documented mechanism of RF/MW injury compatible with re-
ported signs and symptoms; sequelae of endothelial dysfunction (yield-
ing blood flow compromise), membrane damage, blood-brain barrier
disruption, mitochondrial injury, apoptosis, and autoimmune triggering
afford downstream mechanisms, of varying persistence, that merit inves-
tigation. (4) Of note, microwaving of the U.S. embassy in Moscow is his-
torically documented.
Conclusions and relevance: Reported facts appear consistent
with pulsed RF / MW as the source of injury in affected diplomats.

Neural Computation 30, 2882–2985 (2018) © 2018 Massachusetts Institute of Technology.

doi:10.1162/neco_a_01133 Published under a Creative Commons
Attribution 4.0 International (CC BY 4.0) license.
Diplomats’ Mystery Illness 2883

Nondiplomats citing symptoms from RF/MW, often with an inciting

pulsed-RF/MW exposure, report compatible health conditions. Under
the RF/MW hypothesis, lessons learned for diplomats and for RF/MW-
affected civilians may each aid the other.

1 Introduction

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More than two dozen American diplomats in Cuba (Lederman, 2018; Per-
lez & Myers, 2018) and their families (Lederman & Lee, 2017), plus a
smattering of Canadian diplomats in Cuba (Cochrane, 2017; Lederman,
Weissenstein, Lee, & Associated Press, 2017) and their families (Panetta,
2017), reportedly developed a “mystery” illness (Associated Press in Wash-
ington, 2017; Cochrane, 2017; “Cuba’s sonic attacks,” 2017; Associated
Press, 2017a) that “has confounded the FBI, the state department and US
intelligence agencies” (Associated Press in Washington, 2017), “baffling US
officials” (Lederman, Weissenstein, & Lee, 2017): “‘It’s just mystery after
mystery after mystery”’ (Lederman, Weissenstein, & Lee, 2017). Problems
began in 2016, began to be widely reported in 2017, and as of January 2018,
“‘We are not much further ahead than we were in finding out why this oc-
curred,’ Undersecretary of State Steve Goldstein said” (Lederman, 2018).
Similar problems first were recognized in China in April 2018, and “a num-
ber of diplomats at the US consulate in Guangzhou, China, had been sent
home with similar symptoms” (Buckley & Harris, 2018; Harris, 2018a; Per-
lez & Myers, 2018; Stone, 2018)—by June’s end, “at least eight” from the
consulate in Guangzhou, and “at least 11” from China more broadly (My-
ers, 2018).
Media reports have long characterized these so-called health attacks (As-
sociated Press, 2017a, 2017b; Robles & Semple, 2017a, 2017b) as “sonic at-
tacks” (Associated Press in Washington, 2017; Board, 2017; “Cuba’s sonic
attacks,” 2017; Gearan, 2017; Lederman, 2017a; Lederman, Weissenstein, &
Lee, 2017; Perlez & Myers, 2018; Associated Press, 2017c).
This characterization persisted despite rejection of sonic explanations by
experts (Associated Press in Washington, 2017; Lederman, Weissenstein, &
Lee, 2017; Associated Press, 2017c; Zimmer, 2017a, 2017b), for example, “No
single, sonic gadget seems to explain such an odd, inconsistent array of
physical responses” (Lederman, Weissenstein, & Lee, 2017). According to
psychoacoustics expert Joseph Pompei, “‘Brain damage and concussions,
it’s not possible.’ . . . ‘Somebody would have to submerge their head in
powerful ultrasound transducers”’ (Lederman, Weissenstein, & Lee, 2017).
Some suggested a viral hypothesis (Lederman, 2018), but this fails to ex-
plain many features of these cases, including the strange noises associated
with inciting events in some, and there is not a known viral illness with
a compatible profile of symptoms. Though “officials told senators the US
government knew of no weapon, sonic or otherwise, that could produce
2884 B. Golomb

the effects seen in the Cuba patients” (Lederman, 2018), to this date, some
media sources continue to reference sonic attacks (Perlez & Myers, 2018).
A different explanation is proposed that, it is suggested, better ac-
commodates the facts, including the “odd, inconsistent array of physical
responses” (Lederman, Weissenstein, & Lee, 2017) and other “mysteri-
ous” and protean features reported. Reported features are assessed for
compatibility to known effects of radiofrequency/microwave radiation
(RF/MW), particularly pulsed RF/MW. Symptoms and signs are assessed

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against symptoms and signs reported by people who report health effects
from RF/MW exposure, a condition that has been termed “radiofrequency
sickness” (Johnson Liakouris, 1998), “microwave syndrome” (Navarro,
Segura, Portoles, & Gomez-Perretta, 2003), or to encompass people experi-
encing problems from exposures beyond a specific part of the electromag-
netic spectrum, “electromagnetic hypersensitivity” (Genuis & Lipp, 2012;
Hagstrom, Auranen, & Ekman, 2013; Hardell et al., 2008; Leitgeb, 1998;
McCarty et al., 2011), “electrosensitivity” (Woolston, 2010; www.es-uk.info;
www.esnztrust Electrosensitivity New Zealand) or “electrohypersensitiv-
ity” (Belpomme, Campagnac, & Irigaray, 2015; Carpenter, 2014; Heuser &
Heuser, 2017; Johansson, 2006, 2015; Redmayne & Johansson, 2014).

2 Methods

Features of diplomats’ “health attacks”—origins, symptoms, and

findings—are delineated and examined in relation to evidence regarding
symptoms from RF/MW.
Features to be examined for compatibility with an RF/MW-explanation
include the following. Strange noises were heard by some diplomats dur-
ing apparent inciting episodes (Lederman, Weissenstein, Lee et al., 2017;
Stone, 2018). The noises that were heard differed markedly for different
diplomats (Lederman, Weissenstein, Lee et al., 2017). Descriptions included
high-pitched chirping similar to crickets or cicadas, ringing and grinding
(Lederman, Weissenstein, & Lee, 2017). The noises were heard primarily
at night (Lederman, Weissenstein, & Lee, 2017). Other diplomats heard no
noises (Lederman, Weissenstein, Lee et al., 2017) and were not aware of
any inciting episodes—just onset of symptoms. In some cases, noises were
confined to “parts of rooms with laser-like specificity” (Lederman, Weis-
senstein, & Lee, 2017). “Others in the immediate vicinity heard nothing”
(Golden & Rotella, 2018). Within the area in which a sound was perceived,
it seemed to follow the person around the room (Stone, 2018).
Auditory symptoms are a prominently reported and distinctive feature
(though not present in all) and include hearing loss (Associated Press,
2017b; Associated Press in Washington, 2017; Lederman, Weissenstein, &
Lee, 2017; Panetta, 2017; Robles & Semple, 2017a; Wilkinson, 2017) and
tinnitus (Associated Press in Washington, 2017; Harris, 2018b; Lederman,
Diplomats’ Mystery Illness 2885

Weissenstein, Lee et al., 2017; Panetta, 2017), and, particularly during incit-
ing episodes in some, ear pain (Harris, 2018b; Lederman, 2018).
Other symptoms are protean and vary markedly from individual
to individual—“an odd, inconsistent array of physical symptoms”—
Lederman, Weissenstein, & Lee, 2017). Sleep symptoms (Associated Press,
2017a; Panetta, 2017; Swanson et al., 2018), headaches (Associated Press
in Washington, 2017; Harris, 2018b; Panetta, 2017; Swanson et al., 2018),
cognitive dysfunction (Harris, 2018b; Lederman, Weissenstein, & Lee,

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2017; Panetta, 2017; Swanson et al., 2018), fatigue (Harris, 2018b; Panetta,
2017), and dizziness (Associated Press in Washington, 2017; Harris, 2018b;
Panetta, 2017; Swanson et al., 2018) are prominent among the “nonspecific”
symptoms. In some, problems were temporary and apparently recovered
with time away from the exposure (Associated Press in Washington, 2017);
others experienced persistent problems (Lederman & Lee, 2017; Lederman,
Weissenstein, Lee et al., 2017).
Potentially objectively measurable problems with speech (Associated
Press in Washington, 2017; Lederman, Weissenstein, & Lee, 2017), balance
(Associated Press, 2017a; Associated Press in Washington, 2017; Lederman,
Weissenstein, & Lee, 2017; Swanson et al., 2018), and vision (Associated
Press, 2017a; Swanson et al., 2018), as well as epistaxis (nosebleed) (Asso-
ciated Press in Washington, 2017), are a feature in some. Peculiar sensory
symptoms of pressure and vibration are reported (Swanson et al., 2018).
Brain injury (Associated Press in Washington, 2017; Harris, 2017a; Leder-
man & Lee, 2017; Lederman, Weissenstein, Lee et al., 2017), white matter
abnormalities (Weissenstein, 2018), and brain swelling (Associated Press
in Washington, 2017; Lederman, Weissenstein, Lee et al., 2017) have been
reported.
To assess compatibility of symptoms in diplomats with those experienc-
ing symptoms from RF/MW, we focus on those who are symptomatic in
each group. “Only a minority of embassy staff were stricken” (Stone, 2018),
and it is these who have been reported on and studied. The minority who
are symptomatic from RF/MW exposures are the appropriate comparator.
Peer-reviewed publications are the primary source of information. How-
ever, the most authoritative source for information about symptoms and
experiences of individuals is affected individuals themselves, peer review
confers no benefit and has no power to adjudicate individuals’ reports. For
this reason, the peer-reviewed literature to address issues of science is com-
plemented by sources that have elicited and reported on symptoms and
experiences of diplomats, or of RF/MW affected individuals, extending to
encompass news reports, surveys, statements of affected individuals, or,
when applicable, other “gray literature.” For diplomats, news and other
media reports are complemented by a JAMA report focused on neurological
symptoms in diplomats (Swanson et al., 2018). Information that references
“news” rather than science also cites media sources.
2886 B. Golomb

Mechanisms by which RF/MW may cause reported problems are cur-

sorily addressed. Sources of RF/MW reported to affect the comparator
group, and potential RF/MW sources of diplomats’ symptoms, are briefly
reviewed.

3 Results

Table 1 reviews characteristics of noises reported by diplomats in incit-

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ing episodes and compatibility with RF/MW. Pulsed RF/MW in the 2.4 to
10,000 MHz range produces perceived noises that resemble sounds “such as
a click, buzz, hiss, knock, or chirp,” just as diplomats report (Elder & Chou,
2003). Ability to hear RF/MW “sounds” is reported to depend on high fre-
quency hearing, and on low ambient noise (Elder & Chou, 2003) through a
phenomenon termed the Frey effect. (Synonyms include microwave auditory
effect, RF hearing, and variations of these.) This fits reports that noises were
not universally perceived. The requirement for low ambient noise accounts
for perception of “sounds” primarily at night (Lederman, Weissenstein, &
Lee, 2017). The primary pitch perceived reportedly relates to head dimen-
sions (Elder & Chou, 2003)—in addition to pulse waveform and other char-
acteristics (Lin, 1980)—accounting for different “sounds” perceived by dif-
ferent diplomats. Sounds were localized with “laserlike” specificity in some
cases, supposedly defying known physics (Lederman, Weissenstein, & Lee,
2017). This may defy the physics of sound but not the physics of RF/MW:
lasers are electromagnetic radiation (EMR). One diplomat reported that the
sound seemed to follow him within the space in which it was heard (Stone,
2018). Frey sounds also follow the person, often perceived as slightly be-
hind the head, regardless of the body orientation relative to the source of
radiation (Bolen, 1988; Elder & Chou, 2003; Frey, 1961). Covering ears did
not lessen noise, consistent with RF/MR “sounds” (Tucker, 2018). Frey in-
duction is not governed by average radiation intensity but the energy in a
single pulse (Elder & Chou, 2003). (Analogously, if a jackhammer hit each 2
minutes, the low time-averaged pressure would not explain the damage.)
Table 2 reviews diplomats’ symptoms and signs, and compatibility of
these with RF/MW. Auditory symptoms, including tinnitus, hearing loss,
and ear pain or pressure, are prominent in diplomats (Swanson et al., 2018)
and in persons affected by RF/MW (Conrad & Friedman, 2013; Halteman,
2011; Kato & Johansson, 2012; Lamech, 2014). Symptoms are protean in
both groups. Prevalent among nonauditory nonspecific symptoms are sleep
problems, headaches, cognitive problems, and, to a lesser degree dizziness
and nausea (Associated Press in Washington, 2017; Conrad & Friedman,
2013; Halteman, 2011; Harris, 2018c; Kato & Johansson, 2012; Lamech, 2014;
Lederman, Weissenstein, & Lee, 2017; Swanson et al., 2018). Additional
more specific symptoms that are in principle objectively measurable include
problems with balance, speech, vision, and epistaxis (nosebleed) (Associ-
ated Press in Washington, 2017; Conrad & Friedman, 2013; Halteman, 2011;
Table 1: Features of Noises Reported by Diplomats during Apparent Inciting Episodes.

Diplomats’ Reports Compatibility with RF/MW

Strange noises were heard by Sound ordinarily results from air-pressure waves (which are longitudinal waves—variation occurs along the
many “of the 24 ‘medically direction of travel of the wave), whereas radiation arises from electromagnetic waves (which are transverse
confirmed”’ affected U.S. waves—variation occurs perpendicular to the direction of travel of the wave). In each case, a frequency is
diplomats (Lederman, 2018), defined by the number of cycles of the wave (that pass, say, a given point) per second, for the respective
during what were perceived wave type.
Diplomats’ Mystery Illness

as inciting episodes Though electromagnetic signals are not themselves sound, RF/MW can lead to perceived noises through the
(Lederman, Weissenstein, & so-called Frey effect (Elder & Chou, 2003) (also called the microwave auditory effect or RF hearing).
Lee, 2017). A 1976 Defense Intelligence Agency report stated, “Sounds and possibly even words which appear to be
originating intracranially can be induced by signal modulation at very low average-power densities”
(Adams & Williams, 1976).
A 1988 Air Force Materiel Command report stated, based on knowledge at the time, that “individuals exposed
to pulsed RF/MW radiation have reported hearing a chirping, clicking or buzzing sound emanating from
inside or behind the head. The auditory response has been observed only for pulsed modulated radiation
emitted as a square-wave pulse train. The pulse width and pulse repetition rate are factors that appear to
determine the type of sound perceived. . . . James Lin . . . reports that the sensation of hearing in humans
occurs when the head is irradiated at an average incident power density level of about 0.1 mW/cm2 and a
peak intensity near 300 mW/cm2 . Auditory responses have been observed for a frequency range of
200–3000 MIHz and for pulse widths from 1-100 us” (Bolen, 1988).
The frequency range within which sounds can be heard was broadened by 2003: it was reported that sounds
can be perceived by persons exposed to RF/MW in the 2.4 to 10,000MHz range (Elder & Chou, 2003). It was
noted that the same frequency did not produce the same sound from person to person.
Not all diplomats heard noises Ability to hear RF/MW-induced “sounds” (using the term to refer to the perception, not the stimulus) at all
(Lederman, Weissenstein, & depends on individuals’ high-frequency hearing (Elder & Chou, 2003), as well as on low ambient noise
Lee, 2017). (Elder & Chou, 2003).
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 2888

Table 1: Continued.

Diplomats’ Reports Compatibility with RF/MW

Among those who heard In RF hearing/microwave hearing, the “sound” perceived reportedly relates not to the radiation frequency
noises, the noises reported (cycles/sec) but to head dimensions and pulse characteristics (Elder & Chou, 2003; Lin, 1980). This comports
differed markedly for with reports that different sounds were heard by different diplomats, even if they were exposed to the same
different diplomats frequency (or, conceivably, frequencies) of radiation. Of note, whether sound is perceived from RF/MW is
(Lederman, Weissenstein, not governed by the average radiation level but the energy in a single pulse. Injury to cells (in part through
Lee et al., 2017). membrane damage) is also materially greater with pulsed radiation (Bonnafous, Vernhes, Teissie, & Gabriel,
1999; Shil, Sanghvi, Vidyasagar, & Mishra, 2005). (Analogously, if a jackhammer hit very hard but very
briefly at 2 minute intervals, the low time-averaged pressure would not explain the effects produced.)
The relatively high proportion of affected diplomats reporting Frey-type noises suggests the possibility of
comparatively high intensity of pulses and frequencies within the designated 2.4 to 10,000 MHz range.
These noises included a Frey “sounds” are “similar to other common sounds” “such as a click, buzz, hiss, knock, or chirp,” consistent
high-pitched “chirping,” with sounds that diplomats reported (Elder & Chou, 2003).
ringing and “grinding” In a 2007 Dutch survey completed by 250 persons with electrosensitivity (ES), queries related to noise included
(Lederman, Weissenstein, & buzzing (reported by 96), hissing (reported by 80), strong low-frequency sounds (reported by 56), and
Lee, 2017; Associated Press, “sound of bells clanging” (reported by 28) (Schooneveld & Kuiper, 2007). The term chirping (if there is a
2017c). Dutch equivalent) was not included among inquiries. Of note, the “strong low frequency sounds” are
potentially consistent with the “blaring, grinding noise” reported by a diplomat (“blaring” indicative of
“strong,” and “grinding” consistent with low frequency), while the “sound of bells clanging” is consistent
with reports of diplomats who awoke to hear ringing “and fumbled for their alarm clocks, only to discover
the ringing [clanging] stopped when they moved away from their beds” (Lederman, Weissenstein, Lee et al.,
2017).
B. Golomb

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Table 1: Continued.

