sun protection and vitamin d three dimensions of obfuscation.pptVIP

Testimony to the FDA Hearing on Tanning Bed Classification Barbara A. Gilchrest, M.D. Practicing Dermatologist Professor of Dermatology Boston University School of Medicine Boston, MA March 25, 2010 Drugs and devices are evaluated based on a risk: benefit analysis. Tanning beds pose a well documented risk of skin cancer, photoaging, and (less often) exacerbation of multiple skin diseases. The only claimed benefit, aside from cosmetic tanning, is vitamin D production. Sunburn Skin Cancer Photoaging vs Vitamin D Photosynthesis The Pseudo-Controversy Tanning Melanoma is unquestionably among the types of skin cancer caused by UV exposure. The Pseudo-Controversy Should the public maximize vitamin D levels through intentional UV exposure in order to prevent cancer, hypertension, diabetes, multiple sclerosis … ? Which is the lesser evil? Skin cancer and photoaging or cancer of the colon, breast, prostate, and other organs in combination with the other listed diseases? What evidence supports the argument that “insufficient vitamin D” or its proxy – lack of UV exposure – causes these diseases? Some but far from all epidemiologic associations. These associations may be confounded by obesity and lifestyle. Very few intervention studies. Most show no effect of vitamin D supplementation, even for many years. Reddy Gilchrest. JID 130:321-326, 2010. The Pseudo-Controversy is Irrational Ample vitamin D can be obtained from diet, supplements, and incidental sun exposure. A supplement of 1000 IU/day is safe and “sufficient” by even generous criteria. The Pseudo-Controversy is Irrational Cutaneous vit D photosynthesis is least efficient for population groups at highest risk of vit D deficiency Darkly pigmented individuals The elderly The group most responsive to the “unprotected sun exposure” message is at lowest risk of vitamin D deficiency Healthy Cau