The American Suntanning Association (ASA) and the Indoor Tanning Association (ITA) are trade organizations representing the interests of indoor tanning manufacturers, suppliers and salon owners. The product that these trade organizations sell to customers is artificial UV radiation. The ASA has called itself a “science-first organization” and spouts off so-called scientific information on their website, TanningTruth.com, designed to correct “misinformation” about the harms of indoor sun tanning.
One problem, though: the science doesn’t support their position. In May 2013, several scientific researchers wrote in JAMA Dermatology about the ASA’s biased scientific agenda and how its unscientific messages can negatively impact the public: “Clinicians should be aware of this new counter-information campaign by the [indoor tanning] industry and continue to inform their patients about the risks of [indoor tanning] and the existence of potentially misleading information from the ASA and other organizations. Scientists and clinicians have a duty to remain cognizant of such issues and to voice concerns when agenda-based research is presented in order to “defend and promote” a product with potentially devastating health consequences.”
Like the tobacco industry, sugar industry, and fossil fuel industries before them, the indoor tanning industry is refusing to accept its ethical responsibility to inform customers of the harms of its products. Instead it is actively working to create uncertainty around the science and question the integrity of the governmental and scientific institutions that are acting in the public’s best interest.
The indoor tanning industry seeks to become “great again”
As President Trump took office, the ASA began the derivative slogan, “Make Indoor Tanning Great Again” in the industry’s monthly magazine, SmartTan. By “great again,” the industry means repealing the Affordable Care Act’s (ACA) inclusion of a 10% tax on indoor tanning services. In its advertisement, the ASA urges readers to join the movement and add to its effort of “building relationships with key policymakers and educating the federal government about our industry’s scientifically supported position.” In the June issue of SmartTan, in an article titled “Axing the Tan Tax,” the author brags that three full-time ASA lobbyists over the course of four years have convinced Congressional leadership (including current HHS chief Tom Price and Vice President Mike Pence) that the American tanning industry has been treated unfairly and that there is science supporting the benefits of non-burning UV exposure.
I’ll let The American Academy of Dermatology (AAD) take this one.
The AAD recommends that individuals should obtain vitamin D from a healthy diet, not from unprotected exposure to ultraviolet radiation, because there is “not scientifically validated, safe threshold of UV exposure from the sun or indoor tanning devices that allows for maximal vitamin D synthesis without increasing skin cancer risk.” Anyway, even if there were benefits of UV exposure, the business model of these salons operates upon the retention of customers throughout the year, not just during the busy season. And more trips to the salon means an increased risk of burns and unsafe exposure.
The tanning tax has a twofold goal: help reduce skin cancer risk, especially in young adults, and to use funds to help pay for implementation of the Act. The science on the association between indoor tanning and increased risk of skin cancer supported the case for the inclusion of this policy measure in President Obama’s healthcare bill. A quick spotlight on that science can be summed up by the headline on the Centers for Disease Control (CDC) website addressing the topic: “indoor tanning is not safe.”
The Surgeon General issued a call to action to prevent skin cancer in 2014 which warned of the risks of indoor tanning. The International Agency for Research on Cancer (IARC) has said this of tanning bed related exposure: “citing evidence from years of international research on the relationship between indoor tanning and skin cancer, the IARC, affiliated with the World Health Organization, placed this type of UVR in its most dangerous cancer category for humans, alongside offenders such as radon, asbestos, cigarettes, plutonium, and solar UVR.” Incidence of one of the most dangerous types of skin cancer, melanoma, has been rising over the past 30 years. And, people who started tanning before age 35 have an increased risk of developing melanoma. Because indoor tanning is popular among adolescents and it’s a risky behavior to start while young, restriction of indoor tanning would help public health outcomes.
The FDA has proposed a rule restricting indoor tanning bed use to adults over 18 and requiring users to sign a risk acknowledgement certification stating that they understand the risks of indoor tanning. Taxes are also an effective way to curb demand for a substance, the use of which has worked to decrease cigarette smoking and more recently, sugar-sweetened beverage consumption. However, the tanning industry has joined the ranks of the tobacco and sugar industries to fuel a misinformation campaign designed to sow doubt about the body of science showing harm and delay or quash policies that hurt their bottom line.
Shining a light on the tanning industry’s misinformation campaign
The tanning industry has long fought any regulation or control of its messaging and has funneled money to members of Congress to help in these efforts.
Burt Bonn, immediate past president of ASA, told Smart Tan magazine in February 2017 that “[t]he science has been in our favor from the very beginning…Our opponents have relied on just a few out of hundreds of studies on the risks of UV light to make their case. Nearly all of those studies have been debunked.” He continued, “I think the science is already at a point that it ought to be embarrassing to have someone in the medical profession advise complete and total sunlight abstinence or suggest that a tanning bed operated in a professional tanning salon is a major issue.” Embarrassing? Tell that to the American Academy of Dermatologists, the American Academy of Pediatrics, the American Medical Association, representing thousands of experts in their fields who have recommended that all adults reduce UV exposure, and that children under 18 eliminate UV exposure altogether.
