Debate flares between tanning industry and doctors over sun exposure

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By Patricia Meisol
The Baltimore Sun

First came the Dunce of the Month award.

Dr. Rex Amonette was aghast when he saw himself pictured in a national magazine wearing a dunce cap. The past president of the American Academy of Dermatology, an authority on skin cancer, roasted as a dunce?

But that was just the start. Next, his house was pelted with eggs.

The soft-spoken Memphis, Tenn., doctor blamed local agitators and laughed it off. ``I'm not a very adversarial person,'' he says. ``I never planned to get myself involved in something like this.''

What Amonette has become involved in is a vituperative war raging for the past few years between dermatologists like himself and the indoor tanning industry. It's a war pitting the mostly mom-and-pop tanning salons against what they portray as a sinister cabal of doctors and drug companies out to terrify sun-lovers and take away their livelihood.

Professional courtesy? Solid data? Scientific detachment? Forget it.

So far, this war is more heat than light, perhaps not surprising when the battle means billions of dollars to both sides. The charges and countercharges - some substantiated, some not - have flown freely over the basic disagreement: whether any sort of tanning is good or bad for your skin and health.

Despite the fact that by now we know that sunburn can cause melanomas, and untanned skin is back in vogue for the first time since the 1920s, there apparently is no hard and fast evidence about tanning.

The dermatologists don't have data to buttress claims that tanning beds are partly at fault for escalating skin cancer problems they see in their offices, though they are rushing to compile it. The tanning industry has taken advantage of that vacuum to claim that tanning, indoor or out, actually reduces the risk of cancer.

A recent press release by the International Smart Tan Network, the trade group representing the country's 25,000 free-standing tanning salons, says tanning can prevent the blistering sunburn associated with deadly forms of skin cancer.

According to the May release, indoor tanners are 57 percent less likely to sunburn than non-tanners.

Earlier this year, when the American Academy of Dermatology made public a study showing a 9 percent increase in people who reported sunburns, the tanning industry used it as evidence that the doctors' crusade to woo people out of the sun had failed.

``Professional tanning facilities are teaching people to live practical lives by avoiding sunburn,'' Smart Tan executive director Joseph Levy says. ``The dermatology industry's leaders, on the other hand, are telling people to avoid sun exposure - impractical advice that doesn't take into account today's active lifestyles.''

But to dermatologists, any light source, whether natural or artificial, can create change in the skin that leads to aging and skin cancer, Amonette says.

He agrees that some exposure to light is good. But he says the tanning industry goes too far when it alleges regular tanning could help reduce cancer deaths by 30,000 a year.

When tanning beds came into use in 1979, dermatologists and physicians sat back and watched what they expected to be a fad, Amonette says. At the time, they didn't know the dangers of ultraviolet-A, the sun's longer-wave radiation.

The doctors decided to speak out when they began seeing more patients with aging and wrinkling beyond their years and skin cancers of all types in younger patients.

Things got going in earnest in 1993, when some doctors, including Amonette, then president of the American Academy of Dermatology, began saying, ``Yes, tanning beds are harmful'' to the media and fellow dermatologists, and lecturing about what they viewed as a major public health issue - the rapid increase in skin cancer.

By then, indoor tanning had grown into a $5 billion industry annually, and was not about to let such a claim pass unchallenged. It seized on an old statement by Amonette - one he admitted was in error - that the light emitted by tanning beds was four to 10 times as intense as the sun, to attack his credibility.

Tanning Trends, the tanning network's magazine, proclaimed Amonette Dunce of the Month in 1995 and attacked him for a revised claim that tanning bed emissions are twice as intense as the noon-time sun.

The tanning industry maintains that comparing the strength of doses from sun and tanning equipment light is meaningless.

The doctors disagree. But in hopes of defusing the issue, the dermatology academy began campaigning against tanning without rating natural and artificial.

``Tanning: Unsafe at any wavelength,'' its literature pronounced beginning in 1995. This new approach did not appease tanning salon owners.

This spring, in a three-part series it prepared to ``investigate opposition to indoor tanning,'' Tanning Trends accused tanning opponents of acting for personal gain.

The articles focused on dermatologists, drug companies that sell sunscreen products, and beauty magazines that advertise them. All three, the articles claimed, benefit from incorrect information about sun exposure and from ``scaring'' the public about sun exposure. Levy does concede that his magazine is supported by advertising, too - mostly from tanning equipment makers.

Levy, who wrote the Tanning Trends series, this year launched a new campaign aimed at the news media extolling the benefits of sunlight. It featured six advertisements in Editor & Publisher, a journalism trade magazine, and a series of press releases.

This spring, Amonette appeared on the industry's ``Most Wanted'' list.

Others in the ``Anti-Tan'' Establishment include:

- New York dermatologist Vincent DeLeo, attacked for telling his peers that only 6 percent of those who visit salons actually get a tan and most of those using beds are people with sensitive skin. Where's the data? the tanning industry asked him.

- ``Dr. Tan Ban,'' Michael H. Franzblau, the dermatologist who tried unsuccessfully to get the Food and Drug Administration to ban tanning beds. He did convince the American Medical Association to pass a resolution condemning them .

But even as it targets doctors, the tanning industry is offering an olive branch.

For one thing, Levy has renounced the dunce award: It was a lampoon created out of frustration, he says, adding that he has nothing but respect for Amonette.

``He is at least willing to listen ... while other people in the `sun-scare coalition' are blindly passionate,'' he says.

And in April, convinced that ``the truth about moderate tanning will prevail,'' the tanning group called for a ``summit'' with the Academy. The idea is to establish common ground in teaching people how to avoid permanent sun damage.

Meanwhile, Levy's his opponents are upping the ante.

Just this month, the Food and Drug Administration got a letter from a scientist who investigates light sources offering reasons why the federal agency should immediately regulate tanning salons. They include the alleged failure of salon owners to regularly follow manufacturers' instructions .

And in a recent letter mailed to the New England Journal of Medicine, Amonette sounded the alarm against indoor tanning again. ``Those who voluntarily seek a tan do so for cosmetic reasons,'' he wrote. ``In their case, can the risk of melanoma ever be justified?'' Sounds like he'd better be ready for another egging.