The tanning wars
My license plates on my car are personalized, the say WEAR
SPF. I thought it was an amusing plate
for a dermatologist. Today, at the end
of my day , I am walking to my car to go home and notice a business card on
the window. It is a card for a free 15
minute session at a tanning salon. Well, it
gives me the topic of today’s blog. The
reason that we dermatologists know so much about the effects of tanning is
that we used to use tanning booths quite extensively in the 50’s and 60’s for certain
skin conditions.
They were quite effective because ultraviolet light has the effect of
depressing the immune system. That is
why you are so tired after a day of sun exposure, your immune system is telling
you to sleep so that it can recover.
There are immune cells in the skin whose job it is control what it
perceives to be an invader. The inflammation caused by doing their job
sometimes causes a problem in certain skin diseases. So for years we effectively irradiated these conditions
with ultraviolet light and noticed that 20 years later the exposed areas would have premature aging and skin
cancers greater than the rest of the population. A case of we did not know for
sure, what we did not know. So this is
proven in dermatologists minds and in application. So much so we are typically very vocal about it. Apparently our message was getting through so the indoor tanning association launched an aggressive counter marketing campaign called "tanning causes melanoma HYPE." Reminiscent of conspiracy theory in application, its information is meant to promote tanning.
Even if not
mentioned, like in my last post, they will introduce information that there is
no solid evidence linking malignant melanoma to ultra violet radiation. This is
true, there is no solid evidence for a melanoma link. Anyone want to volunteer for this study? It will not happen because it would be
unethical. Regardless of that point, it is a fact, that
ultraviolet radiation will induce other disfiguring types of skin cancer like Basal
Cell and Squamous cell cancers, usually on your face. Another front is that of Sunlight induction of Vitamin D production. This is difficult to determine what is true, because we don't really know yet. Dermatologist will all agree Vitamin D is
essential and necessary vitamin. Most physician's
agree that this vitamin can be obtained through increasing dietary fish products and supplementation. My feeling is that between diet and what is
coming through the sunscreen is probably sufficient. The osteoporosis prevalent in today’s society
is not from people applying too much sunscreen. The only people I know who apply sunscreen and
practice sun avoidance to that degree would be dermatologists. Most people barely apply enough to work. Osteoporosis
etiology is probably more of a lifestyle, hormone, diuretic origin. The bone softening from vitamin D deficiency is a disease called Rickets, that was
prevalent in the days before the advent sun screen and is the reason that milk
now comes fortified with vitamin D.
Another
point of contention is the The base tan argument. True, a base tan provides about an SPF of 4. That may be helpful to you while starting
your vacation or it may be an unneeded extra dose of concentrated radiation. If you practice this behavior, be cautious
not to burn yourself as there is general agreement that burning the skin
increases your risk of neoplasm growth. We also know that ultraviolet light does cause premature aging and loss of elastic tissue cells within the skin.
Consequently, the scientific method requires
that we argue both sides until the preponderance of evidence shows that someone
wins. In most medical arenas this is done in medical journals and at annual
meetings. Since tanning is good media
copy and since it is an industry whom some peoples livelihood depends upon, the
conflicting information is played out back and forth on the news and defended vehemently on the Internet. What happens is there is too much information and there is no certainty in the public's minds.
For me as a dermatologist, it is glaringly obvious. For you, it may be a bit more challenging.
This is all your own personal decision to make. A good rule of thumb that Dr. Hogan taught
me, if you are trying to evaluate your
chances for success, Look at what similar people in similar situations did and
see what their results were. Odds are yours will be the same. The bottom line for me in helping to make your skin more beautiful is to ask yourself, what will the cumulative effects of my habits have on my skin? When you start thinking that in ten years you will not care what your habits bring you, remember what George Burns said.
making your skin more beautiful
Comments
That being said, my whole point is that tanning is a choice one can and should make with full knowledge of the consequences, which is why I support no one tanning before age 18 in a machine.
As always Doc, your information is good and your advice is sound. Keep up the good work.
