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HuffPo blogger claims skin cancer is conspiracy

I was a bit torn when trying to figure out how to approach this piece.  A reader emailed me about an article in the Huffington Post, and there is so much wrong with it that I felt overwhelmed.  My solution is to focus on a few of the problems that can help illuminate broader points.

There is a small but vocal movement of people who refuse to believe that skin cancer caused by sunlight is a significant health risk.  These people tend to also believe that the risk is being purposely hyped by others, and that our current approach to skin cancer prevention is causing an epidemic of vitamin D deficiency. Leaving aside the seemingly insane denialism regarding sunlight and cancer, there are two broad problems with this article.  The first is pretty bad.

With the summer months upon us I wanted to find out firsthand what exactly the mantra is that dermatologists are telling patients. So I went undercover to several San Francisco dermatologists in order to see if there is legitimate concern about the sun-scare media hype. Are these doctors being sensible or going overboard when it comes to advice on sunscreen use and skin cancer prevention? Is the sky falling with dangerous UV rays or are we being induced into a media panic?

He goes on to give links to recorded conversations, and prints out partial transcripts.  He does not specify whether or not he received permission to record these conversations, as required by California law.  Whether or not the law requires it, the writer should have disclosed to his readers whether or not he had received permission.  This information is important in interpreting the conversations he reports to us.

The next problem is broader, and deals with physicians’ willingness to lie on behalf of patients.  The author’s presumably-clandestine recordings of his deceptive visits to dermatologists (catching my breath—this is striking and requires a digression.  The act of deceiving these doctors is not only unethical, but can influence the outcome of the visit.  Doctors make the assumption that most patients are interacting with them out of good faith, and are not intentionally deceiving them.)

In the first conversation the author has with a doctor, the interviewer makes it clear that he wants a mole removed, and the doctor essentially leads him to say “the right thing” so that insurance will cover the procedure.  One thing the author seems to miss is that the dermatologist is going to be paid whether or not insurance covers the procedure.  If the insurance company says “no”, the patient will be billed.  The doctor is lying for the patient, not for herself.

Data have shown that physicians are willing to lie on behalf of patients. There are a number of reasons that this poses ethical problems.  It could be argued that the doctor is lying to help get the patient something that they need, and that lying is a peccadillo compared to the benefit.  This can backfire in a number of ways, not least of which is that both the doctor and the patient can probably be prosecuted for fraud, something that is unlikely to be of benefit to either one.

But there is a fine line between a lie and a truth, one that anyone familiar with the intimacies of the exam room will often experience.  As a doctor, your overall impression may be that the patient is at high risk for coronary artery disease, but perhaps the patient doesn’t quite meet the insurance company’s criteria.  You can then lay out the cost of the test and the risks and benefits for the patient, but I wouldn’t be surprised if some doctors took the short cut of asking, “are you sure you’ve never had any chest pain or difficulty breathing?”

He begins his second dermatology visit by telling the doctor that he has a family history of melanoma, and finds fault in the doctor’s description of the statistics of the disease.  The problem of properly rendering statistics is a common one, and he links to an excellent piece by Ivan Oransky explaining the difference between relative risk and absolute risk.  Unfortunately, he uses this to spin a tale of some sort of dermatology conspiracy to inflate cancer numbers.  Skin cancers (including melanomas and non-melanoma skin cancers) are very, very common, and though many are not fatal, their diagnosis and treatment can be expensive and disfiguring.

His visit continues and the doctor tells him that insurance won’t cover his mole removal because it’s not necessary, and refuses to lie in the medical record. The doc then gives some sound medical advice about how to prevent skin cancers.

I then ask what measures I should take to prevent skin cancer. I’m told to apply sunscreen 24/7, wear a hat and sunglasses, as well as avoid the sun as much as possible. (The only thing she doesn’t mention is to live underground with the mole people.)

