tanningtruth.com
What's driving the anti-tanning message?
Sunshine is free – it has no marketing department for its life-giving benefits. If a pharmaceutical company patented and sold sunshine, the public message we receive about it would be completely different. Instead, the professional indoor tanning community is the only entity in a position to challenge the $35 billion anti-UV industry’s total sun abstinence messaging. This explains why indoor tanning is under attack from this powerful coalition of industries who profit from the exaggerated and largely unsubstantiated anti-UV message.

Cosmetic Dermatology

The cosmetic dermatology’s powerful fear-based marketing message, which drives millions of customers into their offices, has helped grow their businesses by 320%. And the existence of the indoor tanning industry is competitive to dermatology’s multibillion-dollar phototherapy industry. Consider, according to the Journal of the American Academy of Dermatology:

  1. In 1993, 873,000 phototherapy sessions were delivered in dermatology offices in the U.S. By 1998, sessions had fallen off 94 percent to just 53,000.
  2. The cost of a single phototherapy session – which utilizes indoor tanning equipment in a dermatologist’s office – is nearly $100 per session, about 20 times more than an indoor tanning session. An estimated 1.5 million indoor tanning clients today successfully treat psoriasis in indoor tanning facilities.
  3. If tanning salons were closed, the cosmetic dermatology industry would gain up to $5 billion in phototherapy sessions which would be charged to health insurance companies and the Medicare system. (According to dermatology's own reports, psoriasis patients average 35 sessions per year at an estimated average of $85 per session.)
The dermatology industry is in a hypocritical position when it comes to indoor tanning:
  1. According to the phototherapy industry’s own practices, dermatologists use sunburning dosages of UV light for the clinical treatment of psoriasis, a non-life threatening disease. If any UV exposure were as dangerous as a recent statement from the AAD claims, then dermatologists would be guilty of violating their Hippocratic oath for using UV in burning dosages to treat purely cosmetic skin conditions.
  2. Melanoma mortality is increasing in men over age 50, but dermatology is targeting its anti-sun campaign almost exclusively at women under age 50 – the group most likely to visit cosmetic dermatology practices for its services.
  3. The American Academy of Dermatology and other skin-care groups get much of their marketing budget directly from the chemical sunscreen industry. The AAD receives millions for putting endorsement logos on chemical sunscreen products – a much-criticized "pay for play" program.

Chemical Sunscreen Industry

Chemical sunscreen is mis-marketed as a daily use product – as a "fear-based purchase" – designed to be worn 365 days a year (in daily cosmetics for women) – which has turned chemical sunscreen into a $5-6 billion business controlled by a handful of major players. Sunscreen also block as much as 99% of vitamin D production. Consider:
  1. Sunscreen does not prevent melanoma, according to the U.S. Preventive Services Task Force, which makes policy recommendations for the federal government, "The evidence is insufficient to recommend sunscreens for the prevention of skin cancer."
  2. According to the independent Environmental Working Group – a consumer watchdog group that has analyzed hundreds of sunscreen ingredients, "Most sunscreen chemicals are far from innocuous. In sunlight, some release free radicals that can damage DNA and cells, promote skin aging and possibly raise risks for skin cancer. Some act like estrogen and may disrupt normal hormone signaling in the body. Others may build up in the body and the environment."
  3. A 2008 Centers for Disease Control study showed that 97 percent of Americans have the sunscreen active ingredient oxybenzone in our urine. This ingredient has been linked to killing coral reefs, changing the gender in fish and potentially causing cancer.
  4. Chemical Sunscreen manufacturers are not allowed to advertise that chemical sunscreen prevents melanoma. So chemical sunscreen companies pay Dermatology groups millions of dollars to endorse their product and make that claim on their behalf. The AAD received an estimated $6-8 million in 2009 to help misbrand chemical sunscreen as a daily-use product.
  5. The Skin Cancer Foundation is a marketing front group organized by sunscreen manufacturers to create a "Skin Cancer Foundation Seal of Approval" which appears on sunscreen products to convince consumers into thinking their products prevent melanoma, which they are not allowed to claim themselves. The SCF website says: "For adequate protection against melanoma, non-melanoma skin cancers and photo-aging, everyone over the age of six months should use sunscreen daily year-round, in any weather."
What are the real risks of indoor tanning?
Saying that sunlight is harmful and therefore should be avoided is as misleading as saying that water causes drowning, and therefore we should avoid water.