Steve Chambers
Sales Training Expert
All lthe best,
Yann
Yann Vernier - Personal Coach
Scott A Bell
Another great post Peter. I certainly enjoy reading your articles. I like the link back to the George Burn's quote in another article of yours. Smart tactic.
Hypothesis: If vitamin D comes from the sun and strengthens your bones, then why is it that most of the people who develop rickets live in sunny countries?
Naturally, we know the answer is more likely relative to diet but this question could be skewed as an argument that vitamin D, in fact, does not reduce the occurence of rickets. As with all arguments, the premise is true only within the context of the specific argument. As there are so many 'arguments' on the benefits and risks of tanning booths, the public is quite naturally confused.
In the end, each individual must do their own research and make their own decision on their course of action. This, in itself, is very difficult to promote as most people prefer others to make their decisions for them so that the finger of blame (should it be needed at some future date) does not point back to themselves and, God forbid, they would need to accept personal responsibility for their decision.
Sue Crutcher, Life Empowerment Mentor
It is funny to me that this post is much closer to the center of the argument than the last one you referenced. From your previous post, one would think there was no argument at all in the medical community. Everyone was in agreement that any UV exposure was bad and to be avoided at all costs. Now, you admit that there is another side to the story.
Comparing UV with other immunosuppressive agents is as misleading as comparing heparin and aspirin as anticoagulants. This analogy will be lost on most, but Dr. Helton will surely understand that, while both do similar things, they do so in very different ways. UV is described as an immunosuppressant, but it was not pointed out that a Dana Farber study last year proved that UV exposure promoted P53 production. P53 is a protein that is vital in causing mutated cells to die off, thus preventing cancer. (Obviously, that is a simplified version of the explanation, but for those interested, there is always Google.) So, while certain aspects of UV appear immunosuppressive, other aspects are immunostimulant.
You also admitted that there is no solid evidence linking UV and melanoma. Thank you for that. You could also have mentioned the epidemiological studies indicating a reverse correlation between regular UV exposure and melanoma, but that is a pretty big step. For right now, baby steps will do.
Your suggestion that it would be unethical to study the effects of UV exposure is baseless. There were studies regarding the cancer causing properties of cigarette smoke. It was shown that cigarette smoke in the lungs caused a reduction in the same cancer fighting protein that UV exposure increases. The issue isn't ethics, it is economics. Drug companies fund the majority of the studies done today. Which one of them will fund a study showing a benefit of something you can get for free? Government funding of such studies is much harder to come by and slower to materialize.
As you mentioned, for you as a dermatologist, it is "glaringly obvious." However, I am reminded of an old saying: If the only tool you have in your pouch is a hammer, everything starts to look like a nail. There are other parts of the body besides the skin. Premature aging? Could you define that, please? What age would you use as a reference point? How are you supposed to look? Does it matter that studies have shown a link to solar elastosis and reduced death from melanoma?
Those that are interested, there was a very good presentation for CME credit at UC San Diego. http://www.grassrootshealth.org/seminar_presentations.htm has the presentation slides online for all to see. I particularly like this one. http://www.grassrootshealth.org/_download/disease_incidence%20prevention_by_serum_level_chart.pdf
Finally, it has been suggested that you can get enough vitamin D from your diet or casual sun exposure. If you think 20 or 25ng/ml is enough, maybe that is the case. If you believe the latest research, you will need serum levels of over 50ng/ml. 100IU/day of D3 provides an average boost to serum levels of 1ng/ml. So, if you want to go from 25ng/ml to 50ng/ml, you do the math. Current upper levels of recommended safe intake is 1000IU daily. There are several other points that I would like to address, but I find myself running out of time. I will try to stop back by later today.
Hypothesis: If vitamin D comes from the sun and strengthens your bones, then why is it that most of the people who develop rickets live in sunny countries? "
Susan, could you provide a link to this?
Let me first applaud Susan Crutcher for her insight.
As Dr Helton points out, the tanning salon industry is a large, for profit business BUT can't hold a candle to the size and amount of profits generated by the Dermatology industry which is staggering by comparison.