“Mole people”?  He asked the doc how to prevent skin cancer, the doc gave the correct answer.  It’s up to the patient to decide if the application of sunscreen is too onerous for the potential benefit.

This article shows a misunderstanding of journalistic ethics, medical ethics, and medical science.  It’s a disaster.  And it’s no surprise that it’s in the Huffington Post.

Posted in: Science and Medicine

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34 thoughts on “HuffPo blogger claims skin cancer is conspiracy

  1. Michelle B says:

    Excellent rebuttal. This person is just creepy, and apparently is proud of it.

  2. BillyJoe says:

    “A week later I find out that my insurance approved the removal of these two non-cancerous moles–I’m added to the reported melanoma statistics.”

    Surely his lesions would be added to reported mealnoma statistics only if the histology confirmed they were melanomas.

  3. Reading the article, it’s appears that the writer is willing to trust a potential media hype about vitamin D deficiency but not about skin cancer. I love it when the media criticizes “the media” because they have the wrong hype.

    Also, as a woman, I’ve never felt targeted for skin cancer advice, I always thought the marketing message for sunscreen was wrinkles. But I notice the writer doesn’t have any evidence to back-up her ‘skin cancer cautions are targeted to women’ assumption.

    Thirdly, I noticed that the writer self-referred to the dermatologists, many of whom seemed cosmetically focused. I wonder how her experience might defer from someone who is referred by their doctor for a skin condition or suspicious mole.

    Michelle B – you are spot on and gave me a good chuckle.

  4. BillyJoe says:

    “I’m told to apply sunscreen 24/7, wear a hat and sunglasses, as well as avoid the sun as much as possible.”

    “He asked the doc how to prevent skin cancer, the doc gave the correct answer. ”

    Technically it might the correct advice for preventing sunburn, but it is not the correct advice.

    Vitamin D deficiency is a problem, especially in dark skinned races. And even in fair skinned individuals who try to avoid sun exposure because they burn easily.

    And then there is the story of a local dermatologist who, at the age of fifty broke his ankle by simply turning around. He was found to have severe osteoporosis. Apparently he followed the advice he gave all his patients: apply sunscreen 24/7 and 365 days a year.

  5. BillyJoe says:

    This hasn’t happened in more than two months and now I have two comments in a row waiting moderation???

  6. It’s ’cause you’re such a rabble-rouser. :)

  7. weing says:

    Why would dermatologists want patients to prevent skin cancer? Wouldn’t they make more money treating the skin cancers? They must be patient shills.

  8. windriven says:

    I would like to suggest an update on current thinking regarding vitamin D. BillyJoe suggests that (extreme?) sunscreen use may result in vitamin D deficiency. However, DHHR says:

    “There has been some concern that use of sun protection factor (SPF) of 15 results in vitamin D deficiency. However, a randomized trial in people over 40 years of age found that sunscreen use over the summer had no effect on 25-hydroxyvitamin D3 levels.” (www.ahrq.gov/clinic/3rduspstf/skcacoun/skcarr.htm)

    Vitamin D deficiency appears to be a hot topic and reliable information is hard to come by.

  9. Calli Arcale says:

    Technically it might the correct advice for preventing sunburn, but it is not the correct advice.

    The journalist wasn’t asking for life advice; she was asking how to prevent skin cancer, and this is the correct advice for that. It is entirely possible that the doctor did advise vitamin D supplements, and this was not reported, though note that it is not at this point clear just how much vitamin D a person really needs, nor whether or not sunscreen actually causes vitamin D deficiency. Of note, while rates of vitamin D deficiency may have increased, the amount of time spent outdoors has dropped radically for reasons unrelated to skin cancer prevention techniques. The main factor in people staying indoors nowadays isn’t skin cancer — it’s air conditioning, television, video games, and the Internet. Fifty years ago, if you want to stay cool in the summer, you went outside. If you wanted entertainment, you went to the lake or kicked a ball around. If you had friends over, you were playing the back yard together. Today, if you want to stay cool, you go inside, seal up the house, and turn on the A/C. If you want entertainment, you log onto the Internet or turn on the TV. If you have friends over, you fire up the Wii.