Diplomats’ Reports Compatibility with RF/MW

In the Maine Smart Meter survey report (Conrad & Friedman, 2013), comments by affected persons were
included. Exemplars involving Frey noises included these: “The noise I have in my head since smart meters
is almost unbearable, sleep is at times impossible because it is so loud” (Conrad & Friedman, 2013) and “I
became electrically sensitive almost immediately upon smart meter installation. My ears buzz, hum, and
click constantly, pressure in the head and ears, . . . agitation and irritability all since the PLC smart meter was
placed on my home. . . . I was able to vacation where there was no smart meter installed and it felt as if a
Diplomats’ Mystery Illness

vice had been loosened from around my head” (Conrad & Friedman, 2013). A post regarding a woman who
removed her smart meter after becoming symptomatic repeated several times that the exposure caused her
to hear “grinding” (“Smart meters or no power at all?” 2012), confirming this descriptor as among perceived
RF/MW-hearing induced noises. Among those with ES who communicated with the UCSD ES Survey
group, one stated that in proximity to “electrosmog producing devices, ‘I hear sounds like beehives and
similar [buzzing].’” Another stated, “The hissing in my ears is unbearable sometimes.” One wrote
“annoying noise” was among other symptoms.
Sound doesn’t lessen when RF/MW noises do not lessen with ear occlusion, and may intensify (Frey, 1961). [After] “72 Itron AMI smart
cover ears (Tucker, 2018). meters [were installed] near me in my townhome complex. . . I hear a constant buzzing that is driving me
crazy. It keeps me awake and makes it hard to think. I am not sure if it is an actual sound, or if it is being
generated inside my head, because when I put my fingers in my ears I still hear it. . . . In addition, at about
every 15 or 20 minutes, a more intense whine is added that lasts about 12–15 seconds, that hurts and gives
me a mild headache which stops when the whine stops. . . When I go out into the state and regional parks
around me where there are NO smart meters for miles, I no longer hear the buzzing and my heart doesn’t
race.”
The noises were heard Ability to hear RF/MW-induced sounds at all depends on low ambient noise (Elder & Chou, 2003). Night is
primarily at night generally a time of low ambient noise.
(Lederman, Weissenstein, &
Lee, 2017).
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Table 1: Continued.
2890

Diplomats’ Reports Compatibility with RF/MW

A sound that has been Recorded sounds, if similar to what was “heard” by some, need not be what was “heard.” (Just as Frey sounds are
recorded in Cuba and “similar to other common sounds,” so those other common sounds can resemble the Frey sound.) The
reported to be “similar” to recorded sound does not cause symptoms in listeners. The sound does not fit reports by other diplomats of
some sounds heard is either the character of the sound or of strict sound localization (such as reports that when one moved from the
consistent with chirping of bed, sound disappeared). Some diplomats had cited perceived sounds similar to crickets or cicadas, the
crickets or cicadas recorded noises were reportedly very similar to the chirping of crickets or cicadas that are abundant along the
(Lederman & Weissenstein, northern coast of Cuba (Weissenstein & Rodriguez, 2017). Since Frey effects can sound like crickets chirping,
2017). Frey effect sounds presumably recordings of crickets chirping could resemble those Frey effect sounds. Dr. Allen Sanborn, an
should not be able to be expert in Latin American cicadas, listened to a dozen recordings made by Havana diplomats, and stated,
recorded. “They sounded to me like cicadas” (Golden & Rotella, 2018).
Those deploying causative devices could, of course, capitalize on misguided sonic hypotheses to lead the United
States astray by adding a recorded sound resembling Frey sounds; however, there seems little need to
postulate this.
There was apparent laser-like For diplomats, “at least some of the incidents were confined to specific rooms or even parts of rooms with
localization of sounds in laser-like specificity, baffling U.S. officials who say the facts and the physics don’t add up” (Lederman,
some cases. Weissenstein, & Lee, 2017).
One incident was described in media as follows: “The blaring, grinding noise jolted the U.S. diplomat from his
bed in a Havana hotel. He moved just a few feet, and there was silence. He climbed back into bed. Inexplicably,
the agonizing sound hit him again. It was as if he’d walked through some invisible wall cutting straight
through his room. Soon came the hearing loss and speech problems” (Lederman, Weissenstein, & Lee, 2017).
Even for sounds described as loud, others close by heard nothing (Golden & Rotella, 2018).
In claims that “the facts and the physics don’t add up” (Lederman, Weissenstein, Lee et al., 2017), it was the
physics of sonic devices that was inconsistent. The physics of EMR is, to the contrary, compatible: lasers are
themselves focused EMR. Tautologically, EMR can be focused in “laser-like” fashion.
Within the room or parts of the A diplomat reported that “a really odd loud noise seemed to follow him in the room” (Stone, 2018). Frey
room where sounds were “sounds” are also reported to “follow” the listener, often perceived as slighty behind the head, regardless of the
heard, the sound follows the body orientation relative to the source of radiation (Bolen, 1988; Elder & Chou, 2003; Frey, 1961). In other cases,
listener (Stone, 2018). “sounds” are perceived inside or above the head (Cain & Rissmann, 1978; Elder & Chou, 2003; Ingalls, 1967).
B. Golomb

Note: Though “sound” refers to air pressure waves, we will refer to what diplomats “heard” as (perceived) sound.

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Table 2: Symptoms and Signs.

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Distinctively Auditory symptoms are prominent in reports of diplomats’ experience, including ear pain or pressure (Swanson et al.,
prominent auditory 2018), sometimes within minutes of the perceived attack (Lederman, 2018); tinnitus (Associated Press in Washington,
symptoms 2017; Harris, 2018b; Lederman, Weissenstein, & Lee, 2017; Lederman, Weissenstein, Lee et al., 2017; Panetta, 2017)
and hearing loss (Associated Press, 2017a, 2017b; Associated Press in Washington, 2017; Lederman, Weissenstein, &
Lee, 2017; Robles & Semple, 2017a; Swanson et al., 2018; Wilkinson, 2017). This, coupled with the strange noises in
diplomats’ reports, likely launched the sonic theory. These idiosyncratic features are key to winnowing potential
Diplomats’ Mystery Illness

causes. Symptoms like headache and fatigue arise with many exposures and in many conditions. New onset of
tinnitus and hearing loss is far more distinctive. It is particularly so in the context of the spectrum of other reported
symptoms and effects, and in the context of characteristics of instigating episodes. These distinctive auditory
problems are similarly prominent in people reporting symptoms from RF/MW (Halteman, 2011; Lamech, 2014)
Tinnitus and hearing loss were cited by 80% and 34%, respectively, in the UCSD survey of 202 individuals with current
symptoms from EMR, with pulsed RF/MW causing symptoms in the vast majority (Golomb, 2015a).
“Initial” symptoms were reported to include tinnitus in 50%, ear pain in 30%, and hearing loss in 11%.
Case descriptions shared by affected individuals underscore auditory effects. From the UCSD survey: “I bought a
Kindle W-Fi. I charged it not realizing the default setting was ‘on.’ After 5–10 minutes exposure, I became nauseated,
had a headache, loud tinnitus . . . and was dizzy. I turned the Wi-Fi off and the symptoms completely resolved in
5–10 minutes” (Golomb, 2015a). A description by former educator Brinchman (2011) characterizes her abrupt
development of headaches and hearing loss following introduction of pulsed RF/MW-emitting smart meters to her
(and her neighbors’) homes.
Similarly, physicians and physician groups that assessed patients with health effects from RF/MW and recognized the
connection also highlight effects on hearing. A psychotherapist in Germany with a long-time practice described a
new group of patients with a physiological illness profile encompassing organic brain disease, with constellation of
symptoms compatible with other reports of RF/MW injury. She was the one to discern the tie between patients’
symptoms and their proximity to RF/MW sources (a connection that her patients had often missed obviating nocebo
effects as a source; see Table 4), and to note recovery with removal from those sources (Aschermann, 2009). She
describes “sudden hearing loss” as among the symptoms (in addition to sleep problems described as an “almost
2891

ubiquitous” headache as extremely frequent, also noting, for example, fatigue, cognitive problems, and tinnitus).

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Table 2: Continued.
2892

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
A group of 114 physicians, referencing their analysis of medical complaints of 356 people in Oberfranken, signed an
open Letter to the Prime Minister of Germany in 2004 (referred to as the Bamberg Appeal), stating, “The pulsed high
frequency electro magnetic fields (from mobile phone base stations, from cable-less DECT telephones, amongst
others), led to a new, previously unknown pattern of illnesses with a characteristic symptom complex”
(Waldman-Selsam, 2004). Prominent and repeated mention is made of hearing loss: “People suffer from one, several
or many of the following symptoms: Sleep disturbances, tiredness, disturbance in concentration, forgetfulness,
problem with finding words, depressive mood, ear noises, sudden loss of hearing, hearing loss, giddiness, nose
bleeds, visual disturbances, frequent infections, sinusitis, joint and limb pains, nerve and soft tissue pains, feeling of
numbness, heart rhythm disturbances, increased blood pressure episodes, hormonal disturbances, night-time
sweats, nausea. . . . It is no way only a subjective sensitivity disturbance. Disturbances of rhythm, hearing problems,
sudden deafness, hearing loss, loss of vision, increased blood pressure, hormonal disturbances, concentration
impairments, and others can be proved using scientific objective measures” (Waldman-Selsam, 2004). Note also the
mention of “ear noises” (the Frey effect).
Some studies that experimentally examine effects of RF/MW on hearing show effects, though not all do (See Table 4 for
discussion of “inconsistent” effects.) A material consideration is that evidence is consistent with a vulnerable
subgroup.
One experimental study in humans found that 60 minutes of close exposure to EMR from a mobile phone “had an
immediate effect on HTL [hearing threshold limits] assessed by pure-tone audiogram and inner ear (assessed by
DPOAE) in young human subjects. It also caused a number of other otologic symptoms” (Alsanosi et al., 2013).
Of note, melatonin, which can be depressed by EMR (see Table 4) and is low in those with EHS (Belpomme et al., 2015),
protects against oxidative radiation injury (see Table 4), including to the inner ear (Karaer et al., 2015).
Pulsed RF/MW (more than continuous) has been shown to increase tympanic temperature, even when, for instance,
colonic temperature is not increased (Frei, Jauchem, & Heinmets, 1988). Since blood flow is critical for cooling and
oxidative stress leads to endothelial dysfunction and may compromise blood flow, affected individuals (see below;
by hypothesis those with greater oxidative stress effects) may experience greater impairment in blood flow—so less
cooling and also impaired delivery (via impaired blood flow) of oxygen, glucose, and other energy substrates as well
as antioxidant defenses. The downstream effects of oxidative stress (e.g., apoptosis, inflammation; see below) and
B. Golomb

impaired cell energy/ mitochondrial dysfunction (cell dysfunction and death) may contribute to auditory pathology.

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Table 2: Continued.

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
In a study examining the histopathology of cochlear nuclei of rats “exposed continuously for 30 days” to “a GSM-like
2100 MHz EMF” “with a signal level (power) of 5.4 dBm (3.47 mW) to simulate the talk mode on a mobile phone,”
compared to a control group of rats not similarly exposed, “an increase in neuronal degeneration and apoptosis in
the auditory system“ was observed in the RF/MW exposed group (Celiker et al., 2016). “The histopathologic
analysis showed increased degeneration signs in the study group (p = 0.007). In addition, immunohistochemical
Diplomats’ Mystery Illness

analysis revealed increased apoptotic index in the study group compared to that in the control group (p = 0.002)”
(Celiker et al., 2016). In another animal study, “a prominent effect of EMS [electromagnetic stimulation] was . . .
severe cochlear damage and permanent sensorimotor hearing loss in experimental animals” (Counter, 1993).
Protean symptoms Beyond the auditory symptoms, the profile of symptoms in diplomats varies from person to person. Different people
report markedly different symptoms (Lederman, Weissenstein, Lee et al., 2017). It was said that “the symptoms and
circumstances reported have varied widely, making some hard to tie conclusively to the attacks” (Lederman, 2017b),
and “The cases vary deeply: different symptoms, different recollections of what happened. That’s what makes the
puzzle so difficult to crack” (Lederman, Weissenstein, Lee et al., 2017). Reported symptoms encompass sleep
problems (Associated Press, 2017a, 2017b; Panetta, 2017), headaches (Associated Press, 2017a; Lederman,
Weissenstein, & Lee, 2017; Panetta, 2017; Robles & Semple, 2017a), cognitive problems (Associated Press, 2017a;
Lederman, Weissenstein, & Lee, 2017), nausea (Lederman, Weissenstein, & Lee, 2017), fatigue (Panetta, 2017), and
dizziness (Lederman, Weissenstein, & Lee, 2017; Robles & Semple, 2017a).
Similar concerns had been raised with RF/MW injury. As Aschermann noted (translated from German), “In the
Deutsche Aerzteblatt [official journal of the German medical association—Bundesaerztekammer] did an article ask the
incredulous question: How could so many different symptoms possibly be attributed to one common underlying
mechanism?” (Aschermann, 2009).
Despite the protean character of symptoms, multiple survey studies verify that a strikingly reproducible suite of
protean symptoms are reported in setting after setting, and in people citing development of symptoms in response to
EMR including RF/MW (see Table 3). The profile of symptoms is strongly similar from study to study, with
sleep/fatigue, headache, and cognitive problems commonly topping the list and auditory and visual symptoms,
dizziness, and nausea figuring in it.
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Table 2: Continued.
2894

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
A similar primary list (sometimes augmented with a few additional symptoms, often including heart rhythm
problems) is mentioned in other settings. Aschermann’s (2009) analyses of 65 patients cite symptoms of learning
concentration and behavioral problems, headaches, insomnia, exhaustion, tinnitus, hearing loss, dizziness, nerve
and soft tissue pain, “inner agitation,” as well as arrhythmia problems. In the 2004 Bamberg Appeal signed by 114
physicians to the German prime minister, based on analysis of 356 patients: “The pulsed high frequency electro
magnetic fields (from mobile phone base stations, from cable-less DECT telephones, amongst others), led to a new,
previously unknown pattern of illnesses with a characteristic symptom complex. People suffer from one, several or
many of the following symptoms: Sleep disturbances, tiredness, disturbance in concentration, forgetfulness, problem
with finding words, depressive mood, ear noises, sudden loss of hearing, hearing loss, giddiness, nose bleeds, visual
disturbances, frequent infections, sinusitis, joint and limb pains, nerve and soft tissue pains,” also nausea, and
“feeling of numbness, heart rhythm disturbances, increased blood pressure episodes, hormonal disturbances,
night-time sweats. . . . The symptoms occur in temporal and spatial relationship to exposure. It is no way only a
subjective sensitivity disturbance. Disturbances of rhythm, hearing problems, sudden deafness, hearing loss, loss of
vision, increased blood pressure, hormonal disturbances, concentration impairments, and others can be proved
using scientific objective measures” (Waldman-Selsam, 2004).
Among individuals participating in a physiological provocation study examining heart rate variability with RF/MW,
among 25 patients, 40% of whom believed themselves to be moderately or severely electrosensitive, “the most
common symptoms of exposure to electrosmog, as identified by this group of participants, included poor short-term
memory, difficulty concentrating, eye problems, sleep disorder, feeling unwell, headache, dizziness, tinnitus, chronic
fatigue” (Havas et al., 2010).
Of note, the same symptoms also arise in the vulnerable subgroup of persons who develop health problems following
other exposures that share a documented ability to cause mitochondrial impairment and oxidative stress (Chen et al.,
2017; Golomb et al., 2014; Golomb, Koslik et al., 2015; Koslik, Hamilton, & Golomb, 2014; Steele, 2000). However, the
profile, which symptoms dominate, differs from exposure to exposure, based on factors such as what part(s) of the
body the exposure may differentially reach and whether additional mechanisms of injury are involved that
potentiate damage to one domain.
B. Golomb

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Table 2: Continued.

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Sleep and auditory effects are clearly disproportionately represented, in diplomats and with RF/MW exposure, relative
Diplomats’ Mystery Illness

to their prevalence following other exposures that cause oxidative stress. The strong effects on sleep may relate to
depressions in melatonin that can be produced with EMR/ RF/MW (see Table 4). Auditory effects are addressed
above.
A 1990 study commissioned in response to a petition by residents who cited adverse health experiences from a
shortwave radio transmitter in their small town of Schwarzenburg, funded in part by Swiss Telecom, reported that
sleep disruption in association with transmitters related directly to the EMR field strength of the transmitter and
affected 55% of those over age 45 (Altpeter et al., 1995; Lamech, 2014). (There the denominator is not restricted to
those who were symptomatic.)
A 1988 Air Force Materiel Command reports that “pulsed RF/MW radiation was reported to have an analeptic effect in
animals. Experimental results presented by R. D. McAfee in 1971 showed that anesthetized animals could be
awakened by irradiation from a pulsed 10 GHz RF/MW source. . . Experiments conducted on rats showed that these
animals were aroused from states of deep sleep by irradiation” (Bolen, 1988).
The prominence of auditory effects (see above for more on these symptoms) may relate in part to the absence of a skull
structure to protect the inner ear, producing an incident stimulus that is of greater effective intensity.
The coherence of symptoms in response to RF/MW, with findings in Cuba (and China) diplomats, adds further
support to the case for a common cause within each group – and across the two groups.
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Table 2: Continued.
2896

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Symptoms that are The symptoms reported in media and Swanson et al. (2018) for diplomats, extending to the more specific (e.g.,
(potentially) dizziness/balance, vision and speech problems), are also reported in survey studies of those affected by RF/MW
objectively (see Table 3).
measurable: speech Speech problems, mentioned in diplomats, were also among symptoms elicited and reported in a survey study
(Associated Press, examining effects of RF/MW following “smart meter” introduction in Australia (Lamech, 2014). Reported cases
2017a; Associated illustrate speech problems arising following RF/MW exposure. In a case referenced in the LA Times, a woman
Press in reported that if someone fails to turn off their cellphone on entering her home, she gets symptoms within 2 hours:
Washington, 2017; “‘After four hours I can’t speak anymore”” (Woolston, 2010). In a case described in a 2015 Australian presentation on
Lederman, ES (Weller, 2015), “Within hours, it felt as if someone had tied a thick rubber band around her head. Then came
Weissenstein, & nausea, fatigue, ringing in her left ear–an onslaught of maladies all at once, and she had no idea why. . . . A week or
Lee, 2017); vision two into the job, whatever was affecting her wasn’t abating, and before long her speech became so jumbled that she
(Associated Press, couldn’t form a complete sentence in front of an audience. . . . She went outside to inspect the place and found no
2017a). balance fewer than 17 new ‘smart’ electricity meters strapped to the side of the building.”
(Associated Press, In a case reported to UCSD investigators, new-onset right-sided ear pain and hearing loss attended the inciting episode
2017a; Lederman, (seated for 6 hours, unknowingly, directly across the wall from a bank of multiple smart meters for a building,
Weissenstein, & slightly toward her right), along with vise-like headache, concentration problems, and two nights of no sleep
Lee, 2017). (followed by chronic lesser sleep impairment), and, abating over months, continued to be triggered, always
Nosebleeds in some exclusively or predominantly on the right side, by previously tolerated RF/MW exposures thereafter. Many months
(Associated Press in later, left ear predominant ear symptoms developed for the first time. A bank of smart meters was identified to the
Washington, 2017; left of where she had sat, hidden by plants so missed in an initial reconnaissance. That occasion, the only one with
Golden & Rotella, left predominant ear and hearing symptoms, was accompanied by speech difficulty, which resolved over about a
2018). week. In these two cases, aphasia was associated with left predominant ear symptoms (Broca’s area, damage of
which leads to expressive aphasia, is left prefrontal). It is an empirical question whether left-predominant auditory
involvement will prove more often tied to affected speech.
Balance is multifactorial, involving vision, muscle strength, and vestibular function, for example. In some media reports
of diplomat health, the term vertigo is used (Harris, 2018b, 2018c). Balance and vestibular testing were performed in
diplomats (Swanson et al., 2018). Clinical examinations and objective measures raised concern for balance problems
B. Golomb

in 81% (higher than the percent reporting subjective dizziness or balance problems) (Swanson et al., 2018).

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Table 2: Continued.

