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Benefits of Moderate UV Sunshine Exposure

Archive for May, 2010

Did tanning beds take away a profit center for dermatology?

Posted by D3forU on May 28, 2010

WHY IS PHOTOTHERAPY UTILIZATION IN THE UNITED STATES DECLINING?

Article Reference:

A 2004 article in the American Journal of Dermatology (Housman TS, Rohrback JM, Fleischer, AB Jr, Feldman SR. Phototherapy utilization for psoriasis is declining in the United States. J. Am Acad Dermatol. 2002: 46:557-559) substantiated the declining use of phototherapy and psoralen ultraviolet A-range (PUVA) light therapy for psoriasis in nonfederal and non–university-based settings and explored factors that may have contributed to “decreased utilization of a safe and effective treatment for psoriasis.”

Despite the many advantages of phototherapy treatment for psoriasis, which authors called “a mainstay of nontopical therapy for patients with psoriasis,” they cite many of the factors mentioned in the Kaiser Permanente discussion — primarily the associated time and cost requirements for both physicians and patients — for its declining use. Other possible factors mentioned included advances in the use of alternate forms of psoriasis therapy, in particular cyclosporine and acitretin, and the increased use of home light therapy or tanning beds.

STUDY RESULTS

Records of 598 psoriasis visits from 1993 to 1998 were used to estimate the experience of approximately 15 million office-based visits during which psoriasis was a diagnosis. The resulting estimates — a statistically significant decreasing trend over the 6-year period examined — showed decreases similar to that seen in the authors’ university-based practice.

There were 873,000 visits for UV light therapy in 1993-1994, 189,000 in 1995-1996, and 53,000 in 1997-1998 (P < .0001).

There were 175,000 psoralen visits in 1993-1994, 61,000 in 1995-1996, and 25,000 in 1997-1998 (P = .0053).

POSSIBLE REASONS

Physicians’ burden — Authors note that visits may be “too cumbersome and costly” for physicians, many of whom have less manpower available for medical dermatology services than more profitable cosmetic procedures. This burden includes equipment maintenance, staff time, facility space needs, and other fixed and marginal costs that may not be fully reimbursed, plus the need to accommodate changing documentation and regulatory requirements for the degree of physician supervision required.

New drugs, home light therapy — Advances in the use of alternate forms of psoriasis therapy, in particular cyclosporine and acitretin, and the advent of home light therapy or tanning beds may have enabled physicians and patients to side-step issues involved in the cost and time involved in phototherapy office visits.

Cost to patients: impact of co-pays — Changes in third-party reimbursement policies requiring a co-pay for each phototherapy session were also seen as discouraging patients from undergoing this safe and effective treatment in favor of more toxic but better reimbursed systemic options.

PUSH TO NOT ABANDON PHOTOTHERAPY
Yet despite these costs and inconveniences, the authors urge practitioners and their patients not to abandon this “safe and effective treatment for psoriasis,” saying, “Until safer, efficacious therapies become available, we believe it is essential that phototherapy remain accessible to patients with psoriasis.” They support efforts to raise awareness of its efficacy and safety, and encourage increased reimbursement rates, discontinuation of co-pays for each treatment session, and less restrictive regulatory requirements for treatment documentation and supervision.

http://www.skinandaging.com/article/7197

link to PubMed article

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Facts get lost in the headlines of tanning again

Posted by D3forU on May 27, 2010

True journalism looks behind the headline and gets both sides of a story; allowing the reader to make informed decisions, not just get eyeballs.

Did Melanoma Researchers ‘Reverse Engineer’ Their Findings? Anti-Tanning Lobbying Group Downplayed Key Conflicting Information Questions about this study that should have been answered  http://xr.com/RevEng

  • Failure to disclose conflict of interest and deceptive research practices
  • Failure to disclose conflicting findings and confounding factors
  • Failure to highlight study and control group bias by choosing study participants who are naturally predisposed to melanoma
  • Failure to cite absolute risk factors, as opposed to relative risk
  • Failure to cite other sources, such as sunscreen use, for risks associated with melanoma
  • Failure to explain a 5-fold higher usage of indoor tanning in the study’s control group when compared to the national average

