There's a strange health tug-of-war going on. Doctors are now telling us to get back into the sun for better health since a large majority of Americans are being deprived of natural vitamin D and other benefits associated with sunshine. Meanwhile, the cosmetic dermatology industry seems to be turning up the heat on their "stay out of the sun, wear sunscreen 24/7" message.
Who's a person to believe?
With balance and common sense seeming pretty obvious, it calls the question: What's really behind the 'sunshine is killing us' message that's pouring out of dermatologists' mouths, via the media, these days?
With the summer months upon us I wanted to find out firsthand what exactly the mantra is that dermatologists are telling patients. So I went undercover to several San Francisco dermatologists in order to see if there is legitimate concern about the sun-scare media hype. Are these doctors being sensible or going overboard when it comes to advice on sunscreen use and skin cancer prevention? Is the sky falling with dangerous UV rays or are we being induced into a media panic?
Let's journey on into the heart of mole darkness and find out.
Dermatologist Appointment #1: Marina District
My first dermatology stop is in the posh San Francisco neighborhood near Union Street. With nothing to read but Botox literature, I'm made to wait in the pristine reception area for a good hour. This place feels more like a cosmetic spa than a doctor's office. With all these pamphlets on wrinkle elimination, the dermatologists' message seems to be centered on beauty rather than health issues. My excuse for wanting an appointment is to get my moles checked out. The message dermatologists constantly trumpet is that moles should be frequently checked for malignant melanoma. Except these are ordinary moles I've had my entire life.
Finally my name is called.
I'm then made to wait another 20 minutes in the examination room. The dermatologist finally comes in. I take off my shirt and point to my moles. She immediately determines that they don't look cancerous. I press her by saying the mole under my arm is of concern because it rubs against my clothes. She takes a closer look. Then mentions we need to get approval from insurance so that I don't get stuck with the bill. It takes a week to get their permission and it must be for medical reasons. She decides to bill them for the removal of a couple of moles. "I don't think they'll balk at that," she said.
I then point to another mole that gets irritated on clothes and ask if she can get my insurance to pay for that. She asks if it's sensitive or itchy. Itchy, I say. She's pretty sure insurance will cover an irritant mole. Bingo! We go with irritant.
Besides being advised that I should never go into the sun without wearing a visor, sunglasses, long sleeves and sunscreen (which needs to be reapplied obsessively every few hours), I can get my non-cancerous moles removed because they are an irritant. (A week later I find out that my insurance approved the removal of these two non-cancerous moles--I'm added to the reported melanoma statistics.)
It happens more often than you might think. A quick Google search shows that in the past years several dermatologists have been sent to prison for flat-out lying about skin cancer to their patients; slicing up healthy skin for insurance dollars. Do these cases show there's money to be made in cutting off skin lesions and calling them cancer? Is this a factor why skin cancer numbers might seem overinflated? Do the numbers add up when you start digging?
A May 2010 study in the Journal of the National Cancer Institute listed melanoma as one of five cancers over-diagnosed by doctors. Though doctors are removing more and more skin lesions, researchers pointed out that melanoma mortality rates haven't increased since 1975--with insurance companies paying for the procedures.
A 2009 British Journal of Dermatology report also concluded: that melanoma isn't increasing in actual incidence, but merely in reported incidence. What the report found was doctors were simply reporting and removing more lesions that may not actually be cancerous.
Would this explain why the United States has just 4.5 percent of the world's population but has 52 percent of the world's melanomas when you compare the American Cancer Society's numbers (68,720) with those from the World Health Organization (132,000 worldwide)? In contrast, both melanoma and non-melanoma skin cancer have been declining in Canada. A University of Alberta study this year showed that non-melanoma skin cancer incidence in Canada has been declining for a generation. Riddle me this: how is it possible the U.S. estimates more-than-triple while Canada's real numbers are actually declining? Has the U.S. dermatology-induced media scare propagated more dermatologist visits in our for-profit health care system or are a larger number of Canadians simply staying inside to watch their beloved championship curling teams?
Regardless, by having just a few cosmetic moles chopped off, my dermatologist was able to fix it so my insurance company would foot the bill.
Dermatologist Appointment #2: Fillmore District
More literature on Botox. More pamphlets on wrinkle elimination. More tips on how to look young and pretty. But, unlike the previous dermatology office, after I quickly fill out my paperwork I'm immediately whisked into an examination room. When I tell the dermatologist I'm concerned about moles, she asks me if anyone in my family has ever had skin cancer. I tell her they have. She then asks whether it was melanoma or not. I wasn't sure. She told me that people die from it, but that it depends on the stage its diagnosed. She throws out a figure, "It's the fourth-leading cause of death due to cancer."