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Vestibular function involves the same (eighth) cranial nerve as hearing. Vertigo, hearing loss, and tinnitus can arise (as
adverse effects) as a triumvirate (Porto Arceo, 2003; Sepcic et al., 2010). Dizziness more generally, in contrast to
vertigo, is a nonspecific finding that arises with many forms of brain insult, including brain hypoperfusion (low
blood flow). Of note, cerebral hypoperfusion has been reported in persons with symptoms following RF/MW
(Belpomme et al., 2015).
In some surveys of RF/MW-affected individuals, dizziness and balance are queried together (Lamech, 2014); other
Diplomats’ Mystery Illness

surveys use only the term dizziness. Individual reports of balance and dizziness problems were included among
participant narrative reports in the Maine survey—for example: “‘Balance problems have worsened since installation
of the smart meter, leading to several falls”’ (Conrad & Friedman, 2013) and “‘I could not understand the dizzineness
which was scary. I actually thought I had a brain tumor all of a sudden”’ (Conrad & Friedman, 2013). The Cuba
diplomat study considered nausea as a vestibular symptom (Swanson et al., 2018). Though it need not necessarily be,
it was linked to dizziness in some RF/MW/EMR affected cases: “‘Daily nausea and dizziness”’ (Conrad &
Friedman, 2013).
Loss of balance, with dizziness and disorientation, was identified as one of six clusters of symptoms seen in each of two
smart meter surveys from different nations, with the clusters represented nearly in the same order: (1) sleep
disruption, (2) headache, (3) ringing or buzzing in ears, (4) fatigue, (5) loss of concentration, memory or learning
ability, and (6) disorientation, dizziness, or loss of balance) (Powell, 2015).
Vision: Vision is affected by oxidative stress and mitochondrial impairment (see Table 4, mechanisms) (Argun et al.,
2014; Beatty, Koh, Phil, Henson, & Boulton, 2000; Javaheri, Khurana, O’Hearn T, Lai, & Sadun, 2007; King, Gottlieb,
Brooks, Murphy, & Dunaief, 2004; Liang, Green, Wang, Alssadi, & Godley, 2004; Totan et al., 2001), not just to the eye
but to cortical systems involved in vision (Pachalska et al., 2002). Effects of these mechanisms include optic nerve
damage (Javaheri et al., 2007; Qi, Lewin, Sun, Hauswirth, & Guy, 2007; Rucker, Hamilton, Bardenstein, Isada, & Lee,
2006), age-related macular degeneration (Beatty et al., 2000; Feher et al., 2005; Feher, Papale, Mannino, Gualdi, &
Balacco Gabrieli, 2003; Liang & Godley, 2003; Modi, Heckman, & Saffer, 1992; Totan et al., 2001; Yu, Wu, & Lin, 1997),
retinal thinning (Sandbach et al., 2001), and cataracts (Gul, Rahman, Hasnain, Salim, & Simjee, 2008; Karslioglu et al.,
2005; Ottonello, Foroni, Carta, Petrucco, & Maraini, 2000; Tarwadi & Agte, 2004; Taylor, Jacques, & Epstein, 1995).
Where brain swelling ensues (see Table 4), this can affect the shape of the lens, affecting vision.
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Table 2: Continued.
2898

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Effects of RF/MW on the eye and on vision have long been reported (Birenbaum, Grosof, & Rosenthal, 1969; Bolen,
1988; Cleary, 1980; Cutz, 1989; Daily, Wakim, Herrick, Parkhill, & Benedict, 1952; McCally, Farrell, Bargeron, Kues, &
Hochheimer, 1986; Williams & Finch, 1974; Zaret, 1973). Particular attention has gone to effects on the lens, and on
cataracts. RF/MW, via oxidative mechanisms, promotes aging of the lens, which can lead to cataracts. Cataracts have
been a reported complication, sometimes in young people, among persons working with microwave radiation
(Birenbaum et al., 1969; Bolen, 1988; Cleary, 1980; McCally et al., 1986; Zaret, 1973). A Swiss study (Hassig, Jud, &
Spiess, 2012) documented increased cataracts in calves born near cell towers: “We examined and monitored a dairy
farm in which a large number of calves were born with nuclear cataracts after a mobile phone base station had been
erected in the vicinity of the barn. Calves showed a 3.5 times higher risk for heavy cataract if born there compared to
Swiss average. All usual causes such as infection or poisoning common in Switzerland could be excluded.”
Vision problems are reported in RF/MW-affected persons. In a study in Spain, in persons in proximity to two GSM
(Global System of Mobile Communications) cell tower base stations, analysis of the closer group, with exposure in
the range 0.25–1.29 V/m2, in a model adjusted for age, sex, and distance, showed that vision problems were elevated
with an odds ratio of 5.8 (95% CI 1.7–19.8, p = 0.005) (Oberfeld, Navarro, Portoles, Maestu, & Gomez-Perretta, 2004).
Eleven percent reported problems with eyes or vision in the Australian smart meter study. Since this includes
respondents who are unaffected, rates are lower than in purely symptomatic individuals (Lamech, 2014). Twenty-Six
percent of survey participants reported eye/vision problems in the Halteman smart meter impacts survey
(Halteman, 2011). Vision problems were reported by 17% as “severe and new,” by 38% as “moderate and new,” and
by 12% as “severe and worsened” in the Maine smart meter survey (Conrad & Friedman, 2013).
An assessment of neurological problems in U.S. diplomats in Cuba underscores the potential importance of eye
movement dysfunction (Swanson et al., 2018), which is also tied to oxidative and mitochondrial mechanisms (Chen,
Li, Wu, Qi, & Wu, 1998; Dodson, Patten, Hyman, & Chu, 1976; Goto, Koga, Horai, & Nonaka, 1990; Hyman, Patten, &
Dodson, 1977; Kao, 1994; Land, Hockaday, Hughes, & Ross, 1981; Pineda et al., 2004; Schaefer, Blakely, Griffiths,
Turnbull, & Taylor, 2005; Smits, Westeneng, van Hal, van Engelen, & Overeem, 2012).
B. Golomb

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Table 2: Continued.

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Epistaxis (nosebleed): In a study in Selbitz, Bavaria, nosebleed was significantly more frequently reported (p = 0.01) in
those less than 200 m from a cell phone base station than 200 m to 400 m away (Eger & Jahn, 2010). Nosebleed was a
reported symptom in each of several surveys of ES and symptoms associated with RF/MW, including in a study of
smart meter symptoms (Conrad & Friedman, 2013; Golomb, 2015a; Halteman, 2011; Lamech, 2014) (see Table 3). The
Bamberg appeal (on behalf of 114 physicians referencing assessment of medical complaints of 356 people with
symptoms from cell tower base stations and DECT phones in their homes in Oberfranken) noted the more
Diplomats’ Mystery Illness

characteristic RF/MW symptoms (above) as well as nosebleed (Waldman-Selsam, 2004).

Comments from participants in survey studies include the following (all from Conrad & Friedman, 2013): “Severe
headaches, gushing nosebleeds for the first time ever. . . . They all went away when the smart meter was removed”;
“After the first day I was getting bloody noses and not understanding”; “Nosebleeds, nausea, dizziness, . . . ringing
ears and intermittent strong agitation. . . . When I am away from wireless devices the symptoms subside”; “Had it
not been for the severe nose bleeds I’m not sure I would ever have found out what was causing my health problems”.
Peculiar sensory “Associated sensory symptom” of “pressure” or “vibration” were reported in 43% and 14%, respectively, in a
symptoms of neurological evaluation of diplomats (Swanson et al., 2018). The distinctive sensory symptoms of “pressure” and
“vibration” and “vibration” are also reported by subsets of those who report symptoms from RF/MW. Neither were commonly
“pressure” reported elicited as symptoms in surveys. However, some surveys listed head pressure separately from headache, and in some
(Swanson et al., cases, it was more frequent. Eye pressure (Halteman, 2011) and ear pressure (Conrad & Friedman, 2013) have also
2018) been reported in surveys of RF/MW/EMR-affected persons. The UCSD ES survey did include “internal pressure,”
which was reported as a symptom in 71% of participants who cited symptoms from EMR/RF/MW (Golomb, 2015a).
Spontaneous reports of vibration symptoms by different EMR/RF/MW affected persons, shared in a different survey
study, include the following (all from Conrad & Friedman, 2013): “I experienced internal shaking and vibrating
throughout my body” (along with sleep, mood, headache, head pressure, and other problems, after smart meter
installation); “I can’t think clearly, or find words when speaking; my body feels like it is vibrating”; and “Have
uncontrollable jelly-like quivering throughout whole body.” In online comments posted in response to articles on
related topics, in which persons describe their ES symptoms, statements include “vibration through my body” (F.
Wallace, 2017), and “I have a smart meter on my house and I have been experiencing strange vibrations when I
watch TV or use the computer” (Wright, 2013). An email to us from an affected patient (9-2017) sharing her
2899

symptoms stated that it “feels like my brain is vibrating and spinning at night—and my tinnitus gets much worse.”

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Table 2: Continued.
2900

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Brain swelling in 1. RF/MW may alter blood-brain barrier function via oxidative stress.
some diplomats (a) An analysis reported that of 100 peer-reviewed studies examining whether low-intensity RF/MW causes oxidative
(Associated Press in stress, 93 found that it did (Yakymenko et al., 2015).
Washington, 2017; (b) Oxidative stress disrupts the blood-brain barrier (Al Ahmad, Gassmann, & Ogunshola, 2012; Blasig, Mertsch, &
Lederman, 2017a; Haseloff, 2002; Enciu, Gherghiceanu, & Popescu, 2013; Haorah et al., 2007; Hurst, Heales, Dobbie, Barker, & Clark,
Lederman, 1998; Katsu et al., 2010; Lochhead et al., 2010; Nittby et al., 2009; Salford, Brun, Sturesson, Eberhardt, & Persson, 1994;
Weissenstein, Lee Sirav & Seyhan, 2009, 2011; Takemori, Murakami, Kometani, & Ito, 2013; Tang et al., 2015).
et al., 2017). (c) Consistent with this, blood-brain barrier disruption has been shown in multiple studies with RF/MW (Nittby et al.,
2008, 2009; Salford et al., 1994; Sirav & Seyhan, 2009; Soderqvist, Carlberg, Hansson Mild, & Hardell, 2009;
Soderqvist, Carlberg, & Hardell, 2009; Tang et al., 2015). Other studies have not shown blood-brain barrier effects (de
Gannes et al., 2009; Finnie, Blumbergs, Cai, Manavis, & Kuchel, 2006; Finnie et al., 2002; Franke, Ringelstein, &
Stogbauer, 2005; Franke, Streckert et al., 2005; Fritze et al., 1997; McQuade et al., 2009). Studies vary in many respects
(e.g., exposure duration, EMR exposure characteristics, model (in vivo versus in vitro, animal, age), delay between
exposure and blood-brain barrier assessment, and blood-brain barrier assessment used, for example). The
blood-brain barrier is functional, and barrier function need not be affected for all substances equally.
(d) Since genetics of oxidative stress management (De Luca et al., 2014) and levels of key antioxidants (Belpomme et al.,
2015) relate to both RF/MW injury and oxidative stress, these factors, together with specifics of the RF/MW
exposure, may guide blood-brain barrier disruption with RF/MW.
(e) A study that examined gene expression in the brains of rats exposed to GSM radiation, radiation that encompasses
the multiple frequencies and pulsed waveforms present in GSM exposures, identified altered gene expression of a
marker of blood-brain barrier function (Belyaev et al., 2006).
2. Altered blood-brain barrier can lead to brain edema and “malignant brain edema” (Adair, Baldwin, Kornfeld, &
Rosenberg, 1999; Witt, Mark, Sandoval, & Davis, 2008). (Oxidative stress-associated blood-brain barrier disruption is,
for instance, thought to underlie neuroleptic-induced cerebral edema (Elmorsy, Elzalabany, Elsheikha, & Smith,
2014).)
B. Golomb

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Table 2: Continued.

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
3. Among case experiences, perceived head pressure occurs with brain swelling and is reported by many with ES. As
also noted in relation to the sensory symptom of “pressure,” some surveys collate head pressure separately from
headache (which, in some studies, it surpasses: Conrad & Friedman, 2013; Lamech, 2014; Schooneveld & Kuiper,
2007). One survey included eye pressure (Halteman, 2011), and in one, several participants spontaneously reported
ear pressure (Conrad & Friedman, 2013). Communications to the UCSD ES study included the write-in comment,
“Brain feels like it’s swelling” (Golomb, 2015a). One man with severe ES who communicated with the UCSD study
group and shared documentation of his approval for Social Security disability for his ES reported that the severe
Diplomats’ Mystery Illness

brain swelling he experienced in response to EMR had led an eyeball to be pushed from the socket.
Findings are reported 1. Based on findings in an fMRI study of electrosensitive individuals it was stated that “the differential diagnosis for
to be compatible the abnormalities seen on the fMRI includes head injury” (Heuser & Heuser, 2017).
with traumatic 2. Six of the 10 ES individuals assessed reported prior head injury (Heuser & Heuser, 2017). However, 4 did not, and
brain injury (Harris, also showed evidence consistent with brain injury. Moreover, prior head injury is reported to also be present in at
2017a, 2017b, 2018c; least some, but an unstated fraction of, affected diplomats (Stone, 2018).
Harris & Goldman, 3. Head injury could predispose to ES. Head injury, like RF/MW, promotes oxidative stress, and blood-brain barrier
2017a, 2017b; disturbance; and melatonin (which is low in those with ES), protects from these effects in head injury (Dehghan,
Rogers, 2017). Khaksari Hadad, Asadikram, Najafipour, & Shahrokhi, 2013; Ding et al., 2014; Ozdemir et al., 2005; Senol &
Naziroglu, 2014), as it protects against injury from radiation (Argun et al., 2014; Bardak, Ozerturk, Ozguner, Durmus,
& Delibas, 2000; Bhatia & Manda, 2004; El-Missiry, Fayed, El-Sawy, & El-Sayed, 2007; Goswami & Haldar, 2014a,
2014b; Goswami, Sharma, & Haldar, 2013; Guney et al., 2007; Jang et al., 2013; Karaer et al., 2015; Karslioglu et al.,
2005; Kim, Shon, Ryoo, Kim, & Lee, 2001; Koc, Taysi, Buyukokuroglu, & Bakan, 2003a, 2003b; Liu, Ren, Yang, Zhao,
& Mei, 2014; Manda, Anzai, Kumari, & Bhatia, 2007; Manda & Reiter, 2010; Manda, Ueno, & Anzai, 2007, 2008;
Naziroglu, Tokat, & Demirci, 2012; Oliinyk & Meshchyshen, 2004; Ortiz et al., 2015; Sainz et al., 2008; Sener, Atasoy
et al., 2004; Sener, Jahovic, Tosun, Atasoy, & Yegen, 2003; Sharma & Haldar, 2006; Shirazi et al., 2011; Shirazi,
Mihandoost, Mohseni, Ghazi-Khansari, & Rabie Mahdavi, 2013; Taysi, Koc, Buyukokuroglu, Altinkaynak, & Sahin,
2003; Taysi et al., 2008; Vasin et al., 2004; Yilmaz & Yilmaz, 2006)—and from RF/MW . . . (Ayata et al., 2004; Aynali
et al., 2013; Koylu, Mollaoglu, Ozguner, Naziroglu, & Delibas, 2006; Lai & Singh, 1997; Meena et al., 2014; Naziroglu,
Celik et al., 2012; Oksay et al., 2012; Oktem, Ozguner, Mollaoglu, Koyu, & Uz, 2005; Ozguner, Bardak, & Comlekci,
2901

2006; Ozguner, Oktem, Armagan et al., 2005; Sokolovic et al., 2008; Tok, Naziroglu, Dogan, Kahya, & Tok, 2014; S. Xu
et al., 2010).

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Table 2: Continued.
2902

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
4. One RF/MW affected man who communicated with the UCSD study group indicated his ES was precipitated by a
serious occupational head injury. (He also had occupational exposure to EMR, but until the head injury, it had not
affected him.)
5. The study did not report the presence or absence of features indicative of greater severity of head injury, such as loss
of consciousness or symptoms or sequelae. Both because of this and point 5, there is no clarity about whether prior
head impacts were in fact greater in number or intensity than in the general population. But it might be expected that
past head injury would be a risk factor.
6. Given findings consistent with low melatonin in those with ES (Belpomme et al., 2015), this condition (and/or
common cause) may also predispose to more significant damage from a given impact and character of head injury, so
there is a so greater likelihood that a given head impact causes problems and is remembered and reported as a head
injury.
7. ES symptoms are sometimes experienced as similar to a head injury. For instance, a Rhode Island teacher likened
effects experienced with RF/MW to a concussion (“Math teacher raises concerns about WIFI comparing the effects to
a concussion,” 2014). Just as it is important to avoid even minor head trauma following traumatic concussion until
healing has occurred, so avoidance of RF/MW (or more generally EMR) aggravation may prove important following
pulsed RF/MW injury. RF/MW injury may be cumulative (Sadchikova & Glotova, 1973), and in addition to the
intensity-duration profile, the interval between exposures may be important in the clinical course (Zaret, 1973).
White matter In diplomats: “Medical testing has revealed that some embassy workers had apparent abnormalities in their white
abnormalities matter tracts that let different parts of the brain communicate” (Weissenstein, 2018).
reported 1. White matter changes were observed in some with ES, in the fMRI study of persons affected by RF/MW/EMR
(Weissenstein, 2018) (Heuser & Heuser, 2017).
in some diplomats. 2. Oxidative stress and mitochondrial dysfunction (to which RF/MW can contribute; see Table 4) are associated with
white matter injury (Back et al., 2005; Casta, Quackenbush, Houck, & Korson, 1997; Ikeda, Choi, Yee, Murata, &
Quilligan, 1999; Miller, Lawrence, Mondal, & Seegal, 2009; Miyamoto et al., 2013; Munoz-Cortes et al., 2013;
Rosenzweig & Carmichael, 2013).
B. Golomb

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Table 2: Continued.
Diplomats’ Mystery Illness

Diplomats’ Symptoms
and Signs Compatibility with RF/MW
Among potential mechanisms, oxidative stress increases vulnerability of proteins (and, e.g., lipids, DNA, RNA) to
autoimmune attack, which can include attacks on myelin (Gelderman et al., 2007; Iborra, Palacio, & Martinez, 2005;
Iuchi et al., 2010; Kalluri, Cantley, Kerjaschki, & Neilson, 2000; Kumagai, Jikimoto, & Saegusa, 2003; Liu et al., 2003;
Maes et al., 2013; Profumo, Buttari, & Rigano, 2011; Shah & Sinha, 2013; Wang, Cai, Ansari, & Khan, 2007).
Indeed, antibodies directed to O-myelin were reported in a subset of the 675 persons with ES who were included
in a French study (Belpomme et al., 2015), affirming one mechanism by which white matter changes might occur.
3. Following GSM radiation exposure (study cited previously), examination of gene expression in rat brain showed
alterations in myelin-related products (myelin-related glycoprotein) (Belyaev et al., 2006).
2903

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2904 B. Golomb

Lamech, 2014; Lederman, Weissenstein, & Lee, 2017; Swanson et al., 2018).
Peculiar sensory symptoms are reported in both, including pressure and vi-
brations (Conrad & Friedman, 2013; Swanson et al., 2018). Reported brain
findings have included brain swelling, problems consistent with traumatic
brain injury, and white matter abnormalities. Each such feature is also ob-
served in those with symptoms ascribed to RF/MW.
Table 3 lists symptoms commonly reported in diplomats, together with
percentages reporting each symptom, for symptoms assessed in the neuro-

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logical appraisal of Cuba diplomats or mentioned in news reports (Associ-
ated Press in Washington, 2017; Harris, 2018c; Lederman, Weissenstein, &
Lee, 2017; Swanson et al., 2018). These symptoms (when elicited) are ranked
by prevalence in surveys of persons exposed to specific sources of RF/MW
or with symptoms ascribed to EMR exposure (Conrad & Friedman, 2013;
Halteman, 2011; Kato & Johansson, 2012; Lamech, 2014). Fractions of symp-
tomatic diplomats who report each symptom (Swanson et al., 2018) appear
similar to fractions of those symptomatic with EMR symptoms, who do
so. Comparing rates in diplomats (Swanson et al., 2018) to those in a peer-
reviewed study of EMR-affected individuals (Kato & Johansson, 2012) on
symptoms tallied in both, symptom rates were: headache, 81% versus 81%;
cognitive problems, 81% versus 81%; sleep problems, 86% versus 76%; irri-
tability, 67% versus 56%; nervousness/anxiety, 52% versus 56%; dizziness
67% versus 64%; and tinnitus, 57% versus 63% (Kato & Johansson, 2012;
Swanson et al., 2018). Thus, rates conform closely.
The rates of symptoms reported for diplomats appear within reported
variation for studies of persons affected by RF/MW/EMR. Sleep prob-
lems were reported somewhat less frequently in EMR-affected persons in
the Kato study (76%), than in diplomats, but reported sleep problems, or
their by-product, fatigue (for which prevalence was not recorded in the
diplomat study), dominate the number one symptom position in studies
of RF/MW affected persons (see Table 3), and prevalence of sleep prob-
lems was higher than for diplomats in some other studies of RF/MW-
affected persons (Golomb, 2015a). Of note, the Kato study was performed
in Japan, where the traditional diet is rich in fish, which supplies the long-
chain omega-3 fatty acids that reportedly benefit sleep and reduce irritabil-
ity (Conklin et al., 2007; Peet & Horrobin, 2002), the two symptoms that
were more than 3% lower than in affected diplomats.
The protean character of symptoms in diplomats (Lederman, 2017a), as
for RF/MW-affected individuals, has led some to infer that a single cause
cannot account for all. But a number of reports, in a number of nations and
settings, tie RF/MW exposure (in vulnerable individuals) to each of the
problems reported in diplomats. The coherence of findings in those citing
affects of RF/MW, with findings in diplomats, supports a common cause
within each group and across the two groups. Of note, a protean suite of
generally the same symptoms, though in a different distribution, is reported
in other conditions that are tied to mitochondrial alteration and oxidative
Table 3: Symptoms in Diplomats: Comparison to Symptom Rankings in Survey Studies That Report Symptoms with EMR or in
Those with ES.

