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The
Argument for Smart Tanning
So much rhetoric surrounding the concern over ultraviolet light exposure
has clouded what can and cannot be said scientifically about sunlight and
tanning. Our major concern is this: The industries which profit from
creating hysteria about sun exposure have overstated the risks involved
with tanning and have denied that there are any benefits of regular sun
exposure. We believe wholeheartedly that some concern about sun exposure
is legitimate. People do need to be conscious of their sun safety habits.
But that message is lost in the current atmosphere of market- driven
paranoia about sunshine. Fear of the sun is a $5 billion industry, and
much of the hype about this
issue is driven by two misplaced agendas:
1) Financial gain.
The pharmaceutical and cosmetics industries have inundated us with the
message that sunscreen should be worn daily in any climate, watching their
sales skyrocket in the process. Sunscreen is a good product and has an
intelligent use in the fight against sunburn, but the marketing message
delivered by the companies has distorted what the facts actually say about
the proper usage of sunscreen.
2) Belief that the public can't handle the truth.
Some lobbyists are promoting the absolute stance that ANY sun exposure is
bad for you, believing that the public cannot properly figure out how to
define intelligent moderation. They figure that preaching sun abstinence
is easier than teaching the abstract concept of sunburn prevention, which
may be misinterpreted by some as blanket acceptance that
tanning and even burning is okay. But there's a flaw in that thinking. In
reality, we have observed in the past 10 years that sun abstinence only
makes people more likely to sunburn when they inevitably do go outdoors.
It appears that teaching sun abstinence is elevating the incidence of
sunburn, a conclusion supported by analysis of the dermatology industry's
own statistics. In contrast, the professional indoor tanning industry is
concentrating on finding practical ways to teach tanners and non-tanners
how to enjoy outdoor life intelligently and avoid sunburn. That is our
bottom line, and it's working. WE'RE PART OF THE SOLUTION NOT PART OF THE
PROBLEM
In reality, the professional indoor tanning salon industry is part of the
solution not part of the problem in the ongoing battle against sunburn and
in teaching people how to identify a proper and practical skin care
regimen. Our position on this issue is greatly misunderstood in the mass
media today. The information in this kit should show you clearly where we
stand on the issues and provide you with the
facts that support our positions. What's more, we'll show you how anti-
sun critics have twisted the facts to paint a distorted picture of the
issues.
WHAT IS THE PROFESSIONAL TANNING INDUSTRY'S ULTIMATE POSITION ON
TANNING?
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Our position is simple: Moderate tanning, for individuals who can develop
a tan, is the best way to maximize the benefits of sun exposure while
minimizing the risks of either too much or too little exposure. We feel
the public debate on this issue has completely lost the perspective that
some sun may be good for us, and that the risks of avoiding sunshine as a
rule over the course of one's life are greater than any risk associated
with moderate exposure. We feel the multibillion- dollar sunscreen and
cosmetics industry has benefited from the "sun scare" message, and is
overstating the risks of sun exposure to increase their profits. Either
directly or indirectly, they pay for much of
the research on this topic, and sponsor the majority of the public
relations fueling the anti-tanning sentiment.
"Since some exposure to sunlight is beneficial to your health, it is
reasonable that if you wish to be exposed to sunlight, that you can do so
with relative safety if you make sure that you do not receive a sunburn."
- Dr. Michael F. Holick
Research dermatologist and photobiologist
Boston University School of Medicine
The indoor tanning industry is at the forefront in educating people how to
successfully avoid sunburn over the course of one's life. In fact, studies
of indoor tanners have shown consistently that indoor tanning customers,
once they begin tanning in a professional salon, are up to 81 percent less
likely to sunburn than they were before they started tanning. Consider:
Sunburn incidence in the general population has increased 9 percent in the
past 10 years, according to the American Academy of Dermatology. This
increase took place despite the Academy's all-out efforts to convince
people to avoid regular sunshine. Clearly, their campaign didn't work, and
may have contributed to the increase in the number of people who are
burning.
