dermatology

tanning bed, Image courtesy flickr creative commons, Evil Erin

Advocates Try Again To Ban Tanning Bed Use for Teens

March 12, 2015 by Editor

Advocates Try Again To Ban Tanning Bed Use for Teens - North Carolina Health News

For the third year running, cancer treatment advocates are floating a bill to ban the use of indoor tanning beds for anyone under 18.

By Rose Hoban

For the third time in as many years, dermatologists gathered at the legislative building on Jones Street in Raleigh to offer free skin cancer screenings.

Susan Sanders and Sarah A. Wolfe, members of the N.C. Dermatology Association show their support for legislation prohibiting tanning bed use among minors. Photo credit: Hyun Namkoong

And between the screenings on lobbyists and legislative staffers, they had conversations with legislators about tanning beds.

This is the third year that legislation to restrict the use of tanning beds for anyone under 18 has been introduced at the General Assembly. A bill introduced in 2013 passed the House of Representatives with bipartisan support. The bill was then sent to the Senate, where it died. At one point last summer, House lawmakers inserted the tanning bed language into an omnibus regulatory reform bill, where it also died.

“I wish there was a way to keep people from putting [tanning beds] into homes,” said skin cancer patient Nancy Autry, 61, who came to Raleigh from Mt. Olive on Wednesday to advocate for passage of the bill.

Autry had to have several large squamous cell tumors removed from her thigh in 2013 after years of tanning bed use.

“I first started going in my late 20s when the dermatologist recommended it for psoriasis, but he recommended two days a week, not six days for three months at a time,” she said. “I got to liking that tanned look and I abused it. I’d start in February and I’d go right on up to May.

“It was convenient. I could do it on my lunch hour and take a 20-minute nap,” she said.

And two of Autry’s three daughters also started tanning in their teens.

“They’d go with friends, and I never signed anything for them to go,” she said. Both girls were diagnosed with pre-melanoma in their 20s and each had multiple moles removed. Autry herself had another 14 spots frozen off last year.

“I know it all came from the tanning bed,” she said.

Emotional pull

Autry and the dermatologists spent the day Wednesday talking up the latest version of the tanning bed bill, House Bill 158. But this year, there’s an added emotional element: It’s been named for recently deceased Republican House member Jim Fulghum.

Fulghum died in July 2014, just before finishing his freshman term at the legislature, where he put his name on many health-related bills. The avuncular surgeon gained many friends in the short time he served in the legislature.

In the House health committee meeting Wednesday, Rep. Donny Lambeth (R-Winston-Salem) spoke on behalf of this year’s version and asked all the bill’s supporters to stand. Almost everyone in the visitors’ section of the room rose to their feet.

“This bill is essentially the same bill that passed the House with bi-partisan support in our last session. It simply prohibits minors less than 18 to use indoor tanning beds,” Lambeth said. “Skin cancer is a major public health problem.”

He then spoke of Fulghum, “who most of you remember. His passion for this, wanting to leave a lasting legacy, is really the reason I put my name on this bill. It’s a great way to remember Jim, his passion for this particular issue.”

Fulghum’s family approved putting his name on the measure, according to Christine Weason of the American Cancer Society. Fulghum’s daughter and wife were given a posthumous award by the ACS and his wife, Mary Susan, sent a letter to every legislator encouraging them to pass the bill.

Susan Sanders, former president of the N.C. Dermatology Association, said she was hopeful about passage this year, but she’s still concerned about what the Senate will do.

After the 2013 version of the bill went to the Senate, it sat for more than a year and was never brought to a vote. At the time, advocates said enough votes for passage were probably there, but that Senate leadership was uninterested in moving the bill.

“There are a few people who are concerned about regulating small businesses … and telling parents what to do. They don’t want to have a ‘nanny state,’” Sanders said. “It’s a public health issue. It’s really a common sense bill.”

She said dermatologists throughout the state have been meeting with their legislators to gain grassroots support for HB 158.