United States, United States,

Diplomats’ Mystery Illness

2011 2013a (Maine

(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Citation Study of Lamech (2014) Halteman Conrad & Santini, Kato & Golomb Schooneveld Johansson Hagstrom Durusoy,
diplomats (2011) Friedman Santini, Johansson (2015c) & Kuiper (2006); cites et al., (2013) Hassoy,
(Swanson (2013) Danze, Le (2012) (2007) Swedish- Ozkurt, &
et al., 2018) Ruz, & language Karababa
News media Seigne (2002) article (2017)
Holmboe &
Johansson
(2005)
EMR- or NA Smart meter Smart meter Smart meter Proximity to ES ES ES ES, acute ES, acute Cell phone use
ES-related exposure exposure exposure cell phone phase phase symptoms
characteristic base station during
2905

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Table 3: Continued.
2906

United States, United States,

2011 2013a (Maine
(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Sample char- About 24 U.S. 92 residents of 318 U.S. 210 530 people 75 Japanese 202 persons 250 Dutch 22 with 194 with ES 2150 students
acteristics and 2 Victoria, respondents respondents, living near with ES or with current respondents ES-ranked in 26 high
Canadian Australia, from 28 68% ES cellular sensitive to ES with ES symptoms; schools in
diplomats to after states (142)b phone base EMF most Turkey
Havana exposure to stations common
reporting smart meter were listed
symptoms radiation (not ranked)
attributed to
“health
attacks” in
news: 24 U.S.
embassy
community
members
with
neurological
findings
often seen
after mild
traumatic
brain in-
jury/concussion
(Swanson
et al., 2018)
All have Yes No No No No Yes Yes Yes Yes Yes No
symptoms
B. Golomb

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Table 3: Continued.

United States, United States,

2011 2013a (Maine
(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Symptom Two rankings

Diplomats’ Mystery Illness

rankings given: for

severe or
moderate
and
new/severe
and new
Sleep 86% Swanson #1 #1 #4/ #1 #3 #4 (76%) #1 (94%) #5 Yes #2 #6
et al. (2018).
Also see
Panetta
(2017).
Headache 81% Swanson #2 #3 #1/ #3 #2 (81%) #2 (81%) #2 #7, #9, #10 Yes #4 #2
et al. (2018). (pressure in (separated
See also head; into three
Lederman, headache is questions;
Weissenstein, listed #10 is
Lee et al. separately pressure in
(2017); and would head; #7 is
Panetta be #5/#5 numb feeling
(2017); in head)
Robles &
Semple
(2017a)
2907

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Table 3: Continued.
2908

United States, United States,

2011 2013a (Maine
(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Cognitive 81%. Swanson #5 #5 #2/#4 #4, #7 #3 (81%) #3 (85%) #2, #13 Yes #7, #10 #4, #5
et al. (2018).
Also see
Lederman
(2017a);
Panetta
(2017);
Associated
Press
(2017d).
Stress 67% #11 #2 #8/#7 #6 (irritability) #9 and #10. For #6 in “initial
anxiety irritability; (agitation) “irritation” symptoms,”
irritability 57% and irritability
nervousness; “anxiety” (45%)
52% more (56% and
emotional; 55%).
29% sadness.
Swanson
et al. (2018)
Tinnitus 57% Swanson #3 #4 #3/ #2 Not queried #7 (63%) #5 (80%) Not in main Not queried
et al. (2018). (except as symptom
Also see “hearing”) list, but
Lederman, based on
Weissenstein, number
Lee et al. affected in
(2017), auditory
Panetta symptom
(2017). list, #13
B. Golomb

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Table 3: Continued.

United States, United States,

2011 2013a (Maine
(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats’ Mystery Illness

Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Fatigue Not elicitedc #4 #6 #10/#9 #1 #1 (and “Exhaustion” #1 Yes #6 #1

in Swanson possibly #5, was a
et al. (2018). “sluggish” in write-in
Mentioned in the head symptom
news media; (85%) (not
Panetta queried).
(2017)
Dizziness or 67%d Swanson #7 #7 #7/#7 #14 #6 (64%) #4 Initial: 49% #11 Yes #12 #9
balance et al. (2018).
Also see
Lederman,
Weissenstein,
Lee et al.
(2017);
Panetta
(2017);
Robles and
Semple
(2017a)
2909

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Table 3: Continued.
2910

United States, United States,

2011 2013a (Maine
(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Vision 76%. Swanson #12 #8 #10/#11 #12 — #8 in initial #6 — #13 (photosen- #10
problems et al. (2018). Symptoms sitivity)
Also see (38%)
Associated
Press (2017a).
Nausea Associated #9 #12 — — — #9 “Gastroin- — Yes #20 #15
Press in testinal “Symptoms
Washington symptoms” from the gas-
(2017); (64%). trointestinal
Lederman, Nausea not tract.”
Weissenstein, separately
Lee et al. asked.
(2017);
Panetta
(2017)
Epistaxis Not elicited #17 #13 #15 in — — “Nosebleeds” — #12 is “nose — — —
(nose bleed) in Swanson symptoms as a write-in problems.”
et al. (2018). that symptom
Mentioned in intensified. (not
news/media: New onset in queried).
Associated several
Press in write-ins.
Washington
(2017);
Golden &
Rotella
(2018).
B. Golomb

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Table 3: Continued.

United States, United States,

2011 2013a (Maine
(Wireless Smart Meter
Utility Meter Health
Safety Effects
Cuba Impacts Survey & United States, Netherlands,
Diplomats Australia, 2014 Survey) Report) France, 2002 Japan, 2012 2015a 2007 Sweden, 2006 Finland, 2013 Turkey, 2017

Hearing loss 43% Swanson #18 (with ear — — #5 — #11 (34%) #3 — — #14
et al. (2018). pain)
Diplomats’ Mystery Illness

Also see
Associated
Press (2017b);
Associated
Press in
Washington
(2017);
Panetta
(2017);
Robles &
Semple
(2017a);
Wilkinson
(2017)
Speech Not elicitede #30 — — — — f — — — —
problems in Swanson
et al. (2018).
Mentioned in
Associated
Press in
Washington
(2017)
Comment g h i j k l
2911

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Table 3: Continued.
2912

Note: — = Not queried. Surveys in the smart meter era were prioritized for inclusion; proximity of emitting devices to homes may make these
more comparable to diplomat experience. Studies of ES were also prioritized, as these focus on those who are symptomatic, providing symptom
rates better suited for comparison to those in affected diplomats. Other studies on similar themes report similar findings. (An exception is that older
studies from Scandinavia that focused on exposure to video display terminals from that time report high rates of skin problems.) For instance, in
a 2007 study of 85 persons living near the first mobile phone station antenna in Menoufiya governorate, Egypt reported that “the prevalence of
neuropsychiatric complaints as headache (23.5%), memory changes (28.2%), dizziness (18.8%), tremors (9.4%), depressive symptoms (21.7%), and
sleep disturbance (23.5%) were significantly higher among exposed inhabitants than controls: (10%), (5%), (5%), (0%), (8.8%) and (10%), respectively
(P < 0.05).” Sleep, headache, and cognitive again topped the list in frequency (Abdel-Rassoul et al., 2007).
Some studies focus not on ranking, but dose-effect/distance relation. For instance, in Selbitz, Bavaria, those within 200 m of a cell phone base
station were compared on reported symptoms to those 200 m to 400 m away and were found to report significantly more sleep problems, headache,
concentration problems, “cerebral affections,” depression, auditory/vestibular problems, visual problems, GI problems, dizziness, and nosebleed
along with cardiovascular problems, joint problems, infections, and skin problems (p = 0.01 for dizziness and nosebleed, p = 0.001 for the rest; Eger
& Jahn, 2010). A 2003 survey study of the “microwave syndrome” “in Murcia, Spain, in the vicinity of a Cellular Phone Base Station working in DCS-
1800MHz” reported that symptoms included fatigue, irritability, headache, nausea, insomnia, depression, discomfort, difficulty in concentration,
memory loss, visual dysfunction, auditory dysfunction, dizziness, (and several other symptoms) (Navarro et al., 2003). These were more prevalent
within 150 m of the station, relative to more than 250 m, in most cases significantly so. It was noted that symptoms abated with removal from the
RF/MW source (Navarro et al., 2003). A follow-on study examined rates of problems in relation to measured electric fields and showed significance
for 13 of 16 assessed symptoms, with symptom odds ratios as high as 59 (Oberfeld et al., 2004).
Our rankings do not include as a symptom “onset of electromagnetic hypersensitivity syndrome” or “aggravation of electromagnetic hypersen-
sitivity syndrome.” We used the highest ranking if several cognitive queries were used (e.g., memory problems or concentration difficulties) or
several head queries were used (e.g. headache, head pressure, heat or strange sensation in head), and exclude later exemplars of the category in
ranking the lower-ranked items.
a There was no barrier to participation from outside the United States, but participants are predominantly from the United States.
b Sixty-eight percent of participants had ES (N =142) of whom 63% felt certain their exposure to smart meter was responsible for initiating the ES. Of

the 49 who were ES before smart meter exposure, all 49 (100%) stated that smart meter exposure made their ES not only worse but “much worse.”
c Though fatigue was not elicited, it is noted that a number reported a “good day bad day” pattern in which mental or physical exertion on one day

led to exacerbation for several days.

d Separates out balance (67%) and dizziness (63%) and includes nausea (7%) in this category.
e Speech problems were not elicited, but speech audiometry, speech therapy, and speech pathology consultation are each mentioned totaling at least

six references.
B. Golomb

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Table 3: Continued.

f “Aphasia” was a write-in symptom (not queried).

Diplomats’ Mystery Illness

g Seventy-three percent women; 93% over age 40; 43% over age 60; 78% from California; 49% characterize selves as EMF sensitive.
h The first number is severe or moderate and new; the second number is severe and new. Pressure in head and headaches were queried separately.

The overlap is uncertain. The higher ranking (pressure in head) was used. Concentration and memory were queried separately. The overlap is
uncertain. The higher ranking (concentration problems) was used.
i Memory and concentration were queried separately, ranked #4 and #7 in the original. Combined might be higher. The higher ranking is used. This

analysis provides values at different distances. Orderings for the closest distance are used. Ordering shifts slightly with longer distances, but in
general, the more frequently reported symptoms remain the more frequently reported.
j Ratings are based on (videotaped) Commonwealth Club slide presentation. Additional symptoms were elicited but not presented.
k Notes buzzing ears, hissing sounds, loss of hearing, strong low-frequency sounds, earaches, and sound of bells clanging in 96, 80, 64, 545, 38, and

28 participants
l This assesses acute symptoms. It also gives fractions of who report those symptoms before the acute phase, but it is unclear whether someone who

reports a symptom (say, headaches, dizziness) before exposure had those symptoms only occasionally.
Note: Percentages are given for diplomats (chosen for being symptomatic) and rankings for studies of persons reporting symptoms with
EMR/RF/MW (not restricted to acute stage).
2913

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2914 B. Golomb

stress (Golomb et al., 2014; Golomb & Evans, 2008; Golomb, Koslik, & Redd,
2015), mechanisms that each promote the other (Lee & Wei, 1997; Wei &
Lee, 2002). RF/MW is tied to these mechanisms (Barnes & Greenebaum,
2015, 2016; Gao, Hu, Ma, Chen, & Zhang, 2016; Turedi et al., 2015; Yaky-
menko et al., 2015; Yuksel, Naziroglu, & Ozkaya, 2016; Zhu et al., 2014).
However the distinctive prominence of sleep and auditory symptoms, the
peculiar somatic sensory experiences of pressure and vibration, and the
noises perceived during apparent inciting episodes are relatively distinctive

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features—distinctive to diplomats’ reports and reported RF/MW problems.
Table 4 reviews several mechanism considerations. Central to this is the
critical role of oxidative stress and the relevance of oxidative stress to po-
tential auxiliary mechanisms, such as mitochondrial dysfunction, blood-
brain barrier disruption, membrane alterations, impaired blood flow, apop-
tosis, effects on voltage-gated calcium and anion channels, and triggering
of autoimmune reactions. (In some cases, effects are reciprocal—oxidative
stress promotes mitochondrial dysfunction, calcium channel effects, inflam-
mation, and autoimmunity—which in turn can promote oxidative stress.)
One analysis found that of 100 evaluated studies that examined the rela-
tionship of low-level RF/MW to oxidative stress in biological systems, 93%
supported a connection (Yakymenko et al., 2015). A role for oxidative stress
in RF/MW/EMR-affected persons is cemented by evidence that gene poly-
morphisms adverse to antioxidant defense are significantly more prevalent
in persons experiencing symptoms from RF/MW/EMR (De Luca et al.,
2014). In addition, levels of a particular antioxidant, melatonin, known to
be critical for RF/MW and broader EMR defense are consistently low in af-
fected persons (assessed by a urinary metabolite) (Belpomme et al., 2015).
Oxidative stress has been tied to each of the symptoms and conditions re-
ported in diplomats and RF/MW-affected persons.
Also noteworthy is the repudiation of psychogenic causation in the eval-
uation of diplomats (Stone, 2018; Swanson et al., 2018), which holds for
RF/MW-affected persons as well. Case narratives for those affected by
RF/MW underscore that for many, symptoms developed and progressed
when affected parties as yet had no knowledge that an RF/MW-emitting
device had been introduced or that one could cause problems (Conrad &
Friedman, 2013; Golomb, 2015a). A Swiss Telecom-funded study found that
sleep problems related to the electromagnetic field strength of the trans-
mitter and did not correlate with personality traits tied to worry about
health (Altpeter et al, 1995; Lamech, 2014). The circumstance that some
report being affected severely by levels of exposure that cause others no
problem is reviewed in the context of effect modification, variations in an-
tioxidant defenses, and demonstrated variable involvement of secondary
mechanisms such as autoimmune activation (Belpomme et al., 2015). In
fact, analogous marked differences in harm or development of health effects
are well known for other exposures, such as peanuts, penicillin, and pesti-
cides. For EMR-affected persons (De Luca et al., 2014), as for many other
Table 4: Mechanism Considerations.

Oxidative stress, mediated by Oxidative stress refers to a kind of injury against which “antioxidants” relatively protect, in which “reactive
free radicals, is involved in oxygen species” or “free radicals” produce changes/damage that can affect, for instance, lipids, proteins,
RF/MW injury. DNA, and RNA.
Mitochondria, the primary source of energy for cells (and they regulate many other phenomena such as
steroid hormone production and apoptosis) are a leading source and target of oxidative stress (Gruber,
Schaffer, & Halliwell, 2008; Kowald, 2001; Lee & Wei, 1997; Sastre, Pallardo, & Vina, 2003; Wei, 1998). That is,
mitochondrial injury not infrequently accompanies oxidative stress and has been shown with RF/MW (see
below).
RF/MW produces oxidative stress. As above, in an analysis of 100 studies examining if low-level RF/MW
Diplomats’ Mystery Illness

produced oxidative injury, it was reported that about 93 found that it did (Yakymenko et al., 2015).
Oxidative stress and mitochondrial dysfunction are implicated in the symptoms and health effects that have
been reported by diplomats and RF/MW-affected persons (Adamczyk-Sowa et al., 2014; Berr, Balansard,
Arnaud, Roussel, & Alperovitch, 2000; Bonne & Muller, 2000; Brubaker, Mohney, & Pulido, 2009; Carelli,
Ross-Cisneros, & Sadun, 2002; Feng et al., 2010; Fetoni et al., 2013; Finsterer, 2008; Fukui et al., 2002;
Hoshino, Tamaoka, Ohkoshi, Shoji, & Goto, 1997; Ikeda-Douglas, Zicker, Estrada, Jewell, & Milgram, 2004;
Insel, Moore, Vidrine, & Montgomery, 2012; Jeyakumar, Williamson, Brickman, Krakovitz, & Parikh, 2009;
Kilic, Selek, Erel, & Aksoy, 2008; Koga & Nataliya, 2005; Koillinen, Jaaskelainen, & Koski, 2009; Kuruppu &
Matthews, 2013; Liang et al., 2004; Manwaring et al., 2007; Massin et al., 1995; Neri et al., 2006; Ottonello
et al., 2000; Reynolds, Laurie, Mosley, & Gendelman, 2007; Riordan-Eva, 2000; Rosen, 2008; Sandbach et al.,
2001; Savastano, Brescia, & Marioni, 2007; Seidman, Khan, Bai, Shirwany, & Quirk, 2000; Sharma et al., 2013;
Someya et al., 2009; Tiwari & Chopra, 2013; Vurucu et al., 2013; D. Wallace, 2001; Yamasoba et al., 2007;
Zhang et al., 2013; Zoric et al., 2008). For instance, oxidative stress is tied to tinnitus, antioxidants modestly
alleviate it, and markers of oxidative stress in tinnitus are reported to be greater in jugular blood (near the
ear) than the more commonly measured brachial blood (Neri et al., 2006; Savastano et al., 2007; Van
Campen, Murphy, Franks, Mathias, & Toraason, 2002).
Two findings substantially cement a role for oxidative stress in RF/MW health effects. First, persons who are
“electrosensitive” (i.e., who experience symptoms at levels of radiation that many others tolerate) are
significantly more likely to harbor gene variants that confer less avid protection against oxidative injury (De
Luca et al., 2014). This is an extremely important finding. People cannot manipulate their genes in response
to suggestibility and did not know their genes when they reported their sensitivity status. This powerfully
2915

supports a causal role for oxidative stress in the injury experienced.

