This position is founded on the following tenets:

1. The professional indoor tanning industry promotes and teaches what we refer to as The Golden Rule of Smart Tanning: Don't ever sunburn.
2. The indoor tanning industry has been more effective at teaching sunburn prevention than those who promote complete sun avoidance. Non-tanners sunburn more often than people who tan indoors.
3. An estimated 30 million North Americans patronize indoor tanning facilities at some point during the year. Every year, millions of indoor tanners successfully develop "base tans" before embarking on sunny vacations - tans that, combined with the proper use of sunscreen outdoors, help them prevent sunburn.
4. Public debate on this issue has completely lost the perspective that there are known physiological and psychological benefits associated with sunlight, that there are many other potential benefits that need further research, that the risks are manageable for anyone who has the ability to develop a tan and that, for many people, the benefits of sun exposure outweigh the risks associated with overexposure.
5. A tan is the body's natural protection against sunburn. Your skin is designed to tan as a natural body function, and the body is designed to repair sun damage as a natural process.
6. The professional indoor tanning salon industry is part of the solution in the ongoing battle against sunburn and in teaching people how to identify a proper and practical life-long skin care regimen.

Tanning in a professional facility today minimizes risk because commercial tanning salons in the United States and in most Canadian provinces are regulated by the government. In the United States, exposure times for every tanning session are established by a schedule present on every piece of equipment that takes into account the tanner's skin type and the intensity of the equipment to deliver a dosage of sunlight designed to minimize the risk of sunburn. The schedule, regulated by the Food and Drug Administration, also takes into account how long an individual has been tanning, increasing exposure times gradually to minimize the possibility of burning.

That kind of control is impossible outdoors, where variables including seasonality, time of day, weather conditions, reflective surfaces and altitude all make outdoor tanning a random act and sunburn prevention more difficult.

Consider that sunburn incidence in the general population has been steadily increasing. Sunburn increased 9 percent from 1986-1996, according to the American Academy of Dermatology (AAD), and the sub-group most likely to burn was older men.

We believe that teaching people strictly to avoid the sun may be making them more likely to sunburn when they do go outside for summer activities - and everyone does go outdoors at some point. Consider:

1. Tanning is your body's natural defense mechanism against sunburn, and indoor tanners have activated this defense against burning; non-tanners are more vulnerable when they inevitably do go outdoors.
2. Indoor tanners are educated at professional tanning facilities how to avoid sunburn outdoors, how to use sunscreens appropriately and how to properly moisturize their skin.

When you also consider that the majority of people who sunburn are male, according to the AAD, and that 65-70 percent of indoor tanning customers are female, clearly, it is non-tanners who are doing most of the burning outdoors. In the war against sunburn, tanning salons are part of the solution. Those who abstain from sun exposure completely are more likely to sunburn when they inevitably do go outdoors, even if they attempt to wear sunscreen.

The word "safe" implies that one can recklessly abuse something without any fear of causing harm. And reckless abandon certainly is not the behavior the professional indoor tanning industry is teaching. In fact, we are playing a key role in successfully preventing that kind of reckless abuse. By teaching a "smart" approach to sunburn prevention that recognizes that people do perceive different benefits from being in the sun, we are able to teach sunburn prevention in a practical way that respects both the potential benefits and the risks of sun exposure.

For example, previous generations believed that sunburn was an inconvenient but necessary precursor to developing a tan. Today we know better, and we are teaching a new generation of tanners how to avoid sunburn at all costs. Again, our position: Moderate tanning is the best way to maximize the potential benefits of sun exposure while minimizing the potential risks of either too much or too little exposure.

These graphs illustrate our point. The top graph shows the conventional thinking about sunlight: that totally eliminating sun exposure eliminates risks. That oversimplification is why the $30 billion sun-care industry tells us to wear sunscreen 365 days a year, no matter where we live. But the bottom graph is a more accurate, albeit more complicated, description of the risk function. The one thing we do know for certain about sunlight is that zero exposure does NOT equal zero risk; in fact, the risks of zero exposure would be deadly. So the risk function must be curved. The vertex of that curve - where risk is minimized - is different for every person and cannot be randomly defined. What's more, this graph does not even take into account the balance between benefits and risks. That has to be part of the equation if any campaign is going to be effective.

Human life is totally reliant on sun exposure, and the life-giving effects of ultraviolet light. The question for each of us - a question that nobody knows the exact answer to - is how much sun exposure is appropriate, and how much is too much. Basing the answer to that question on the belief that any exposure increases one's risk of skin damage - a belief that is not categorically supported in the medical literature -fails to recognize the positive influence ultraviolet light and sunlight have on our lives.

