How Do Indoor Tanning Facilities Teach Sunburn Prevention?
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 that sunburn incidence in the general population has been steadily increasing. Sunburn increased 9 percent from 1986-1996, according to the American Academy of Dermatology (AAD), and the sub-group most likely to burn was older men.
We believe that teaching people strictly to avoid the sun may be making them more likely to sunburn when they do go outside for summer activities - and everyone does go outdoors at some point. Consider:
- 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.
- Indoor tanners are educated 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 65-70 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. Those who abstain from sun exposure completely are more likely to sunburn when they inevitably do go outdoors, even if they attempt to wear sunscreen.
Smart Tanning Means Understanding Benefits and Risks
The professional indoor tanning industry promotes responsible indoor tanning and sunburn prevention as "smart." We choose not to use the word "safe." Here is why:
The word "safe" implies that one can recklessly abuse something without any fear of causing harm. And reckless abandon certainly is not the behavior the professional indoor tanning industry is teaching. In fact, we are playing a key role in successfully preventing that kind of reckless abuse. By teaching a "smart" approach to sunburn prevention that recognizes that people do perceive different benefits from being in the sun, we are able to teach sunburn prevention in a practical way that respects both the potential benefits and the risks of sun exposure.
For example, previous generations believed that sunburn was an inconvenient but necessary precursor to developing a tan. Today we know better, and we are teaching a new generation of tanners how to avoid sunburn at all costs. Again, our position: Moderate tanning is the best way to maximize the potential benefits of sun exposure while minimizing the potential risks of either too much or too little exposure.
These graphs illustrate our point. The top graph shows the conventional thinking about sunlight: that totally eliminating sun exposure eliminates risks. That oversimplification is why the $30 billion sun-care industry tells us to wear sunscreen 365 days a year, no matter where we live. But the bottom 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. What's more, this graph does not even take into account the balance between benefits and risks. That has to be part of the equation if any campaign is going to be effective.
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 -fails to recognize the positive influence ultraviolet light and sunlight have on our lives.
New research on breast cancer, prostate cancer, colon cancer 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 potential benefits of sun exposure while minimizing the potential risks of either too much or too little exposure.
Tanning is a Natural Body Process
Tanning is your body's natural protection against sunburn - it is what your body is designed to do. Many have referred to this process as "damage" to your skin, but calling a tan "damage" is a dangerous oversimplification. Here is why:
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, examined at the micro-level, that could be called "damage." But that damage on the micro-level is your body's natural way on the macro-level 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 any 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.
Saying that any ultraviolet light exposure causes skin damage is a dangerous oversimplification. It would be like saying that since water causes drowning, humans should avoid all water. Yes, water causes 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.
Dermatology industry leaders, in attempts to scare people out of the sun, often have compared tanning to smoking, making the statement that indoor tanning is like a cigarette for your skin. This hyperbole alone calls into question the credibility of overzealous anti-tanning lobbyists.
On one level, comparing the numbers is ridiculous. Smoking is related to 20 percent of all deaths in the United States and 30 percent of all cancer deaths, according to the American Cancer Society. What's more, lung cancer rates are 22 times higher for current male smokers and 12 times higher for current female smokers.
In contrast, 18 of 22 studies ever conducted on indoor tanning and melanoma have shown no connection at all, and the four that have alleged small increases in risk have all contained unexplained statistical anomalies. Additionally, the most recent study - the largest conducted to date - showed no connection between tanning and melanoma. And this study was authored by the author of one of the four studies that did allege a connection.
On another level, smoking introduces substances into your body that your body is not designed to process. In contrast, your body IS designed to process UV light, and in fact is reliant on UV exposure for natural body functions.
The public and the press look up to medical professionals as objective sources of public health information. But when dermatology industry lobbyists obscure the facts and distort the picture to attempt to influence health policy, that creates an abrogation of trust that is unfortunate for all parties involved, and the consumer suffers.
What About Melanoma Skin Cancer?
Melanoma is the only form of skin cancer that is aggressive with any regularity. But you need to understand this clearly: Melanoma skin cancer does not fit the mold of other skin cancers for the following reasons:
- Melanoma is more common in people who work indoors than in those who work outdoors.
- Melanoma most 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, most 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. We are promoting smart, moderate tanning for those individuals who can develop a tan.
What is the Truth About Skin Cancer?
You must realize that skin cancer has a 20- to 30-year latency period; the rates of skin cancer we are seeing today are a function of the ignorant misbehaviour of the 1960s, 1970s and 1980s. Recall: Society used to view sunburns as an inconvenient rite 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.
