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The powerful dermatology lobby has consistently misled the public about the so-called dangers of sun exposure. We've known for decades that sun exposure has a s

The powerful dermatology lobby has consistently misled the public about the so-called dangers of sun exposure. We've known for decades that sun exposure has a strong inverse relationship with all-cause mortality. The fact of the matter is that the vast majority of Americans should be getting a lot more sun exposure, not less. The intellectual sleight-of-hand comes from an obsessive focus on skin cancer mortality to the exclusion of all other causes of death. At the end of the day skin cancer is a relatively rare, easily treatable disease, which only makes up 1.2% of all cancer deaths and 0.25% of all deaths. Another way to think about this is even if sun exposure increased skin cancer mortality by 250% (it doesn't), the documented 3%+ reduction in CVD is more than enough to outweigh it. [1] https://www.ncbi.nlm.nih.gov/pubmed/28074966 https://www.ncbi.nlm.nih.gov/pubmed/28074966 [2] https://seer.cancer.gov/statfacts/html/melan.html https://seer.cancer.gov/statfacts/html/melan.html

gniv 7y ago
> At the end of the day skin cancer is a relatively rare, easily treatable disease Please don't say that. Most skin cancers are indeed treatable (basal cell and squamous cell). But melanoma is not, unless caught early. Yes, there are some better drugs now, but it's far from treatable. I have heard too many stories of people who went to the dermatologist to have a mole checked, and 9 months later they were dead. Melanoma is scary.
- fragsworth 7y ago
  Melanomas are largely treatable because they are caught early. People tend to notice fast-growing tumors on their skin, unlike in other areas of their bodies.
  - epmaybe 7y ago
    That's not always true. You have lots of skin in places you don't tend to look at regularly.
  - 01100011 7y ago
    People often miss things, or mistake them for something else. My buddy thought he had a mole on his ear until it turned out it was aggressive melanoma. They reconstructed his ear and took out some lymph nodes, and 2 years later it came back in his lung. Fortunately he enrolled in a clinical trial of immune based chemo, so he only lost his thyroid and adrenal glands. How likely is it that you'd notice melanoma on your scalp or back?
- aantix 7y ago
  It’s scary so therefore he shouldn’t say that skin cancer is rare and treatable?
  - dang 7y ago
    "Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
tqi 7y ago
I've never understood the sun exposure guidance to be "stay indoors", but rather wear sunscreen / hats / etc, esp if you are prone to sunburns or have a family history... which doesn't seem that sinister.
- jkoudys 7y ago
  Aha! It was the powerful hat lobby all along!
lame-robot-hoax 7y ago
You can wear sunscreen and still get the benefits of sun exposure. This isn’t an either/or situation. Portraying it as such is harmful.
- elbasti 7y ago
  Here is a pop-science account that contradicts that: https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure...
fragsworth 7y ago
> The powerful dermatology lobby has consistently misled the public What is their incentive for misleading people about this? What goals are they achieving? I'm not arguing, I still think the misleading happened - I just don't know what their incentives were. Without any incentives, the cause would probably have to be due to genuine misunderstanding of studies and statistical analysis.
- kurthr 7y ago
  I don't know the parent's reasoning, much less that of the doctors... but Upton Sinclair said, "It is difficult to get a man to understand something, when his salary depends on his not understanding it.” Dermatology in particular has many lucrative continuing treatments and rarely focuses on cures. Although many in the medical fields also say, don't ask a surgeon for an opinion unless you want to cut (e.g. everything looks like a nail).
- chance_state 7y ago
  > This community has gone to shit. I want to upvote you because I think this is a great question too. Can you remove this part though? I don't think it's helpful.
rickycook 7y ago
maybe in america, but in australia we have a huge amount more UV because of the hole in the ozone layer. i was in the US for the first time a few weeks ago, and the first thing i noticed was “huh... i didn’t know that going out in summer, the sun could literally feel different”... in australia it feels, no joke, like you’ve stuck your arm under an oven: you can feel the dry heat and UV. in the US, the sun was just a nice warm heat. please, it’s a big problem over here... people should go outside (and we have a very “beaches and surf” type culture), but sunscreen is hugely important, and often forgotten.
jdietrich 7y ago
>the documented 3%+ reduction in CVD is more than enough to outweigh it. People with high sun exposure have lower CVD mortality; this does not in any meaningful way suggest that sun exposure reduces CVD mortality. To quote from your linked paper: "we cannot exclude the possibility that a bias exists between a healthy lifestyle and high sun exposure habits." It is notoriously difficult to control for confounding variables in observational studies of this sort and the authors have provided nowhere near enough information in their paper for me to have any confidence in their adjustment. I think anyone reading this comment can easily think of a multitude of reasons why people who get less sun exposure might have poor health habits, or why people in poor health might get less sun exposure.