The American Academy Of Dermatology (AAD) has for years been in the news proclaiming that the "sun" is our enemy. The very same organization that will gladly sell you the right to use their seal of approval for a payment of $10,000 up-front and another $10,000 a year. And guess what? One can do their own research as to the safety of the products one wishes to display the AAD seal of approval on. Sort of like the fox guarding the hen house. The best example is the toxic sunscreen industry. Let me say it again. In my opinion, it is morally unacceptable for a physician to encourage the use of OTC products to people which they know are toxic to humans. It's been going on for years now and all in the name of "profits".
I'm old enough to remember those Lucky Strike cigarette commercials from years ago. The ones that proclaimed THEIR cigarettes were approved by 9 out of 10 doctors. Does that mean 9 out of 10 doctors back then were paid by the cigarette companies for their endorsement?
Bill:
The hyposthesis was one I simply created to make a point of 'if this, then that' with the result being whatever you want be based on how you word your original hypothesis. Main point: a conclusion may not be a complete study, only a conclusion of that specific (and, often, very carefully worded) study.
Interesting post from you by the way and very informative.
Sue
I'm appalled by the number of OTC products that are recommended by professionals that the general public 'trust' for their advice. The more courses I take and the more I read ... the more leary I am. I no longer use body washes, deodorants, colognes and perfumes; am careful with my cleaning products; reduce what I can on the 'pollution' in my home (such as 'air fresheners'; removed carpets). I don't think we have to go insane the other way, but I do feel that since our bodies are in a constant state of renewal that the reduction of chemical products in our environment will make a difference in our health.
I have never seen a tanned person over 60 whose skin looked good. Yes, I like the bronzed, sun-kissed look too but I am no longer willing to risk my health to achieve it (and I am extremely leary of spray-on tans as well).
Sue
Hackle may refer to one of the following.
Hackle, a feather plume attached to a headdress Hackle (animal), erectile plumage or hair in the neck area In fly fishing, "hackle" refers to a feather or feathers that are wrapped around the shank of a fishing hook in the creation of artificial flies. A hackle is usually wrapped at the end of the hook nearest the eye, and creates a "spiky" appearance designed to imitate an insect's legs on the surface of the water.Dr. Helton,
Why do I always feel like at least a little of what you're saying is directed at me? :-) Am I just being paranoid?
I always enjoy your posts (even if I feel like I'm being scolded). Keep up the fight doc! And, I promise I'll TRY to, to, to.......hmmm to, to, "tan less." I can't go Casper though.
Hugs,
Lisa McLellan
Sorry Susan, I read that too quickly. I understand now. You were pointing out that correlation does not necessarily mean causation. A very good point indeed.
Funny that we should be having this online conversation at this point. My wife's doctor just faxed over her lab results from yesterday's testing. She has been avoiding UV exposure due to some health issues. Around the first of April, we had her vitamin D levels tested. Her serum 25 (OH)D was 19ng/ml. Enough to prevent rickets, but low compared to what is almost universally agreed on as a lower limit. In mid April, she started on 50,000 IU of D2, once a week for 4 weeks, then she started taking 2000IU if D3 daily and has continued to do so through today. Yesterday, she went for testing again and her 25(OH)D level was 24ng/ml. Supplements just aren't enough to maintain proper levels.
Dr. Peter-
Thank you for this post. I must admit that I get fairly exhausted trying to follow all the conflicting information that is out there. Tomorrow our school is headed to the pond for a day of swimming, Thanks to your argument, I will bring the sunscreen!