This year, a companion bill to the House version has been introduced in the Senate. If Fulghum had lived, he likely could have been the sponsor, as he was campaigning for the Senate when he got sick and withdrew from the race. The seat he was running for went to Republican John Alexander (R-Raleigh), who ran in his stead.

Alexander is with a bevy of Republican co-sponsors signing onto this year’s Senate bill.

When asked if she thought it would pass this year, co-sponsor Sen. Tamara Barringer (R-Raleigh) said she believed it would.

“I hope so,” she said “It’s for the children.”

Old Issues and New on Legislative Health Care Agenda

January 12, 2015 by Hyun Namkoong

Old Issues and New on Legislative Health Care Agenda - North Carolina Health News

As legislators reconvene in Raleigh this week, health advocates will be on Jones Street to push for their priorities – some of them new, some left over from prior legislative sessions.

By Hyun Namkoong

During the last legislative biennium, a number of health care initiatives were introduced, some of which made it through only one chamber. Advocates say they’re back again to get their priorities passed. They also have some new initiatives they want lawmakers to consider.

Autism health insurance

Advocates are hopeful that legislation requiring insurance companies to provide coverage for the screening, diagnosis and treatment of people with autism will pass this year after several failed attempts at passage during the last biennium.

House Bill 498, known as the Autism Health Insurance Coverage bill, passed the House but was sent to an insurance committee after its first reading in the Senate in May. There the bill languished without action until the legislature recessed in August.

Advocates looking to convince lawmakers to pass the autism insurance measure roamed the halls of the General Assembly to speak to legislators early in July. — Advocates looking to convince lawmakers to pass the autism insurance measure roamed the halls of the General Assembly last summer to speak to legislators. Photo credit: Rose Hoban

Advocates saw some last-minute hope for the bill’s passage when it was tucked into a regulatory reform bill, but that also failed to get final approval in the Senate.

Jen Mahan, director of advocacy and public policy for the Autism Society of North Carolina, said she’s hopeful the legislation will pass this year because a lot of progress has been made in recent years. She said there’s been movement around this legislation for seven years and many states around the country have passed similar bills, including South Carolina and Virginia.

“We know there are a lot of people who need these services and we are hoping that the Senate will recognize the importance of it,” Mahan said.

Raising the age of youth incarceration

State advocates are optimistic that the age of criminal jurisdiction will be raised to 18 after last year’s passage of the “Raise the Age” bill in the House.

North Carolina and New York are the only states in the country that automatically charge 16- and 17-year-olds as adults in the criminal justice system. But changes in New York are starting to take place, which could leave North Carolina in a unique position.

Raise the Age supporters watch proceedings in the Senate Chamber at the General Assembly Thursday — Raise the Age supporters watch proceedings in the Senate chamber at the General Assembly in 2012.

An investigation into the treatment of adolescent inmates on New York City’s Rikers Island Correctional Facility resulted in a scathing report from the U.S. Department of Justice that found that there was a “deep-seated culture of violence” throughout the adolescent facilities at Rikers. The report also found adolescent inmates were inadequately protected from harm caused by correctional officers and adult inmates.

In the wake of the report, New York State Gov. Andrew Cuomo directed the Commission on Youth, Public Safety & Justice to develop a strategy and recommendations for raising the age of criminal jurisdiction.

Rob Thompson from the advocacy organization NC Child said that with North Carolina potentially being the only state in the country that automatically charges 16- and 17-year-olds as adults, the Raise the Age bill is more important than ever.

A report from the Centers for Disease Control and Prevention found that the incarceration of juvenile offenders in adult prisons not only increases the risk of recidivism but can also make juvenile inmates more violent. Advocates have long argued that incarcerating youth in adult prisons is dangerous to their health. In addition, young offenders who cannot have their criminal records expunged end up with few employment options once they’re released from prison, adding to their economic woes.