- jkoudys 7y ago
  Yep - play outside, but wear sunscreen.
jazoom 7y ago
The problem here is you're completely ignoring morbidity. Skin cancers are a whole lot easier and safer to cut out when they're small. Of course, I do work in Australia, so pretty much everyone gets skin cancer. Source: I cut out skin cancers.
brandonmenc 7y ago
> The powerful dermatology lobby has consistently misled the public about the so-called dangers of sun exposure Amusingly, most of the people I know who are into things like high fat, red meat heavy, paleo/keto diets are also into things like intentionally getting way too much sun - and like with the diets, there's always some lobbying industry keeping the "real" medical information from us. I suspect most of them will have heart disease and skin cancer when we're in our 60s.
- rangibaby 7y ago
  > I suspect most of them will have heart disease and skin cancer when we're in our 60s. You've got to die of something, if enjoying the sun and eating fatty tasty cuts of meat means dying 10 years earlier, I'm OK with that
  - brandonmenc 7y ago
    Except they think it's going to help them live longer. And quality of life is poorer with atherosclerosis and cancer - so the years that you do live could potentially be much worse ones.
elbasti 7y ago
Apparently the positive health effects of sun exposure are negated by sunscreen. Here's a pop-science explanation: https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure...
atombender 7y ago
There was a very interesting essay that circulated earlier this year called "Is sunscreen the new margarine?" [1]. It was on the front page of HN [2]. According to the article there's also some evidence that long-term sun exposure correlated with a decreased risk of melanoma (outdoor workers have half the melanoma rate of indoor workers!). The hypothesis is that a tan protects against the DNA damage that causes it. Some of the researchers quoted in the article believe that dermatology has gone too far in considering UV exposure a health risk, and that we're due for a correction in that thinking, because there's too much evidence that UV light is, in fact, healthy. [1] https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure... [2] https://news.ycombinator.com/item?id=18890475 https://news.ycombinator.com/item?id=18890475
- gniv 7y ago
  Thanks for linking to that article. I'd like to quote from the same paragraph that you quoted, about the outdoor workers: “The risk factor for melanoma appears to be intermittent sunshine and sunburn, especially when you’re young,” Sunburn is the real culprit. And according to my dermatologist, a sunburn now can cause melanoma 20 years hence. Do not get sunburnt!
  - A_Parr 7y ago
    Sunburn is cell death due to DNA damage. It's a fail-safe that tries to limit the chance of things like melanoma by killing damaged cells off before they can reproduce. The real culprit is the small chance some cells didn't die off and an even smaller subset manage to replicate with damaged DNA. The actual sunburn is just an indicator that you've exposed a number of skin cells to those odds.
- cactus2093 7y ago
  Seems like obvious selection bias. People who sunburn easily (and are thus more susceptible to melanoma) are less likely to take jobs that require working all day in direct sun.
  - 7y ago
lhl 7y ago
Even for melanomas, the dangers of sun exposure have been misguided. It turns out getting regular sun exposure (not burning) appears to actually lower your risk: "Overall the clearest relationship between reported sun exposure and risk was for average weekend sun exposure in warmer months, which was protective (OR 0.67, 95% CI 0.50-0.89 for highest versus lowest tertile of exposure)" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046902/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046902/
pravda 7y ago
>The fact of the matter is that the vast majority of Americans should be getting a lot more sun exposure, not less. Not if you don't want to look like leatherman (or leatherwoman) when you are in your 40s! There are strong aesthetic benefits of never letting sunlight impinge upon your skin. Women used to carefully cover exposed skin when outdoors and their skin would remain smooth and youthful into their 50s.
- fyfy18 7y ago
  The point is to have more regular sun exposure, not stay locked up in an office for 6 months, then spend a week on a beach for 4 hours at a time. To end up looking like that you need to do some serious sunbathing or outdoor work without covering yourself. You aren't going to end up looking like that just from walking outside for 30 mins a day, especially not at latitudes further from the equator.

gniv 7y ago

> At the end of the day skin cancer is a relatively rare, easily treatable disease Please don't say that. Most skin cancers are indeed treatable (basal cell and squamous cell). But melanoma is not, unless caught early. Yes, there are some better drugs now, but it's far from treatable. I have heard too many stories of people who went to the dermatologist to have a mole checked, and 9 months later they were dead. Melanoma is scary.