Professional indoor tanning facilities promote balance and educate their patrons about the potential risks of UV overexposure. Consumers are required to read and sign consent forms that include warnings about potential eye damage, photoaging and skin cancer. Warning labels are found on every tanning device and almost always in other general areas. Professional tanning facilities require parental consent for teenagers who tan even though most states don't require this measure.

While this serious approach to caution is just good sense, it needs to be noted that understanding the risks of UV exposure is not as straightforward as some suggest. Consider: Research has not established a "causal" relationship Between Melanoma and Indoor Tanning.

Melanoma skin cancer is the most aggressive of the three major categories of skin cancer, accounting for only 5 percent of all skin cancer cases each year, but responsible for a majority of skin cancer fatalities (Approximately 8,000 annually).

While melanoma has captured a great deal of public attention in the past 15 years, much of the discussion has been oversimplified in stating that melanoma is caused by overexposure to sunlight. In fact, the exact nature of the relationship between melanoma and ultraviolet light remains unclear, and the mechanism by which the two are related is still unknown – which is why some independent dermatology researchers even question whether the two are related at all.
  1. While it is believed that melanoma is somehow related to ultraviolet light exposure, this relationship is not straight-forward and the photobiology research community still does not know how it works. That’s because while a minority of associative survey-studies have suggested a correlation between UV from indoor tanning and melanoma, no direct experimental evidence exists to show a causative connection. Even American Academy of Dermatology spokesperson Dr. James Spencer admits, "We don’t have direct experimental evidence" connecting indoor tanning and melanoma.
  2. Melanoma is more common in people who work indoors than in those who work outdoors, and those who work both indoors and outdoors get the fewest melanomas. Because this is true, the relationship between melanoma and sunlight cannot possibly be clear-cut. If it were a clear-cut relationship, outside workers would have higher incidence than inside workers. But the opposite is true.
  3. Melanoma most commonly appears on parts of the body that do not receive regular exposure to sunlight. Again, because this is true, the relationship between melanoma and sunlight cannot be clear-cut. If it were, melanomas would appear most often on parts of the body that receive the most sunlight.
  4. 18 of 23 epidemiological studies ever conducted attempting to correlate indoor tanning and melanoma incidence show no statistically significant association – including the largest independent study, a 2005 multi-ethnic international European study which reported, "The relationship between UVR and melanoma is very complex and, despite many studies on the topic, remains a controversial issue. 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. In conclusion, sunbed and sun exposure were not found to be significant risk factors for melanoma in this case–control study performed in five European countries."
  5. A 2009 opinion paper published by an ad-hoc working group representing the World Health Organization’s International Agency for Research on Cancer has been widely misrepresented in the media. That report’s actual conclusion stated, "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." While the report attempted to suggest that performing a meta-analysis of the old data showed a 75 percent increased risk for those who started tanning at an early age, the authors failed to disclose that conclusion failed to take into account that removing those with skin so fair it cannot tan – called Skin Type I – from the analysis made the overall results statistically insignificant.
    1. Dr. William Grant, founder of the Sunlight, Nutrition and Health Research Center in San Francisco, published a peer-reviewed critique of the IARC report showing that, after adjusting for skin type, the analysis showed no increased risk with indoor tanning.
    2. Closer analysis of IARC report data (by Dr. Mia Papas and Dr. Anne Chappelle) – when separated by unsupervised home tanning equipment verses usage in indoor tanning facilities and medical usage of tanning equipment in doctor’s offices – reveals that no statistically significant increase in risk (6 percent) was attributable to commercial tanning facility usage, while larger increases (40 percent and 96 percent) were attributable to home and medical usage of tanning equipment.
  6. A 2010 University of Minnesota study on fair-skinned Minnesotans claimed to show a connection between tanning and melanoma but actually supported Grant’s point that UV-related risk seems centered on the fairest skin type. But the study also showed that those who got the most outdoor sun exposure had the lowest risk of melanoma – a divergent conclusion to the rest of the paper underscoring that whatever relationship UV and melanoma may have is still not understood.