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Table 4: Continued. 2916

Second, a French study in electrically and chemically sensitive individuals (93% with ES), found consistently
low levels of a urinary melatonin metabolite (Belpomme et al., 2015). Since melatonin is an antioxidant that
protects against damage to many toxins, but has been shown in numerous studies to be particularly vital for
defense specifically against oxidation injury due to radiation across the electromagnetic spectrum (Argun
et al., 2014; Bhatia & Manda, 2004; El-Missiry et al., 2007; Goswami & Haldar, 2014b; Goswami et al., 2013;
Griefahn, Kunemund, Blaszkewicz, Lerchl, & Degen, 2002; Guney et al., 2007; Imaida et al., 2000; Jang et al.,
2013; Karaer et al., 2015; Karslioglu et al., 2005; Kim et al., 2001; Koc, Taysi, Buyukokuroglu, & Bakan, 2003a,
2003b; Manda, Anzai et al., 2007; Manda & Reiter, 2010; Manda et al., 2008; Naziroglu, Tokat, & Demirci,
2012; Ortiz et al., 2015; Sener, Atasoy et al., 2004; Sener, Jahovic et al., 2003; Sharma & Haldar, 2006; Shirazi
et al., 2011, 2013; Taysi et al., 2003, 2008; Vasin et al., 2004; Yilmaz & Yilmaz, 2006), including due to RF/MW
(Ayata et al., 2004; Aynali et al., 2013; Koylu et al., 2006; Lai & Singh, 1997; Meena et al., 2014; Naziroglu,
Celik et al., 2012; Oksay et al., 2012; Oktem et al., 2005; Ozguner et al., 2006; Ozguner, Oktem, Armagan
et al., 2005; Sokolovic et al., 2008, 2013; Tok et al., 2014), this dovetails with the genetic data to compellingly
support a role for oxidative stress and to show that that those with ES (those who experience symptoms
with radiation that others tolerate) are also experiencing greater cellular and subcellular injury from this
radiation.
Many studies show the importance of antioxidant defenses, including melatonin, in protection against
RF/MW injury. For instance, melatonin and, to a lesser degree, caffeic acid protect against cell
phone–induced oxidative stress in rats, and melatonin increased the activity of other endogenous
antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase, which were
depressed with the cell phone radiation (Ozguner et al., 2006). Melatonin protected against laryngotracheal
oxidative injury from wireless (2.45 GHz) radiation in rats (Aynali et al., 2013). It also protected against skin
oxidative injury in an experimental mobile phone model in rats (Ayata et al., 2004). It protected against 900
MHz microwave radiation–induced lipid peroxidation in rats (Koylu et al., 2006); reversed the oxidative
damage of microwaves to rat testes including protecting testosterone level and sperm count, and protecting
against DNA fragmentation (a marker of cell death) (Meena et al., 2014) and protected against oxidative
damage from cell phone radiation to rat brain (Sokolovic et al., 2008). Melatonin protects against oxidative
damage from Wi-Fi to the lens of rats (Tok et al., 2014). Vitamins E and C protect against “900 MHz
radiofrequency-induced histopathologic changes and oxidative stress in rat endometrium” (Guney,
Ozguner, Oral, Karahan, & Mungan, 2007). Ginkgo biloba protected against cell phone–induced oxidative
B. Golomb

injury in rat brain (Ilhan et al., 2004). And so on.

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Table 4: Continued.

Antioxidants work together, for instance, to recycle one another to the reduced form in which they are active
as antioxidants. The importance of antioxidant defenses in protection against radiation injury from RF/MW
extends what is well known for injury from radiation throughout the electromagnetic spectrum, including
so-called ionizing radiation (which includes gamma)—for instance, “A positive correlation was found
between GPx activity, glutathione content and cell survival following ionizing irradiation”; Bravard et al.,
2002). Glutathione depletion increased with gamma radiation–induced DNA damage (Dutta, Chakraborty,
Saha, Ray, & Chatterjee, 2005) and cell death (Dethmers & Meister, 1981). Glutathione determined the
survival “shoulder” for X-ray radiation in hypoxic cells (Evans, Taylor, & Brown, 1984), and melatonin
protected against X-ray-induced lung injury (Jang et al., 2013). Melatonin protected against
Diplomats’ Mystery Illness

radiation–induced cataract (Karslioglu et al., 2005) and increased activity of other critical antioxidant
enzymes, SOD and GPx. SOD protected against fractionated radiation–induced esophagitis (and reduced
the effect of that radiation on glutathione) (Epperly et al., 2001). Melatonin protected against UVB
radiation-induced oxidative skin injury (Goswami & Haldar, 2014a, 2014b), as did glutathione (Hanada,
Gange, & Connor, 1990) and chocolate, which is rich in antioxidant polyphenols (Williams, Tamburic, &
Lally, 2009). Melatonin has specifically been reported to protect the inner ear against radiation injury in rats
exposed to “radiotherapy” at 4 KHz to 6 KHz (Karaer et al., 2015)
A role for oxidative stress in radiation injury transcends labels of “ionizing” versus “nonionizing,” and
“thermal” versus “nonthermal” radiation. For this reason, those labels are of questionable utility in
understanding radiation damage.
Radiation may depress A number of studies report that EMR, including but not limited to RF/MW, can depress melatonin (Bergqvist
melatonin—more so in et al., 1997; Burch, Reif, & Yost, 1999, 2008; Fernie, Bird, & Petitclerc, 1999; Griefahn et al., 2002; Halgamuge,
some—and, in part through 2013; Qin et al., 2012; Reiter, 1993a, 1994; Weydahl, Sothern, Cornélissen, & Wetterberg, 2000). Evidence
depressed melatonin, may suggests that (like virtually all other biological effects), a subgroup is more vulnerable (Parry et al., 2010;
depress other antioxidants Wood, Loughran, & Stough, 2006). (Note that sunlight, which provides EMR of a kind “expected”
evolutionarily, is well recognized to govern (depress) melatonin, toward producing day-night and seasonal
effects.)
Light (a portion of the electromagnetic spectrum) inhibits melatonin as part of establishing circadian and
seasonal rhythms (Gammack, 2008; Glickman, Byrne, Pineda, Hauck, & Brainard, 2006; Navara & Nelson,
2007). Evolution did not plan for man-made radiation sources, and one hypothesis is that such radiation
sources may induce similar effects in some people.
2917

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Table 4: Continued.
2918

“EMF [electromagnetic fields] are known to affect Ca2+ homeostasis and suppress melatonin activity in a
wide wavelength range. Ca2+ ions in pinealocytes are involved in regulation of cAMP synthesis that
mediates conversion of serotonin into melatonin. Their leakage from pinealocytes results in a decrease of the
cAMP level and thereby suppresses production of melatonin” (Rapoport & Breus, 2011). Longterm radar
workers reportedly have increased serotonin and depressed melatonin, consistent with this impaired
conversion and effects in the RF/MW frequency range (Singh, Mani, & Kapoor, 2015). Electronic repair
workers have also been reported to have lower melatonin than controls and more sleep problems (El-Helaly
& Abu-Hashem, 2010).
Melatonin and its derivatives, though better known for effects on sleep, provide a critical antioxidant defense
system that protects against toxicity of an extraordinary array of toxins and conditions (Abdel Moneim et al.,
2015; Antunes Wilhelm, Ricardo Jesse, Folharini Bortolatto, & Wayne Nogueira, 2013; Bandyopadhyay,
Ghosh, Bandyopadhyay, & Reiter, 2004; Baxi, Singh, Vachhrajani, & Ramachandran, 2013; Chabra,
Shokrzadeh, Naghshvar, Salehi, & Ahmadi, 2014; Chen, Gao, Li, Shen, & Sun, 2005; Ebaid, Bashandy,
Alhazza, Rady, & El-Shehry, 2013; El-Missiry et al., 2014; Fuentes-Broto et al., 2010; Garcia-Rubio, Matas, &
Miguez, 2005; Jindal, Garg, Mediratta, & Fahim, 2011; Korkmaz, Uzun, Cakatay, & Aydin, 2012; Laothong
et al., 2010; Mehta et al., 2014; Melchiorri et al., 1995; Montilla, Vargas et al., 1998; Ochoa et al., 2011; Othman
et al., 2014; Shokrzadeh et al., 2014; Skaper, Floreani, Ceccon, Facci, & Giusti, 1999; Sousa & Castilho, 2005;
Souza et al., 2014; Thomas & Mohanakumar, 2004; Uygur et al., 2013; S. C. Xu et al., 2010; L. Zhang et al.,
2013; Aranda et al., 2010; Carrillo-Vico et al., 2005; Das, Belagodu, Reiter, Ray, & Banik, 2008; El-Sokkary,
Nafady, & Shabash, 2010; Esrefoglu, Gul, Ates, & Selimoglu, 2006; Esrefoglu, Gul, Emre, Polat, & Selimoglu,
2005; Fagundes, Gonzalo, Arruebo, Plaza, & Murillo, 2010; Y. K. Gupta, Gupta, & Kohli, 2003; Hu, Yin, Jiang,
Huang, & Shen, 2009; Kacmaz et al., 2005; Kerman et al., 2005; Omurtag, Tozan, Sehirli, & Sener, 2008;
Ozacmak, Barut, & Ozacmak, 2009; Ozacmak, Sayan, Arslan, Altaner, & Aktas, 2005; Ozcelik, Soyoz, &
Kilinc, 2004; Rao & Chhunchha, 2010; Rezzani, Buffoli, Rodella, Stacchiotti, & Bianchi, 2005; Sadir, Deveci,
Korkmaz, & Oter, 2007; Sahna, Parlakpinar, Turkoz, & Acet, 2005; Sahna, Parlakpinar, Vardi, Cigremis, &
Acet, 2004; Saravanan, Sindhu, & Mohanakumar, 2007; Suke et al., 2006; Tunez, Montilla, Del Carmen
Munoz, Feijoo, & Salcedo, 2004; Wang, Wei, Wang et al., 2005; Wang, Wei, Zhang et al., 2005; Watanabe et al.,
2004; Zavodnik et al., 2004) (Abdel-Wahab, Arafa, El-Mahdy, & Abdel-Naim, 2002; Bagchi et al., 2001;
B. Golomb

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Table 4: Continued.

Behan, McDonald, Darlington, & Stone, 1999; Bruck et al., 2004; Cadenas & Barja, 1999; Chen, Lin, & Chiu,
2003; Dabbeni-Sala, Floreani, Franceschini, Skaper, & Giusti, 2001; El-Sokkary, 2000; Gazi, Altun, & Erdogan,
2006; Hara et al., 2001; Herrera et al., 2001; Karbownik & Reiter, 2002; Lankoff, Banasik, & Nowak, 2002;
Martin et al., 2002; Mayo, Tan, Sainz, Lopez-Burillo, & Reiter, 2003; Mayo, Tan, Sainz, Natarajan et al., 2003;
Montilla, Tunez, Munoz de Agueda, Gascon, & Soria, 1998; Mor et al., 2003; Morishima et al., 1998, 1999;
Ortega-Gutierrez et al., 2002; Othman, El-Missiry, & Amer, 2001; Popov et al., 2015; Princ, Maxit, Cardalda,
Batlle, & Juknat, 1998; Sener, Kacmaz et al., 2003; Sener, Paskaloglu et al., 2004; Sener, Sehirli, &
Ayanoglu-Dulger, 2003; Shen et al., 2002; Shifow, Kumar, Naidu, & Ratnakar, 2000; Shokrzadeh et al., 2015;
Soyoz, Ozcelik, Kilinc, & Altuntas, 2004; Spadoni et al., 2006; Sutken et al., 2007; Tomas-Zapico et al., 2002;
Diplomats’ Mystery Illness

Tunez et al., 2003).

For this reason, to the extent that EMR does depress melatonin, it is expected to potentiate the array of adverse
health outcomes tied to these toxins, and other sources of injury.
Again, melatonin specifically protects against radiation injury at frequencies across the electromagnetic
spectrum (Bardak et al., 2000; Cruz et al., 2003; Dogan et al., 2017; Goswami & Haldar, 2014a; Guney et al.,
2007; Jang et al., 2013; Karaer et al., 2015; Kim et al., 2001; Koc et al., 2003a, 2003b; Koylu et al., 2006; Liu
et al., 2014; Manda, Anzai et al., 2007; Manda & Reiter, 2010; Manda et al., 2008; Naziroglu, Celik et al., 2012;
Oliinyk & Meshchyshen, 2004; Ortiz et al., 2015; Sener, Atasoy et al., 2004; Sener, Jahovic et al., 2003; S.
Sharma & Haldar, 2006; Sokolovic et al., 2008, 2013; Taysi et al., 2003, 2008; Tok et al., 2014; Yilmaz & Yilmaz,
2006).
A study examining gene expression in rat brain reported that brain expression of N-acetyltransferase-1, the
rate-limiting enzyme in melatonin production (Reiter, 1993b), had significantly reduced expression
following 915 MHz GSM-consistent RF/MW radiation (encompassing pulsed RF/MW) in rats, fold
difference 0.48 ±0.13, p < 0.0025 (Belyaev et al., 2006).
Suppressed melatonin or sleep deprivation in turn increases damage to the pineal gland (Lan, Hsu, & Ling,
2001), which produces most of the circulating melatonin. Thus, sufficiently depressed melatonin can beget
still further depressed melatonin—and heightened vulnerability to injury from future EMR exposure.
The ability to sustain adequate melatonin production in the face of EMR/RF/MW, may be a critical
determinant of pineal vulnerability. The pineal gland has high antioxidant needs (Lan et al., 2001;
Razygraev, 2010), and in the absence of such protections, it is vulnerable to involution (Lin’kova, Poliakova,
Kvetnoi, Trofimov, & Sevost’ianova, 2011; Polyakova, Linkova, Kvetnoy, & Khavinson, 2011).
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Table 4: Continued.
2920

Age-related involution of the pineal gland may help to explain why more middle-aged persons are reportedly
affected by ES than younger people (Gruber, Palmquist, & Nordin, 2018), though presumably younger
adults may be more exposed to technology. (Older persons, however, may have had more years of EMR
exposure and injury may be cumulative (Sadchikova & Glotova, 1973).)
Melatonin supports the levels and activity of other antioxidants, including in the setting of radiation exposures
(Karslioglu et al., 2005; Ozguner et al., 2006; Tok et al., 2014). Modest exposure to oxidative stressors
(including from radiation) in persons or animals or plants whose system is not overwhelmed can lead to
antioxidant upregulation, a phenomenon called oxidative preconditioning, seen with many sources of limited
oxidative stress, including limited exposure to radiation (Chen, 2006). In part because of this, the net effect of
an oxidant exposure on antioxidant levels depends on factors like intensity and duration of exposure, other
oxidative exposure (so, mitochondrial dysfunction state), and the status of antioxidant defenses, as well as
time from exposure to assessment. Some studies in some systems show antioxidant upregulation (Irmak
et al., 2002) or mixed direction effects on different antioxidants (Tok et al., 2014), but many show depression
of assessed antioxidants following EMR exposure (Duan et al., 2013; Goswami & Haldar, 2014a, 2014b;
Martinez-Samano, Torres-Duran, Juarez-Oropeza, Elias-Vinas, & Verdugo-Diaz, 2010) or specifically
RF/MW exposure (Akpinar, Ozturk, Ozen, Agar, & Yargicoglu, 2012; Bahreymi Toossi et al., 2017; Ceyhan
et al., 2012; Esmekaya, Ozer, & Seyhan, 2011; Guney et al., 2007; Megha et al., 2015; Ozguner, Altinbas et al.,
2005; Oktem et al., 2005; Ozguner et al., 2006; Ozguner, Oktem, Armagan et al., 2005; Ozguner, Oktem,
Ayata, Koyu, & Yilmaz, 2005; Tok et al., 2014; Yurekli et al., 2006). Such depressions, coupled with melatonin
depressions, may increase vulnerability to future EMR exposures, particularly where genetics provide for
less effective variants of one or more antioxidants (De Luca et al., 2014).
It is expected that mitochondrial impairment (J. Gruber et al., 2008; Lee & Wei, 1997; Sastre et al., 2003; Wei,
1998) or brain inflammation (sometimes itself a result of oxidative stress, amenable to reduction with
melatonin; Guney et al., 2007; Halliday, 2005), since associated with greater production of free radicals and
an expected less favorable balance of oxidative stress to antioxidant defenses, may be a risk factor for
problems with the added oxidative stress from RF/MW or from the depression in antioxidant defenses to
which RF/MW may contribute.
B. Golomb

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Table 4: Continued.

RF/MW may depress RF/MW is reported to depress butyrylcholinesterase (McRee, 1980), a key xenobiotic defense; low levels are
xenobiotic protections tied to higher cardiovascular and all-cause mortality (Calderon-Margalit, Adler, Abramson, Gofin, & Kark,
2006).
Oxidative stress contributes to Oxidative stress contributes to multiple documented auxiliary mechanisms of RF/MW damage that likely
auxiliary mechanisms of contribute to health effects in subsets, including membrane alterations—cell membranes (Benderitter,
radiation injury, such as Vincent-Genod, Pouget, & Voisin, 2003) and mitochondrial membranes (Shonai et al., 2002; Thomas,
mitochondrial dysfunction. Gebicki, & Dean, 1989; Vayssier-Taussat et al., 2002; Wang et al., 2002), blood-brain barrier disruption (Al
Ahmad et al., 2012; Barichello et al., 2011; Freeman & Keller, 2012; Gasche, Copin, Sugawara, Fujimura, &
Diplomats’ Mystery Illness

Chan, 2001; Haorah, Knipe, Leibhart, Ghorpade, & Persidsky, 2005; Haorah et al., 2007; Hurst et al., 1998;
Lochhead et al., 2010; Nittby et al., 2009; Salford et al., 1994; Zehendner et al., 2013), effects on voltage gated
calcium channels (Cui et al., 2012) affected by and affecting oxidative stress—(Nishiyama, Nakano, &
Hitomi, 2010; Pall, 2015)—but also on voltage-gated anion channels that are an important part of the outer
mitochondrial membrane (Ferrer, 2009) potentially contributing to mitochondrial impairment and
amplification of oxidative stress, EEG spiking (Naziroglu, Celik et al., 2012), impaired mitochondrial
function (Aitken, Bennetts, Sawyer, Wiklendt, & King, 2005; Xu et al., 2010)—bidirectionally related to
oxidative stress (Houston, Nixon, King, De Iuliis, & Aitken, 2016; Mancuso, Coppede, Migliore, Siciliano, &
Murri, 2006; Wei & Lee, 2002)—and protected by melatonin (Tan, Manchester, Qin, & Reiter, 2016), impaired
blood flow—e.g., via oxidative stress-driven endothelial dysfunction (Engin, Sepici-Dincel, Gonul, & Engin,
2012; Indik, Goldman, & Gaballa, 2001; Jarasuniene & Simaitis, 2003; Loscalzo, 2002), autoantibodies (Ahsan,
Ali, & Ali, 2003; Fiorini et al., 2013; Gilgun-Sherki, Melamed, & Offen, 2004; Kirkham et al., 2011; Kumagai
et al., 2003; Maes et al., 2013; Ryan, Nissim, & Winyard, 2014), and apoptosis (Aoki et al., 2001; Bresgen et al.,
2003; Espino et al., 2010; Filomeni, Cardaci, Da Costa Ferreira, Rotilio, & Ciriolo, 2011; France-Lanord,
Brugg, Michel, Agid, & Ruberg, 1997; Li et al., 2015; Li et al., 2008; Salido & Rosado, 2009; Yalcinkaya et al.,
2009; Zhang, Zhang, Rabbani, Jackson, & Vujaskovic, 2012)—programmed cell death, which in turn triggers
inflammation and coagulation activation (Reutelingsperger & van Heerde, 1997). Laboratory correlates for
some of these were reported in ES participants in the French study: about 15% of those with ES had elevated
markers of blood-brain barrier permeability; 29% in those with ES (23% in those with ES and multiple
chemical sensitivity, MCS) had antibodies to O-myelin (Belpomme et al., 2015).
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 2922

Table 4: Continued.