Sunburns outdoors among indoor tanners are becoming less frequent,
according to Smart Tan surveys. Two factors explain this: 1) Tanning is
your body's natural defense mechanism against sunburn, and indoor tanners
have activated this defense against burning; non-tanners are more
vulnerable when they inevitably do go outdoors. 2) Indoor tanners are
educated by skin care specialists at professional tanning facilities how
to avoid sunburn outdoors, how to use sunscreens appropriately and how to
properly moisturize their skin. When you also consider that the majority
of people who sunburn are male, according to the AAD, and that 70 percent
of indoor tanning customers
are female, clearly, it is non-tanners who are doing most of the burning
outdoors. In the war against sunburn, tanning salons are part of the
solution, and those who promote sun abstinence may ultimately be creating
more problems.
SO IS SUN TANNING SAFE?
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Dermatology industry lobbyists have made the statements that "There is no
such thing as a safe tan" and that "Any tan is a sign of damage."
Unfortunately, both of these statements, without further qualification,
are terribly misleading. In fact, the statement that "There is no such
thing as a safe tan" is a semantic deception because the antithesis of
that statement is also not true. Avoiding sunlight completely isn't safe
either. In fact because avoiding sunlight carries risks, as does getting
too much sunlight there is no such concept as "safe" when it comes to
sunlight. The best we can possibly do is minimize the risks inherent with
either too much or too little exposure. These graphs illustrate our point.
The left graph shows the conventional thinking about sunlight, what
"sun-scare" lobbyists have drilled into our heads for more than a decade:
that totally eliminating sun exposure eliminates risks. That is why "sun
scare" lobbyists tell us to wear sunscreen 365 days a year, no matter
where we live. But the right graph is a more accurate, albeit more
complicated, description of the risk function.
The one thing we do know for certain about sunlight is that zero exposure
does NOT equal zero risk; in fact, the risks of zero exposure would be
deadly. So the risk function must be curved. The vertex of that curve
where risk is minimized is different for every person and cannot be
randomly defined. Anti-tanning lobbyists want to define it for you anyway.
Therein lies the essence of our objection to the "sun scare" campaign:
Human life is totally reliant on sun exposure, and the life-giving effects
of ultraviolet light. The question for each of us a question that nobody
knows the exact answer to is how much sun exposure is appropriate, and how
much is too much. Basing the answer to that question on the belief that
any exposure increases one's risk of
skin damage a belief that is not categorically supported in the medical
literature is naive and fails to recognize the positive influence
ultraviolet light and sunlight have on our lives.
New research on breast cancer, melanoma and other deadly diseases research
that shows that regular sun exposure may play a key part in preventing the
onset or retarding the growth of these deadly diseases supports the
position that moderate sun exposure, for those of us who can develop a
tan, is the best way to maximize the benefits of sun exposure while
minimizing the risks of either too much or too little exposure.
That is exactly why the professional tanning industry uses the word
"smart" to describe moderate tanning today. The word "safe" implies that
one can recklessly abuse something without any fear of causing harm. And
that certainly is not what we are trying to say. In fact, we are playing a
key part in preventing that kind of reckless abuse. For example, previous
generations believed that sunburn was an inconvenient but necessary
precursor to developing a tan. Today we know better, and are teaching a
new generation of tanners how to avoid sunburn at all costs. Again, our
position: That moderate tanning is the best way to maximize the benefits
of sun exposure while minimizing the risks
of either too much or too little exposure.
WHY IS INDOOR TANNING SMART?
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Indoor tanning, for individuals who can tan, is an intelligent way to
minimize the risk of contracting sunburn while maximizing the enjoyment
and benefit of having a tan. Again, we call this SMART TANNING because
tanners are taught by trained tanning facility personnel how their skin
type reacts to sunlight and how to avoid sunburn outdoors, as well as in a
salon. Tanning in a professional facility today minimizes risk because:
Commercial tanning salons in the United States and in most Canadian
provinces are regulated by the government. In the United States, exposure
times for every tanning session are established by a precise schedule that
takes into account the tanner's skin type and the intensity of the
equipment to deliver a dosage of sunlight designed to minimize the risk of
sunburn. The schedule, regulated by the
Food and Drug Administration, also takes into account how long an
individual has been tanning, increasing exposure times gradually to
minimize the possibility of burning.
That kind of control is impossible outdoors, where variables including
seasonality, time of day, weather conditions, reflective surfaces and
altitude all make sun tanning a random act and sunburn prevention more
difficult. But those who tan in indoor tanning facilities are better
educated to address these variables outdoors. A 1997 Smart Tan survey of
4,000 indoor tanners showed that indoor tanners, once they begin tanning
in a salon, are 81 percent less likely to sunburn outdoors. At the same
time, the American Academy of Dermatology reports that sunburn incidence
has increased 9 percent over the past 10 years. Clearly, the non-tanners
are doing most of the burning. All of which
shows that indoor tanning can be an intelligent part of an active
lifestyle.