The tanning industry has been on fire in its repeated attempts to misrepresent the science on UV exposure in multiple venues. In 2010, the Federal Trade Commission (FTC) charged that the ITA made misleading representations in its advertising and marketing for indoor tanning including falsely claiming that indoor tanning poses no risk to health, including no risk of skin cancer. The 2010 administrative order from the FTC prohibits the ITA from making representations that imply that the indoor tanning does not increase the risk of skin cancer. In March of 2017, the FTC wrote to the ITA informing them that its FAQ page on its website that claimed that “indoor tanning [was]more responsible than outdoor tanning” and that “melanoma was not associated with UV exposure from tanning bed[s]” were not allowed.
Apparently, the failure to remove that language since 2010 was an oversight by the ITA, but those non-scientific bits of information had persisted on their website, and had been picked up and used on third-party websites, for years! Not only are the indoor tanning industry trade associations still distributing their own unscientific materials to convince users of their products’ safety, but they are using these same arguments to attempt to meddle with public messaging and federal policy at the CDC and FDA and in its lobbying for tanning tax relief since 2011.
According to the tanning industry’s January 2015 issue of Smart Tan, the ASA’s legal and lobbying teams succeeded in getting the CDC to remove claims of a 75% increase in melanoma risk from sunbed use from its website, and “the ASA legal team is following appropriate CDC protocol to challenge even more language that we believe is not supported by sound science.” ASA’s Burt Bonn told the industry magazine that the previous leadership of the CDC and the Surgeon General were unwilling to consider the appropriate scientific evidence regarding indoor tanning and seems hopeful that the new directors will be more “open-minded.” He continued, “The federal government is currently treating tanning like smoking, when there’s no science to support that ridiculous comparison. The consumer advocacy campaigns need to stop…The science is overwhelmingly supportive of sunlight and human health, and we currently have an administration that seems to be driven more by politics than current science. But now they are gone and change is coming.” It should not surprise us that the Administration that coined the moronic oxymoron “alternative facts” would be supportive of an industry wed to the abusive use of such things.
The ASA and ITA’s 2016 comment to the FDA opposed its proposed rule that would restrict the sale, distribution, and use of indoor tanning beds to minors on the basis that the science that the agency relied upon is outdated and doesn’t support the “onerous requirements” of the FDA’s rule.
Section 118 of the Better Care Reconciliation Act of 2017 would repeal the 10% excise tax on indoor tanning services established by the 2010 Affordable Care Act. According to the Joint Committee on Taxation, its repeal would reduce revenues by approximately $622 over ten years and would drastically reduce funding to implement the Affordable Care Act.
There have also been several failed Congressional attempts to repeal the ACA tanning tax, lobbied for by none other than the ITA. In 2015 and 2017, Representative George Holding introduced a bill to repeal the tanning tax after receiving over $6,000 from the Indoor Tanning Association. Representative Michael Grimm had introduced a similar bill in 2011 and 2014 and received over $8,000 in 2012. And now, the indoor tanning industry is cheering the introduction of the provision within the draft Senate healthcare bill, the Better Care Reconciliation Act of 2017, that would repeal the tax.
The truth about indoor tanning risks must inform federal policy
In spite of the tanning industry’s best efforts so far, the government’s messaging on the risks of indoor tanning and the policy measures instituted to reduce its use are working. CDC data from the High School Youth Risk Behavior Surveillance System found that the number of high school students who used an indoor tanning device decreased by more than half since the ACA and the tanning tax went into effect, from 15.6% in 2009 to 7.3% in 2015. In light of the great body of scientific evidence demonstrating the risks of UV exposure, we should be doing even more to educate and protect teenagers and adults alike from the harms of UV exposure, rather than rolling back important policies aimed at accomplishing just that.
The Senate healthcare bill ignores the science on health impacts of indoor tanning and caves to the tanning industry and their misinformation campaign. It is currently opposed by nearly all scientific voices that work in healthcare. The American Academy of Dermatology opposes the repeal of the tanning tax provision, and the full bill is opposed by the American Medical Association, the American Hospital Association, the Federation of American Hospitals, the American Academy of Pediatrics, the American College of Physicians, the American Academy of Family Physicians, the Association of American Medical Colleges, and the list goes on.
We have the right to make decisions based on accurate scientific information, not the information cherry-picked and screened by an industry who stands to profit from our ignorance. We should put the Indoor Tanning Association and the American Suntanning Association in the hot seat (and not the kind you find in a tanning salon) for perpetuating falsehoods about their products that could harm consumers’ health. This goes for the current draft Senate healthcare bill and any other future measures that would limit the amount of information available to consumers about the risks of indoor tanning or otherwise compromise policy solutions aimed at keeping us safe.