Thompson said he expects strong support from both sides of the aisle in raising the age.

“I think [bi-partisan support] speaks a lot about the issue. There are a lot of really good reasons that appeal to a lot of different people and it shows the overwhelming need to get this done,” he said.

Banning minors from tanning-bed use

Legislation making it unlawful for minors to get a bronzed-skin glow – that is, if it’s from a tanning bed – will try to make its way through the General Assembly again this year.

Susan Sanders, former president of the N.C. Dermatology Association, said there’s a lot of momentum around the issue with the release of national reports and scientific studies showing the harm to young skin from tanning beds. Sanders said she’s hopeful it will get passed this year.

A 2014 report from the CDC showed that skin cancer is the most commonly diagnosed cancer in the country and that many cases of melanoma, the deadliest kind of skin cancer, are related to exposure to ultraviolet light from tanning beds.

Sanders said she’s seen in her own practice a rise of young patients, especially women, who have been diagnosed with melanoma. She said that work on educating the public and lawmakers about the importance of the ban as a public health issue needs to be done to help people realize that the ban is not about regulating small businesses or taking away parent’s authority, as some opponents of the ban have claimed.

“There is a precedent for this kind of legislation that protects children,” Sanders said.

She pointed to laws that require children to wear seat belts or the ban of tobacco sales to minors as public health-oriented legislation that’s similar to the proposed ban on tanning bed use for minors.

“It’s really [about] protecting our children in the state,” Sanders said.

Toxic-free products for kids

Legislation banning certain categories of chemicals in children’s products has been introduced twice before, and advocates are optimistic that the third time’s the charm. The previous two bills banning from children’s products harmful chemicals such as bisphenol A (BPA), phthalates and particular kinds of flame retardants were introduced during the 2011-12 and 2013-14 sessions but failed to make it out of committee.

chemical structure for bisphenol A (BPA) — Chemical structure for bisphenol A (BPA)

The Child Fatality Task force identified legislation banning the sale of children’s products containing harmful chemicals as a priority issue for this year’s long session.

“We’re trying to protect North Carolina’s children from these different chemicals that have been scientifically linked to various cancers, respiratory disease, endocrine disrupters [and] various kinds of health problems associated with it,” said Preston Peck, a policy advocate for Toxic Free NC, which has supported the bills in the past.

Peck said that children are more vulnerable to harm from different chemicals because they’re very tactile and often put things into their mouths or touch things with their hands.

Tom Vitaglione, a senior fellow at NC Child, said that it remains uncertain what the bill would specifically ban or restrict.

New initiatives

Advocates say they have some new initiatives they’d like to see considered at the General Assembly this year, including a proposal to ensure that pregnant women receive basic safety protections at their jobs so that they don’t have to make a choice between a safe pregnancy and maintaining stable employment.

Thompson said that many states around the country are taking the issue of workplace safety during pregnancy into their own hands as the country awaits the Supreme Court’s decision on a case involving the United Parcel Services and former delivery driver Peggy Young.

In 2006, Young asked to be given “light duty” during her pregnancy that didn’t require her to lift more than 20 pounds. Instead, UPS told her that they don’t offer light duty to pregnant workers, and Young lost her job and health insurance coverage.

Advocates also say they want to work to decriminalize the possession of syringes as a way to reduce harm from injection drug use.

In the past decade, rates of abuse of prescription painkillers has resulted in increased rates of opiate addiction and overdose deaths. But as states have moved to limit access to prescription pain medications, many addicted users have looked to instead use heroin, a cheaper and more easily acquired substance that’s commonly injected with a syringe.

“Because of the rise of heroin use, syringe disposal is a major concern for communities here in North Carolina,” said Tessie Castillo, advocacy and communications coordinator of the N.C. Harm Reduction Coalition.

Castillo said that the current law does not provide incentives for people to safely dispose of syringes in a secure container, putting them at risk for needle-stick injury. She said her organization would push for introduction of a bill to decriminalize possession of needles in an attempt to protect the public.

