Tanning Research
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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.

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.

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 multi billion- 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 photo biologist - 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.

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.

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.

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 1980's 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 Os 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.

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 that, 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  "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.

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 1960 's, 1970 's and 1980 's. 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.

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.

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, redheaded, green-eyed person may not have the ability to develop a tan without sun burning. Unless this person can tan very slowly and not burn they should not attempt to tan. 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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