Opinion of Professor Anthony J Pinching, Associate Dean and Professor of Clinical Immunology, Peninsula Medical School
Low-Energy Lighting and Chronic Fatigue Syndrome (CFS/ME)
This consultation response is from Professor Anthony 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 b) 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.
Professor Anthony J Pinching
Associate Dean and Professor of Clinical Immunology