    I really think it’s more to do with our increasingly sedentary lifestyle than with skin cancer prevention.

  10. Anarres says:

    Here, there is more woo, Holick’s Vitamin D deficiency pandemic myth:

    “It is estimated that one billion people world-wide are at risk of vitamin D deficiency. Upwards of 30-50% of both children and adults in the United States, Europe, South America, Middle East
    and Far East are at risk. The major cause for this pandemic is the lack of appreciation of the beneficial effect of sunlight in producing vitamin D. In the sunniest areas of the world, vitamin D deficiency is common because of lack of adequate sun exposure.”

    Sunlight, Vitamin D and skin cancer. Pag. 7

    http://www.vitamindhealth.org/

  11. blu says:

    Love this reasoning:

    “By 1998 that number had gone down 94 percent to 53,000 for a procedure they still consider safe and viable. Maybe that’s why the dermatologist sternly warned that I should never go into a tanning booth–under any circumstance–even though in often cases the indoor tanning equipment is exactly the same. They’re trying to drum up more business. ”

    So, the dermatologists have reduced the number of times they prescribe the procedure by 94%, but the author claims that the dermatologists are promoting the procedure. How does that make sense?

    This is consistent. The dermatologists think that tanning is risky, so they have cut it back 94% in office and recommend against getting it commercially. The 6% remaining are the cases where the short term cosmetic and therapeutic benefits out weigh the long term risks. This statistic by itself shows that the premise of the article is false.

  12. Did the dermatologist really recommend sunscreen “24/7″ – sunscreen while in bed at night? Somehow I doubt it. This is more likely sloppy and agenda-driven reporting.

  13. Peter Lipson says:

    I’m still appalled that there is no reported consent for the recordings.

  14. tommyhj says:

    sunscreen 24/7? Sounds like something I would say laughing if someone asked how to be _absolutely_ sure not to get melanomas from UV-exposure.

    Maybe the Huff reporter even asked in a humorous tone, maybe she even asked: Should I wear it 24/7? Who knows, with the HuffPo, everything could be made up for all we know.

  15. superdave says:

    re: the 24/7 comment
    it is also well known that UV exposure depends greatly on time of day, geographic location, and time of year.

  16. Bogeymama says:

    Up here in the Great White North it takes up to 8 months to see a dermatologist for a “suspicious mole”. It amazes me how Americans can just self-refer to a specialist.

    Living in an area that gets limited sun exposure (compared to most … although I could do without 5 am sunrises these days…), I can say that most family doctors are routinely recommending 2000ug of Vit D daily for almost all patients.

  17. qetzal says:

    @blu -

    I think the author is suggesting that people used to go to dermatologists for “psoriasis treatments” that were really just an excuse to get tan. Then, when tanning booths became widespread, those people stopped going to the dermatologists, who lost a significant source of income. In response, the derms are supposedly overstating the dangers of tanning booths, while claiming that “psoriasis treatments” (wink wink) are still safe, because they (the derms) want that business back.

  18. wales says:

    As with most medical conditions, it is good to step back and take a look at the risk statistics regarding melanoma. The risks have been somewhat over-hyped. People born today will have a 1.93% lifetime risk of melanoma diagnosis. The age adjusted melanoma death rate is 2.7 per 100,000. Melanoma is the most deadly of all skin cancers, but represents a small percentage of all skin cancers.

    http://seer.cancer.gov/statfacts/html/melan.html#risk

  19. egstra says:

    “And then there is the story of a local dermatologist who, at the age of fifty broke his ankle by simply turning around.”

    I’d have to see some documentation on that. If it’s accurate, I suspect something else was going on to account for the problem. I know too many people who avoid the sun (one woman even wears gloves snorkeling) and yet have perfectly normal Vitamin D levels and good bone density.