What's more, you must realize that the photobiology research community has determined that most skin cancers are related to a strong pattern of intermittent exposure to ultraviolet light in those people who are genetically predisposed to skin cancer, and not simply to cumulative exposure. That again suggests that heredity and a pattern of repeated sunburning is what we need to prevent. And that kind of prevention is exactly what the indoor tanning industry is doing effectively.
The indoor tanning industry believes that our role in teaching sunburn prevention will help to reverse the increases that largely are a result of misbehavior that took place years ago before the professional tanning industry existed and before we were organized to teach sunburn prevention.
What We Know About the Positive Effects of UV Light
Determined To Defend Vitamin D
Dr. Michael Holick took a big step forward in 2001 in making the case that sun-induced vitamin D is critical to human health.
He stood there, again, on the ballroom stage in Nashville in front of hundreds of indoor tanning facility operators, for the sixth year in a row playing a major part in Smart Tan's educational conference.
He is Boston University's Dr. Michael Holick - perhaps the world's leading researcher touting the belief that humanity, in its recent obsession over fitness and preventative medicine, has overlooked the importance of one particular vitamin - the human hormone sometimes called "The Sunshine Vitamin." We know it as vitamin D.
So Holick stood there again Oct. 25 in Nashville, reviewing what he has deemed "The Good, The Bad and The Ugly" about ultraviolet light. Many in the audience have heard him speak several times before - three, four or even five times. For any other speaker, that's a recipe for yawns. But the indoor tanning industry soaks in Holick's material each year, and Holick pours an increasing amount of energy and excitement into his talks.
And this year the tanning industry had something to be excited about. Holick is on the verge of publishing the results of research the tanning industry funded, confirming some long-believed theories about indoor tanning and vitamin D production. Call it the first giant step in the tanning industry's new effort to mount data in support of the positive effects of ultraviolet light.
"We think that in general the population is in risk of vitamin D deficiency chronically at all ages," Holick said. "Only by having adequate exposure to sunlight or taking much more vitamin D will you satisfy your vitamin D requirements."
Holick is the director of the General Clinical Research Center at the Boston University School of Medicine - a lofty, credible position in the research community. He also directs the school's Vitamin D, Skin and Bone Center. He is perhaps the world's most respected photobiologist who believes that the benefits of regular sun exposure received in a non-burning fashion outweigh the risks.
The lack of vitamin D, and what that deficiency can lead to, is Holick's main concern. Bone diseases such as osteoporosis and osteomalacia are linked to vitamin D deprivation, and researchers this year have uncovered the mechanism by which vitamin D plays a role in the prevention of breast, colon and prostate cancers.
To make his case, Holick had to attack some pretty established preconceived notions about ultraviolet light. "I think many dermatologists don't understand it. They have pseudo-information, and as a result it is easy for them to stick their heads in the sand and say that 'That is our policy: No exposure to sunlight and always wear sunscreen. End of story.' They don't appreciate the potential health consequences of that."
But now he believes he is turning the corner in getting people to recognize his work and the work of others who believe in the positive effects of sunlight. The U.S. Food and Drug Administration, for instance, is watching his work very closely. "I think that more of the research dermatologists - those that are really in the forefront of dermatology - are finally getting the message that I have been trying to get across for a long time that maybe there is in fact a benefit. And that we really need to look at both sides of the coin, that it is not simply black and white that you should not have any exposure to sunlight or tanning bed radiation."
Holick's New Research
Dr. Michael Holick presented preliminary data on three studies he completed this year at Smart Tan's educational conference at the ITA Indoor Tanning World Expo. Holick first proposed these studies in 1999 and approached the tanning industry for financial support for the project. Smart Tan did much of the early legwork, and funded 38 percent of the project. The Indoor Tanning Association - formed in 1999 to fund research and promotional efforts for the industry - made completion of the project funding possible, by funding 62 percent of the effort.
"Tanning bed exposure has both benefits and potential harmful effects if not used properly," Holick says. "The concept that Smart Tan is trying to get across is a very good one. That is, that if you want to tan, you should tan properly and intelligently and you should never, never burn."
Here is a glimpse at what Holick will be publishing in peer-reviewed medical journals in the coming months from research conducted with funding from ITA and Smart Tan:
1. UV Light Treats Osteoporosis
Holick has submitted a paper to the Journal of Gastroneurology summarizing a case study completed with funding from ITA and Smart Tan. The study is of a 61-year-old woman who came to his Vitamin D clinic who was severely vitamin D deficient and showed signs of significant bone decay consistent with osteoporosis.
"It was so severe when she came to my office she couldn't sit down, she was in tears because all her bones ached so much," Holick explained. "So what do you do? Tanning beds to the rescue.">
Using the tanning equipment donated to Holick by Tan America and puretan as part of the ITA study, Holick exposed the woman three times a week to tanning bed light, following the recommended exposure schedule for her skin type. The woman's condition improved significantly.
