Below is Orzag’s column. [My comments are in bold brackets.]
Young White Women, Killing Themselves by Tanning
By Peter Orszag – Jul 9, 2013, Bloomberg
Despite the hoopla over dysfunction in Washington, the government can still do useful things. To prove it, the Food and Drug Administration should move aggressively to implement and then strengthen its proposed cancer warnings about tanning beds.
A stunning 20 million to 30 million Americans each year use tanning beds. Use is particularly concentrated among young white women. The Centers for Disease Control and Prevention estimated that about 30 percent of white women between the ages of 18 and 25 used an indoor tanning machine in 2010. And about 60 percent of that group did so at least 10 times during the year.
The ultraviolet radiation from indoor tanning far exceeds that of the natural sun. For example, tanning machines’ output of UVA rays, which cause skin darkening, is at least four times that of natural sunlight, even the rays during the summer at noon in Washington. The UVB output, which causes burns, is about twice that of natural sunlight. [As always, it’s the exposure/dose that matters. Here, UV radiation exposure = UV intensity x exposure duration. Indoor tanning time is calibrated so that tanners spend less time in tanning beds than they would tanning outside getting similar exposures from the sun. Indoor tanners are exposed to substantially less UV than would cause sunburn.]
Studies suggest that people who use indoor tanning before age 35 increase their risk of melanoma (the most serious type of skin cancer) by about 75 percent. [In addition to this 75% number being inherently suspect as weak association epidemiology, when the analysis is confined to exposures from indoor tanning salons, the reported 75% increase drops to a statistically insignificant 6% — i.e., there is no evidence of an increase in melanoma incidence associate with tanning salons.] Similarly, the National Cancer Institute estimates that women who use indoor tanning at least once a month are 55 percent more likely to develop melanoma. [The claimed 55% increase is statistically insignificant — again this is not evidence of a link.]
The Indoor Tanning Association, an industry lobbying group, has claimed that indoor tanning is safer than exposure to natural sunlight. [Let’s say indoor tanning is a more controlled experience than outdoor tanning.] But the Federal Trade Commission has found those claims to be false, and forced the association to stop making them. [It’s a good thing for Orszag that the First Amendment prevents the FTC from reviewing his column.]
All of which is why excessive indoor tanning by young women is particularly troubling. Many high school girls, for example, use tanning beds frequently before their proms — without realizing the harm that they may be doing to themselves.
The rate of melanoma among young U.S. adults has been rising rapidly. In 1973, for example, about 6 in every 100,000 white women ages 15 to 39 were diagnosed with melanoma. By 2004, that rate had more than doubled to about 14 per 100,000. The good news is that the mortality rate from melanoma has been declining, perhaps because of earlier detection and better treatment. [What’s going on is that more melanoma is being detected while death rates largely haven’t changed. We are simply detecting and treating more benign cancers.]
So what can we do?
First, if you’ve used indoor tanning beds extensively, get a melanoma screening. Such screening may not make sense for the general population, but it does for those at high risk, which includes people who have used indoor tanning a lot. [So why doesn’t Orszag recommend that outdoor tanners or really anyone who spends time outdoors get screened as well? There is nothing special about indoor tanning in terms of UV radiation exposure or cancer risk.]
Second, pediatricians and other doctors could be even more forceful in warning about the risks for young people, as urged in a March 2013 article in Pediatrics by Sophie Balk of Children’s Hospital at Montefiore, David Fisher of Harvard Medical School and Alan Geller of the Harvard School of Public Health. [There are many more real and significant risks young people face than UV exposure.]
Third, more states should consider banning indoor tanning for those younger than 18. California and Vermont already have, along with a variety of cities, including Chicago. At the very least, all states should ban indoor tanning for minors without written permission from parents. [On the basis of what? Do kids need written permission to go outside to play? To go to the pool? To go to the beach?]
Fourth, in the Affordable Care Act, the Obama administration imposed a 10 percent excise tax on indoor tanning services to help pay for expanded health insurance coverage. The inspector general at the Treasury Department, however, reported in 2011 that the tax was being collected from less than half of the expected number of tanning facilities. [There are about 3 million injured by automobiles annually while only 63,000 reported cases of melanoma. Should driving be subject to an Obamacare tax?]
Treasury should more aggressively collect this tax, and Congress should consider raising it to 25 percent or even 50 percent. If Congress won’t act, states should impose higher taxes themselves. In other areas, including cigarette smoking, significantly increased taxes along with a public health effort have helped to reduce use among younger adults.
Finally, in May, the Food and Drug Administration proposed tighter regulatory oversight of tanning beds along with new warnings about cancer risks. [What cancer risk?] This is welcome, but not enough: The proposed warnings, for example, would be placed on promotional materials and websites, rather than the machines themselves. The FDA should finish its regulations quickly, and then follow up with even tighter standards if these relatively weak warnings don’t do much to discourage use. [Should beaches, pools, golf courses, playgrounds, tennis courts, baseball parks, etc. also carry warnings?]
The bottom line is that melanoma and other skin cancers from indoor tanning use are entirely preventable. [The precise cause(s) of melanoma are unknown.] In an era of increasing concern about rising health costs, aren’t these steps the least we should be doing? [Nannying tanning is not going to make a dent in health care costs.]
(Peter Orszag is vice chairman of corporate and investment banking and chairman of the financial strategy and solutions group at Citigroup Inc. and a former director of the Office of Management and Budget in the Obama administration.)
To contact the writer of this article: Peter Orszag at firstname.lastname@example.org.