  20. hokieian says:

    Sounds like someone else has a degree from “Google University”.

    I especially like this line:
    “I ask if sunblock prevents cancer. I’m told it prevents skin damage, which can cause cancer. Linking these two elements together makes it imply that sunscreen is the antidote for skin cancer, rather than a preventative against skin damage.”

    Ummm…didn’t she just tell you in those exact words that it’s preventative against skin damage?

  21. Wales – Somehow I just must be missing the hype – maybe I use the wrong media. Personally, I use sunscreen when I will be in direct sun for a longer period of time (like the beach) because I’ve been badly sunburned once and it was really misreable. Otherwise I just try to hang in the shade, cause I don’t like being hot.

    I’ve never had a doctor tell me to wear sunscreen 24/7 and that’s including the time that I had the odd mole removed from my ankle (which turned out fine).

    The only people I know who have been told to really avoid sun are people who have actually had melanomas or basal cell carcinomas and that doesn’t seem inappropriate to me.

  22. weing says:

    “The only people I know who have been told to really avoid sun are people who have actually had melanomas or basal cell carcinomas and that doesn’t seem inappropriate to me.”

    I presume you haven’t met any xerdoderma pigmentosum patients.

  23. JayHawkDoc says:

    @BillyJoe

    During my dermatology rotation in medical school, literally every patient was told to supplement with Vitamin D, as well as always use over 30 SPF sunscreen.

    Vitamin D supplementation is even in their position statement!

    http://www.aad.org/Forms/Policies/Uploads/PS/PS-Vitamin%20D.pdf

  24. keleton says:

    Because vit D deficiency is an issue here in the NW at least for those who don’t supplement, last time I saw my derm for an unrelated issue I asked her all about it.

    Her advise: wait 20-30 min to apply sunscreen, even to your kids, (we are fair but tan easy w/o burning) – then you make your vitamin D and protect yourself from skin damage. She didn’t think 20 min of unprotected northern lattitude sun exposure was going to increase our risk for melanoma.

  25. Me “The only people I know who have been told to really avoid sun are people who have actually had melanomas or basal cell carcinomas and that doesn’t seem inappropriate to me.”

    weing “I presume you haven’t met any xerdoderma pigmentosum patients.”

    Nope, but I do know a couple of software engineers who never see the sun. And, maybe I just don’t have the look that makes a doctor say “whoa, you need to start using some sunscreen!”

    I was speaking loosely to the “melanoma hype” topic and I really hope that people won’t take my layman’s comment as a guideline for who should avoid sun exposure or use sun screen. In fact, I have a friend with Rosacea who’s been told that sun aggravates the condition. When there was some suspicion that I had Lupus, I was told that sun exposure could cause a flare-up (no one recommended sunscreen since it was January). I’m sure there’s other conditions as well…

  26. desta says:

    Excellent. Just what I needed to keep me on my toes.

    This will change my life how? Well, my kids’ woo-day-care-disguised-as-montessori (and no doubt they all drool over the huffpo) will switch from insisting on hats and multiple globby thick applications of sunscreen on my very dark skinned children even on cloudy/rainy days for recess, to insisting all the children, be they fair or dark, bake in the sun in their pullups to avoid that “vitamin D epidemic.”

    Oh, huffpo, why do you make my life so hard?

  27. jhunter00 says:

    But Pete, is this much than the SDSU study where researchers lied in order to collect data? …. “Data collectors phoned tanning salons posing as fair-skinned, 15-year-old female potential customers who had never tanned before. http://newscenter.sdsu.edu/sdsu_newscenter/news.aspx?s=71581

    Somebody finally exposed what the REAL issue is. What are derms after? Is it to reduce skin cancer incidence? Or is it to eliminate tanning salons in order for them to gain back the significant amount of UV biz that they have lost?