  7. The relative risk of melanoma is very small – much less than 1 percent and very close to the relative risk for non-tanners – and is often misreported. As reported in the Wilmington News Journal, "Even the IARC’s strongest study – which followed more than 100,000 women over eight years – found that less than three-tenths of one percent who tanned frequently developed melanoma, while less than two-tenths of one percent who didn’t tan developed melanoma. Almost all the other studies in the report did not establish a strong link between the two. The overall risk of contracting melanoma – whether using tanning beds or not – remains well under 1 percent. For that reason, using the 75 percent statistic is misleading, said Dr. Lisa M. Schwartz, general internist at Veterans Affairs Medical Center in VT and co-author of "Know Your Chances," a book on understanding health statistics..."Melanoma is pretty rare and almost all the time, the way to make it look scarier is to present the relative change, the 75 percent increase, rather than to point out that it is still really rare."
  8. "Absolute risk just tells you the chance of something happening, while relative risk tells you how that risk compares to another risk, as a ratio. If a risk doubles, for example, that’s a relative risk of 2, or 200 percent. If it halves, it’s .5, or 50 percent. Generally, when you’re dealing with small absolute risks, as we are with melanoma, the relative risk differences will seem much greater than the absolute risk differences. You can see how if someone is lobbying to ban something – or, in the case of a new drug, trying to show a dramatic effect – they would probably want to use the relative risk."-Ivan Oransky, M.D.
  9. The American Cancer Society’s key document measuring cancer rates in the United States – "Cancer Facts and Figures" – says that melanoma rates have not increased since 2000 and that rates are declining for women under age 50 - the opposite of what anti-tanning lobbying groups claim. "During the 1970's, the incidence rate of melanoma increased rapidly by about 6 percent per year. However, from 1981-2000, the rate of increase slowed to 3 percent per year and since 2000 melanoma incidence has been stable," the ACS "Cancer Facts and Figures 2008" reports. "The death rate for melanoma has been decreasing rapidly in whites younger than 50, by 3 percent per year since 1991 in men and by 2.3 percent per year since 1985 in women."
  10. A paper published by the British dermatology community in 2009 showed that "diagnostic drift" and more aggressive screening are responsible for the increase in "reported" melanomas, but that there isn’t an actual increase in thick melanoma lesions, which explains why the mortality rate is not increasing. According to the authors, "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.
  11. Many scientists and dermatologists have taken firm positions that melanoma's connection to UV light is unclear or doesn't exist at all. Dr Bernard Ackerman – a pioneer in dermatology pathology who was recognized as a master dermatologist by the American Academy of Dermatology – the Academy’s highest honor – insists there is no evidence connecting UV and melanoma in his monograph, "The Sun and the Epidemic of Melanoma: Myth on Myth. According to Ackerman:
    1. "The American Academy of Dermatology, for decades, has kept up a drumbeat on behalf of faith in an epidemic of melanoma and rays of the sun as the major cause of it, at the same time that it has flayed, incessantly, the tanning bed industry. Although the organization is termed an Academy, never has it presented in fashion academic a whit of evidence, available readily, contrary to its position entrenched, namely, there is no epidemic of melanoma and that tanning beds have not been proven to be a cause direct of melanoma."
    2. "There is no proof whatsoever that blistering sun-burns, no matter the number and even in childhood, enhance risk for development of melanoma and there is no evidence at all that sunscreens prevent development of melanoma. What is more, it has yet to be established that exposure excessive to sunlight (or sun lamps and tanning beds) alone, in the absence of inclination genetic, causes melanoma."
  12. Dr. Sam Shuster, Emeritus Professor of Dermatology at the University of Newcastle, penned "The Skin Cancer Cover-Up" to point out that there is no hard evidence that UV is the cause of melanoma or that there is an actual increase in melanoma incidence.
  13. Dr. Arthur R. Rhodes, Professor of Dermatology at Rush Medical College, in Chicago, believes that melanoma’s public message needs to stop focusing on UV light – pointing out that UV-melanoma campaigns are killing people who get melanoma who failed to recognize the disease because they never spent time in the sun.

