JAN MESHON
CITY SUN TANNING
COMMENTS REGARDING MAYOR BLOOMBERG TANNING SALON PROPOSAL
November 17, 2013
Thank you for the opportunity to submit the following comments on Mayor Bloomberg’s proposal to change regulations on New York City tanning salons.
In general, City Sun Tanning, the salon my wife, Terry, and I opened in 2005, is fine with the city taking over oversight from the state. Most of the proposed regulations – licensing, trained operators, etc. – are steps we already take in our salon.
However, the “basis” for these regulations contains false information stating that tanning in a commercial salon is highly dangerous which a full view of the facts makes clear is not the case. Also, the very real benefits of UV exposure, indoors and out, which have been firmly established by a mountain of peer-reviewed studies, are entirely ignored or downplayed.
Therefore, we ask that the outgoing administration stop the current proceedings and allow us to work with the incoming administration, which would implement any rules and regulations passed at this time, thereby enabling us to work cooperatively with the city on regulations that will achieve the desired result of proper oversight in a fair and efficient manner without resorting to false information.
The implications of what the NYC Department of Health does in this matter go far beyond the fate of the indoor tanning industry and my small business which is my family’s and employees’ livelihood. By throwing the weight of the city behind the strange notion that sunlight, the source of all life on the planet, is bad for you, the city will be exacerbating the well-established risks of too little sun exposure which have been associated in numerous studies with increased risk of heart disease1, stroke1, breast, colon and prostate cancers2, lymphoma2, diabetes3, multiple sclerosis4, and osteoporosis5, to name a few. Diseases associated in studies with underexposure add up to more than 20,000 NYC deaths a year6 constituting the majority of deaths by disease in the city. Melanoma, on the other hand, accounts for 115 deaths a year7 and, as we’ll see, few if any of those are associated with indoor tanning.
We respectfully ask that the NYC Department of Health not pass an 11th hour effort to improperly diminish our business based on provably false information.
The comments below will focus on countering false statements and dubious assumptions in the “Statement of Basis and Purpose of Proposed Rule.”
I. “There is no such thing as a safe tan” is a false statement.
II. Commercial tanning salons do not significantly increase the risk of melanoma.
III. The Department of Health should not recommend avoiding all UV exposure because of the risk of skin cancer. UV exposure is critical to human health.
IV. Indoor tanning has known health benefits that have largely been kept from the public.
V. The city should not be actively working to diminish use of commercial sunbeds.
I. “There is no such thing as a safe tan” is a false statement.
The “no such thing as a safe tan” canard pushed by dermatologists and sunscreen manufacturers ignores hundreds of thousands of years of human history and biological evolution. A tan is protective. That is its central biological purpose.
Here’s a quote from a paper from the Proceedings of the National Academy of Science titled, “Human skin pigmentation as an adaptation to UV radiation.”8
“Development of facultative pigmentation (tanning) was important to populations settling between roughly 23° and 46°, where levels of UVB varied strongly according to season. Depigmented and tannable skin evolved numerous times in hominin evolution via independent genetic pathways under positive selection.”
Positive selection means that those that were able to tan were more likely to survive and reproduce and that we are primarily the descendents of those that were able to tan. NYC, by the way, is roughly 41 degrees north, right in the zone where the ability to tan has been essential to survival. Please keep in mind as well that humans throughout history have been getting far more sun exposure than the typical New Yorker does. And yet somehow our species has survived for hundreds of thousands of years without the aid of sunscreen.
A suntan protects from sunburn, which, unlike a tan, actually does cause skin damage. A tan may also reduce the risk of DNA damage. A detailed study that used sunlamps to induce a tan found “We here demonstrate that our irradiation regimen provides protection against erythema [sunburn] and DNA damage formation: a 4-fold higher dose was required to cause erythema, and 60% less CPD formation.”9 In other words, the risk of sunburn decreased by 75% on tanned skin and a specific mutation linked to melanoma development is reduced by more than half.