“[People] get in just as much trouble for a syringe in a bio-hazard container as one tossed in a playground,” Castillo said. “So we need to change the law to give people incentives to put them in safe containers where they can’t hurt anyone.”

Health Care Budget Briefs: Epi Pens, Tanning Beds, Raise the Age

July 31, 2014 by Jasmin Singh

Health Care Budget Briefs: Epi Pens, Tanning Beds, Raise the Age - North Carolina Health News

The final 2014 budget has a number of small, but significant, changes.

By Jasmin Singh, Hyun Namkoong, Rose Hoban

As lawmakers worked behind closed doors this week to put the finishing touches on this year’s budget revision, health care advocates and lobbyists were walking the halls, holding conversations with key lawmakers where they could. They were hoping to induce movement on a number of bills that have been parked in obscure legislative committees, some for more than a year.

The final budget bill includes some of the measures of concern to health care lobbyists, but some came away disappointed.

School epinephrine pens

A bill passed by the House last year would have provided for schools to supply epinephrine auto-injector devices in every school.

EpiPen on a thigh — EpiPens are designed to administer a dose of epinephrine into a thigh through clothing, if necessary. Image Greg Friese, flickr creative commons.

The devices allow for quick treatment of severe allergic responses, whether it be to a peanut or the venom of a bee sting. The most serious kind of reaction is called anaphylaxis, a rapid onset of hives, throat swelling and low blood pressure. Untreated, anaphylaxis can quickly proceed to death.

The bill has been waiting for action by the Senate since last year.

The budget released late last night includes a provision to have schools obtain epinephrine injection devices and train several staff members in how to use them in case of an emergency. An earlier version of the budget introduced by the House included the same provision.

The original bill was one of many sponsored by Rep. Jim Fulghum (R-Raleigh), a physician who died earlier this month from complications due to cancer.

Youth skin cancer prevention

Another bill co-sponsored by Fulghum last year and passed by the House would restrict teens under 18 years old from using tanning beds – a measure legislators were convinced would reduce the number of premature cases of skin cancer.

Initially, the bill faced stiff resistance from the tanning bed industry, but the industry has since withdrawn opposition to the bill.

This bill is a response to the growing number of skin cancer cases in the country’s youth. The Centers for Disease Control and Prevention reports that in 2012, 61,061 people in the United States were diagnosed with melanomas of the skin – 35,248 men and 25,813 women. The research also shows that young people who begin tanning before the age of 35 have a 59 percent higher risk of melanoma, the deadliest form of skin cancer.

Nonetheless, the measure has been languishing for more than a year, and it looks less likely that tanning bed regulation will become law at the end of this legislative session.

Initially, the bill was standalone, but after a year of inaction by the Senate, House budget writers wrote the provision into their version of the budget. That bill stalled, and House lawmakers then rolled the tanning bed bill into a larger regulatory reform bill, SB 493.

In a recent version of the budget, the statutory language banning teen use of tanning beds was included; but in the final version released late Wednesday evening, the language was gone.

“It’s a sad irony that we received the news about the North Carolina tanning bed bill the same week as the U.S. Surgeon General issued a national call to action on skin cancer,” wrote Brent Mizelle, head of the N.C. Dermatology Association, in a statement Thursday morning.

Raise the age

Historic legislation that would allow 16- and 17-year-olds to be charged as minors rather than adults in the criminal justice system passed the House in May after failing multiple times in the past decade.

North Carolina and New York are the only states in the country that automatically try 16- and 17-year-olds as adults in the criminal justice system.

But almost two months after overwhelmingly passing muster in the House, the bill continues to languish in the Senate. Advocates and lawmakers in favor of the bill argue that North Carolina juveniles are unfairly subjected to the negative economic impact of a criminal record.

They also point to findings from the National Prison Rape Elimination Commission that show that 16- and 17-year-olds placed in adult prisons have the highest risk for sexual abuse, more than any other group of incarcerated people.

