May 21, 2004
Why The Dermatologists In This Story Are Wrong
Posted by Bill
Because like many doctors (and humans, for that matter), they can be patronizingly paternalistic and hidebound by bad science and personal ideology, even when presented with new evidence and more than a little common sense:
But beyond bone and muscle problems, some evidence suggests a dearth of vitamin D may be associated with an array of more serious illnesses, including many forms of cancer, high blood pressure, depression, and immune-system disorders such as multiple sclerosis, rheumatoid arthritis and diabetes.
In response, many scientists have begun pushing to sharply boost the official recommendations for how much vitamin D everyone should get daily, either by taking supplements, by eating more food that contains the nutrient or from the sun -- a major source of vitamin D.
Suggestions that people get more sun exposure, however, have sparked an unusually intense, and sometimes bitter, debate. Skin cancer experts are alarmed that people will disregard warnings about unprotected sun exposure, making them more vulnerable to what is the most common malignancy.
Are many (perhaps most) Americans frying themselves into premature aging and skin cancer? Certainly. Would that in any way increase via Vitamin D-geared recommendations of "exposing the hands, face, arms and legs to the sun for five to 15 minutes a day a few days a week?" No.
Visit a dermatologist and they'll typically bombard you with draconian admonitions to apply sunscreen every day, wear tightly woven clothing and broad-brimmed hats for a trip to the mailbox, or simply build a network of interconnecting underground tunnels that would allow safe transit to work and the grocery store without the fear of any UV exposure. The problem with this conventionally unwise ideal, (along with most exaggerated long-term medical protocols) is the fact that it presents a simple, reactionary course of action for a vastly multifactorial situation. It's narrowly tailored to one specialty's research.
Sunlight in overabundance causes DNA mutation, suppression of the immune system, a chronic increase in collagen-degrading enzymes (eventually leading to thinner skin), distortion of the skin's structure and a permanent imbalance in the natural level of anti-oxidant protection. On the other hand, a chronic underexposure to sunlight can be tied to Vitamin D deficiency, loss of sex drive, suppression of anabolic hormones, depression, increased susceptibility to various cancers (including melanoma from acute burns) and thinner skin, along with other consequences that likely haven't been charted.
But in simplistic fashion, most dermatologists draw the following conclusions:
1. Wear sunscreen every day, all day, especially during the summer months.
This will keep your skin smooth and unlined, but it may also give you rickets and a serious case of depression. While seasonal UV mood enhancement is generally assumed to take place via light that travels through the eyes, science also now indicates that complex chemical reactions occur in the skin. A singular example would be how the body absorbs the radiation and locally produces @-Melanocyte Stimulating Hormone, aka the stuff that gives you pigment. This hormone has been directly tied to various central nervous system functions, including sex drive, appetite supression and sense of well-being. Too much sun damage mutates your skin and gives you cancer - a tiny bit of damage may provoke just enough hormonal reaction to keep you happy, trim, sexually interested and cancer-free. But please realize - most Americans do get too much sun in irregular doses; it's all about balance, moderation and consistency.
2. Don't advise the layman to get any sun! Skin cancer rates are epidemic, and any grudging advisory will be blown out of proportion by a sun-hungry public.
Rubbish. Give patients the best available information and allow them to make appropriate judgments about the proper course of action. When I was 18, I went to a dermatologist for a halo nevus. After getting it removed, the doctor read me the extreme riot act about staying indoors, wearing SPF 30 every day and even wearing specialty clothing that offered 100% UV blockage. Being a swimmer, life guard and Florida teenager, I regarded her advice with confusion and contempt; it was looney. It failed to take into account anything regarding my age, attitudes or lifestyle; hence, it was almost completely ignored.
Regulatory bodies and professional societies serve up this patronizing condescension on a regular basis. The next time you read an article regarding a medical controversy or breakthrough, pay close attention to the quotes served up by the official professional society of whatever medical specialty is regarded by the article; often it's somewhat appropriately cautious. Just as often, it contains some tacked-on soundbite that serves up an irresponsible scare tactic employed to buttress the speaker's conservatism on the issue.
So get some sun! 15-20 minutes, a few days a week, is probably enough to give you what you need, more for darker-skinned folks, less if you turn pink within 10 minutes. Depending on your skin type, if you plan to be outside for more than a half-an-hour, especially between 10 and 2, definitely use at least an SPF 15 sunscreen and perhaps a hat and sunglasses. The only effective broad spectrum (block UVA/UVB) sunscreens are physical blockers - look for sheer, micronized zinc or titanium dioxide on the ingredient list. A little common sense and moderation will keep you happy, cancer-free and banging like a steel drum.
ONE YEAR LATER UPDATE: Please see my comments under this thread for more thoughts on skin cancer and medical advice.
Posted by Bill at May 21, 2004 11:15 AM | TrackBack (4)
This reminds me of those studies that suggest a glass or two of wine per day is good for you. Doctors are skittish about talking this up because the last thing they want is to be accused of promoting alchoholism.
Frankly, I think this sort of thing is more lawsuit CYA than paternalism.
Posted by: Robert the Llama Butcher at May 21, 2004 03:04 PM
Trust me, surprisingly, on many levels, it's patronizing paternalism. On the part of individual docs it very well could be CYA, but the NIH and the AMA aren't regularly subjected to lawsuits; they largely just act in the public interest ()though they of course keep a big eye open for liability). dermatological societies and dermatologists are some of the worse offenders re: sun avoidance.
Posted by: Bill from INDC Journal at May 21, 2004 03:15 PM