Melatonin considerations: While depressions in a melatonin metabolite were the norm in participants with ES in a French study
RF/MW/EMR versus (Belpomme et al., 2015), this need not necessarily be the case for diplomats, even if a related cause (pulsed
diplomats RF/MW) and related processes (e.g., tied to oxidative stress) are involved in symptom induction. In persons
with “ES,” lowered defenses are needed for nominally modest exposures to produce problems. But if
exposures in affected diplomats were more intense or otherwise injurious, lowered defenses would not be
required to produce injury. To evaluate this, it may be prudent to assess urine melatonin metabolites at the
time diplomats are identified with symptoms.
Psychogenic illness has been Psychogenic causation has been repeatedly suggested as the basis for diplomats’ symptoms (Buckley & Harris,
dismissed 2018; Myers, 2018; Stone, 2017). This has been correctly dismissed, however, for the Cuba and China
diplomats (Harris, 2018c; Stone, 2018; Swanson et al., 2018).
Psychogenic causation has similarly been suggested for symptoms from RF/MW (Maisch, 2012) and has been
similarly repudiated (Aschermann, 2009; Tressider, 2017). The Swiss Telecom-funded study that
documented a relation of sleep problems to transmitter field strength also showed that symptoms were not
related to a health-worrying personality (Altpeter et al., 1995; Lamech, 2014). The concordance of symptom
profiles across studies, the emergence of RF/MW problems in people unaware of the exposure or its
potential for problems, the concordance of symptoms and objective signs with known documented
mechanisms of RF/MW injury, the presence of objective markers, and ties to genetics that each cohere with
known mechanisms of RF/MW injury (Belpomme et al., 2015; De Luca et al., 2014; Havas et al., 2010)
effectively preclude a psychogenic basis for the problem—were such a diagnosis meaningful. (See below, in
the entry for study inconsistency, for provocation studies.)
The notion that chronic symptoms can arise from psychogenic sources dates to Freud, who also pioneered the
flaws associated with its application (Crews, 2017). The foundation is substantially circular, a mechanism
has never been physiologically defined or substantiated (much less documented to be operating in cases
where the label is applied), and the label is deployed without the most basic scrutiny of the tacit
assumptions (Golomb, 2015b). Historically, many conditions that were presumed psychogenic (such as
ulcers, seizures) were recognized as organic as evidence emerged (Golomb, 2015b).
B. Golomb

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Table 4: Continued.

Not all are affected—a subset How might some people experience symptoms and signs of injury from what seem to be “low levels” of an
of embassy personnel exposure, seemingly well below levels that other people tolerate? For toxins, we designate an LD50 (Baiomy,
(Stone, 2018) and of RF/MW Attia, Soliman, & Makrum, 2015; Jagetia & Baliga, 2003; Jagetia, Venkatesh, & Baliga, 2004; Pal & Chatterjee,
exposed 2006; Shafiee et al., 2010; Shimoda, Akahane, Nomura, & Kato, 1996) (dose lethal in 50%) or an LD5. This
reflects the recognition that for each potentially toxic exposure, there is a range in which some will
experience an outcome and others will not. One can also define an SD50 (symptoms in 50%)—or an SD25, or
SD5. It would be surprising if a highly useful and lucrative technology were not pushed as far into this
intensity range as possible. Genetic variations in a range of free radical detoxification systems, competition
for those systems, alterations in gene expression based on prior exposures, differences in vulnerability of the
Diplomats’ Mystery Illness

tissue affected (via factors like mitochondrial “heteroplasmy,” past injury of that organ), and variations in
secondary mechanisms triggered by oxidative stress provide among the mechanisms by which variability is
produced.
The de facto intensity of the “same” exposure may differ radically (no pun intended) from person to person.a
A further mode of variability arises from immune activation. Considering a more familiar allergen, one
person can eat a jar of peanut butter without a problem, while another is hospitalized for exposure to a
crumb of peanut. As above, oxidative stress can modify substances in a fashion that makes them vulnerable
to autoimmune attack. Immune or autoimmune activation is a documented feature in a subset of those
citing symptoms from RF/MW/EMR (Belpomme et al., 2015).
Effect modification “Effect modification” refers to differences in effect in different individuals, and it is the rule rather than the
exception in biology. Particular considerations are germane when the exposure has potential for prooxidant
or antioxidant effects (Golomb, 2018). Many prooxidants can be antioxidant at low doses in some people (via
“oxidative preconditioning” in which low-level exposure to prooxidants may upregulate native antioxidant
defenses; this can lead to net antioxidant effects in persons whose defenses are not already overwhelmed or
maximally upregulated—as above). Conversely, many substances thought of as antioxidants are prooxidant
in some settings, often including high dose (Azam, Hadi, Khan, & Hadi, 2003; Bowry, Mohr, Cleary, &
Stocker, 1995; Gerster, 1999; Hiramoto, Ohkawa, Oikawa, & Kikugawa, 2003; Hu, Chen, & Lin, 1995;
Kontush, Finckh, Karten, Kohlschutter, & Beisiegel, 1996; Lee, Kim, Park, Chung, & Jang, 2003; Palozza,
Luberto, Calviello, Ricci, & Bartoli, 1997; Young & Lowe, 2001). So the same exposure can produce even
opposite-direction effects in different persons. Exemplifying the principle, statin cholesterol-lowering drugs
are net antioxidant in many people (often tested in nonelderly males without metabolic syndrome factors),
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Table 4: Continued.
2924

but are reproducibly prooxidant in a subset, and prooxidant dominance is tied to side effects (Sinzinger,
Lupattelli, & Chehne, 2000; Sinzinger, Lupattelli, Chehne, Oguogho, & Furberg, 2001). These side effects,
attended by net prooxidant effect (Sinzinger et al., 2000; Sinzinger et al., 2001) arise disproportionately with
higher doses and in persons with conditions like older age and metabolic syndrome factors, that are
statistically tied to mitochondrial impairment (Golomb & Evans, 2008). Side effects, too, occur
disproportionately in women (Golomb & Evans, 2008). Women show higher rates of adverse effects from
many drugs and environmental toxins (and many medical procedures); they are also more often affected by
EMR (Gruber et al., 2018; Levallois et al., 2002; Röösli, Möser, Baldinini, Meier, & Braun-Fahrlander, 2004;
Santini et al., 2002; Schooneveld & Kuiper, 2007).
There are many potential sources of effect modification from genetics (De Luca et al., 2014), level of exposure,
and past and current environment that influence biology. Some exposures may cause mitochondrial injury
or oxidative stress or depress concentrations of antioxidants, boosting vulnerability. Others may have
protective effects.
Chemical exposures may serve Many drugs and chemical exposures cause oxidative stress, cause mitochondrial injury (which also increases
as one source of effect intracellular oxidative stress), depress antioxidant defenses, and/or compete for or inhibit detoxification
modification systems. Through these and other mechanisms, these exposures may magnify harm from RF/MW and vice
versa. Preliminary evidence comparing Swedish ES-affected persons versus controls identifies higher levels
of some organic pollutants in those with ES (Hardell et al., 2008), though larger studies are needed.
Chemical exposures that cause oxidative stress compete for or inhibit detoxification systems may magnify
harm from RF/MW and vice versa.
Melatonin and glutathione (and other antioxidants) can be “radioprotective” (Bravard et al., 2002; Jensen &
Meister, 1983; Shirazi et al., 2013; Simone, Tamba, & Quintiliani, 1983). (Here the root radio refers to
radiation, not specifically to radiofrequency radiation.) Other agents or conditions can be “radiosensitizing.”
As might be expected, glutathione depletion can be radiosensitizing, though the status of other antioxidants
may be important (Hodgkiss, Stratford, & Watfa, 1989; Koch & Skov, 1994; Vallis, 1991; Vos, van der Schans,
& Roos-Verheij, 1986). The tie between low melatonin (assessed by the principal metabolite) and ES in the
French study (Belpomme et al., 2015) supports the expectation that melatonin depletion is radiosensitizing
as well. Radiosensitization is used therapeutically to enhance killing by radiation of tumor cells (Yi, Ding,
Jin, Ni, & Wang, 1994), but its existence there is a reminder that chemicals interact with radiation to modify
B. Golomb

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Table 4: Continued.

radiation effects. Radiation itself may be radiosensitizing—as potential effects on antioxidant systems,
reviewed elsewhere, suggest—and reportedly ultrahigh-frequency radiation is a particularly effective
radiosensitizer (Holt, 1995). Oxidative stress is an important, but not the only, means by which
radiosensitization occurs (Park et al., 2005), consistent with multiple downstream mechanisms of injury.
Of note, because critical systems that are involved in radiation defense (e.g., melatonin, glutathione, and other
antioxidant systems) are also involved in defense against toxicity of chemicals and drugs (Mitchell & Russo,
1987) and because factors that adversely affect antioxidant:oxidant balance may be adverse for oxidative
stress–mediated injury from either type of source, it is expected, as it is observed, that there will be overlap
between chemical and electrical sensitivity (Belpomme et al., 2015; Golomb, 2015a).
Diplomats’ Mystery Illness

Two illustrations where we can see the radiosensitizing effect occur with ultraviolet (uv) light, since due to its
high frequency, the effect is primarily on the skin. Photosensitizing agents and radiation recall are the
illustrations.
Photosensitizing or phototoxic or photoallergic agents are agents that magnify damage observed with uv
radiation. (For simplicity we use photosensitizing to encompass each of these.) In some cases, radiation breaks
down a chemical to something toxic. Drugs may also photosensitize, for instance, by augmenting one of the
mechanisms of radiation injury, such as oxidative stress or mitochondrial dysfunction (Shea, Wimberly, &
Hasan, 1986). Fluoroquinolone antibiotics, which can cause serious problems in a vulnerable subset through
oxidative stress and mitochondrial dysfunction (Golomb et al., 2015), are strongly reported to photosensitize
and to be phototoxic (Agrawal, Ray, Farooq, Pant, & Hans, 2007; Akter et al., 1998; Bilski, Martinez, Koker, &
Chignell, 1996; Boccumini, Fowler, Campbell, Puertolas, & Kaidbey, 2000; Burdge, Nakielna, & Rabin, 1995;
Chetelat, Albertini, & Gocke, 1996; Ferguson & Johnson, 1990, 1993; Fujita & Matsuo, 1994; Granowitz, 1989;
Kimura, Kawada, Kobayashi, Hiruma, & Ishibashi, 1996; Man, Murphy, & Ferguson, 1999; Nedorost,
Dijkstra, & Handel, 1989; Oliveira, Goncalo, & Figueiredo, 2000; Scheife, Cramer, & Decker, 1993; Snyder &
Cooper, 1999; Trisciuoglio et al., 2002; Wagai & Tawara, 1991; Wagai, Yamaguchi, Sekiguchi, & Tawara, 1990).
Fluoroquinolones have been tied to development of persistent phototoxicity (following withdrawal of the
drug; Sailer et al., 2011)—that is, ongoing higher vulnerability to this radiation—consistent with evidence
that a vulnerable group experiences persistent damage from fluoroquinolones in which oxidative stress and
mitochondrial injury play a role (Golomb et al., 2015). This “vulnerability” may be acquired, as
mitochondrial injury can be cumulative, and a serious reaction sometimes follows a previous course of
2925

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Table 4: Continued.
2926

fluoroquinolones with a milder and time-limited reaction or none at all (Golomb et al., 2015). (Mitochondrial
injury from radiation can also be cumulative; Prithivirajsingh et al., 2004.) Fluoroquinolones have led to
reported “photosensitivity” reactions to fluorescent lighting (Jaffe & Bush, 1999). Statins, which as elsewhere
are sometimes prooxidant (Sinzinger et al., 2001) and sometimes mitochondrially toxic (Golomb & Evans,
2008), are also sometimes linked to photosensitivity (Morimoto, Kawada, Hiruma, Ishibashi, & Banba, 1995;
Thual, Penven, Chevallier, Dompmartin, & Leroy, 2005). (The information that follows about
photosensitivity in Smith-Lemli-Opitz syndrome explains one reason that statins can be prooxidant, though
they also have antioxidant mechanisms.)
Given oxidative mechanisms of radiation injury that apply across the electromagnetic spectrum, it is expected
that some agents that photosensitize may sensitize to other forms of radiation, potentially including
RF/MW. Others have noted that photosensitizing drugs have played an apparent role in other radiation
injury (Dawson, Brown, & Tellefsen, 2009). (Data we have presented, but not published, showed that past
use of fluoroquinolones was significantly tied to the development of ES. Past adverse effects to
fluoroquinolones, which signify oxidative-mitochondrial injury to a point producing symptoms (at least,
they surpassed the symptom threshold for a time), showed a particularly strong connection (Golomb,
2015a).)
There are also disease conditions tied to the magnified photosensitivity (Murphy, 2001). Where these are tied
to depressed antioxidant defenses, or increased mitochondrial injury, they might be predicted to be tied to
increased risk of ES development (accounting for radiation exposure). In Smith-Lemli-Opitz syndrome,
which many studies have tied to photosensitivity, cholesterol levels are low (Anstey, 1999, 2001, 2006; Anstey,
Azurdia, Rhodes, Pearse, & Bowden, 2005; Anstey et al., 1999; Anstey & Taylor, 1999; Azurdia, Anstey, &
Rhodes, 2001; Charman et al., 1998; Chignell, Kukielczak, Sik, Bilski, & He, 2006; Eapen, 2007; Martin,
Taylor, Trehan, Baron, & Anstey, 2006; “[A new congenital photosensitivity syndrome. Smith-Lemili-Opitz
syndrome],” 1999). Cholesterol transports critical fat-soluble antioxidants (Golomb & Evans, 2008).
In the phenomenon of “radiation recall,” injury to tissue initially caused by radiation can be made to reappear
by another agent with shared mechanisms of injury (e.g., oxidative stress and mitochondrial injury), such as
fluoroquinolone antibiotics, best recognized for skin reactions, since we are able to see these (Cho,
Breedlove, & Gunning, 2008; Jain, Agarwal, Laskar, Gupta, & Shrivastava, 2008; Wernicke, Swistel, Parashar,
& Myskowski, 2010).
B. Golomb

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Table 4: Continued.

Hypothesis: One possible Evidence supports a relationship between genetics of intellectual promise, and a different condition in which
vulnerable group oxidative stress and mitochondrial impairment play a critical role: autism spectrum disorder (ASD; Frye,
Delatorre et al., 2013; Frye, Melnyk, & Macfabe, 2013; Frye & Rossignol, 2011; Rose et al., 2012; Rossignol &
Frye, 2012). (EMR exposure has been considered as a possible factor (Herbert & Sage, 2013a, 2013b.) It was
found that gene profiles that increase risk of ASD (polygenic risk) are tied to higher intelligence in the
general population (Clarke et al., 2015): “We report that polygenic risk for ASD is positively correlated with
general cognitive ability (beta = 0.07, P = 6 × 10−7 . . .), logical memory and verbal intelligence,” findings
that were replicated in a different sample by positive relation to full-scale IQ (Clarke et al., 2015). This
supports a line of reasoning by which impaired cell energy, through oxidative stress and mitochondrial
Diplomats’ Mystery Illness

dysfunction, may disproportionately affect the “best and the brightest,” on whom society differentially
depends—with implications for vulnerability to RF/MW. Many mechanisms tied to high function are tied to
high energy demand. Higher energy demand may create greater vulnerability in the setting of impaired
energy supply. (It is the chasm between demand and that guides degree of injury.)
Many drugs and chemical exposures cause oxidative stress, cause mitochondrial injury (which also increases
intracellular oxidative stress), depress antioxidant defenses, and/or compete for or inhibit detoxification
systems. Through these and other mechanisms, these exposures may magnify harm from RF/MW and vice
versa.
Are provocation studies Several so-called provocation studies have been conducted in persons with ES; some focus on symptoms,
contributory? some on objective markers. In most of those that focus on symptoms, those with ES fail to reliably
distinguish between blinded EMR “exposed” and “unexposed” settings (Rubin, Das Munshi, & Wessely,
2005). Major flaws in the designs have been recognized and reviewed by others (Leszczynski, 2015;
Schooneveld & Kuiper, 2007); for instance, studies assume that the details of exposure and time course do
not need to be individualized, which is contrary to the evidence.
But there are further problems. The most fundamental is the assumption that in ES, symptoms serve as a
meter. This is invalid. Consider the analogy of sunburn: a form of radiation injury mediated by oxidative
stress that affects some but not others at usual exposure levels. Those who are affected “believe” sun
exposure is responsible. They would be unlikely to discern when they are being exposed versus not to
ultraviolet radiation. (It is their failure to know when significant injury is occurring or has occurred that
leaves them in the sun long enough to receive injury.) What is discerned is the inflammation that follows the
oxidative stress that may emerge only late in exposure or after the sun exposure has been “withdrawn.” A
2927

blinded sham-exposed study would likely also produce inability to discern sham from active treatment.