That sounds pretty severe--I mean death is as extreme as it gets. But according to the National Cancer Institute, melanoma only contributes just 0.1 percent of all cancer deaths--it isn't even in the top 15 when it comes to cancer.
This past spring the Association of Health Care Journalists called into question dermatology's math about melanoma. AHCJ reported a person's risk of melanoma is identified at roughly two-to-three per thousand. (Whether they catch sun outdoors or in a tanning bed.) Melanoma is quite rare and it's actually declining in most of the population, except for older men, who get it most often. Oddly, the media marketing campaign for skin cancer prevention is aimed almost entirely at young women, who have less than a one in 100,000 chance of succumbing to melanoma. According to the National Cancer Institute's data, that number has actually gone down more than 50 percent in women 20 to 49 since 1975.
And yet, dermatology leaders regularly state that melanoma is the fastest growing cancer in women between the ages of 25 to 29 -- ignoring men, the group most at risk, altogether. Is there a correlation between young women being the largest consumers of skin care products as well as being the largest demographic group scared into dermatologists' offices to have moles removed? (And Botox injections--the fastest-growing procedure in dermatology today.) Is there a connection between dermatologists getting more press over skin cancer than heart disease or other top cancer killers that have no connection to the multibillion-dollar cosmetics industry?
Back to my appointment: The dermatologist continues to examine my non-cancerous moles. Unlike my previous appointment, she tells me that if I want the moles removed it would be a purely cosmetic procedure and my insurance won't cover it. I press the irritated issue. Candidly, I ask her if she could simply write it up as being cancerous so my insurance will cover it. The dermatologist says she won't but admits a big flaw in the system. She was certain they don't cover it. She told me point blank that I could go to some dermatology offices that may lie and say it's irritated but she won't do that.
I then ask what measures I should take to prevent skin cancer. I'm told to apply sunscreen 24/7, wear a hat and sunglasses, as well as avoid the sun as much as possible. (The only thing she doesn't mention is to live underground with the mole people.) I ask her if she wears sunblock. She does, SPF 30 and higher. She reminds me to reapply. I told her I read that some sunblocks are bad for you. "We don't believe that," she said. "The sun is more harmful."
Human beings and our predecessors have been living and working under the sun for millennia. This advice seems like de-evolution. Are we experiencing Darwinism in reverse? Now we're being told to use chemical sunscreen products on a daily basis--even when a sunburn isn't possible.
Some sources suggest that the rise in skin cancer cases is due to the excessive use of sunscreens due to the toxic ingredients that we've recently learned seep into our bodies, rather than the increased exposure to ultraviolet light. Nearly half of the 500 most popular sunscreen products may increase the speed at which malignant cells develop and spread skin cancer because they contain vitamin A or its derivative. According to researchers at Environmental Working Group, their annual report cites problems with bogus sun protection factor (SPF) numbers, the use of the hormone-disrupting chemical oxybenzone (which penetrates the skin and enters the bloodstream), overstated claims about performance, and the lack of needed regulations and oversight by the Food and Drug Administration. If their claims are correct, then even though the white sunscreen goop might prevent sunburn don't count on it to prevent skin cancer from forming.
More goop for thought: sunscreen companies can't actually advertise that their product prevents skin cancer because research doesn't support that claim. So companies fork over millions of dollars in "pay for play" endorsements to groups like The American Academy of Dermatology and The Skin Cancer Foundation to make that claim for them. Indeed, most people are surprised to learn that the Skin Cancer Foundation is mainly funded by the very pharmaceutical companies who profit from its anti-sun message.
Could this multimillion-dollar business from cosmetics companies be affecting the objectivity of dermatology lobbying groups and the derms in our communities?
Dermatologist Appointment #3: Large Medical Building In Pacific Heights
These dermatology offices all seem to subscribe to the exact same Botox pamphlets and literature. Sure the sun gets a bad rap from dermatologists, but that's nothing compared to their take on indoor tanning booths. Dermatologists, along with the media, have launched a full out blitzkrieg on the tanning industry. A recent 20/20 report made it seem like indoor tanning was as dangerous as putting the bronze barrel of a gun in your mouth. If I were to believe their reports, an indoor tanning session is as deadly as arsenic and as addictive as heroin.
