FDA proposes indoor tanning ban for minors

Interesting dichotomy here. On one hand we have the libertarian desire to minimize government interference in our lives, albeit admittedly not reduce it, quite, to zero. Libertarianism ≠ anarchism. Although we need to go a long way in the direction of anarchy I doubt many here want to go to the literal end. On the other hand we have the conservative desire to protect minors. We shouldn't want to protect them so much that they never learn to function as adults, but we do want to minimize injuries they're too young to avoid on their own. Both legitimate concerns in this case.

Now I should disclose my conflict. I'm a Dermatologist, so it's my professional colleagues pushing this. In their defense they're pushing this out of altruism; if they wanted to make more money they'd be encouraging the dang tanning beds. However I recognize the dangers of altruism. Personally I haven't lobbied for government bans on tanning beds for minors, rather I've tried to discourage their use through education. I tell my older sun damaged, skin cancer ridden, patients to show their kids and grandkids their bad sun exposed skin and their often dramatically less bad relatively sun protected skin. The visual difference and pattern makes the culprit pretty obvious in many. Then ask the kids which part of Grandma they want to match when they're older. Do they want to wear out their skin before they're done wearing it? Do they like shots? The spray on or rub one fake tans risk neither, but look as good at prom.

The evidence is solid that there is non-zero risk so some kind of government regulation, at some level of government can be debated. The FDA currently even regulates tongue depressors, and until two years ago regulated tanning beds no more than tongue depressors. I'm glad they moved tanning beds to a higher risk grouping; I'm still not sure why they regulate the tongue depressors. A couple years ago the FTC hit the tanning bed industry for false advertising. I'm not sure the government should be looking at false advertising, but if we're letting them do that, they ruled correctly in this case.

And although there is plenty of 'scientific' data the basic case for ultraviolet light damaging skin is an obvious deduction, with mere common sense, to anyone who's really looked at many people's skin across many ages. Having literally treated thousands of skin cancers and more thousands with various non-cancerous sun induced complaints there's no doubt the sun encourages some problems. Having practiced since early in the tanning bed era I now see some heavy tanning bed users looking much worse for their age than I'd seen before with seasonal sun tanners limited by Iowa's climate. Not all are equally susceptible, tanning beds, and the sun, are racist!

Data has shown tanning bed users do have more skin cancers, including melanoma, with noticeable increases even with relatively few sessions. Some evidence suggests use at younger ages does more damage. Those who start tanning at younger ages tend to tan more over their lifetime. Tanning beds allow year round tans, piling on the damage much faster than the summer limited sun tans of many areas. Tanning beds also let you put at increased risk for skin cancer that are rarely exposed to such risk otherwise. I've seen such. Tanning can be addictive. Some tanners behave like some alcoholics. Interestingly this probably isn't just a psychological addiction in some cases, but a physical one. Ultraviolet damaged skin, at exposures less than a sunburn, releases endorphins, the natural analogs to narcotics. And those who claim to receive a 'buzz' from tanning report that narcotic blockers block their 'buzz.' I'm not claiming tanning is as dangerous as heroin, just pointing out it can be a hard habit to break.

I don't want to overstate the risk. Lots of older folks complain about worn out, UV damaged, skin, but few die of skin failure. Burns from tanning beds are common, but mostly mild. However severe burns, even fatal burns, have been reported when taking some photosensitizing medications. Skin cancer is very common, over half of all cancer in US, but well over 90% is of two types that don't often spread and kill people. It can be disfiguring, but most are caught early enough to avoid that. Melanoma has a higher risk of being fatal, and at best leaves larger scars, but currently has an average 90% cure rate thanks to people catching it earlier than in the past. However the exceptions can be very sad. Not many women in their 20s die of cancer, but of those who do the leading cancer killer is melanoma. And people shouldn't just figure on the risk of one skin cancer. They've baked lots of skin and growing multiple skin cancers is common. I've seen over 50 folks with double digit skin cancers. I've seen a few with double digit skin cancers at one time! They're less fun in bulk.

What should be the Federal, or other governmental, role in reducing tanning bed use? I'm not sure, so I'm not suggesting anything specific. I don't think they should encouraging it, as some state colleges and universities are by supplying tanning beds to their students. I don't want folks here to trivialize the problems tanning beds can cause, even if they favor less coercive solutions. And I'm sadly confident that whatever the best solution is, Obama's administration will do something different.

Not all dangers are fatal dangers. Happily death is the least common danger from tanning beds, important for those few, but irrelevant for most. That does not mean that the nonfatal dangers are irrelevant, but in this debate too often they are ignored. There are already more cancers on the outside of the body, the skin, than all the cancers on the inside combined, 3+ million/year. Tanning beds significantly increase that. Most are relatively minor, but so is any 'benefit' the kids get from transiently being closer to Obama color. Non-malignant skin damage from UV light accounts for most of what people usually blame as aging changes in the skin. Ideal skin is sometimes represented as "soft as a baby's bottom." Said bottom skin is usually still soft and spotless on most current 90 year olds. The skin of their face, arms, etc. is quite different. We call that 'old' but most of 'old' is really UV damage. It's dry, itchy, fragile, scarred, encrusted with spots, bruises easily and they gripe about it a lot, along with all their other old age gripes. In spite of Madison Avenue hype modern treatments for most 'old skin' complaints are either impractical or not very effective. But unlike most of the inner old age complaints, these outer ones could be easily prevented. Or they can be made worse by choosing to bake the skin more. Teens think they look bad when pale. I think pale looked pretty good on Barbara Eden back in the 60s and it still looks good there in her 70s. I want to help kids choose better, to stay pretty rather than become prunes.

I value liberty so throughout my rant I haven't taken a position on the FDA's proposed ban of tanning beds for minors. I'm trying to educate people so they can make their own informed choices on it. But minors by legal definition are not entitled to full liberty, they are only entitled to what adults choose to give them. That adults are free to tan themselves to death doesn't necessarily imply the same for minors. That minors complain about their restrictions is a sign that they value liberty, but isn't necessarily evidence that they are ready for it. Some liberties are awarded them gradually, some abruptly at certain ages, but the adults chose the particulars. Chose wisely.

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