Advocates worried privately that the troubles resolving the budget would result in the bill remaining stuck in the House. But they said they were determined to return to Raleigh next year to keep pushing for the measure.

Anne Bowman needed a 6" long incision to remove her melanoma, along with the removal of lymph nodes in her groin to prevent recurrence.

Tanning Bed Bill Languishes in State Senate

May 23, 2014 by Editor

Tanning Bed Bill Languishes in State Senate - North Carolina Health News

A bill that would restrict the use of tanning beds by teens under 18 made it through the House last year … and has been sitting ever since.

By Rose Hoban

When Anne Bowman was a teenager, she’d hit the tanning salon before a big dance. Later, in college, she would go to get a “base tan” before spring break.

Bowman didn’t think much of it until she was diagnosed with melanoma, the most aggressive form of skin cancer, when she was a 32-year-old mother of two.

So she came to Raleigh this week to ask legislators to make it harder for young girls to tan.

“I can’t go back to my 16-year-old self and beg her not to set foot in a tanning bed, but I can share my story in hopes of protecting our teens from going through what my family has gone through for the past three and a half years,” said Bowman, who lives in Charlotte.

But despite passing the House of Representatives by an overwhelming majority last March, a bill to restrict young teens’ access to tanning beds has since been sitting in the Senate without action.

And even though industry representatives who fought the bill as it made its way through the House during the 2013 legislative session have withdrawn their opposition, senators have not indicated that passing the Youth Skin Prevention Act is a priority.

The bill, which would ban the use of indoor tanning devices for kids under 18, has been sitting in the Rules and Operations of the Senate Committee since the day the chamber received it. Rules is a committee where bills often go to wither and die, or they stay there until the Senate needs a bargaining chip to get something it wants from the House.

“I’ve talked to Senate colleagues about this,” said Rep. Jim Fulghum (R-Raleigh), a physician who sponsored the bill in the House last year. “I intend to keep talking to them about this issue.”

This week, the North Carolina Dermatology Association attempted a full-court press at the legislature, establishing a free temporary skin cancer screening clinic in a legislative meeting room, bringing in close to a dozen white-coated dermatologists to walk the halls and holding a press conference featuring Bowman, who needed to have a six-inch-incision on her lower back to remove her pencil eraser-sized tumor three and a half years ago. She also needed to have lymph nodes in her groin removed to prevent the spread of her cancer.

“I would rock my baby to sleep at night wondering if I’d be there to see him grow up,” she said, choking up.

Bowman wasn’t a regular tanner, but dermatologist Craig Burkhart from UNC-Chapel Hill was adamant that even a small amount of exposure is enough to jack up the chances of being diagnosed with melanoma.

The light used by tanning beds is “an artificial light; it’s [ultraviolet-A], very intense, that you don’t find anywhere else on Earth,” he said.

Burkhart said there’s “piles of data” showing that tanning beds increase the risk of melanoma.

But what got him into advocating for a ban was looking at the numbers. Melanoma is now the most common form of cancer for those 25 to 29 years of age and the second most common form of cancer for those 15 to 19. Recent studies show that teens and young adults who begin tanning before the age of 35 have a 59 percent higher risk of melanoma.

“When I ran a melanoma clinic for three years, a third of my patients were young females, 25- to 35-years-olds who used indoor tanning beds,” Burkhart said. The epidemiological data on melanoma cases shows that the other primary demographic that gets melanoma, white men in their 50s, has had about the same rate of the disease for decades.

“But what’s alarming is that the incidence in young women is going up,” he said, noting that the increase in incidence in younger women parallels the widespread introduction of indoor tanning in the 1980s. He said that by tanning, young women are adding about 25 years or more of exposure to their skin.

“It’s the only skin cancer in North Carolina that’s growing in incidence,” Burkhart said. “Everything else is leveling off.”