Tanning beds: What do the numbers really mean? http://xr.com/ARtanRR

Journalists who report only on relative differences in making claims about a new idea should tell the rest of the story. It is absolute differences that probably matter most to most people trying to make sense out of such claims. http://xr.com/ARvRR

UVA Light Does Not Cause Melanoma Univ Texas Report http://xr.com/UVAnoMel

EWG reports many sunscreens may cause cancers http://xr.com/SSaol

NEW STUDY SHOWS TANNING AND MELANOMA LINK SCIENTIFICALLY FLAWED http://xr.com/Sunarc

False and deceptive headlines don’t tell all the story http://xr.com/resp75

These are just a few of the recent articles and research papers that show the other side of the picture. Look behind the headline and give readers a complete picture.

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“Risk of skin cancers increase by 75% when people start using tanning beds before age 30.”

Posted by D3forU on May 24, 2010

“Risk of skin cancers increase by 75 % when people start using tanning beds before age 30.”

This quote has been used frequently in the news as the basis for banning tanning either completely or for all under 18 years of age. The implication here is that 75%, or 3 out of every 4 people, who enter a tanning bed will at some time in their lives, contract Melanoma as a direct result of their actions.

What the original report in 2006 actually stated was: “Based on 19 informative studies, ever-use of sunbeds was positively associated with melanoma (summary relative risk, 1.15; 95% CI, 1.00–1.31), although there was no consistent evidence of a dose–response relationship. First exposure to sunbeds before 35 years of age significantly increased the risk of melanoma, based on 7 informative studies (summary relative risk, 1.75; 95% CI, 1.35–2.26).”

The studies claiming to show that sunlight, UVR or a tanning device causes CMM all have very small RR (Relative Risk) values, less than 2.0, when the authors know, or reasonably should know, that a RR of at least 3.0 is required to prove that there is a cause-and-effect relationship between two events. In case they forgot, here are a few quotes to remind them:

· “As a general rule of thumb, we are looking for a relative risk of 3.0 or more before accepting a paper for publication.” Marcia Angell, editor of the New England Journal Of Medicine

· “My basic rule is, if the relative risk isn’t at least 3 or 4, forget It.”Robert Temple, Director of Drug Evaluation for the U.S. Food And Drug Administration

· “Relative risks of less than 3.0 are considered small and are difficult to interpret. Such increases may be due to chance, coincidence, statistical bias or the effect of confounding factors that are sometimes not evident.” Excerpt from a National Cancer Institute publication.

Even Vincent Cogliano, head of the IARC Monographs program at the International Agency for Research on Cancer– where the World Health Organization-sanction group’s debate originated — admits the results on which many of the conclusions are based are “limited,” and “most (of the 2009 position) is based on the 2006 working group report and we do not have the gold standard, double-blind type of research to work with,” he said.

When asked why tanning beds were made such a focus of this WHO/IARC position, Cogliano said: “It was our 100th year and we wanted to pick something that looked at the past and into the future. UV radiation and the sun is (from the) past, tanning beds (are linked to) the future.”

A new study published in the peer-reviewed journal “Dermato-Endocrinology” (Dermato-Endocrinology 1:6, 1-7; Nov/Dec 2009; © 2009 Landes Bioscience) shows that there is no statistically significant connection between sunbeds and melanoma in those who can develop suntans (skin type II-VI), with increased risk centered only on those whose skin is so fair it cannot tan (skin type I).

William B. Grant, PhD, a former NASA atmospheric research scientist and founder of SUNARC, Sunlight, Nutrition and Health Research Center (SUNARC), re-examined the same epidemiological data used by the International Agency for Research on Cancer (IARC) group from their findings in 2007 titled, “The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review”. Grant’s study strongly challenges this review and argues it is both flawed and cannot be used as the basis for U.S. health policy.

ACCORDING TO GRANT’S ANALYSIS:

  • The reported 75% increased risk of melanoma for those ever having used a sunbed prior to age 35 drops to a 25% Reduced Risk of Melanoma in the United States based on a scientifically-centered re-analysis of the data in the IARC report.
  • When skin type I is omitted from the IARC analysis, the reported 15% increased risk in melanoma fails to remain statistically significant. This is based on a meta-analysis of the 14 studies not from the UK, where skin type I is most prevalent.
  • The IARC study inappropriately combined four studies from northern Europe, one from the UK, one from Canada, and one from the U.S. in the analysis of first use of sunbeds before the age of 35 years. There are vast differences between American and European sunbed regulations and use. US regulations do not allow Skin Type I patrons to tan, European tanning beds are often used at home or are unsupervised and do not follow the regulations in the U.S. The study fails to state that its findings are not, and should not be considered “universal findings.”