New research on breast cancer, prostate cancer, colon cancer and other deadly diseases - research that shows that regular sun exposure may play a key part in preventing the onset or retarding the growth of these deadly diseases - supports the position that moderate sun exposure, for those of us who can develop a tan, is the best way to maximize the potential benefits of sun exposure while minimizing the potential risks of either too much or too little exposure.

• By wearing sunscreen in northern climates most of the year you totally block your body's ability to produce vitamin D. New research has shown that vitamin D deficiency is epidemic in American adults today, that we do not get vitamin D from our diets and that up to 90 percent of the vitamin D in our systems comes from sun exposure. Ultraviolet light exposure is the body's natural way, and the only reliable way, to produce vitamin D. In fact, according to accepted anthropologic evolutionary theory, that is why fair-skinned cultures developed fair skin: To better produce vitamin D from sunlight.
• A study published in March 1998 in the New England Journal of Medicine showed that more than half of all Americans may be vitamin D deficient, and that 37 percent of people whose diet included sufficient levels of vitamin D were still vitamin D deficient upon blood testing. Vitamin D deficiency is a leading cause of osteoporosis, a disease affecting 25 million Americans which leads to 1 million hip and bone fractures every year. In elderly individuals, such fractures are often deadly. Encouraging everyone to wear sunscreen all year long in any climate undoubtedly is contributing to this problem.
• While the tanning industry does support the use of sunscreens as a tool to prevent sunburn outdoors, we do not believe it is proper to teach people to wear this product during times of the year when one would not be able to sunburn outdoors. That is misbranding the product.
• Women's cosmetics today almost always contain sunscreen. It is very difficult for women to find products that do not block UV exposure. Again, while sunscreen is an excellent product that has an intelligent usage in the fight against sunburn, overuse of the product may have serious consequences as well. Because most women wear foundation products daily, their make-up may be preventing them from producing vitamin D much of the year. And because women are more likely than men to develop osteoporosis, making up 18 million of the 25 million Americans afflicted with the disease, they would stand to benefit even more from an increase in vitamin D production.
• Vitamin D and sun exposure have been linked to lower incidence of many internal cancers, most notably breast cancer. A study published in 1999 by the Northern California Cancer Center (NCCC) confirmed that women who receive regular sun exposure are 30-40 percent less likely to develop breast cancer than those who do not receive regular sunlight. It has been hypothesized that vitamin D formed in the body through ultraviolet light exposure plays a role in inhibiting or retarding this disease. Previous studies have shown a relationship between sun exposure and lower incidences of breast, colon, ovarian and prostate cancers. This is an emerging topic and the NCCC study has added credibility to the relationship. The media and the sun care industry can no longer ignore that there may be very significant positive effects of regular sun exposure.

Calling a tan damage to your skin is like calling exercise damage to your muscles. Consider, when one exercises you are actually tearing tiny muscle fibers in your body. On the surface, examined at the micro-level, that could be called "damage." But that damage on the micro-level is your body's natural way on the macro-level of building stronger muscle tissue. So to call exercise "damaging" to muscles would be terribly deceiving. The same can be said of sun exposure: Your body is designed to repair any damage to the skin caused by ultraviolet light exposure. Developing a tan is its natural way to protect against the dangers of sunburn and further exposure.

Saying that any ultraviolet light exposure causes skin damage is a dangerous oversimplification. It would be like saying that since water causes drowning, humans should avoid all water. Yes, water causes drowning, but our bodies also need water; we would die without it. Similarly, we need ultraviolet light exposure; we would die without it. It is the professional indoor tanning industry's position that sunburn prevention is a more effective message than total abstinence, which ultimately encourages abuse. It is a responsible, honest approach to the issue.

What's more, you must realize that the photobiology research community has determined that most skin cancers are related to a strong pattern of intermittent exposure to ultraviolet light in those people who are genetically predisposed to skin cancer, and not simply to cumulative exposure. That again suggests that heredity and a pattern of repeated sunburning is what we need to prevent. And that kind of prevention is exactly what the indoor tanning industry is doing effectively.

The indoor tanning industry believes that our role in teaching sunburn prevention will help to reverse the increases that largely are a result of misbehavior that took place years ago before the professional tanning industry existed and before we were organized to teach sunburn prevention.

1. Melanoma is more common in people who work indoors than in those who work outdoors.

2. Melanoma most commonly appears on parts of the body that do not receive regular exposure to sunlight.

Heredity, fair skin, an abnormally high number of moles on one's body (above 40) and a history of repeated childhood sunburns have all been implicated as potential risk factors for this disease. But because people who receive regular exposure to sunlight get fewer melanomas, blanket statements that ultraviolet light causes melanoma cannot be made. Indeed, some studies have found that an individual's genetic susceptibility to sunburn, and not the actual sunburn incidence itself, is the risk factor. Further, most studies on indoor tanning have not shown a statistically significant connection between commercial use of tanning equipment and an increased risk of melanoma.