"The bone pain over several months gradually dissolved, and the vitamin D level increased by 700 percent, just by simply being exposed to tanning bed radiation," Holick explained.
Osteoporosis is a greater problem than many people realize. More than 25 million Americans suffer from osteoporosis, 20 million of whom are women. This debilitating disease usually leaves a person stooped over, and their activity is severely limited. Vitamin D deficiency also can cause osteomalacia, a mineralization defect that causes intense pain.
However, vitamin D alone isn't enough for good bone health; calcium helps the body absorb the vitamin. Dr. Holick's recipe: Calcium plus vitamin D plus exercise equals good bone health. Without vitamin D, the body can only absorb 10 to 15 percent of the calcium it does when healthy vitamin D levels are present. Holick's case study should be published in the next few months.
pic2And now this is how your skin tans…
There are 3 components responsible for the complete tanning process to work. UVB exposure starts the tanning process by stimulating the tanning cells (melonocytes) to produce melanin (pigment). The skin then receives oxegen from the blood stream to facilitate tanning. Finally UVA shines on to melanin to darken it.
2. Tanning Bed Light Is a Good Source of Vitamin D
For years Holick has talked about the theory of "Vitamin D Winter" - a term he coined describing the fact that there is not sufficient UVB outdoors from November through March in the Northeast for a person to even produce vitamin D.
This may explain why so much of the population is vitamin D deficient. In 1998, Holick published a paper in the medical journal The Lancet showing that 41 percent of hospital patients at Massachusetts General Hospital were vitamin D deficient.
Since that time, with funding from ITA and Smart Tan, Holick has compiled data on another group of chronically unexposed people: his own medical students, whose studies leave them little time outdoors at all. "These are people who never see the light of day," Holick explained.
Sure enough, 41 percent of his medical students were vitamin D deficient. But, upon exposure to the tanning beds in Holick's lab, the condition was corrected. Holick will be publishing a paper on this data in the near future. "It will show that tanning is a very effective way to maintain your vitamin D status," Holick said.
3. Studying UV Light and DNA
Studying the intercellular activity of tanned skin cells is a field Holick is pioneering. In the mid 1990s California Tan purchased a specialized $100,000 confocal microscope for Holick that helped him gaze into individual live skin cells as they tanned and explore this field for the first time.
Now ITA and Smart Tan have leased Holick a $100,000 genetic testing machine that will help him measure gene expression, DNA repair and chart the role vitamin D plays in the regulation of cell growth. He is closely monitoring a substance known as TGF beta which is believed to regulate cell growth. This is particularly important, given work that now suggests vitamin D may play a role in the prevention of breast, colon and prostate cancers. "We are now in the process of trying to understand how that impacts skin health and disease," Holick said. "We are now in the process of analyzing our data."
Clearing the Anti-Cancer Picture
Holick and other photobiologists are excited about new work this year that appears to have unlocked the puzzle of why sunlight exposure is linked to lower risks of many internal cancers. The research community has known since the 1940s that prostate, colon and breast cancers are less common in sunny parts of the world. While vitamin D was suspected to play a role in this, nobody understood exactly why until this year.
Vitamin D produced from sun exposure is activated in the body in the liver and kidneys. "The activated form does something else very important. It tells your cells to grow properly. Activated Vitamin D inhibits cancer growth." But researchers this year discovered something new that explains this relationship. "Breast, colon and prostate cells all activate vitamin D. That is a new concept." We now realize that not only does your kidney make it - but your colon, breast and a lot of other tissues make it as well, This is a likely explanation for the sun-cancer connection." That has Holick wondering if recommendations for vitamin D intake - which are based on maintaining bone health - should be reviewed. "There may be two levels of vitamin D deficiency - one for bone health, and one for cellular health," he explained.
Turning to the Sun
Holick's work in the mid 1990s showed that there is no reliable source of vitamin D in our diets, that vitamin D levels reported on milk cartons are overestimated half of the time and that 15-20 percent of milk has no vitamin D content at all. That leaves sun exposure and vitamin supplementation as the only alternatives.
Since it is not reasonable to assume that the entire population will turn to vitamin supplementation, that puts sunshine back into play as an important source of this important vitamin.
"With adequate exposure to sunlight, dietary vitamin D becomes unnecessary. It is remarkable how exposure to sunlight a few times a week can reduce the risk of osteoporosis, osteomalacia, muscle weakness, fractures and maybe some of the common cancers, but also induce a sense of well-being." Holick wrote in an article in The Lancet earlier this year.
And Holick is determined to get that message to the masses.