Jennifer Skinner
Wardrobe Planning Expert
Again Susan, you have some wonderful insights concerning our exposure to man-made chemicals. As the U.S. population moved from the farm to the factory in the early 1900's, man-made chemicals were introduced into the diets and enviroment. It continues today and I would guess, THAT is a primary reason for many illnesses today. I read an article a year ago about a tribe of Indians who lived on an island off of Papa New Guinea. It was discovered that these people ONLY died of natural causes or by accidents. There were NO illnesses like high blood pressure, cancer of any kind including skin cancer, lung disorders, digestive disorders or obesity. NONE. They were all lean and well tanned from being in the sun all day, every day. Their diet consisted of fresh fruits and vegetables that grew on the island, fish caught fresh that day from the ocean, chickens and pigs raised locally. They even smoked tobacco however, it was grown by them locally. They used no man-made chemicals. They ALL lived a long and healthy life except for one member of the tribe. He developed high blood pressure. It was interesting to note that he was the ONLY member of the tribe who frequently left the Island to visit other countries in the Far East.
I would agree with you Susan. Perhaps our ills are caused by the man-made chemicals that surround use every day or we ingest from our foods or the pills we take. Mother nature never built the human body to tolerate all those chemicals. For the most part, I think doctors due serve a purpose when we break bones or cause trama to our bodies. Most of the other stuff that happens to humans is by our own lack of knowlege or just plain laziness to understand what's good and bad for our bodies.
You seem to have come here to argue, rather than to enter the discussion.
What's your game?
Sheridan
making your skin more beautiful
I am not an expert in vitamin D research nor am I a doctor. I am not an intern. At 47, I am a bit old for that. Working for the tanning industry? I own a small tanning salon, but that is not my primary business. I am not employed by any tanning related business or organization, if that was the implication. Anything I have stated in my previous posts, I think I have referenced to the source.
If you are referring to Clubby, I think he would probably be offended that you thought we were the same person. Reading his posts, we have very different writing styles.
Doc, I have no doubt that you believe what you have posted. Give me credit for the same. While the debate may become spirited, I haven't made it into a personal attack. I have tried to present evidence that there is another side to this story. If you doubt my anecdote regarding my wife's lab results, I would be happy to fax them to you. Send me your # in a PM and I will let you take a look at them.
Oh now Dr Helton, Chubby? This kind of sarcasm from a real doctor? You're being faced with some tough replies to your opinions and that's the best you can do, name calling? From a college educated doctor?
As for Sheridan Randolph's comment, I have entered the discussion but you see it as arguing. I'm starting to sense this blog is nothing more than a Dr Helton love fest.
Calm down people. Everyone has a right to voice their opinion. There are always at least two sides to a discussion. I spent years trying to get my children to understand this. If you want to be heard, be willing to listen.
It is very important, especially in today's world, that we do NOT take everything we hear to be the 'truth'. Personal choice based on research, not what your hairdresser or barber or best friend says, is your decision and no one else's business. If you really listen to your body, it will tell you what is right for you. Chemicals of any type rarely are. However, bear in mind, there are 'good' chemicals as well. It is sad that we have to label things 'good' and 'bad'. Bad chemicals can be good in specific situations and doses.
As with everything -- moderation is the key.
Sue Crutcher, Life Empowerment Mentor
Thank you again Susan, the voice of reason and I agree with you. EVERYTHING in moderation.
I have learned over my life to develop an opinion based on what I believe are sound FACTS. I am also human enough to listen to other's and their opinions just in case they are able to articulate additional, factual information which may modify my opinion. I find it morally disturbing when well educated humans mislead others all in the name of ego, power or money. I also find it disturbing when humans with less education make no attempt to determine fact from fiction but rather believe everything that comes out of the mouth of a human with a title.
Dr Helton and the rest of the Dermatologists in the world are now being faced with tough questions based on research and FACT. They're having a tough time answering those challenges while attempting to maintain a sense of trustworthiness among their patients. In my opinion, doctors should always strive to stay ahead of the curve, not behind it.
Here's an interesting article about what "scientists" have discovered sunscreen is doing to coral reef's. "Promoting viral infections"? Oh my, and people want to put that stuff on their kids before they go to the pond?
12-Feb-2008 - Ingredients in sun care products may be bleaching coral reefs by promoting viral infections, say scientists at the University of the Marche, Italy.
http://www.cosmeticsdesign.com/news/ng.asp?n=83206-sunscreens-parabens