Expert says physicians offer mixed messages about dangers of sunbeds

Key Points

Baltimore - According to one expert, the tanning bed industry is heavily lobbied, and it is the job of dermatologist to not only recognize the health concerns associated with tanning beds, but also to give sound healthcare advice to patients regarding UV protection.

Political pressure surrounding the tanning bed industry is a timely issue, given Congress' recent proposal to levy a 10 percent tax on indoor tanning bed services in the United States. At press time, the proposal was set to head to conference committee along with a House-sponsored bill.

"We hold the tanning bed industry up as very symbolic as one of the challenges we face in healthcare - specifically, conflicts of interest. When doctors start making a lot of money endorsing a particular treatment or product in the name of health, it raises ethical issues. Unfortunately, this has become a common practice in medicine today," says Nanette J. Liégeois, M.D., Ph.D., department of dermatology, Johns Hopkins University School of Medicine, Baltimore.

Historical perspective

At the beginning of the 20th century, alabaster skin was still the fashion, and only people who worked outdoors were tanned, because of the nature of their work. Dr. Liégeois says physicians advocated the therapeutic benefits of the sun, in particular to address diseases such as lupus vulgaris and rickets.

Along with the discovery of the therapeutic benefits of UV light came a change in attitude toward sun exposure. People began flocking to the beaches with the intent of either burning their skin or at least tanning it significantly.

One would assume that cosmetic companies' marketing strategies would be to blame for such a change in trend. However, according to Dr. Liégeois, no company or product at that time was leading the charge. Interestingly, a decline in the availability of bleaching products was inversely related to the increase in products that could manage and preserve a tan, she adds.

"The medical community soon gave their seal of approval to sunlight therapy and subsequently extrapolated specific UV light interventions to a broad host of diseases that were completely unfounded and entirely unstudied," Dr. Liégeois says.

Dr. Liégeois' research also found that physicians in the 20th century denied any causal role of sunlight in nonmelanoma skin cancer. The role of sunlight was so hyped that the top medical specialists of the time (as recorded in the New England Medical Journal) downplayed any role that UV exposure might play in the development of nonmelanoma skin cancer, which was then called epidermoid carcinoma.

It wasn't long after that fashion magazines began to capitalize on the medical community's endorsement of UV light by promoting UV lamps. Instead of wasting time baking and sweating on the beach, people could stay home and use tanning devices.

"This is symbolic of what we have now in the tanning bed industry, where we have physicians who have profited widely, in my opinion, based on medical recommendations with no disclosures to the public regarding their own financial gain, and this has gone on now for almost 100 years," Dr. Liégeois says.

Medical considerations

Although the grassroots push to use tanning beds was innocent, the financial opportunities associated with the booming industry marred the initial intent, Dr. Liégeois says.

"Rickets is still an issue today, particularly due to poor nutrition. However, in my opinion, the dangers of rickets are overplayed in order to promote the tanning bed industry," Dr. Liégeois says.

According to Dr. Liégeois, the cause for concern with regard to tanning is large enough to warrant tighter regulation at a national level. Conflicts of interest for physicians who are endorsing tanning devices should be publicly disclosed, she adds.

Disclosures: Dr. Liégeois reports no relevant financial interests.