“The reason this “Skin Type I” distinction is so important is that we now know that UV avoidance among people who can develop a tan has contributed to epidemic-level vitamin D deficiency in North America, with 3 out of 4 Americans being vitamin D deficient today,” said Grant. “Our public health messages about the benefits of UV radiation from any source need to recognize this.”

The IARC report was a meta-analysis of epidemiologic surveys – questionnaire surveys designed to retrospectively identify correlations, but which do not by nature identify causation. As stated in the IARC report, “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.”

Melanoma’s connection with UV exposure is controversial, as research clearly shows it is more common in indoor workers than in outdoor workers and is more common on parts of the body that aren’t regularly exposed to sunlight, implicating sun burning rather than regular tanning.

Another recent study from Grant, “In Defense of the Sun,” published in Dermato-Endrocrinology, suggests that raising vitamin D blood levels to 45 ng/ml could reduce mortality rates in the United States by 15% and prevent up to 400,000 premature deaths from vitamin D deficiency-related diseases annually. Such diseases include many types of cancers, cardiovascular disease, heart failure, respiratory infections, diabetes, and falls and fractures.

Vitamin D researchers today recommend vitamin D blood levels should be maintained above 40-60 ng/ml. At least 2,000 IU of vitamin D daily in addition to dietary sources and casual solar UV irradiance are required to maintain those levels. According to peer-reviewed, published research, indoor tanners have those levels, but non-tanners do not. Indoor tanners: 42-49 ng/ml. American average: 23-25 ng/ml

“There is conclusive evidence that indoor tanning in a non-burning fashion offers a tremendous source of vitamin D,” Grant says. “The benefit of regular UV exposure as the body’s only true natural source of sufficient vitamin D production easily outweighs the manageable risks associated with overexposure to sunlight,” Grant says. “We know now through more than 2,000 papers published in 2009 that smart UV exposure and increased vitamin D levels will not only save lives, but also extend and increase our quality of life.”

For more info, visit www.vitamindhealth.org , www.vitamindcouncil.com , www.sunlighttruth.com , www.grassrootshealth.net , www.sunarc.org

PDF of this summary

Link to Dr Grant’s complete report

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Vitamin D May Allow American Olympians To Dominate In 2012

Posted by D3forU on May 23, 2010

Evidence that Vitamin D improves athletic choice reaction time, muscle strength, speed, and endurance may provide an American Olympic advantage in 2012 much like the Russian and German athletes domination in the Olympics for 30 years from the 1950s to the mid 1980s. Those elite athletes performances were linked to a training technique in which the athletes may have been irradiated with Vitamin D-producing UVB radiation. The American College of Sports Medicine published a paper Athletic Performance and Vitamin D that outlines such evidence.

Controversy surrounding upping the Vitamin D intake is paralleled to “doping.” However, most athletes, professional or domestic, of the day are deficient in Vitamin D and upping the intake of the vitamin would not be considered an athletic unfairness, but rather maintaining a healthy vitality potentially preventing “stress factors, and other athletic injuries.” Those doctors and trainers that do not treat such may be faltered with medical malpractice and hindering the athlete to reach his/her optimal potential as outlined below.

Co-authors of this article include Professor Timothy Taft, the team physician for the NCAA basketball champions, the UNC Tar Heels, and Professor John Anderson of the UNC School of Nutrition.

Several quotations from the paper:

Indeed, in reading the early German literature, it seems the athletic benefits of UV radiation were widely known by the 1930s, at least in Germany: ”It is a well-known fact that physical performance can be increased through ultra-violet irradiation. In 1927, a heated argument arose after the decision by the German Swimmers’ Association to use the sunlamp, as an artificial aid, as it may constitute an athletic unfairness, doping, so to speak.

In 1952, Spellerberg reported on the effects of an extensive program of irradiation of athletes training at the Sports College of Cologne-including many elite athletes-with a ”central sunlamp.” They reported a ”convincing effect” on athletic performance and a significant reduction in chronic pain due to sports injuries. Improved athletic performance with irradiation was so convincing that Spellerberg notified the ”National German and International OlympicCommittee.”

