Fluorescent Lights & CFS/ME by Professor Pinching

[Guest guest]

Professor J Pinching

Associate Dean for Cornwall

Peninsula Medical School

Knowledge Spa

Royal Cornwall Hospital

TRURO

Cornwall

TR1 3HD

Low-Energy Lighting and Chronic Fatigue Syndrome (CFS/ME)

This consultation response is from Professor Pinching, Associate Dean

and Professor of Clinical Immunology at Peninsula College of Medicine &

Dentistry. I have wide experience of Chronic Fatigue Syndrome (CFS/ME), through

caring for over 4,000 patients with over 25 years, and am an experienced

clinical academic. I was Clinical Lead for CFS/ME at Department of Health during

the service investment programme and Deputy Chairman of the Independent Working

Group on CFS/ME to the Chief Medical Officer. I have no expertise in lighting

technologies.

I have, over many years, been struck by the consistency with which a proportion

of CFS/ME patients report adverse experiences in settings lit with fluorescent

lights. This is especially, but not exclusively, amongst those in whom general

light sensitivity is present; this tends to affect those with more severe

disability, but can be present in less severely affected people.

These patients have a disability that already has a pervasive effect on their

lives, and greatly constrains their functioning in all domains. It greatly

reduces their ability to achieve basic activities of daily living, to do basic

shopping, to participate in social activities with others, let alone to be able

to function within their limitations in working environments.

For most patients until now, it seems that fluorescent tubes have been most

likely to cause problems. Note that we are not talking about defective

fluorescent tubes, but about a problem resulting from the characteristics of the

light emitted when they are functioning as intended. The use of other low-energy

bulbs is not sufficiently widespread yet to have an estimate of how widely such

effects occur with other products, but patients have already expressed serious

concerns. I understand that representative organisations have heard from dozens

of people with CFS/ME who have tried to use the new low-energy bulbs, and have

had bad reactions to them.

The effect of fluorescent lighting is immediate, and it generally means that the

patient has to leave the environment (eg a store) or get the lights switched off

(eg in clinics). The symptoms evoked vary from headaches and visual distortion,

to more general increases in their wide-ranging CFS/ME symptoms, the latter

being most common. In many cases, such exposures can trigger relapses that may

last for days; I am aware of severe instances that have lasted for months.

The mechanism of this effect and its relation to the physical properties of the

lighting products is unclear. It is likely to relate to the wider sensory

distortion and overload experienced by patients with CFS/ME, probably consequent

upon altered neural processing and cognitive changes. The observations are

consistent, and were being made long before the present discussions.

As with much else in CFS/ME, this effect has not yet been researched, and it is

inadequately documented in formal research studies. It is only of late that

serious and high quality research studies are being done on CFS/ME (see the 2003

MRC Report on Research needed on CFS/ME). However, the clinical phenomenon has

been consistently noted as a feature by patients and by experienced clinicians

for years, and well before the present proposals.

The proposal to switch to low energy bulbs obviously has much to commend it in

environmental terms, but was launched with little warning, and seemingly little

prior investigation into potential health impacts, as judged by the material

provided supporting this consultation. Understandably, it has not yet been

possible to conduct systematic research studies to give more detail on the

concerns expressed by various disease groups, and the clinicians caring for

them, since the proposals were announced.

Normally, if a new product is being introduced, the onus is on those who would

introduce that product, and those who produce it, to demonstrate safety or lack

of harm. I have been troubled by some comments of those proposing this change

that seem: a) to diminish and undermine the legitimate concerns represented by

patients and clinicians; and to dismiss them because of lack of evidence. It

is of course well known that absence of evidence is not evidence of absence (of

effect).

I would argue that it is essential that those who are proposing this widespread

change in the built environment should conduct surveys and studies on the impact

of the new lighting products on those disease groups where legitimate concerns

have been raised. In this way, it can be determined the extent to which such

problems affect these populations, and in particular, if different new products

differ in the extent to which such things occur.

In the light of such evidence, proposals could be modified or safeguards

introduced to avoid creating new health problems by the mass introduction of an

inadequately researched set of products. I am sure that – with appropriate

resources – clinicians and academics with groups supporting patients with a

range of relevant diseases would be pleased to assist in obtaining such

evidence.

Yours faithfully

Professor J Pinching

Associate Dean and Professor of Clinical Immunology