Days before the 2024 presidential election, future Health and Human Services Secretary Robert F. Kennedy Jr. posted a statement on X promising to end the U.S. Food and Drug Administration’s “aggressive suppression” of such alternative therapies as raw milk, ivermectin, psychedelics and, somewhat perplexingly, “sunshine.”
While the post did not explain how the FDA was limiting Americans’ access to the sun, many dermatologists were dismayed when Kennedy abruptly withdrew a proposed FDA rule that would have banned minors from using devices that mimic sunlight — indoor tanning lamps.
The rule, which was withdrawn March 16, would have also required indoor tanning facility users to sign a form acknowledging the risk of cancer, early skin aging and other health effects.
Kennedy’s action comes at a time when many adherents of his Make America Healthy Again movement have adopted regular sun exposure as a core principle of wellness, with social media influencers encouraging followers to abandon sunscreen and build up their “solar callus,” or sun tolerance, instead.
The trend has frustrated many dermatologists, who warn that the damage of frequent sunburns and tans accumulates over a lifetime, and those acquired early in life appear to play a disproportionate role in later risk of skin cancer. The Skin Cancer Foundation notes also that you cannot build up a tolerance to sun exposure and “there is no such thing as a ‘solar callus.’”
Dermatologists have long cautioned that indoor tanning lamps are no less dangerous, since they expose users to ultraviolet light at concentrations far above natural sunlight. Like sunlight, the lamps emit two different types of ultraviolet wavelengths: UVA, which are longer and penetrate more deeply into the skin, and UVB, which are shorter and more easily burn the outer layers.
Both light sources darken skin through the same biological process: UV rays change the structure and chemical profile of DNA in the skin, which then produces more melanin in order to prevent further damage.
A tanning bed session exposes users to UVB rays akin to those at noon at the equator — an intense experience, but at least one with a terrestrial equivalent, said Hunter Shain, an associate professor of dermatology at UC San Francisco. The UVA radiation in a tanning bed is roughly 15 times that found anywhere on the surface of the planet.
“They’re really blasting you with these super physiological doses of UV radiation that you couldn’t even find in a natural environment,” he said.
The World Health Organization counts UV-emitting tanning beds as a Group 1 carcinogen, alongside other known human carcinogens like tobacco cigarettes and asbestos. One study Shain co-authored found that tanning beds accelerate DNA mutations in parts of the body not typically exposed to the sun, leading to a nearly threefold increase in indoor tanners’ lifetime melanoma risk. Rates of melanoma diagnoses have increased by 46%in the last decade.
The tanning lamp rule, which was first proposed in 2015, focused on age as a specific risk factor. Tanning bed usage before the age of 35 is associated with a 75% increasein the risk of melanoma, the most serious and frequently fatal form of skin cancer.
The rule drew more than 9,000 public comments from both physicians and cancer research organizations supporting its implementation and from tanning bed industry representatives and business owners opposed.
Kennedy, who was photographed leaving a Washington tanning salon last year, was ultimately unconvinced of the need to ban minors from such establishments.
“In light of the scientific and technical concerns raised in the comments on the Proposed Rule, concerns regarding possible unintended consequences of certain proposals in the Proposed Rule, and potential alternatives proposed in comments received on the Proposed Rule, FDA is withdrawing the Proposed Rule in order to reconsider the best means for addressing the issues,” Kennedy wrote in the withdrawal letter.
Health and Human Services did not respond to questions about what scientific concerns and unintended consequences Kennedy was referring to.
Nineteen states (including California) and the District of Columbia have already banned people under 18 from indoor tanning salons. Roughly two dozen more have some kind of regulations regarding minors and indoor tanning, such as requiring parental permission or barring only younger children.
The collapse of the proposed federal ban has left many dermatologists disappointed.
“As you can see, when it’s left to the states, the implementation and the guardrails to minimize the exposure to carcinogens are not consistent. … Why are you going to default to a system that we know isn’t working correctly?” said Dr. Clara Curiel-Lewandrowski, chair of dermatology and co-director of the Skin Cancer Institute at the University of Arizona.
Minors in sun-baked Arizona are free to patronize indoor tanning establishments as long as they have a note from their parents. Curiel-Lewandrowski has treated many former sunbed enthusiasts for advanced melanoma in their 20s and 30s, she said.
“There’s a lot of regret. Regret for not knowing more, for not getting more help to understand the threat,” she said. “This is an age group that has a very hard time assessing risk. At that age, they don’t view carcinogens as a real threat.”
The U.S. is a bit of an outlier in its permissive approach to youth indoor tanning. Australia and Brazil have banned cosmetic indoor tanning entirely for people of all ages. Most western European countries ban minors from indoor tanning, as do most Canadian provinces.
“After the proposal lay dormant for more than a decade, I can’t say I was surprised to hear that the FDA withdrew it,” said Dr. Deborah S. Sarnoff, president of the Skin Cancer Foundation. “On the positive side, we made the public very aware of this issue, and this fight is far from over. We won’t be satisfied until tanning beds are banned in this country.”
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