Few athletes live and train in a sun-rich environment, thus few have ”natural” 25(OH)D levels, with the exception of equatorial athletes, such as the runners of Kenya. Another possible exception was the 1968 Summer Olympics in Mexico City, where athletes had to arrive early to acclimatize to the 7400-ft altitude. Because UVB penetration of the atmosphere is higher at high altitudes, because Mexico City is relatively close to the equator, and because of thsummer season, ambient UVB irradiation from sunlight would have been intense during the 1968 summer games and should have rapidly increased               25(OH)D levels of any athlete acclimatizing outdoors. Many new world records were set that summer, and the Americans, perhaps unexpectedly, won more gold and total medals than either the Russians or East Germans. Although most experts attribute the impressive number of world records to decreased ambient air pressure, vitamin D may also have contributed. For example, the Americans dominated in outdoor sports, winning 42 of their 45 gold medals in     outdoor sports, whereas the Russians won most their gold medals (18 of 29) in indoor sports. Both the number of new world records, almost entirely in outdoor sports, and the percentage improvement in outdoor world records, for example, Bob Beamon added 21 inches to the long jump (Fig. 6), are consistent with the theory that vitamin D improves athletic performance.

Further controversy may arise as activated Vitamin D is a steroid hormone, in exactly the same manner that testosterone is.  The paper concludes that:

Because activated vitamin D is a steroid hormone, questions may arise if use of its precursor, vitamin D, constitutes an unfair advantage, ”doping, so to speak,” as the Germans noted in 1940. However, unlike testosterone or growth hormone, vitamin D deficiency is probably common among athletes.

Furthermore, untreated vitamin D deficiency is associated, not only with stress fractures and other athletic injuries, it is also associated with numerous serious illnesses and is a risk factor for early death. Withholding vitamin D in vitamin D-deficient athletes seems to violate most rules of modern medical ethics and may expose the sports medicine physician to needless future liability. Although science may or may not find performance enhancing effects of vitamin D in the future, good medical practice in the present always supersedes performance enhancing theories awaiting future research. Vitamin D deficiency may be quite common in athletes. Stress fractures, chronic musculoskeletal pain, viral respiratory tract infections, and several chronic diseases are associated with vitamin D deficiency. Those caring for athletes have a responsibility to promptly diagnose and adequately treat vitamin D deficiency.

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Chicago Blackhawks are the first Vitamin D team in modern professional sports history

Posted by D3forU on May 23, 2010

May 23, 2010

The Chicago Blackhawks are the first vitamin D team in modern professional sports history.

According to my sources, the Chicago Blackhawk team physicians began diagnosing and treating vitamin D deficiency in all Blackhawk players about 18 months ago. Apparently, most players are on 5,000 IU per day.

After many losing seasons, last year the Blackhawks came out of nowhere to get to the Western conference finals. This year they are playing even better.

According to my sources, improved athletic performance is only one of the benefits for the Blackhawk players. The other is a reduction in the number and severity of colds and flu and a reduction in the number and severity of repetitive use injuries.

Six months ago, Runner’s World published a story on vitamin D and physical performance.

Asp K. Running on D: The “sun vitamin” may boost performance, but you probably aren’t getting enough. Runners World, December 2009.

A year ago, the flagship journal of the American College of Sports Medicine was the first journal to publish the theory that vitamin D would improve athletic performance.

Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ.  Athletic performance and vitamin D. Med Sci Sports Exerc. 2009 May;41(5):1102-10.

However, readers of this newsletter first learned about it in 2007:

Cannell, JJ. Peak Athletic Performance and Vitamin D. Vitamin D Council Newsletter, March 2007.

I can only hope that, if the Blackhawks win the Stanley Cup this year, other teams, from high school to professional, may start paying attention to the vitamin D status of their players. That would be a big boost to the Council’s goal of educating the world about the importance of vitamin D.