Of course, the majority of tanning salon clients and, in fact, most New Yorkers, have personally experienced that a base tan prevents sunburn. Yet our opponents have claimed in various venues that even this irrefutable fact is untrue.
Considering all the talk by anti-tanning crusaders about how UV exposure causes melanoma, the reader may find it strange that most melanoma researchers now believe that “chronic” sun exposure – regular, daily exposure such as that of outdoor workers or heavy outdoor recreational exposure – have a decreased risk of melanoma incidence and mortality. Some quotes:
“Chronic sun exposure, as observed in those occupationally exposed to sunlight, is either protective or without increased risk for the development of melanoma”10
“Some patterns of sun exposure may also offer protection, as some studies have suggested that people with heavy occupational exposure to the sun exhibit a lower risk for melanoma compared to individuals with intermittent sun exposure.”11
“Sun exposure is associated with increased survival from melanoma.12
“In this study, as in others, outdoor workers were at lower risk of melanoma than indoor workers”13
The notion that avoiding sunlight is the way to avoid melanoma is false. Ironically, the “sun-avoidance” message could increase melanoma incidence and mortality. One must ask why our opponents have not informed the NYC DOH of the overwhelming conclusion of research that people who get the most sun exposure appear to have a reduced risk of melanoma.
Not only can a tan be “safe” – it is typically protective, as per its evolutionary purpose.
II. Commercial tanning salons do not significantly increase the risk of melanoma.
The claim by tanning salons’ opposition that tanning before age 30 increases the risk of melanoma has been the centerpiece of their anti-tanning campaign and is the main underpinning of the current proposed action against us. It is provably false.
The specific claim is of a supposed 75% “increase in risk for melanoma in people who first used indoor tanning facilities in their twenties or teen years” as stated in the International Agency for Research on Cancer’s (IARC) 2006 report “Exposure to Artificial UV Radiation and Skin Cancer.”14
Before moving to the “75%” claim, it should be noted that the top-line finding of the IARC report was:
“Epidemiologic studies to date give no consistent evidence that use of indoor tanning facilities in general is associated with the development of melanoma or skin cancer.”
Let me restate that. The main finding was that tanning salons are not associated with melanoma or skin cancer.
Of course, this finding was entirely ignored in the PR campaign anti-tanning advocates have built around the IARC report and certainly not provided to the NYC DOH. But the report itself could not ignore the simple fact that almost every study they looked at – 15 of 19, to be precise – did not find a statistically significant increase in melanoma among those who had used a sunbed or sunlamps. Several studies, including the two largest, found a slight decrease in melanoma among tanners.
The “75%” claim isn’t built, however, on the full range of 19 studies but on 7 cherry-picked studies. And that 75% is a so obvious misrepresentation of the data that it is hard to consider it as anything other than a deliberate attempt to mislead the public and government officials such as this board.
Here’s the main problem. While the report blames “indoor tanning facilities” – which can only be read as meaning tanning salons – almost every bit of that 75% risk is due to use of unsupervised home equipment and “phototherapy” conducted by dermatologists.
For example, more than half of the subjects in the largest study whose data was included in the 75% figure (Walter15) did not go to tanning salons at all. Among women – who make up the majority of tanning salon patrons – Walter’s data showed that those who went to tanning salons showed an 8% decrease in melanoma, home units were associated with a 90% increase in melanoma and “medical” use was associated with a whopping 542% increase in melanoma. And that 542% increase is baked right into the 75% attributed to “indoor tanning facilities.”
