Wednesday, October 12, 2011

The New Merchants of Death

Why buy your carcinogens when you can get them for free?

Imagine a place where a child is allowed to buy cigarettes for herself, with only a permission slip from her parents.  In many instances, she may smoke her first pack with her mom -- a popular mother-daughter bonding activity. The tobacco industry is completely unregulated, minimizing the risks and touting the health benefits of cigarettes.  A popular T.V. celebrity extols the virtuals of the GTL lifestyle -- Gym, Tobacco, Laundry.

Sounds like a scene from a developing country?  Substitute "indoor tanning" for "cigarettes," and what I've described takes place in all 50 states in the U.S.  The comparison of tanning salons to smoking may sound like hyperbole, but consider the similarities:

Indoor tanning causes cancer. 

A 2007 meta-analysis of 19 studies in over 7,000 patients found that indoor tanning is associated with a 15% increased rate of melanoma, the deadliest of all skin cancers.  That may not sound like much, but when the analysis looked specifically at indoor tanning in those under 35 years old, there was a 75% increased rate of melanoma.  There was also a higher risk of squamous cell carcinoma, which is not as lethal, but more common.

Most of these studies were "case-control," meaning they looked at the rates of indoor tanning in those who had been diagnosed with melanoma versus those who hadn't.  Sure, you could argue that these findings weren't based on randomized, controlled trials, and that people who go to tanning salons are also more likely to sunbathe (just as smokers are more likely to drink and overeat).  But there is also a large body of laboratory evidence that UV radiation, whether natural or artificial, induces skin cell mutations, the first step in carcinogenesis. 

The tanning industry minimizes risks and promotes questionable health benefits.

Just as the tobacco companies marketed filters for "safer cigarettes," so the tanning industry pushes the concept of the "safe tan."  Many companies claim to use only UVA, which is less likely to cause sunburns than UVB.  The problem is that both forms of radiation are carcinogenic.  Moreover, one can still get burned in a tanning booth, and there are even case reports of patients requiring treatment in a burn unit following indoor tanning. 

The other argument for a "controlled" indoor tan is that the increase in melanin protects against burns from natural sunlight.  Many people using tanning booths to prep themselves for sunbathing.  A tan is indeed protective against a sunburn, with a whopping SPF level of 3.  Do they even make sunscreen with that SPF level?  Increased use of tanning beds has also been associated with more frequent sunburns, so any so-called protective effect is a myth.

One fascinating review compared the advertising tactics of the tobacco and tanning industries.  Both, for example, use physicians in their ads:

Text: "After working 16-hour shifts for my residency,
I tan because it recharges me for work tomorrow."

More recently, the industry has trumpeted the benefits of tanning on raising vitamin D levels:

This claim is wrong on so many levels.  Vitamin D deficiency is most frequently seen in the elderly and housebound, not exactly the GTL demographic.  You need only 15 to 45 minutes a week of sunlight in order stimulate adequate vitamin D production; a 15 to 30-minute indoor tanning session is equivalent to a day on the beach.  Finally, only UVB stimulates vitamin D production.  If a tanning salon advertises that it uses only UVA, then the vitamin D argument is patently false.

The tanning industry targets youth. 

A recent study showed that 10% of kids ages 12 to 18 have used a tanning bed at least once in the previous year.  The figure is highest in teenage girls ages 15 to 18, with a 25% indoor tanning rate.  The incidence of melanoma is increasing more rapidly than that of any other cancer in the U.S.  Take a wild guess which population is fueling this rise: young females, with a 2.7% annual increase.

Everyone in my generation remembers Joe Camel.  But even old Joe wouldn't stick his oversized proboscis into a kids' magazine.  Not so with tanning salons.  A survey of high school newspapers in the Denver area showed that almost half carried ads for indoor tanning:

Indoor tanning can be addictive.  

In a survey of 229 college students who used sunbeds, almost 40% met psychiatric criteria for addiction to indoor tanning.  When we're exposed to light, our brain produces melanocyte-stimulating hormone (MSH) in order to ramp up production of skin melanin.  A byproduct of MSH production is beta-endorphin, a natural opioid.  Many users report a sense of relaxation and well-being following a round of indoor tanning, and you can actually block this euphoric response by administering an opiate antagonist.

Daylight saving time is ending soon, and many will be tempted to catch their rays indoors.  This week, California became the only state in which minors will not be allowed to indoor tan (starting in 2012), even with parental permission.  For those of you in the remaining 49, ask yourself: Would I buy cigarettes for my teenager?  If the answer is no, then you know what to do with that tanning permission slip.

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