Meanwhile, dermatologists sell indoor tanning sessions in their own offices for up to $100 a visit to treat cosmetic skin conditions. Could some of their angst at indoor tanning be about profit? A January 2009 New York Times article states that some psoriasis patients have benefited from commercial-grade tanning beds that use UVB radiation; many of which are actively in use in dermatologists office across America. The indoor tanning industry reports that 1 million clients are actually referred to them annually by dermatologists to treat psoriasis, eczema and other cosmetic skin conditions. But stepping into a tanning booth, according to dermatology lobbying groups, is about as dangerous as jumping in front of a speeding truck. UV light, in the form of sun or indoor tanning, produces vitamin D. (Affectionately known as the "sunshine vitamin.") Surely dermatologists must see some benefit in moderate UV light? What suddenly set off their dragon-fire?
I told her I was doing some phototherapy for psoriasis and asked if she recommends it. She says it's great. After I asked if it does the same thing as a tanning booth she explained that tanning booths can't control the beams, so they're not localized like in phototherapy. After some prodding she tells me that tanning booths are dangerous but the doctor has control over the intensity of the beams so you can't get burnt. So, is it covered by insurance? You bet it is! The phototherapy that is, but not the tanning beds.
If you refer to the Journal of the American Academy of Dermatology, back in the early 90s dermatologists used to annually deliver roughly 873,000 phototherapy sessions. By 1998 that number had gone down 94 percent to 53,000 for a procedure they still consider safe and viable. Maybe that's why the dermatologist sternly warned that I should never go into a tanning booth--under any circumstance--even though in often cases the indoor tanning equipment is exactly the same. They're trying to drum up more business.
Dermatologist Appointment #4: Financial District
At my final appointment, the dermatology assistant informs, once again, how I should engage in obsessive daily sunscreen use. She neglects to mention that constant use of sunscreen is suspected to be a factor in vitamin D deficiency--a condition that affects three-quarters of U.S. teens and adults. According to findings in the Archives of Internal Medicine, the deficits are increasingly blamed for everything from cancer and heart disease to diabetes.
Yet the advice--slather it on daily, even in the winter--still flows from the mouths of most dermatologists with little regard to these reports.
She asks me if I use sunblock. Honestly, I answered, how and then. She asked what SPF -- I usually use around 15. She says she recommends 30 and higher -- especially on your face and to reapply every two to four hours. When I inquired about the toxins in sunblock, she said that oxidized zinc doesn't have toxins -- it's important to choose a raw mineral. She told me to reapply a couple times a day.
I ask if sunblock prevents cancer. I'm told it prevents skin damage, which can cause cancer. Linking these two elements together makes it imply that sunscreen is the antidote for skin cancer, rather than a preventative against skin damage. When the dermatologist finally comes in to examine my moles ("These moles are totally normal. Totally normal. Everybody has got moles"), she sings a completely different tune.
Do I need to use sunblock everyday? I ask. She recommends to be responsible -- like if you're going to the beach -- but that we need the sun to produce vitamin D.
Amazing. Finally a dermatologist who actually gives sound, sane advice about the use sunscreen, rather than sounding like she's part of some strange sunscreen cult. Does she have similar moderation counseling on phototherapy and tanning booths?
I mentioned I was doing some phototherapy for psoriasis and asked if I could use a tanning booth with ultraviolet rays. She told me that's fine and tanning booths are the same thing as phototherapy -- they both use UVB light. You just have to choose to have UVB.
It only took four separate appointments to finally find a dermatologist who wasn't spouting the exact same overblown anti-sun mantra as all the rest of the industry. The sun scare message, fueled by dermatologists, has helped sunscreen companies turn a multimillion-dollar industry into a six billion dollar cosmetic juggernaut that uses dermatology endorsements to drive overuse of their product, which in some cases has been implicated in containing undisclosed toxins.
Because of it, U.S. Sen. Chuck Schumer has called for a full investigation into sunscreen safety. In this nation of panic, cosmetic dermatology is benefiting by driving a fear-based pipeline of customers directly into their offices. But as a whole, the dermatology industry is retreating to their corner of the sandbox, refusing to accept the scientific reality of a balanced message about sun protection in light of research clearly showing the need for regular sun exposure.
Do you feel bombarded by the sun scare messages? Are your fears justified or do you think there a profit motivation behind the dermatology messaging? Let us know what you think.