That is important, considering that most of the studies did not account for confounding variables such as outdoor exposure to sunlight, childhood sunburns, type of tanning equipment utilized and duration and quantity of exposures. (What's more, European studies on this topic do not account for regulations in place in the United States governing maximum exposure times for people of all skin types.)

So the professional indoor tanning industry is doing its part to help individuals of all skin types minimize their risks by teaching them how to avoid sunburn at all costs. We are promoting smart, moderate tanning for those individuals who can develop a tan.

Determined To Defend Vitamin D

Dr. Michael Holick took a big step forward in 2001 in making the case that sun-induced vitamin D is critical to human health.

He stood there, again, on the ballroom stage in Nashville in front of hundreds of indoor tanning facility operators, for the sixth year in a row playing a major part in Smart Tan's educational conference.

He is Boston University's Dr. Michael Holick - perhaps the world's leading researcher touting the belief that humanity, in its recent obsession over fitness and preventative medicine, has overlooked the importance of one particular vitamin - the human hormone sometimes called "The Sunshine Vitamin."
We know it as vitamin D.

So Holick stood there again Oct. 25 in Nashville, reviewing what he has deemed "The Good, The Bad and The Ugly" about ultraviolet light. Many in the audience have heard him speak several times before - three, four or even five times. For any other speaker, that's a recipe for yawns. But the indoor tanning industry soaks in Holick's material each year, and Holick pours an increasing amount of energy and excitement into his talks.

And this year the tanning industry had something to be excited about. Holick is on the verge of publishing the results of research the tanning industry funded, confirming some long-believed theories about indoor tanning and vitamin D production. Call it the first giant step in the tanning industry's new effort to mount data in support of the positive effects of ultraviolet light.

"We think that in general the population is in risk of vitamin D deficiency chronically at all ages," Holick said. "Only by having adequate exposure to sunlight or taking much more vitamin D will you satisfy your vitamin D requirements."

Holick is the director of the General Clinical Research Center at the Boston University School of Medicine - a lofty, credible position in the research community. He also directs the school's Vitamin D, Skin and Bone Center. He is perhaps the world's most respected photobiologist who believes that the benefits of regular sun exposure received in a non-burning fashion outweigh the risks.

The lack of vitamin D, and what that deficiency can lead to, is Holick's main concern. Bone diseases such as osteoporosis and osteomalacia are linked to vitamin D deprivation, and researchers this year have uncovered the mechanism by which vitamin D plays a role in the prevention of breast, colon and prostate cancers.

That discovery has Holick very excited. "The dermatology community is beginning to rethink this issue," he explained. "It has been a long and tough battle in trying to have them appreciate that there are some beneficial effects to the tanning process and being exposed to sunlight."

To make his case, Holick had to attack some pretty established preconceived notions about ultraviolet light. "I think many dermatologists don't understand it. They have pseudo-information, and as a result it is easy for them to stick their heads in the sand and say that 'That is our policy: No exposure to sunlight and always wear sunscreen. End of story.' They don't appreciate the potential health consequences of that."

But now he believes he is turning the corner in getting people to recognize his work and the work of others who believe in the positive effects of sunlight. The U.S. Food and Drug Administration, for instance, is watching his work very closely. "I think that more of the research dermatologists - those that are really in the forefront of dermatology - are finally getting the message that I have been trying to get across for a long time that maybe there is in fact a benefit. And that we really need to look at both sides of the coin, that it is not simply black and white that you should not have any exposure to sunlight or tanning bed radiation."

Holick's New Research

Dr. Michael Holick presented preliminary data on three studies he completed this year at Smart Tan's educational conference at the ITA Indoor Tanning World Expo. Holick first proposed these studies in 1999 and approached the tanning industry for financial support for the project. Smart Tan did much of the early legwork, and funded 38 percent of the project. The Indoor Tanning Association - formed in 1999 to fund research and promotional efforts for the industry - made completion of the project funding possible, by funding 62 percent of the effort.

"Tanning bed exposure has both benefits and potential harmful effects if not used properly," Holick says. "The concept that Smart Tan is trying to get across is a very good one. That is, that if you want to tan, you should tan properly and intelligently and you should never, never burn."

Here is a glimpse at what Holick will be publishing in peer-reviewed medical journals in the coming months from research conducted with funding from ITA and Smart Tan:

1. UV Light Treats Osteoporosis

Holick has submitted a paper to the Journal of Gastroneurology summarizing a case study completed with funding from ITA and Smart Tan. The study is of a 61-year-old woman who came to his Vitamin D clinic who was severely vitamin D deficient and showed signs of significant bone decay consistent with osteoporosis.

"It was so severe when she came to my office she couldn't sit down, she was in tears because all her bones ached so much," Holick explained. "So what do you do? Tanning beds to the rescue."