UV Light Does Not Deserve the Blanket Label of 'Carcinogen'

The U.S. National Institutes of Health’s National Toxicology Program in 2000 placed ultraviolet light on the federal government’s list of known human carcinogens. In July 2009 the World Health Organization wrote a brief report also declaring that UV light is a Class I carcinogen – a list that also includes red wine, birth control pills, salted fish and other highly used substances that, when experienced in their intended dosages, do not elevate cancer risk. Much like the NIH listing in 2000, WHO erred in not pointing out that the "list" doesn't mean a substance is dangerous in every-day dosages, but only potentially in "overexposure" situations.
  1. The listing does not mean that moderate tanning will cause skin cancer. The NIH listing criteria shows us why: "The Report does not present quantitative assessments of carcinogenic risk. Listing of substances in the Report, therefore, does not establish that such substances present carcinogenic risks to individuals in their daily lives." This exclusion – in the absence of any direct experimental research on indoor tanning and melanoma – makes this listing almost meaningless.
  2. The list does not take into account that there are positive effects to ultraviolet light exposure. Many forms of cancer – including breast, colon, prostate and ovarian tumors – now appear to be retarded or even prevented by regular exposure to ultraviolet light. This omission on the NTP list is conspicuous, given that positive effects are listed for other substances in the government's list of carcinogens that have positive effects, such as the breast cancer drug Tamoxifen, which is a Class I carcinogen.
  3. As a result, thousands of news reports suggest that "sun tanning is as dangerous as tobacco" – a blatant misrepresentation.
    1. Smoker’s risk of lung cancer: 15 percent – or 2,000 percent higher than that of non-smokers. Smoking introduces up to 60 man-made known carcinogens into the body – substances the body was never designed to process. Smoking is related to 1 in 3 cancer deaths.
    2. Tanner’s risk of melanoma: 0.3 percent – compared to 0.2 percent for non-tanners (a difference of 1 in 1,000) The body needs ultraviolet light to survive – calling it a carcinogen without that caveat is totally misleading.
  4. One thing we know for certain: You would be dead today if you did not receive any ultraviolet light.
How does indoor tanning work?
Indoor tanning equipment, like outdoor sunlight, emits UVA (ultraviolet A) and UVB (ultraviolet B) light. Of the UV light emitted by the sun at noon in the summer in the United States: 95 percent is UVA and 5 percent is UVB.

More than 90 percent of professional indoor tanning units emit about 95 percent UVA and 5 percent UVB in regulated dosages similar to summer sun. Recommended exposure schedules developed by the U.S. FDA in cooperation with the tanning industry allow trained indoor tanning operators to set incremental exposure times, based on the "skin type" of a patron, that deliver consistent non-burning dosages of UV light to allow a tanner to gradually build a tan.

The statement that "indoor tanning units are more intense than sunlight" is misleading and inaccurate because the total output of a tanning unit is measured the following way:

Total UV Output = UV Intensity x Duration of Exposure

While tanning units may be 2-3 times as intense as summer sun, the duration of exposure is controlled, and thus the total UV output is controlled, to minimize the risk of sunburn. Exposure times in the more intense tanning units are calculated in similar fashion.

A typical indoor tanning exposure schedule (below) allows a professional indoor tanning operator to gradually increase the exposure times of a tanner over the course of the tanner’s regimen based on the individual’s skin type.

Recommended Exposure Schedule

Skin Types Week 1 Week 2 Week 3 Week 4
Skin Type I Unable to tan. Do not expose Skin Type I to indoor tanning.
Skin Type II 3 minutes 5 minutes 8 minutes 12 minutes
Skin Type III 3 minutes 5 minutes 8 minutes 15 minutes
Skin Type IV 4 minutes 8 minutes 13 minutes 20 minutes
Skin Type V 5 minutes 9 minutes 16 minutes 20 minutes
Skin Type VI 6 minutes 10 minutes 16 minutes 20 minutes


Less than 5 percent of North Americans are what is called "Skin Type I" – which includes people of Northern European heritages (some Irish or English people, for example) whose skin is so fair that it cannot tan without burning. North American indoor tanning protocol is not to allow these people to tan in salons, and our skin type questionnaire identifies them. If they wish to tan, they are advised to use non-UV self-tanning products.

In professional North American tanning facilities today:
  1. Trained operators control all tanning exposure times, minimizing a client’s risk of overexposure and sunburn, and require tanners to use FDA-compliant protective eyewear, which eliminates the risk of eye injury.
  2. All clients undergo comprehensive evaluations, including identifying their sun sensitivity (skin type). Clients also are taught about photosensitizing medications, which can potentially make a person more susceptible to sunburn.
  3. Clients are taught sunburn prevention and the appropriate use of outdoor sunscreen. Combined with the fact that a tan is nature’s protection against sunburn, this is why indoor tanning clients are up to 81 percent less likely to sunburn outdoors as compared to non-tanners, according to Smart Tan surveys.
  4. Clients are presented with material outlining the potential risks of overexposure to UV light and sign informed consent agreements acknowledging this.
Because of all these safeguards, the professional indoor tanning has an exemplary safety record: From an estimated 6 billion indoor tanning sessions from 1985-2006 only 142 adverse events are reported in U.S. federal records – most occurring before 1997. That’s an injury rate of 0.0000000236 – or less than one report in every 44 million sessions over a 21-year period, with most of the reports coming in earlier years.
Are there any benefits to indoor tanning?
Professional indoor tanning salons understand that it is inappropriate to make direct health claims about indoor tanning or to suggest there are no risks associated with UV exposure from any source. But regardless of what a facility can say about its services, surveys show many indoor tanners utilize tanning for more than just the cosmetic tan.