Objections overcome

According to the Centers for Disease Control and Prevention, 13.3 percent of high school students have used a tanning bed. But drilling down in the statistics reveals that 29.3 percent of white high school girls have used a tanning bed in a given year.

Duke University dermatologist Sarah Wolfe checks the skin on NCGA staffer Karen Johns' neck during the free skin cancer screening event Thursday. — Duke University dermatologist Sarah Wolfe checks the skin on NCGA staffer Karen Johns’ neck during the free skin cancer screening event Thursday. Photo credit: Rose Hoban

Currently, teens between the ages of 13 an 18 can go tanning if they have a parent’s permission. During the debate last year, Rep. Marilyn Avila (R-Raleigh) expressed her misgivings about the ban, saying that she worried about taking parents out of the picture.

“I was a teenager,” she said. “I know how we cooked ourselves in the sun and all that kind of stuff, and no one was around to tell us how long we should lay there.”

Burkhart countered that although sun exposure is dangerous to young skin, the radiation from tanning beds is much worse.

“Some of these lamps are 15 times as strong as the sunlight you can get on Earth at any time of the year,” he said.

In addition, a study done by researchers from UNC-Chapel Hill’s Lineberger Cancer Center found that even though a majority of women went tanning for the first time with their friends, a significant number started alongside their mothers.

This year, the American Suntanning Association dropped its objections to the bill, noting that teen girls comprise only about 2 percent of the industry’s business. And Planet Beach, one of the largest tanning bed chains in the U.S., recently banned teens under 18 from its North Carolina salons.

“We want to elevate the discussion about a balanced message about UV exposure, and we believe in responsibly teaching people about the risks of overexposure to UV,” ASA spokesman Joseph Levy told WBTV in Charlotte earlier this year.

The industry has also supported bans for teens in 11 other states where they’re proposed.

In North Carolina, now it’s up to the state Senate.

Sen. Louis Pate (R-Mt. Olive), who sits on several health care committees, said members of his chamber are currently focused on getting the budget written and passed.

“The bill came over from the House, and they’ve asked that we take a look at it if we have time,” Pate said. “But it’s not part of the appropriations process.”

Tan Ban for Teens Moves Forward at Legislature

February 27, 2013 by Rose Hoban

Tan Ban for Teens Moves Forward at Legislature - North Carolina Health News

After a vote to delay consideration of a ban on tanning bed use for teenagers, a House committee heard arguments on the bill again Tuesday

By Rose Hoban

High school girls wanting to have a tan for the prom may soon be back to using the sun, or spray-on makeup, instead of tanning beds to get a glow after a bill to ban teenagers from using tanning salons got through a legislative committee Tuesday.

Currently, 14- to 18-year-olds must get parental consent to use a tanning bed.

Tanning industry representative Joseph Levy spoke against the tanning bed ban to a House committee Tuesday.

Last week, advocates’ efforts to get the Youth Skin Cancer Prevention Act through the House of Representatives Health and Human Services committee was derailed when an industry lobbyist contested the science behind dermatologists’ claims that use of tanning beds increases the risk for skin cancer and melanoma.

The House committee voted last week to learn more before making a final vote on the bill.

Children’s health advocates spent this past week talking to legislators on the committee while industry representatives were simultaneously flooding legislative email inboxes with studies intended to bolster their case that tanning is unrelated to melanoma in young people.

Pinehurst tanning salon owner Jim Bivens said the bill would mean a 25 percent reduction in his business.

“This bill is not doing anything to help small business. It’s doing nothing but hurt it,” Bivens told the committee.

“Like a lot of other issues based on science, I find it hard to come down on one side or the other when there is still a question about the validity of the absolute,” said Rep. Marilyn Avila (R-Raleigh).

Avila also expressed doubt about the advocates’ arguments about tanning, quoting the medieval toxicology pioneer Paracelsus: “Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.”

Dr. Kelly Nelson from Duke University argued for banning teens from using tanning beds.