    If derms were REALLY concerned about skin cancer, they would plant themselves at the beaches, pools, lakes, ballfields etc where every summer people (and young children) are overexposed to UV with resulting sunburn and post signs warning everyone to stay out of the sun! If all UV is cancer causing, then derms will have to agree and immediately stop using their own UV devices, correct? Hah, doubtful!

    Millions of people weigh the risks and benefits of UV exposure and choose indoor tanning where sessions are delivered by skin type and a timer and the risk of over exposure and erythema are minimized.

  28. Calli Arcale says:

    Millions of people smoke, too, so I wouldn’t use the popularity of tanning booths as evidence that people have actually weighed the risks and benefits of them. People tend to actually be pretty bad at weighing long-term risks versus immediate benefits. In any case, it’s the “argumentum ad populum”. It doesn’t tell you it’s safe; it tells you it’s popular, nothing more.

    Any study where people are lying in order to collect data has a major weakness in that the act of lying may be predisposing the data. That includes the SDSU study. The real question is how well this effect is accounted for. I’m not sure it’s fair to compare a scientific study to the casual work of an investigative reporter, since the latter is not as likely to describe how they account for that problem (making it difficult to compare the quality of the two).

  29. jhunter00 says:

    Calli–I respect your comments but lets look further. Why is it that the predominant research being on UV exposure/ skin cancer is being done in countries such as Sweden, Norway and Australia? Countries that have some of the highest rates of skin cancer. Why are they not researching Brazil, Jamaica, and Ecuador? Sure sounds like these folks have the answer they want and look to provide the support. ” Post hoc, ergo propter hoc”.

  30. BillyJoe says:

    Steven: “Did the dermatologist really recommend sunscreen “24/7″

    Tommy: “sunscreen 24/7? Sounds like something I would say laughing if someone asked how to be _absolutely_ sure not to get melanomas from UV-exposure.”

    I can’t speak for the dermatologist in the report but the local dermatologist said it for just that reason – to make absolutely sure that his patients never let the sun touch their skin. The dermatologist himself has been observed to leave his surgery wearing gloves and a broad brimmed hat.
    (Of course, since his misadventure, he now allows 15 minutes of sunlight per day)

  31. BillyJoe says:

    egstra,

    “I’d have to see some documentation on that. If it’s accurate, I suspect something else was going on to account for the problem. ”

    I have to admit that this is a word of mouth report, but the source is reliable.
    He had osteoporosis and low vitamin D levels.
    And he didn’t have a parathyroid tumour.

  32. SD says:

    @Calli Arcale:

    Millions of people smoke, too, so I wouldn’t use the popularity of tanning booths as evidence that people have actually weighed the risks and benefits of them. People tend to actually be pretty bad at weighing long-term risks versus immediate benefits. In any case, it’s the “argumentum ad populum”. It doesn’t tell you it’s safe; it tells you it’s popular, nothing more.

    Let’s hope the “quote” tag works okay – not sure how it works on these blogs.

    This is called “discounting the future relative to the present”. F’rinstance, in the future, you *could* die of melanoma in twenty years… or you *could* die from being hit by a bus tomorrow. Nobody has a crystal ball that tells the future, except in broad strokes. You can say “You will *probably* experience Problems A, B, C… Z, based on your lifestyle”, but nobody can say “You *will* die of lung cancer if you smoke.” That’s because not everybody who smokes dies of lung cancer, and not everybody who dies of lung cancer has smoked.

    As an “economic” aside, this is the reason for “interest rates” – if the future was knowable, then interest rates would tend to close to zero, since the chief factor in interest computations is “probability of the lender being paid back by the borrower”. (If you doubt this, declare bankruptcy, then try to obtain a loan.)

    I seem to recall reading a report of a study somewhere which indicated higher cancer rates in those in northern latitudes (where I live); some suspect this is due to vitamin D deficiency in the winter months.