Using the tanning equipment donated to Holick by Tan America and puretan as part of the ITA study, Holick exposed the woman three times a week to tanning bed light, following the recommended exposure schedule for her skin type. The woman's condition improved significantly.

"The bone pain over several months gradually dissolved, and the vitamin D level increased by 700 percent, just by simply being exposed to tanning bed radiation," Holick explained.

Osteoporosis is a greater problem than many people realize. More than 25 million Americans suffer from osteoporosis, 20 million of whom are women. This debilitating disease usually leaves a person stooped over, and their activity is severely limited. Vitamin D deficiency also can cause osteomalacia, a mineralization defect that causes intense pain.

However, vitamin D alone isn't enough for good bone health; calcium helps the body absorb the vitamin. Dr. Holick's recipe: Calcium plus vitamin D plus exercise equals good bone health. Without vitamin D, the body can only absorb 10 to 15 percent of the calcium it does when healthy vitamin D levels are present.
Holick's case study should be published in the next few months.

2. Tanning Bed Light Is a Good Source of Vitamin D

For years Holick has talked about the theory of "Vitamin D Winter" - a term he coined describing the fact that there is not sufficient UVB outdoors from November through March in the Northeast for a person to even produce vitamin D.

This may explain why so much of the population is vitamin D deficient. In 1998, Holick published a paper in the medical journal The Lancet showing that 41 percent of hospital patients at Massachusetts General Hospital were vitamin D deficient.

Since that time, with funding from ITA and Smart Tan, Holick has compiled data on another group of chronically unexposed people: his own medical students, whose studies leave them little time outdoors at all. "These are people who never see the light of day," Holick explained.

Sure enough, 41 percent of his medical students were vitamin D deficient. But, upon exposure to the tanning beds in Holick's lab, the condition was corrected. Holick will be publishing a paper on this data in the near future. "It will show that tanning is a very effective way to maintain your vitamin D status," Holick said.

His work with the medical students also produced some other results. Using a flash spectrometer purchased by Smart Tan, Holick was able to "measure" and chart the progress of the students' tans. Two hours after tanning, the group showed immediate pigment darkening - a 2-3 percent increase in pigmentation. Within 48 hours, melanin content increased up to 40 percent.

Holick believes there may be a link between melanin production and vitamin D production. This data will help him explore that theory.

3. Studying UV Light and DNA

Studying the intercellular activity of tanned skin cells is a field Holick is pioneering. In the mid 1990s California Tan purchased a specialized $100,000 confocal microscope for Holick that helped him gaze into individual live skin cells as they tanned and explore this field for the first time.

Now ITA and Smart Tan have leased Holick a $100,000 genetic testing machine that will help him measure gene expression, DNA repair and chart the role vitamin D plays in the regulation of cell growth. He is closely monitoring a substance known as TGF beta which is believed to regulate cell growth. This is particularly important, given work that now suggests vitamin D may play a role in the prevention of breast, colon and prostate cancers.
"We are now in the process of trying to understand how that impacts skin health and disease," Holick said. "We are now in the process of analyzing our data."

Clearing the Anti-Cancer Picture

Holick and other photobiologists are excited about new work this year that appears to have unlocked the puzzle of why sunlight exposure is linked to lower risks of many internal cancers. The research community has known since the 1940s that prostate, colon and breast cancers are less common in sunny parts of the world. While vitamin D was suspected to play a role in this, nobody understood exactly why until this year.

Vitamin D produced from sun exposure is activated in the body in the liver and kidneys. "The activated form does something else very important. It tells your cells to grow properly. Activated Vitamin D inhibits cancer growth."
But researchers this year discovered something new that explains this relationship. "Breast, colon and prostate cells all activate vitamin D. That is a new concept." We now realize that not only does your kidney make it - but your colon, breast and a lot of other tissues make it as well, This is a likely explanation for the sun-cancer connection."
That has Holick wondering if recommendations for vitamin D intake - which are based on maintaining bone health - should be reviewed. "There may be two levels of vitamin D deficiency - one for bone health, and one for cellular health," he explained.

Turning to the Sun

Holick's work in the mid 1990s showed that there is no reliable source of vitamin D in our diets, that vitamin D levels reported on milk cartons are overestimated half of the time and that 15-20 percent of milk has no vitamin D content at all. That leaves sun exposure and vitamin supplementation as the only alternatives.

Since it is not reasonable to assume that the entire population will turn to vitamin supplementation, that puts sunshine back into play as an important source of this important vitamin.

"With adequate exposure to sunlight, dietary vitamin D becomes unnecessary. It is remarkable how exposure to sunlight a few times a week can reduce the risk of osteoporosis, osteomalacia, muscle weakness, fractures and maybe some of the common cancers, but also induce a sense of well-being." Holick wrote in an article in The Lancet earlier this year.

And Holick is determined to get that message to the masses.