WHY DON'T WE HEAR MORE ABOUT SMART TANNING THEN?
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As we mentioned, the truth about sun exposure is abstract and complicated
it is a lot easier just to tell people to avoid sunshine than teach them
how to enjoy it responsibly. Instead of teaching you how to maximize the
benefits and minimize the risks, anti-tanning lobbyists would rather
oversimplify the scenario and mislead you into believing that any exposure
is bad for you. Instead of teaching people how to live practical lives and
avoid sunburn by using sunscreen products intelligently, dermatology
industry lobbyists are preaching total sun avoidance and what we believe
is most likely a total misuse of sunscreens.
"I use it (sunscreen) everyday and recommend it to my patients."
Dr. Roger Ceilley,
Iowa dermatologist and immediate-past president,
American Academy of Dermatology
The dermatology industry's most vocal lobbyists are encouraging everyone
to wear sunscreen lotion 365 days a year no matter where they live. This
radical message which conveniently benefits the $5 billion sunscreen
industry, members of which are among the largest supporters of dermatology
industry programs may in fact cause more harm than good in the long run.
Consider: By wearing sunscreen in Iowa from November through March, Dr.
Ceilley is totally blocking his body's ability to produce vitamin D. New
research has shown that vitamin D deficiency is epidemic in American
adults today, that we do not get vitamin D from our diets and that up to
90 percent of the vitamin D in our systems comes from sun exposure.
Ultraviolet light exposure is our body's natural way, and the only
reliable way, to produce vitamin D. A study published in March 1998 in the
New England Journal of Medicine showed that more than half of all
Americans may be vitamin D deficient, and that 37 percent of people whose
diet included sufficient levels of vitamin D were still
vitamin D deficient upon testing. Vitamin D deficiency is a leading cause
of osteoporosis, a disease affecting 25 million Americans which leads to 1
million hip and bone fractures every year. In elderly individuals, such
fractures are often deadly. By encouraging everyone to wear sunscreen all
year long in any climate, the dermatology community is undoubtedly
contributing to this problem.
While the tanning industry does support the use of sunscreens as a tool to
prevent sunburn outdoors, to our knowledge there have been no long-term
studies on the toxicology of wearing sunscreen products daily. Putting a
chemical substance on your body every day, when there is no real research
to suggest that doing so is necessary, is reckless and gives every
appearance of being profit motivated. Recall, sunscreen products for years
contained the substance PABA, which was found in the 1980s to be a
carcinogen itself. Today, some sunscreen products use a PABA derivative,
Padimate O, instead. Dr. John S. Knowland, of Oxford University in
England, told the Philadelphia Enquirer in February that Padimate O can
damage human DNA in laboratory dishes, according to his research.
Women's cosmetics today almost always contain sunscreen. It is very
difficult for women to find products that do not block UV exposure. Again,
while sunscreen is an excellent product that has an intelligent usage in
the fight against sunburn, overuse of the product may have serious
consequences as well. Because most women wear foundation products daily,
their make-up may be preventing them from producing vitamin D. And because
women are more likely than men to develop osteoporosis, making up 18
million of the 25 million Americans afflicted with the disease, they would
stand to benefit even more from an increase in vitamin D production.
Vitamin D and sun exposure have been linked to lower incidence of many
internal cancers, most notably breast cancer. A 1997 study by the Northern
California Cancer Center confirmed that women who receive regular sun
exposure are 30-40 percent less likely to develop breast cancer than those
who do not receive regular sunlight. It has been hypothesized that vitamin
D formed in the body through ultraviolet light exposure plays a role in
inhibiting or retarding this disease. Previous studies have shown a
relationship between sun exposure and lower incidences of breast, colon,
ovarian and prostate cancers. This is an emerging topic and the NCCC study
has added credibility to the relationship. The dermatology community can
no longer ignore that there are in fact positive effects of regular sun
exposure, as they have in the past.
BUT ISN'T ANY TAN A SIGN OF DAMAGE TO YOUR SKIN?