The Vitamin D Council

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Let’s put cancerous myths to bed

Posted by D3forU on May 21, 2010

There’s no causal link between sunbed-use and cancer, so why are politicians clamping down on teens tannning?
Basham and Luik

Ever since the International Agency for Research on Cancer (IARC) concluded, last summer, that ultraviolet (UV) radiation exposure from sunbeds is ‘carcinogenic to humans’, the British medical and health promotion establishment, along with the government, has been ramping up efforts to ban the use of sunbeds. Now, Gillian Merron, Britain’s public health minister, has said that the government intends to ban under-18s from using tanning salons after a study in the British Medical Journal reported that at least 250,000 children aged 11 to 17 use sunbeds.

The basis for the IARC decision and the government’s intervention is twofold: first, that there is a melanoma epidemic in the UK, and, second, that there is a causal connection between sunbed-use and melanoma. Both of these claims are scientifically suspect.

In a recent study about the reported incidence of melanoma in the UK, a group of scientists at the dermatology department of Norfolk and Norwich University Hospital found that the increase in melanoma in East Anglia between 1991 and 2004 was ‘almost entirely due to minimal, stage 1 disease. There was no change in the combined incidence of the other stages of the disease, and the overall mortality only increased from 2.16 to 2.54 cases per 100,000 per year.’ According to the report authors, the claims of a melanoma epidemic are based not on a real increase in cases but rather on a ‘diagnostic drift which classifies benign lesions as stage 1 melanoma’. In the past these cases would have been diagnosed as benign melanocytic nevi, not melanoma.

Further weakening the claim that these early stage melanomas were the result of excessive sun exposure is the fact that most of the cases were in areas of the body not exposed to the sun. One of the report authors, Dr Nick J Levell, told Reuters, ‘The main message is to be cautious about overstating messages about a melanoma epidemic to the public and media. Such behaviour will tend to induce unnecessary anxiety and behaviour that may cause distress and harm.’

Yet the IARC claim about sunbeds and cancer risk does precisely what Levell warns against. In its press release announcing that it had concluded that radiation from sunbeds is carcinogenic, IARC implied that this finding was based on new scientific evidence. This was not the case. The basis for IARC’s conclusion is the agency’s 2006 report Exposure to Artificial UV Radiation and Skin Cancer. But this report provides no compelling evidence that sunbed-use is associated with an increased risk for skin cancer.

The report references 24 cohort and case-control studies on the association between use of indoor tanning facilities and melanoma risk. Of these only four show a small statistically significant relationship. None of the four have a relative risk greater than 1.50, indicating an extremely weak and unlikely relationship. Indeed, even the report authors admit that the evidence for a positive association between indoor tanning and melanoma is ‘weak’. It might be suggested that this statement is in itself misleading since the relationship is, in fact, practically nonexistent.

Despite the fact that there is virtually no scientific support in IARC’s report for the conclusion that ultraviolet radiation exposure from sunbeds is ‘carcinogenic to humans’, it is this very study that provides the sole basis for Gillian Merron’s move to ban adolescent use of tanning beds.

Finally, the largest prospective study of the risk of sunbeds for melanoma was by a team of researchers headed by Marit Veierød at the University of Oslo. They followed more than 100,000 Norwegian women over an average eight-year period and found no statistically significant association between sunbed-use and melanoma in those aged 10 to 19 who used a tanning facility more than once a month. Yet this is the target group for the UK government’s anti-sunbed campaign. Moreover, these findings correspond to a British study from 2004 which did not find a statistically significant association between use of sunbeds and melanoma.

So, not only is the public health minister failing, in the words of Levell, to be ‘cautious about overstating messages about a melanoma epidemic’ and tanning parlours – she has also proposed action that is clearly unsupported by the scientific evidence.

Patrick Basham directs the Democracy Institute and is a Cato Institute adjunct scholar. John Luik is a Democracy Institute senior fellow. They will be discussing the faux melanoma epidemic and other attacks on working-class culture on 29 April at the Institute of Economic Affairs. For more information about the event, click here.

link

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Sun, wind and dioxines

Posted by D3forU on May 21, 2010

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Melanoma epidemic: a midsummer night’s dream?

Posted by D3forU on May 1, 2010

A 15 year study of Melanoma patients from 1991 through 2004 concluded that  any changes in incidence were likely due to ‘diagnostic drift’, or categorizing benign lesions as stage 1 melanoma. There was no change in the combined incidence of all other stages of the disease, and mortality overall was increased less than 1/2 case per every 100,000 per year.

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.

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