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Table 4: Continued. 2928

People do not sense the EMR, but the effects produced by it and studies show that those with ES respond to
different EMR sources. In RF/MW-affected persons, as in diplomats, the effects can arise after hours of
exposure or hours after a short exposure—oxidative stress can cause apoptosis and can then trigger
inflammation (Reutelingsperger & van Heerde, 1997) or can cause blood-brain barrier damage allowing
brain swelling (see above). Progression of these mechanisms may not peak for hours or, in some cases, even
a couple of days. Recovery from effects can take still longer.
For such a study to have a chance to succeed, it would be essential to pretest and individualize both the
control/negative exposure condition and the active/positive exposure condition (including exposure and
time course) in each individual to define a condition that will be effective in that person—if such conditions
can be successfully defined and if cumulative effects do not alter the condition from one trial to the next. For
some people, the background EMR at the facility, or its parking lot or lobby, or the exposure during transit to
the facility may obviate the ability to define a negative exposure condition for that individual. It would be
better to bring the EMR exposure to a place where the affected party is stable and asymptomatic. And the
specific EMR and timing must be individualized to produce a positive condition in a suitable time course.
To be valid, such a study must also protect against the possibility of physiological conditioning effects. These
are distinct from nocebo effects and arise because the true stimulus produces actual physiological harm. It is
known, for instance, that chemotherapy patients may vomit when they enter the room in which they have
received chemotherapy. (Chemotherapy agents like EMR also cause toxicity via oxidative stress (Abraham,
Kolli, & Rabi, 2010; Brea-Calvo, Rodriguez-Hernandez, Fernandez-Ayala, Navas, & Sanchez-Alcazar, 2006;
Husain, Whitworth, Somani, & Rybak, 2001; Shokrzadeh et al., 2014) and mitochondrial injury (Nicolson &
Conklin, 2008). The fact that symptoms also occur with expectation of chemotherapy does not mean that the
chemotherapy itself lacks toxicity (or that perceived adverse effects are due to a nocebo effect); rather,
expectation produces symptoms because the exposure is toxic. Expectation of the noxious exposure may, via
conditioning processes, produce symptoms ordinarily produced by the noxious exposure. (This is
potentially evolutionarily adaptive, serving to encourage persons to avoid settings in which the toxic
exposure is expected.) To ensure against conditioned effects arising with expectation, a set of negative
exposure visits at the test site before (and between) each positive exposure visit may be required to ensure
extinction of physiologically conditioned expectation effects. In essence, the setting that optimizes prospects
to identify a real effect, if present, is that in which the participant believes there will not be an active
exposure.
B. Golomb

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Table 4: Continued.

N-of-1 studies that focus on physiological effects of EMR have proven somewhat more able to identify EMR
effects in those with ES, or subsets of them for which that physiological marker is affected. Just as symptoms
vary, so physiological changes may do so, so outcomes suited to one person may not apply for all.
Physiological markers changed with blinded EMR exposure in a published study of a female physician with
ES. She could not discern when the exposure was present or not, but measurable changes occurred and
symptoms arose with the positive condition (McCarty et al., 2011). Symptoms were significantly more
intense with pulsed (but not continuous) radiation than sham exposure (McCarty et al., 2011). An N-of-1 test
Diplomats’ Mystery Illness

was reportedly conducted in a former Miami organized crime prosecutor who developed ES and chemical
intolerance, with seizures an important part of his clinical profile, following a significant chemical exposure.
An EEG was undertaken, turning on and off a TV, with the party blinded to the stimulus (blindfolded and
with headphones to prevent him hearing when the TV was turned on or off). When the TV was shielded, no
effect on the EEG was seen. With an unshielded television, EEG changes including seizure activity occurred
when the television was turned on, and he experienced physical twitching (Bell, 2017). (This particular
marker is unlikely to be generally useful, as seizure activity is not a usual part of the clinical profile in those
affected by RF/MW.) A provocation study focused in a group of individuals showed changes in heart rate
variability (Havas et al., 2010), an index of autonomic function that is tied to hard outcomes like sudden
death and coronary artery disease (Hayano, 1990; Singer, Martin, Magid, & et al, 1988). Moreover, three of
the four participants who characterized their ES as “intense” (though only persons in this group) exhibited a
striking heart rate increase of between 45 and 90 beats per minute virtually immediately with the microwave
exposure, associated with marked increase in sympathetic response. Declines in parasympathetic response
with RF/MW exposure were seen for 23 of 25 tested people, in all groups, including, though less so, those
with no ES.
In general, assessments of objectively measurable quantities of relevance, including both differences in
affected vs unaffected persons irrespective of current exposure (Belpomme et al., 2015; De Luca et al., 2014),
and changes occurring with exposure (Havas et al., 2010), provide a more promising approach than
real-time assessments of subjective outcomes for understanding this condition.
2929

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Table 4: Continued.
2930

Financial conflict of interest is One key source of disparities in study results is financial conflicts of interest. When present, financial conflicts
a major source of apparent strongly predict that study results will conform to the financial interests of authors or funders (Barnes &
disparities in results Bero, 1998; Bero, Oostvogel, Bacchetti, & Lee, 2007; Friedman & Richter, 2004; Golomb, 2008; Heres et al.,
2006; Smith, 2005, 2006). An analysis examined why some review articles on passive smoking concluded it
was harmful while others concluded it was not. The only identified factor that predicted which conclusion
was industry conflict by authors—which was often undisclosed (Barnes & Bero, 1998).
Financial conflicts have been a concern specifically in relation to RF/MW, for both studies and regulatory
decisions (Adlkofer & Richter, 2011; Alster, 2015; Hardell, 2017; Huss et al., 2007; Leszczynski, 2015). In an
analysis of studies looking at cell phone effects as a function of funding source, “Studies funded exclusively
by industry reported the largest number of outcomes, but were least likely to report a statistically significant
result” (So, they report everything that wasn’t affected?) “The odds ratio was 0.11 (95% confidence interval,
0.02–0.78), compared with studies funded by public agencies or charities.” Analogous to findings for a
relation of industry funding to failure to find tobacco-related problems (Barnes & Bero, 1998), “the finding
was not materially altered in analyses adjusted for the number of outcomes reported, study quality, and
other factors” (Huss et al., 2007).
It has been generally assumed that the disproportionately product-favorable results from industry-funded
studies (including less evidence of product harm) arise by virtue of choices, selecting study design, exposure
specifics, subjects, and outcomes to support the desired result. (These can in fact influence outcomes. See
below.) But where harms of lucrative products are concerned, there is precedent for industry-funded studies
going beyond those factors to hide even large and lethal harms, even for prespecified or primary
outcomes—via means that have the appearance, at least, of fraud (“Did GSK trial data mask Paxil suicide
risk?” 2008; Harris, 2010). Special circumstances led the apparent shenanigans in those cases to be
uncovered. Whether frank manipulation of data to hide harms of lucrative products is the rule or the
exception in industry-funded studies is simply not known.
Because a robust body of evidence documents a strong relation of industry conflicts to outcomes, deliberations
and standards should be based exclusively on studies in which such conflicts of interest are absent.
(Industry-funded studies can be used for hypothesis generation.) This obviates one major source of apparent
inconsistency in studies, but it eliminates inconsistencies due to this factor only as far as it is possible to
discern when financial conflicts are operating.
B. Golomb

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Table 4: Continued.

Study outcomes may appear Design features can influence outcomes and may be selected to do so.
different without Details of RF/MW exposure that may influence outcomes include the following (some relevant features have
“inconsistency”: Details doubtless been missed):
matter, to see an effect • Radiation frequency or frequencies (Belyaev, Sheheglow, Alipov, & Ushakov, 2000; Chen, Yang, Tao, & Yang,
2006; Gupta, Mesharam, & Krishnamurthy, 2018),
• Radiation intensity (Adams & Williams, 1976)
• Radiation waveform (Adams & Williams, 1976)
• Polarization (Belyaev et al., 2000; Pall, 2018; Panagopoulos, Johansson, & Carlo, 2015),
• Pulsed versus continuous radiation (Lai, Horita, Chou, & Guy, 1987; Pall, 2018)
Diplomats’ Mystery Illness

• Pulse width (Bonnafous et al., 1999)

• Time between pulses (Belyaev et al., 2006)/repetition rate (1988)
• Pulse waveform (Bolen, 1988; Wood, Armstrong, Sait, Devine, & Martin, 1998),
• Pulse intensity (Elder & Chou, 2003),
• Exposure duration (Lai & Singh, 1995; Robison, Pendleton, Monson, Murray, & O’Neill, 2002)
• Exposure intermittency (Ivancsits, Diem, Pilger, Rudiger, & Jahn, 2002) on every timescale
• Environmental conditions: temperature, humidity, air currents (Adams & Williams, 1976; Laszlo et al., 2006)
• Concurrent (or preceeding) exposures to other radiation (Adams & Williams, 1976; Bua et al., 2018; Kostoff &
Lau, 2017), which can cause synergistic effects (Adams & Williams, 1976)
• Concurrent (or preceeding) chemical exposures or environment (Bua et al., 2018; Kostoff & Lau, 2017)
• State of health of the animal or subject (Adams & Williams, 1976)
• Species (Adams & Williams, 1976)
• Size of the subject relative to wavelength (Adams & Williams, 1976)
• Genetics of the animal (Belyaev et al., 2000; De Luca et al., 2014)
• Antioxidant/nutrient status of the animal or subject (Ceyhan et al., 2012; Gajski & Garaj-Vrhovac, 2009;
Guney et al., 2007; Gurler, Bilgici, Akar, Tomak, & Bedir, 2014; Koyu et al., 2009; Li et al., 2014; Oksay et al.,
2012; Oktem et al., 2005; Oral et al., 2006; Sokolovic et al., 2013; Zhang et al., 2011; Zhang et al., 2014)
• Orientation of the animal or subject relative to the radiation source (Adams & Williams, 1976)
• Portion of the body irradiated (Adams & Williams, 1976)
• Time between exposure and assessment of effect (Belyaev et al., 2000)
• Effect measured
2931

• Metric used to measure effect

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Table 4: Continued. 2932

Radiation that is pulsed (i.e., polarized), is applied intermittently, is more intense, and is applied for a longer
time may be more likely to produce problems, for instance.
Even for studies nominally examining the “same” RF/MW exposure, different choices may be made. A range
of choices are illustrated in this text: “There are 124 different channels/frequencies that are used in GSM900
mobile communication. They differ by 0.2 MHz in the frequency range between 890 and 915 MHz. The test
mobile phone was programmed to use channel 124 with the frequency of 915 MHz. The signal included all
standard GSM modulations. No voice modulation was applied. A GSM signal is produced as 577 μs pulses
(time slots), with an interpulse waiting time of 4039 μs (seven time slots). The test phone was programmed
to regulate output power in the pulses in the range of 0.02–2 W (13–33 dBm). This power was kept constant
during exposure at 33 dBm, as monitored online using a power meter (Bird 43, USA)” (Belyaev et al., 2006).
Studies that examine symptoms as a function of distance from cell towers and base stations suggest that in
important real-world settings, more intense RF/MW exposure is generally a greater problem (Altpeter et al.,
1995; Navarro, Sanchez Del Pino, Gomez, Peralta, & Boveris, 2002; Oberfeld et al., 2004; Santini et al., 2002),
though there may be an intensity range below which this ceases to be the case.
In some conditions, nonmonotonic effects of radiation have been reported (Chiang et al., 1989; Pall, 2018), and
they are arguably expected for agents in the antioxidant-prooxidant spectrum (high-dose antioxidants are
often prooxidant; low-dose prooxidants, via oxidative preconditioning, may be antioxidant).
Opposite-direction effects on a critical mechanism can produce opposite-direction effects in a resulting
outcome. Thus, lower doses of vitamin E fluidize, and higher concentrations stabilize membranes (Packer &
Fuchs, 1993); low vitamin E benefits and higher vitamin E harm vasodilatory function in cholesterol-fed
rabbits (Keaney et al., 1994); “low tocopherol concentrations have stronger antiinflammatory effects in
PUVA-induced erythema than higher concentrations” (Fuchs & Packer, 1993); low doses are tied to lower
mortality in people, higher doses to higher all-cause mortality (Miller et al., 2005). For statins, an agent class
that can produce prooxidant or antioxidant effects, bidirectional effects have been shown on many outcomes
(Golomb et al., 2015). Such bidirectional effects have been shown for many outcomes with RF/MW
(Bergman, 1965). It is common that where a lower amount of something may be favorable (or neutral), a
higher amount may be the adverse, with a transition zone in which subject characteristics and covariables
matter a lot in determining the direction. There are instances in which this directionality is flipped (Au,
Cantelli-Forti, Hrelia, & Legator, 1990); for instance, sometimes a sufficient concentration leads an adaptive
protection to be triggered.
B. Golomb

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Table 4: Continued.

Beyond characteristics of the radiation, the subject may be exposed to it differently; for example, in animal
studies, there may be whole-body radiation (Bilgici, Akar, Avci, & Tuncel, 2013) or head-only exposure
(Burdelya et al., 2012; de Gannes et al., 2009), triggering a different spectrum of responses. And with in vitro
exposure, even fewer of the variables that might contribute to effects are present. The environment in which
exposure occurs may differ in ways that influence toxicity of radiation—for instance, differences in
temperature may produce different effects (Laszlo et al., 2006), or concurrent or background electromagnetic
exposure (Bua et al., 2018) or chemical exposures (Del Vecchio et al., 2009; Kostoff & Lau, 2017).
Amphetamine use represents one exposure that has been reported to magnify problems with RF/MW
Diplomats’ Mystery Illness

(Bolen, 1988).
Characteristics of the “subjects” may differ. In animal and in vitro studies, they may differ in species, strain,
genetic features, cell type cell preparation, and cell density, for instance (Belyaev, Sheheglov, Alipor, &
Ushakov, 2000; Del Vecchio et al., 2009).
As above, “effect modification” refers to the phenomenon by which effects, including adverse effects, are not
equal in all subgroups. This is a major issue in biology, particularly for exposures mediated by oxidative
stress and cell energy impairment. Findings with statin cholesterol-lowering drugs illustrate how massive
the disparity may be as a function of participant group. Like RF/MW, these agents have the potential for
toxicity through prooxidant and mitochondrial adverse mechanisms (Golomb & Evans, 2008; Sinzinger
et al., 2001). RF/MW disproportionately affects sleep and hearing (through its special extra features), but
muscle and tendon problems are sometimes reported (Aschermann, 2009; Lamech, 2014; Schooneveld &
Kuiper, 2007). Fluoroquinolones disproportionately affect tendons through their extra mechanisms. Statins
can do so too, though more rarely (Esenkaya & Unay, 2011; Hoffman, Kraus, Dimbil, & Golomb, 2012; Marie
& Noblet, 2009; “Tendon disorders due to statins,” 2010). Statins disproportionately affect muscle. The most
feared muscle complication is rhabdomyolysis, massive breakdown of muscle that can overwhelm the
kidneys and lead to kidney failure and death, which is also reported with fluoroquinolones though more
rarely (Eisele, Garbe, Zeitz, Schneider, & Somasundaram, 2009; George, Das, Pawar, & Badyal, 2008; Gupta,
Guron, Harris, & Bell, 2012; Hsiao et al., 2005; Khammassi, Abdelhedi, Mohsen, Ben Sassi, & Cherif, 2012;
Korzets, Gafter, Dicker, Herman, & Ori, 2006; Petitjeans et al., 2003; Qian, Nasr, Akogyeram, & Sethi, 2012;
Sanjith, Raodeo, Clerk, Pandit, & Karnad, 2012).
2933

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Table 4: Continued. 2934

Statins were commonly hailed as so safe they should be put in the water supply (Brown, 2001; Dales, 2000;
Haney, 1999; Roberts, 2004). But analysis of insurance claims data show that (focusing on the one adverse
effect) while the rate of rhabdomyolysis was rare overall, it was common in identifiable vulnerable
subgroups. Hospitalized rhabdomyolysis, per year of treatment, occurred in fewer than 1 in 22,000 on statin
monotherapy. However, the rate was far higher for older persons with diabeties also on a fibrate (a second
class of cholesterol-lowering drug); if they were on the statin agent whose clearance was most affected by
fibrates, rhabdomyolysis occurred in about 1 in 10 per year of treatment (Graham et al., 2004). So depending
on characteristics of the exposure, co-exposures, and the subject, rates of a problem—and ability for science
to show the problem—can vary widely. (The particular statin agent that caused the worst problems was
pulled from the market, but the conceptual point stands.) Risks of harm with exposures are not distributed
equally. A problem that appears very rare overall or in one test group, often apparently not increased relative
to unexposed, can be frankly common in another. If the groups most at risk are not studied or their presence
is seriously diluted, serious harms can be missed. Studies that fail to detect a harm do not invalidate those
that show one—and are not of equal importance where a purpose is to establish that harms can occur.
Rates of problems Though a minority of embassy personnel were reportedly affected (Stone, 2018), the fraction is not small
(Golden & Rotella, 2018). The fraction of U.S. diplomats in Cuba (and now China) reporting effects is higher
than the fraction of civilians citing similar severity problems with RF/MW exposure, though in neither
group can the exposure of those affected be presumed to have been typical. Table 3 suggests that once
persons are symptomatic, the profile of symptoms is similar. The reportedly high prevalence of
Frey-compatible effects and what seem a comparatively large number of diplomats in Cuba affected suggest
exposures of a more intense or more damaging character considering that intensity, frequency, pulse
waveform, pulse duration, duration, polarization, intercurrent exposures, and many other factors influence
injury from RF/MW (Belyaev et al., 2000).
Natural history Both diplomats (Associated Press in Washington, 2017) and RF/MW-affected individuals (Conrad &
Friedman, 2013; Schooneveld & Kuiper, 2007) have shown variable time course to onset of symptoms after
apparent inciting exposure and variable time course and completeness of recovery with time away from the
exposure. Doctors submitting the Bamberg Appeal to the Prime Minister of Germany noted, “The
symptoms occur in temporal and spatial relationship to exposure. . . . Some of the health disturbance
disappears immediately the exposure ceases (removal of DECT telephone, temporary moving away from
home, permanently moving away, using shielding)” (Waldman-Selsam, 2004). An intervention study from
B. Golomb

Japan, involving the “intervention” of removing a cellular phone base station on a condominium, affirms

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Table 4: Continued.

improvement with removal of the exposure. One hundred seven of 122 inhabitants were interviewed and
had medical examinations at two time points while the base station was in operation and three months after
it was removed. “The health of these inhabitants was shown to improve after the removal of the antennas,
and the researchers could identify no other factors that could explain this health improvement. . . . The
results of these examinations and interviews indicate a connection between adverse health effects and
electromagnetic radiation from mobile phone base stations” (Shinjyo & Shinjyo, 2014). Studies in Russia of
Diplomats’ Mystery Illness

occupationally affected persons report that even with treatments that target mechanism of RF/MW injury,
for those at least moderately affected, placing them back in the setting of exposure leads to a progressive
course (Sadchikova & Glotova, 1973).
Natural history could differ for diplomats who may have been exposed to a more intense stimulus or one with
more injurious characteristics—suggested by what appear to be a comparatively high number affected and a
high prevalence of Frey effects. With a powerful exposure, depressed defenses are not equally required to
produce injury. There is not a basis to know if affected diplomats will have heightened vulnerability to
“usual” RF/MW exposures going forward, though this bears assessing.
a An illustration from a common drug, and a common food: “Grapefruit juice increased the mean peak serum concentration (Cmax) of unchanged
simvastatin about 9-fold (range, 5.1-fold to 31.4-fold; P < .01) and the mean area under the serum simvastatin concentration-time curve [AUC
(0-infinity)] 16-fold (range, 9.0-fold to 37.7-fold; P < .05)” (Lilja, Kivisto, & Neuvonen, 1998). Thus, just one comparatively innocuous interacting
factor, grapefruit juice (which inhibits an enzyme involved in simvastatin metabolism), led some to have a 38-fold greater blood “amount” of a
drug, than that same person would have had without the juice. Potential differences are magnified comparing different persons with or without
juice, and more so factoring in impact of other exposures. Other risk-multiplying factors are tied to the individual. The same serum level can
produce a radically different impact from person to person; relevant factors include genetic differences in muscle and factors that reduce energy
supply or increase energy demand to muscle (Golomb, 2014; Golomb & Evans, 2008; Golomb & Koperski, 2013; Oh, Ban, Miskie, Pollex, & Hegele,
2007; Sinzinger & O’Grady, 2004; Vladutiu et al., 2006). Thus, what is the “same” exposure before it hits two people can become a radically different
exposure once it interacts with individuals’ biology.
2935

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2936 B. Golomb

exposure-related illnesses, genetic influences on phase I or phase 2 detox-

ification, as well as factors that inhibit or compete for detoxification sys-
tems, play a documented role in who develops health effects (Cherry et al.,
2002; Ishikawa et al., 2004; Molden, Skovlund, & Braathen, 2008; Page &
Yee, 2014; Rowan et al., 2009; Steele, Lockridge, Gerkovich, Cook, & Sastre,
2015). (Phase II detoxification encompasses protections against oxidative
damage.)
Table 5 briefly addresses the range of RF/MW sources that have been

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presumptively tied to problems. It observes that RF/MW/microwave radi-
ation is known to have been used on the U.S. embassy in Moscow; there is
precedent for use on diplomats (Gwertzman, 1976; Schumaker, 2013). That
instance, though with presumably differing details of exposure, led to (dis-
puted) reports of health effects in embassy staff and shielding efforts by the
United States. Since the exposing device can be outside the building—and
typically has been, for persons affected by RF/MW-emitting utility meters
(Lamech, 2014)—failure of the FBI to find devices in sweeps of diplomats’
rooms remains compatible with this explanation.