The second largest study included in the 75% figure was conducted in nearby Connecticut (Chen16). A table in this study clearly shows that the majority of subjects first used sunlamps prior to 1970. The first tanning salons didn’t open in the United States until the late 1970’s so whatever type of sunlamp they used it certainly wasn’t in a commercial salon such as those you are looking to regulate. In the Chen study, those that were under 25 when they first tanned before 1970 had a 62% increase in melanoma. Those who were under 25 when they first tanned after 1970 (a group that likely contains tanning salon customers) had a 46% decrease in melanoma. And yet the combined figure of a 35% increase in melanoma was included in the 75% claim attributed to “indoor tanning facilities.”
Latitude is another confounding factor that was ignored in crafting the false 75% claim. Figure 4 of the IARC report clearly shows that increased latitude of location of study was associated with increased risk of melanoma from sunlamps. This is likely due to the much higher percentage of people with Skin Type I – people who are unable to tan – in far northern locales like Sweden. In fact, IARC’s Figure 4 indicates that there would be no increased risk at NYC’s latitude. But beyond the two large studies mentioned above (Walter and Chen), the other 5 studies selected to manufacture the 75% claim were conducted in Sweden (2 studies), Norway, Scotland and the U.K. – some of the most northerly population centers in the world.
The 75% figure is the core basis of the proposed rules. One need look no further than the IARC report itself and its underlying studies to ascertain that it indicts, not tanning salons, but home units and dermatologists’ medical use of “phototherapy.” In fact, IARC shows that tanning salons do an admirable job of managing the real risks of sunlamps, far better than dermatologists. Meanwhile, the proposed rules explicitly exempt the medical use of UV that is associated with the highest increased risk for melanoma. How is that fair to us or the public?
III. The Department of Health should not recommend avoiding all UV exposure because of the risk of skin cancer. UV exposure is critical to human health.
Skin cancer is a legitimate concern. It is also one of the diseases least likely to kill you and highly treatable if caught early. In NYC, 115 people die each year from melanoma accounting for 0.2% of deaths. According to NYS statistics, roughly two-thirds of those who die from melanoma are at least 65 years old and the majority of them men17. In other words, they are the group least likely to have ever been in a tanning salon. I would bet that if the DOH investigated they would be hard pressed to find a handful among those 115 victims of melanoma who have ever been in a tanning salon. This seriously undermines using those deaths as a rationale for further regulating tanning salons especially since, as we’ve seen above, most studies have not found a significant association between indoor tanning and melanoma.
Opponents of our industry and natural sunlight point to a supposed explosion of melanoma incidence. But these statistics may be greatly misleading. There are strong indications that the threat of melanoma, real as it is, has been overstated through overdiagnosis, diagnostic shift, and misdiagnosis.
1. Overdiagnosis. A study conducted by a Veterans Affairs Hospital18 states: “Overdiagnosis is the term used when a condition is diagnosed that would otherwise not go on to cause symptoms or death.” Regarding melanoma the study found:
“[T]he rate of diagnosis has almost tripled (from 7.9 per 100000 to 21.5 per 100000). Again, the rate of death is generally stable (little change in the past 15 years). Although there may be an element of a true increase in clinically significant melanoma, these data suggest that most of the increase in diagnosis reflects overdiagnosis. The issue of overdiagnosis is well known to dermatologists. Because almost all the new diagnoses are localized (or in situ) melanomas and because their appearance almost perfectly tracks the increase in population skin biopsy rates, overdiagnosis is likely the predominant explanation for the rise.”
2. Diagnostic shift. Levell’s 2009 study published in the British Journal of Dermatology19 echoed the above findings:
“We therefore conclude that the large increase in reported incidence is likely to be due to diagnostic drift which classifies benign lesions as stage 1 melanoma. This conclusion could be confirmed by direct histological comparison of contemporary and past histological samples. The distribution of the lesions reported did not correspond to the sites of lesions caused by solar exposure. These findings should lead to a reconsideration of the treatment of ‘early’ lesions, a search for better diagnostic methods to distinguish them from truly malignant melanomas, re-evaluation of the role of ultraviolet radiation and recommendations for protection from it, as well as the need for a new direction in the search for the cause of melanoma.”