Tanning: Nature’s Sunscreen

One reason so many people enjoy the professional indoor tanning experience is that trained operators can give a tanner controlled UV exposures to gradually develop natural sunscreen – often called a "base tan" – while minimizing the risk of sunburn. The tanning process actually creates two different forms of natural protection against sunburn:
  1. Melanin pigment produced when UV light meets the skin literally enshrouds and shields skin cells in the skin’s epidermis, protecting each cell from getting too much UV exposure. Melanin is a powerful anti-oxidant, helping the skin naturally eliminate free-radicals that can cause damage.
  2. As the skin tans, the outer layer thickens (a natural process called acanthosis) which is nature’s design to make the skin naturally more resistant to sunburn.
The value of a base tan, as any indoor tanner knows, is that it adds another layer to your sun protection arsenal – making sunscreen worn outdoors for outings on sunny days even more effective. Here’s how that works:
  1. A typical new client begins tanning with 5-minute sessions, gradually develops a tan and can work her/his way up to 20-minute sessions. At this point, she/he becomes naturally FOUR TIMES more resilient to sunburn than when she/he first started tanning. (5 minutes x 4 = 20 minutes). So that tan has an SPF 4 value.
  2. When someone with a base tan uses sunscreen outdoors, they essentially multiply the effectiveness of the sunscreen. In other words, an SPF 15 product applied to the skin of a person whose base tan has already made her four times more resilient to sunburn creates a net SPF of 60. (SPF 15 x 4 = SPF 60).
In sunny environments many fair-skinned people can sunburn during normal outdoor activities even while wearing sunscreen. But with a base tan their sunscreen becomes more effective and they are much less likely to sunburn.

Casual Self-Treatment of Cosmetic Skin Conditions

Millions of indoor tanning customers frequent U.S. indoor tanning salons for their own self-treatment of cosmetic skin conditions and other non-cosmetic tanning reasons - physiologic benefits that can occur when one follows the cosmetic regimen at a tanning facility. According to a 2010 Smart Tan survey:
  1. More than three million consumers frequent tanning salons for self-treatment of psoriasis, eczema, acne, vitiligo, seasonal affective disorder (SAD) and to increase vitamin D levels.
  2. Approximately one million indoor tanners said they were referred to tanning facilities by their dermatologist.

Could Indoor Tanning Be a Surrogate for What Nature Intended?

Vitamin D production is one of the benefits that has been associated with human exposure to ultraviolet-B (UVB) emitted in sunlight and by an estimated 90 percent of commercial indoor tanning equipment. While the North American indoor tanning industry conducts indoor tanning as a cosmetic service, an undeniable physiological side effect of this service is that indoor tanning clients manufacture sufficient levels of vitamin D as a result of indoor tanning sessions.
  1. Vitamin D is a hormone produced naturally when skin is exposed to UVB in sunlight or indoor tanning units. Scientists through thousands of studies now recommend vitamin D blood levels of 40-60 ng/ml. Only those who get regular UV exposure have those levels naturally:

    Indoor Tanners...........................42-49 ng/ml...........................Sufficient
    Non-Tanners................................23-25 ng/ml...........................Deficient
    Dermatologists...........................13-14 ng/ml...........................Severe Deficiency

  2. Vitamin D sufficiency is linked to a reduction in 105 diseases, including heart disease, diabetes, multiple sclerosis and most forms of cancer. It is believed that vitamin D deficiency contributes to nearly 400,000 premature deaths and adds a $100 billion burden to our health care system.
  3. 77 percent of Americans are considered vitamin D deficient according to government data and overzealous sun avoidance is the only plausible explanation for the 50 percent increase in that figure in the past 15 years.
The indoor tanning industry believes that, for those individuals who can develop tans, the cosmetic and vitamin D-related benefits of non-burning exposure to ultraviolet light in appropriate moderation outweigh the easily manageable risks associated with overexposure and sunburn. Many doctors agree: "I believe the health benefits of exposure to UVA and UVB rays greatly outweigh the disadvantages, even if that means using a sunbed during winter months." -British Oncologist Dr. Tim Oliver