4 Discussion

4.1 Recap of Findings. Health effects reported by U.S. and Canadian

diplomats (and family members) in Cuba and China, and the circumstances
surrounding inciting episodes, are consistent with effects of RF/MW. Re-
ports of perceived sounds fit known characteristics reported for the Frey
effect (microwave auditory effect). Sounds were heard by some but not
other diplomats during inciting episodes; sounds differed in character
from person to person; sounds included chirping, ringing, and grinding;
and sounds were heard predominantly at night. Sounds were localized
with laserlike specificity in some of the cases and, within that localization,
seemed to follow people. Prominence of auditory symptoms, including
hearing loss, tinnitus, and ear pain in diplomat reports, typify reports of
injury from pulsed RF/MW. Presence of variable additional symptoms of
protean character that differ markedly from person to person, with a rel-
ative emphasis on sleep disturbance, headaches, and cognitive problems,
plus presence in smaller subsets of vision, balance, and speech problems,
are also characteristic. Affected persons in both groups report sensory
symptoms of pressure and vibrations. Persons in both groups show evi-
dence of brain injury. Reports in both indicate that some persons had prior
head injury, and brain injury may be a predisposing factor for as well as
a consequence of RF/MW injury (Heuser & Heuser, 2017; Stone, 2018).
Both show varying rates of symptom persistence. How subsequent natural
history will compare, for diplomat symptoms that might follow more in-
tense discrete exposure (a more intense exposure may produce problems in
persons who need not have relative vulnerability), versus follow repeated
less intense ones (producing symptoms, evidence suggests, selectively in
Table 5: RF/MW Source Considerations.

What kinds of RF/MW In the UCSD survey, smart meters were the dominant inciting trigger (about 50% of those 70% or so who recognized
sources affect a triggering episode), with cell phones, Wi-Fi introduction or new routers, medical radiation, and other factors also
civilians? reported (Golomb, 2015a). The range of apparent triggers has been vast, with RF/MW, and particularly pulsed
RF/MW, commonly implicated. Considering those who have communicated with us, a couple from Scotland
became affected several decades ago, after they moved to a rural area but across from a radar factory. Though they
moved away, both remain “electrosensitive” decades later. Others became affected when a cell tower was placed
next to their home. Gro Harlem Brundtland reports becoming sensitized following exposure to a malfunctioning
microwave oven in an episode that also reportedly blinded her for a year (Woolston, 2010; www.es-uk, 2012). An
Australian veteran reports that he became affected during his military service, working with radiofrequency
Diplomats’ Mystery Illness

radiation (radar workers in the military were among the first groups in whom such problems were recognized
many decades ago). One who communicated with us became sensitized in association with a job placing radio
collars on wildlife. An architect who contacted us was sensitized after several months working closely with
Bluetooth-enabled lighting devices. Parents reported to us the onset of ES in their children with Wi-Fi introduced
to the school; accommodations were denied, forcing parents to remove their children from school and move
elsewhere and forcing some teachers from their job (“Math teacher asks school to protect children from Wi-Fi,”
2015; “Math teacher raises concerns about WIFI comparing the effects to a concussion,” 2014). In Sweden and the
United Kingdom, a controversial radio system, TETRA, reportedly caused health problems in some police officers,
severe insomnia in a Swedish officer resolved when the officer’s managers noted the connection and placed the
officer in a room without the exposure (www.es-uk, 2012). Some U.S. firefighters were affected after municipalities
placed cell towers on roofs of fire stations (International Association of Fire Fighters Division of Occupational
Health Safety and Medicine, 2006): “Symptoms experienced by the firefighters have included neurological
impairment including severe headache, confusion, inability to focus, lethargy, inability to sleep, and inability to
wake up for 911 emergency calls. Firefighters have reported getting lost on 911 calls in the same community they
grew up in, and one veteran medic forgot where he was in the midst of basic CPR on a cardiac victim and couldn’t
recall how to start the procedure over again. Prior to the installation of the tower on his station, this medic had
reportedly not made a single mistake in 20 years” (Foster, 2017). The International Association of Fire Fighters
Division of Occupational Health, Safety and Medicine crafted a position paper (International Association of Fire
Fighters Division of Occupational Health Safety and Medicine, 2006), and firefighters were exempted in the recent
proposed California bill, SB-649 (Foster, 2017; “State of California Senate Bill 649 (SB-649): Wireless
2937

Telecommunications Bill,” 2017), that sought to bypass local control in placing of 5G cell towers (Foster, 2017).

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Table 5: Continued. 2938

These were not nocebo effects; many developed symptoms prior to identifying the source of the problem or, in some
cases, even being aware that the exposure existed at that time. Many had no idea the exposure had the potential to
produce problems. They were blindsided by the onset of new problems. The causes were identified by their
spatial and temporal relationship to onset, worsening, and abatement.
Reports of problems from commercial sources of RF/MW have emerged from many nations including Russia
(Sadchikova & Glotova, 1973), Korea (Cho et al., 2016), Japan (Kato & Johansson, 2012), Taiwan (Tseng, Lin, &
Cheng, 2011), Turkey (Durusoy et al., 2017), Israel (Tachover, 2013), Australia (Lamech, 2014), New Zealand
(www.esnztrust), France (Belpomme et al., 2015), England (Bergqvist et al., 1997; Eltiti et al., 2007), Ireland
(Bergqvist et al., 1997; IDEA, www.iervn.com), Spain (Bigorra, 2016; Navarro et al., 2003; Oberfeld et al., 2004),
Italy (Bergqvist et al., 1997; De Luca et al., 2014), the Netherlands (Schooneveld & Kuiper, 2007), Switzerland
(Altpeter et al., 1995; Schreier et al., 2006), Austria (Bergqvist et al., 1997; Hutter, Moshammer, Wallner, & Kundi,
2006; Leitgeb, 1998; Schröttner & Leitgeb, 2008), Germany (Bergqvist et al., 1997; Hensinger & Wilke, 2016),
Denmark (Bergqvist et al., 1997; EHS Foreningen, 2018), Sweden (Gruber et al., 2018; Johansson, 2015) where
Ericsson designer Per Segerbäck was seriously affected (Nordström, 2004), Norway (www.felo.no) afflicting
three-time Prime Minister Gro Harlem Brundtland; Finland (Hagstrom et al., 2013) reportedly affecting former
Nokia chief technology officer Matti Niemela (Nikka, 2014), the United States (Carpenter, 2014; Heuser & Heuser,
2017; Levallois et al., 2002; Woolston, 2010), where affected former Silicon Valley techies Peter Sullivan
(Harkinson, 2017) and Jeromy Johnson (Johnson, n.d.) strive to bring attention to the problem; and
Canada, where Frank Clegg, formerly President of Microsoft Canada, Inc, now CEO of Canadians for Safe
Technology—spearheads the effort toward recognition (Clegg, 2013).
Past RF/MW use and Exposure of diplomats to RF/MW is not a new phenomenon. The U.S. embassy in Moscow was reportedly radiated
diplomats with microwaves from 1953 to 1988 (other sources give earlier or later end dates), spawning U.S. efforts to shield
the embassy (Gwertzman, 1976; Schumaker, 2013). The Soviets claimed the purpose was to jam U.S. listening
devices (Gwertzman, 1976).
Based on reports of past embassy staff, a number of personnel and their offspring developed health effects, some
developed white blood cell count elevations, and a couple developed hematological malignancies (Schumaker,
2013). Elevated white blood cell counts (Aschermann, 2009), as well as depressed ones (Adams & Williams, 1976),
have elsewhere been reported in association with RF/MW, as have hematological malignancies (Dolk et al., 1997;
Hocking & Gordon, 2003), including a recent report of an occupational relationship of RF/MW to
“hemolymphatic” malignancies in the military setting: “The PF [percentage frequency] of HL [hemolymphatic]
B. Golomb

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Table 5: Continued.

cancers in the case series was very high, at 40% with only 23% expected for the series age and gender profile,
confidence interval CI95%: 26–56%, p < 0.01, 19 out of 47 patients had HL cancers. We also found high PF for
multiple primaries. As for the three other cohort studies, in the Polish military sector, the PF of HL cancers was
36% in the exposed population as compared to 12% in the unexposed population, p < 0.001. In a small group of
employees exposed to RF/MW in Israeli defense industry, the PF of HL cancers was 60% versus 17% expected for
the group age and gender profile, p < 0.05. In Belgian radar battalions the HL PF was 8.3% versus 1.4% in the
control battalions as shown in a causes of deaths study and HL cancer mortality rate ratio was 7.2 and statistically
significant. Similar findings were reported on radio amateurs and Korean war technicians. Elevated risk ratios
were previously reported in most of the above studies” (Peleg, Nativ, & Richter, 2018). There was also a news
Diplomats’ Mystery Illness

report of a “blood disorder” in a Cuban diplomat, but its character was unspecified (Robles & Semple, 2017a).
A controversial Johns Hopkins study was commissioned to assess the health of Moscow embassy personnel but was
never published in peer-reviewed literature. Staff from other Eastern European embassies were used as controls
(Elwood, 2012), a problematic control group as these are the embassies most likely to have been subjected to
similar exposures. Indeed a Freedom of Information Act request reportedly yielded claims of exposure from
employees at other embassies (Elwood, 2012). A reanalysis asserted that Russian and Eastern European
diplomats, if combined, exhibited a significant increase, relative to expectation from the general US population, in
three cancer types (Elwood, 2012; Goldsmith, 1995) that have each been associated with RF/MW exposure in
other studies: hematological malignancy (Peleg et al., 2018), brain cancer (Hardell & Carlberg, 2013, 2015; Hardell,
Carlberg, & Hansson Mild, 2011; Hardell, Carlberg, Soderqvist, & Mild, 2013), and breast cancer (Balekouzou
et al., 2017; West et al., 2013). Some complaints, such as vision problems, concentration problems, memory loss,
depression, and “other symptoms” were greater in the Moscow than the comparator group, in either men or
women or, for vision and concentration problems, in each men and women. A reanalysis concluded that the
Lilienfeld evidence in the context of other literature “support the RF sickness syndrome as a medical entity”
(Johnson Liakouris, 1998).
Current RF/MW source The source of proposed EMR/RF/MW (probably pulsed) affecting diplomats is not a principal focus of this article.
possibilities in For the diplomats in Cuba, causative RF/MW could in principle emanate from monitoring and surveillance devices,
diplomats as has been speculated for microwaving of the U.S. embassy in Moscow (Gwertzman, 1976); from efforts to jam
our listening devices, as claimed by the Soviets (Gwertzman, 1976); or from electronic weaponry, or conceivably
from innocent communications sources of the type that affect some civilians (but presumably of higher typical
pulse intensity, or shorter pulse duration, or in the setting of other exposures that amplify oxidative stress, or with
2939

some other feature that amplifies the fraction affected).

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 2940

Table 5: Continued.

Weaponry or surveillance would seem perhaps the most likely, given the apparent preferential involvement of CIA
operatives under diplomatic cover (Golden & Rotella, 2018).
Room sweep by FBI The source of the historical microwave exposure on the U.S. embassy in Moscow was also outside the embassy
yielded no devices. building. It reportedly originated from the building next door and later from the building across the street
(Lederman, (Gwertzman, 1976).
Weissenstein, & Lee, Smart meters (or banks of them), outside the room, were the number one reported instigating cause of symptoms in
2017) the UCSD survey, with other causes, including base stations or cell towers outside the home. Pulsed
RF/MW-producing devices, including so-called “Through the wall” (TTW) surveillance technology, need not be
in the room. The exposure can be short term or intermittent; it need not be continuous. For this reason, devices in
whatever their location need not remain present after health effects have been produced.
B. Golomb

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Diplomats’ Mystery Illness 2941

persons more vulnerable to free radical injury from RF/MW, at a level to

which they will likely have subsequent exposure), is not known.

4.2 Fit with Literature. Evidence for health effects of RF/MW is not
new (Adams & Williams, 1976; Bergman, 1965; Bolen, 1988; Raines, 1981).
A 1971–1972 naval report bearing over 2300 citations, many from Russia and
eastern Europe, already documented health effects of microwave/RF/MW,
emphasizing “non-ionizing radiation at these frequencies” (Glaser, 1972).

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Contrary to claims by industry-affiliated parties, copious evidence docu-
ments that radiation that is not “ionizing” can also cause health effects.
Entire sections of the 1971–1972 report were devoted to each of a num-
ber of the symptoms that diplomats are now reporting, including insom-
nia, headache, fatigue, cognitive problems, and dizziness (Glaser, 1972).
Injury from nonionizing radiation occurs also without measurable heat-
ing: nonthermal radiation (Avendano, Mata, Sanchez Sarmiento, & Doncel,
2012; Leszczynski, Joenvaara, Reivinen, & Kuokka, 2002; Markova, Hillert,
Malmgren, Persson, & Belyaev, 2005). Indeed, oxidative stress, which me-
diates nonthermal effects, also mediates thermal effects, and melatonin,
which defends against oxidative RF/MW injury, also defends against so-
called thermal injury (Bekyarova, Tancheva, & Hristova, 2009; Maldonado
et al., 2007; Sener, Sehirli, Satiroglu, Keyer-Uysal, & Yegen, 2002a, 2002b;
Tunali, Sener, Yarat, & Emekli, 2005). Moreover, other sources of heat do
not produce the same so-called thermal damage that RF/MW does (Bolen,
1988): what are deemed thermal effects may be among the manifestations
of oxidative injury. While a low percentage of individuals experience overt
symptoms from usual RF/MW, the absolute number may be vast: the frac-
tion with electrosensitivity/electromagnetic illness has been estimated at
between 1% and 5%, and is apparently rising (Hillert, Berglind, Arnetz, &
Bellander, 2002; Johansson, 2006; Levallois, Neutra, Lee, & Hristova, 2002;
Schreier, Huss, & Roosli, 2006; Schröttner & Leitgeb, 2008).

4.3 Limitations. Features of diplomats’ experiences rely on media re-

ports and one published neurological evaluation. We did not examine
diplomats; however, in conditions with highly distinctive characteristics,
the history is often the most important factor in the diagnosis, and diplo-
mats’ reports bear highly distinctive characteristics. The close matching of
these distinctive characteristics to those of persons with health problems
arising in apparent relation to pulsed RF/MW provides a basis for concern
that RF/MW exposures may underlie diplomats’ symptoms and health
conditions.
A tremendous number of physicians and scientists and entities and sci-
entific studies and government reports, in many nations and over many
decades, have identified that RF/MW causes symptoms consistent with
the spectrum now described for diplomats. Scientific skepticism about
RF/MW health effects is well represented in the literature but is of the
2942 B. Golomb

industry-fueled stripe (think tobacco): effects of conflicts of interest on re-

search results (as well as on funding, regulatory agencies, legislation and
academics) regarding RF/MW, have been repeatedly documented and de-
cried (Alster, 2015; Hardell, 2017; Huss, Egger, Hug, Huwiler-Müntener, &
Röösli, 2007; Kostoff & Lau, 2017; Leszczynski, 2015), and evidence of this
influence parallels evidence of the potent impact of conflict of interest in
medicine more generally (Golomb, 2008). In one illustrative analysis, stud-
ies of health effects of cell phones that were funded exclusively by industry

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were least likely to report a significant effect. Relative to studies funded ex-
clusively by public agencies or charities, the odds ratio was 0.11 (95% CI
0.02–0.78) (Huss et al., 2007)—that is, the odds were about a tenth as great
for a significant finding in a study in purely industry-funded studies. The
finding was not materially altered when analysis was adjusted for factors
like study quality.
Richard Smith, then editor in chief of the British Medical Journal, penned
an article “Conflicts of Interest: How Money Clouds Objectivity.” Respond-
ing to evidence tying study results on a different lucrative product (tobacco)
to conflicts of interest (often undisclosed), he suggested, “far from conflict
of interest being unimportant in the objective and pure world of science
where method and the quality of data is everything, it is the main factor
determining the result of studies” (Smith, 2006).

5 Conclusion and Implications

Numerous highly specific features of diplomats’ experiences and symp-

toms fit the hypothesis of RF/MW injury. If doubts remain, earplugs could
be issued to diplomats for use in candidate episodes (e.g. strange noise plus
ear pain); these should mute perceived noise from sonic sources (caveat: a
sound like crickets chirping may in fact be crickets chirping), but not mi-
crowave ones—which may even be intensified. Monitoring for culpable
radiation sources must sensitively capture pulsed RF/MW, including that
which may be used only on an intermittent basis. It should encompass the
2.4 to 10,000 MHz range in which the Frey effect has been reported. Per-
haps attention to diplomats’ plight can ignite awareness of the many others
affected by similar problems. Meanwhile, research documenting compat-
ible health effects of RF/MW in a subgroup may inform those caring for
diplomats and those in pursuit of causative devices.

Acknowledgments

For kindly helping to retrieve sources for this article, I thank Emily Nguyen,
Hayley Koslik, Leeann Bui, Andrea Sember, Annabelle Amos, Karl Chen,
Arthur Pavlovsky, Rebecca Hunter, and Aubrey Bunday.
Diplomats’ Mystery Illness 2943

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Received June 14, 2018; accepted July 18, 2018.