She concluded that teens would find a way to tan, whether it is in a salon, or in the sun or using a home unit. Avila said she felt “it needs to be in a controlled environment with supervision, which I feel belongs in the parents’ hands.”

But advocates were ready this week to counter industry claims that they called “misrepresentative scientific information that the tanning industry has used to try to confuse the issues about this bill.”

Kelly Nelson, a dermatologist who heads a melanoma clinic at Duke University Medical Center, said many hours had been spent in the past week talking to legislators and researchers to bolster the case against tanning beds.

Nelson said she had contacted a researcher whose study was cited last week by an industry lobbyist to emphasize disagreement in the dermatology community around the causes of melanoma.

He was very upset to learn of how his views were being misrepresented,” Nelson told the committee. “He, like many other dermatologists, supports legislation to prohibit teens from using tanning beds.”

Nelson called the data associating use of tanning beds by young people with melanoma development “overwhelming.”

“Of course, everyone who uses a tanning bed will not develop skin cancer, just as everyone who smokes will not develop lung cancer,” Nelson said. “Children who use indoor tanning beds are increasing their risk of skin cancer and deserve the protection this law entails.”

“You may ask why we’re doing this, it certainly not to benefit our bottom line,” she said. “To be honest about it, this legislation will hopefully mean a reduction in business for me, which is exactly what myself and all of our colleagues who work on melanoma want.”

The committee voted overwhelmingly to approve the bill and sent it on to the House Regulatory Reform Committee.

Tanning Bed Opponents Get Burned

February 20, 2013 by Rose Hoban

Tanning Bed Opponents Get Burned - North Carolina Health News

For several years, opponents of tanning bed use in teens have been pushing to ban the practice for kids under 18. Just when they thought they would get a bill out of committee, it got derailed.

By Rose Hoban

After a year of committee meetings about banning tanning bed use for teens under 18 years old, proponents who wanted to limit their use finally thought their bill would make it out of committee.

But an impassioned plea from a tanning industry representative at the close of a committee meeting Tuesday morning convinced lawmakers to delay consideration of the Youth Skin Cancer Prevention Act (House Bill 18).

Joseph Levy, scientific advisor for the American Suntanning Association, told the House Health and Human Services Committee that the science around tanning beds and their relationship to skin cancer and melanoma is still unclear.

Levy, who travels the country on behalf of the tanning salon industry to testify at legislative hearings, said he believed that North Carolina’s requirement for adolescents under 18 years of age to get parental permission to use a tanning salon is sufficient.

“We just heard a tremendous amount of misinformation about melanoma and photobiology and about UV light,” Levy told the committee. He went on to contradict an earlier presentation about skin cancer by the head of the Duke University Medical Center melanoma clinic. Levy asked for a “higher level” discussion on the science of tanning.

His seven-minute presentation was enough to raise doubts for the legislators sitting in the room.

“It is very disturbing to me to hear testimony from people I believe have legitimate credentials that are so contradictory,” said Rep. Verla Insko (D-Chapel Hill). “I agree that we need more time.”

A motion to keep the bill in committee passed easily.

Science contradictory?

“This bill has been heard in the Child Fatality Task Force for the past year, and it’s had time to be aired in public,” said bill sponsor Rep. Mark Hollo (R-Taylorsville).

“The science is contradictory, if you want to call it that,” Hollo said, visibly frustrated. He went on to give a laundry list of the bill’s supporters, including the American Cancer Society and the North Carolina Medical Society.

But much of the science is not contradictory, said DeAnn Lazovich, an associate professor of epidemiology at the Masonic Cancer Center at the University of Minnesota School of Public Health. She cited a recent paper that aggregated data from dozens of other pieces of research.

“They concluded indoor tanning was a human carcinogen,” she said.