    Incidentally, hiding behind the law is not particularly scientific, Dr. Lipson; the conversation happened, period. That is the “fact”, the absolute, cold, hard truth. Whether it was “supposed” to be recorded or not is the “opinion” of the California State Legislature. I somehow doubt you would be so fired up about the legal ramifications were it a patient recording a chiropractor blowing bullshit about subluxations, so let’s dispense with the “zOMG ILLEGAL WIRETAP RECORDING” crap, shall we? This is no more “deception” than any standard “hidden-camera” interview; it describes what *really happened*, without any of the play-acting, euphemization, or mummery inherent in “on-the-record” interviews. *That’s why reporters and investigators do it*, because the procedure highlights “The Undisputed Truth”. If you don’t like that… umm, tough shit? I doubt you could argue satisfactorily that what goes on in the doctor’s office is not a matter of public interest. Undercover expose’s are a critical tool in discovering what goes on in secret. Do you seriously contend otherwise?

    “undercover agent”
    -SD

  33. theshortearedowl says:

    One of their “references” is from NaturalNews. (“Sunscreen use actually causes cancer”)

    ‘Nuff said.

  34. jaysee says:

    ># jhunter00on 16 Jul 2010 at 11:53 am
    >Calli–I respect your comments but lets look further. Why is it that the predominant research being on UV exposure/ skin cancer is being done in countries such as Sweden, Norway and Australia? Countries that have some of the highest rates of skin cancer. Why are they not researching Brazil, Jamaica, and Ecuador? Sure sounds like these folks have the answer they want and look to provide the support. ” Post hoc, ergo propter hoc”.

    Just for the record, the WHO lists the deaths from “Melanoma and other skin cancers” in Brazil as being twice that of Australia (http://www.who.int/research/en/ — see the causes of death xls) so complaining that no one is researching Brazilian data seems a bit odd.

    With regards to Jamaica and Ecuador, both of those countries have non-white majority populations (>90%). Brazil has ~50% white, and Australia, Sweden and Norway have large majority white populations. Given that caucasions are most at risk of skin cancer, I would say that the data adds up – countries with more white people have higher incidences of skin cancer and that’s where the research is done (often).

    And, as an Australian, I find the “information” in the article sickening – most Australians know someone who has had a skin cancer scare (and many will know someone for whom it was more than a scare). Skin cancer kills people. Tanning beds kill people. It’s not a beat up!

    Also, on your points above:

    >If derms were REALLY concerned about skin cancer, they would plant themselves at the beaches, pools, lakes, ballfields etc where every summer people (and young children) are overexposed to UV with resulting sunburn and post signs warning everyone to stay out of the sun! If all UV is cancer causing, then derms will have to agree and immediately stop using their own UV devices, correct? Hah, doubtful!

    At least in Australia, that’s what they do! In summer the “stay out of the sun” message is number 1 everywhere (TV, buses, radio, posters… they’ve even talked about running special campaigns aimed at British backpackers – http://www.abc.net.au/science/articles/2009/07/06/2618056.htm) – and there’s an emphasis on pointing out that sunscreen isn’t 100% effective and that staying out of the sun is the best way of stopping damage (and “derms” don’t win there!).

    >Millions of people weigh the risks and benefits of UV exposure and choose indoor tanning where sessions are delivered by skin type and a timer and the risk of over exposure and erythema are minimized.

    Also in Australia, a campaign was launched about three years ago to better regulate the tanning industry and also make people aware of the risks of tanning salons (and their deceptive tactics) by publicising the death of a 26 year-old serial tanning-bed-goer. 18 months later, the Cancer Council was cheering that, when given the facts, people were “weighing the risks and benefits” and choosing *not* to tan at all (http://www.abc.net.au/news/stories/2009/10/07/2706889.htm).

    Maybe in the US the “derms are out to get us” line adds up but in many places it simply doesn’t. Getting a reasonable amount of sun + stopping excessive sun exposure = reduced risk of skin cancer. It’s science!

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