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In reporting on this topic, we hope you consider that the dermatology
industry's agenda of total UV avoidance, as we mentioned earlier, seems to
be increasing the incidence of sunburn which, aside from one's heredity,
is undoubtedly the biggest risk factor for skin damage. They have defended
their position by ignoring the fact that there are positive aspects of UV
exposure and by stating that "any tan is a sign of damage." But this
statement is terribly misleading. Here's why:
Tanning is your body's natural protection against sunburn it is what your
body is designed to do. Calling a tan damage to your skin is like calling
exercise damage to your muscles. Consider, when one exercises you are
actually tearing tiny muscle fibers in your body. On the surface, that is
damage. But that damage is your body's natural way of building stronger
muscle tissue. So to call exercise "damaging" to muscles would be terribly
deceiving. The same can be said of sun exposure. Your body is designed to
repair damage to the skin caused by ultraviolet light exposure; developing
a tan is its natural way to protect against the dangers of sunburn and
further exposure.
Here's how we see it: Saying that any ultraviolet light exposure causes
skin damage is a dangerous oversimplification. It would be like saying
that water causes drowning. Yes, water can cause drowning. But our bodies
also need water; we would die without it. Similarly, we need ultraviolet
light exposure; we would die without it. It is the professional indoor
tanning industry's position that sunburn prevention is a more effective
message than total abstinence, which ultimately encourages abuse. It is a
responsible, honest approach to the issue.
BUT WHAT ABOUT THE INCREASING RATES OF SKIN CANCER?
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You must realize that skin cancer has a 20-30 year latency period; the
rates of skin cancer we are seeing today are a function of the ignorant
misbehavior of the 1960s, 1970s and 1980s. Recall, society used to view
sunburns as an inconvenient right of spring a precursor to developing a
summer tan. Society felt that sunburns would "fade" into tans, and so
tanners hit the beaches and blacktops with baby oil and reflectors. Severe
burns were commonplace. Today we know how reckless that approach was, and
the rates of skin cancer we are seeing today reflect that ignorance. But
here's something encouraging: the trend seems to be reversing. Death rates
for non-melanoma skin cancer have been declining significantly this
decade. Estimates range from 1,200 to 1,500 people down significantly from
years past.
WHAT ABOUT MALIGNANT MELANOMA?
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Melanoma skin cancer does not fit the mold of other skin cancers. Melanoma
is more common in people who work indoors than in those who work outdoors
and commonly appears on parts of the body that do not receive regular
exposure to sunlight. Heredity, fair skin, an abnormally high number of
moles on one's body (above 40) and a history of repeated childhood
sunburns have all been implicated as potential risk factors for this
disease. But because people who receive regular exposure to sunlight get
fewer melanomas, blanket statements that ultraviolet light causes melanoma
cannot be made. Indeed, some studies have found that an individual's
genetic susceptibility to sunburn, and not the actual sunburn incidence
itself, is the risk factor. Further, studies on indoor tanning have not
shown a statistically significant connection between commercial use of
tanning equipment and an increased risk of melanoma. That is important,
considering that most of the studies did not account for confounding
variables such as outdoor exposure to sunlight, childhood sunburns, type
of tanning equipment utilized and duration and quantity of exposures.
(What's more, European studies on this topic do not account for
regulations in place in the United States governing maximum exposure times
for people of all skin types.) So the professional indoor tanning industry
is doing its part to help individuals of all skin types minimize their
risks by teaching them how to avoid sunburn
at all costs.
HOW DO YOU DEFINE "MODERATE TANNING?"
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The term "moderate tanning" means something different for every different
individual, and that is an important point. The bottom line --- what we
call "The Golden Rule of Smart Tanning" --- is simple:
Don't EVER sunburn.
A fair-skinned, red-headed, green-eyed person may not have the ability to
develop a tan without sun burning. This person should not attempt to tan
then. On the other hand, most of us have the ability to develop a tan, and
the majority of us tan very easily. Moderation, in our view, means
avoiding sunburn at all costs. Going about that agenda will mean something
different to every different person. "People need to focus on their
individual risk characteristics, such as their pigmentary phenotype, their
family history, and the type and number of moles they have. I recommend
that people avoid the sun when they are clearly at high risk and that they
should enjoy a
reasonable amount of outdoor activities with less anxiety when they are
clearly at reduced risk."
Dr. Marianne Berwick,
Attending Epidemiologist
Memorial Sloan-Kettering Cancer Center
New York City
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