Lazovich, who has published extensively on the use of tanning by adolescent and young women, said the use of indoor tanning has changed over time. The industry really took off in the 1980s and ’90s, far enough in the past, she said, that young women who used tanning beds heavily a decade or two ago are starting to have negative effects.

About 37 percent of young women reported using indoor tanning, according to the 2009 national Youth Risk Behavior Survey. A 2005 National Cancer Institute survey found about the same use rates in women aged 18 to 30, with rates highest for Caucasian women.

“It’s a staggering prevalence of use in women, especially when you take into account age, race and ethnicity,” Lazovich said. “There is use in other groups, but for young girls and women, it’s far higher than tobacco use.”

“If you look at documents that Levy presented to the Connecticut legislature, he says that melanoma is really affecting older men,” she said. “But if you look under the age of 40, melanoma is higher in women than in men. It’s increasing in all age groups, but it’s increasing especially rapidly in young women.”

“And the timing coincides with when people really started tanning,” she said.

That was the message sent by Ann Bowman, a 34-year-old cancer survivor from Charlotte who testified at the committee meeting.

“I first used tanning when I was 16 years old to get a base tan for proms, sorority formals and later my wedding,” she told the committee while showing photographs of the scars on her legs and left torso left from removal of melanoma tumors.

Bowman, who now represents the advocacy group AIM at Melanoma, was diagnosed with melanoma in 2010. “My melanoma was the size of a pencil eraser, but they had to take out enough tissue that it left a six-inch scar,” she said.

Levy claimed that Bowman’s organization is funded by the sunscreen industry in an attempt to scare people into using more sunscreen. An examination of the organization’s IRS filings for the past three years found it was difficult to determine where the group gets funding.

Paralysis by analysis

According to the National Cancer Institute, about 76,000 new cases of melanoma will be diagnosed in the U.S. in 2013, and 9,480 people will die from the disease.

“It’s a rare cancer, compared to breast or prostate cancer,” with an incidence of about 10 cases per 100,000 among Caucasians younger than age 65, in the absence of indoor tanning use, Lazovich said.

“But unlike those other cancers, a high proportion of those who get it are under 50,” she said. In her data and that of others, Lazovich found tanning beds use increases the overall risk in the population to about 23 cases per 100,000, more than double the risk.

After the meeting, Levy said that “from a health standpoint, the discussion we heard today did not address this issue in a balanced fashion.”

“The greatest risk factor for melanoma is having a high number of moles, red hair – genetic factors. Those are what we need to be concentrating on in terms of skin cancer prevention,” Levy said. “It’s conspicuous that time after time we hear testimony that attempts to say that sunlight is bad in a dogmatic fashion.”

He also warned that kids who can’t legally use tanning beds would buy their own on eBay or Craigslist and create a “garage tanning industry.”

“I’ve never seen a study that if you couldn’t tan at a salon that you would seek tanning elsewhere that’s been published in the scientific literature,” retorted Lazovich, who’s published data on usage habits of tanning salon patrons. “We’ve surveyed this many times. I don’t know where they got this data.”

She said the delaying tactic called for by Levy is a common industry ploy, a tactic often called “paralysis by analysis,” whereby study commissions substitute for action.

Lazovich also said she’s been targeted by the industry in the past, which distributed materials calling into question her credibility as a scientist in advance of the publication of a paper critical of the industry.

‘Selective’ data

Advocates for the bill were dismayed that the bill failed to get referred to the House floor for a vote.

“The selective utilization of data was something we did not expect,” said Kelly Nelson from the Duke University Medical Center melanoma clinic. “We’re disappointed.”

One of the only votes against delaying the tanning bed bill came from Rep. Nelson Dollar (R-Cary), who said it’s hard on parents to resist their teens’ requests to tan.

“Kids will say, ‘Sally’s mom lets her do it,’ and then it becomes hard to say no,” Dollar said. “We afford the same protections for young people in other areas like smoking. They’re not prepared to think about the long-term effects of what they’re doing.”

Additional Thanks

Categories

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