fragsworth 7y ago
Melanomas are largely treatable because they are caught early. People tend to notice fast-growing tumors on their skin, unlike in other areas of their bodies.
- epmaybe 7y ago
  That's not always true. You have lots of skin in places you don't tend to look at regularly.
- 01100011 7y ago
  People often miss things, or mistake them for something else. My buddy thought he had a mole on his ear until it turned out it was aggressive melanoma. They reconstructed his ear and took out some lymph nodes, and 2 years later it came back in his lung. Fortunately he enrolled in a clinical trial of immune based chemo, so he only lost his thyroid and adrenal glands. How likely is it that you'd notice melanoma on your scalp or back?
aantix 7y ago
It’s scary so therefore he shouldn’t say that skin cancer is rare and treatable?
- dang 7y ago
  "Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

tqi 7y ago

I've never understood the sun exposure guidance to be "stay indoors", but rather wear sunscreen / hats / etc, esp if you are prone to sunburns or have a family history... which doesn't seem that sinister.

jkoudys 7y ago
Aha! It was the powerful hat lobby all along!

lame-robot-hoax 7y ago

You can wear sunscreen and still get the benefits of sun exposure. This isn’t an either/or situation. Portraying it as such is harmful.

elbasti 7y ago
Here is a pop-science account that contradicts that: https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

fragsworth 7y ago

> The powerful dermatology lobby has consistently misled the public What is their incentive for misleading people about this? What goals are they achieving? I'm not arguing, I still think the misleading happened - I just don't know what their incentives were. Without any incentives, the cause would probably have to be due to genuine misunderstanding of studies and statistical analysis.

kurthr 7y ago
I don't know the parent's reasoning, much less that of the doctors... but Upton Sinclair said, "It is difficult to get a man to understand something, when his salary depends on his not understanding it.” Dermatology in particular has many lucrative continuing treatments and rarely focuses on cures. Although many in the medical fields also say, don't ask a surgeon for an opinion unless you want to cut (e.g. everything looks like a nail).
chance_state 7y ago
> This community has gone to shit. I want to upvote you because I think this is a great question too. Can you remove this part though? I don't think it's helpful.

rickycook 7y ago

maybe in america, but in australia we have a huge amount more UV because of the hole in the ozone layer. i was in the US for the first time a few weeks ago, and the first thing i noticed was “huh... i didn’t know that going out in summer, the sun could literally feel different”... in australia it feels, no joke, like you’ve stuck your arm under an oven: you can feel the dry heat and UV. in the US, the sun was just a nice warm heat. please, it’s a big problem over here... people should go outside (and we have a very “beaches and surf” type culture), but sunscreen is hugely important, and often forgotten.

jdietrich 7y ago

>the documented 3%+ reduction in CVD is more than enough to outweigh it. People with high sun exposure have lower CVD mortality; this does not in any meaningful way suggest that sun exposure reduces CVD mortality. To quote from your linked paper: "we cannot exclude the possibility that a bias exists between a healthy lifestyle and high sun exposure habits." It is notoriously difficult to control for confounding variables in observational studies of this sort and the authors have provided nowhere near enough information in their paper for me to have any confidence in their adjustment. I think anyone reading this comment can easily think of a multitude of reasons why people who get less sun exposure might have poor health habits, or why people in poor health might get less sun exposure.

jkoudys 7y ago
Yep - play outside, but wear sunscreen.

jazoom 7y ago

The problem here is you're completely ignoring morbidity. Skin cancers are a whole lot easier and safer to cut out when they're small. Of course, I do work in Australia, so pretty much everyone gets skin cancer. Source: I cut out skin cancers.

brandonmenc 7y ago

> The powerful dermatology lobby has consistently misled the public about the so-called dangers of sun exposure Amusingly, most of the people I know who are into things like high fat, red meat heavy, paleo/keto diets are also into things like intentionally getting way too much sun - and like with the diets, there's always some lobbying industry keeping the "real" medical information from us. I suspect most of them will have heart disease and skin cancer when we're in our 60s.

rangibaby 7y ago
> I suspect most of them will have heart disease and skin cancer when we're in our 60s. You've got to die of something, if enjoying the sun and eating fatty tasty cuts of meat means dying 10 years earlier, I'm OK with that
- brandonmenc 7y ago
  Except they think it's going to help them live longer. And quality of life is poorer with atherosclerosis and cancer - so the years that you do live could potentially be much worse ones.

elbasti 7y ago

Apparently the positive health effects of sun exposure are negated by sunscreen. Here's a pop-science explanation: https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

atombender 7y ago

There was a very interesting essay that circulated earlier this year called "Is sunscreen the new margarine?" [1]. It was on the front page of HN [2]. According to the article there's also some evidence that long-term sun exposure correlated with a decreased risk of melanoma (outdoor workers have half the melanoma rate of indoor workers!). The hypothesis is that a tan protects against the DNA damage that causes it. Some of the researchers quoted in the article believe that dermatology has gone too far in considering UV exposure a health risk, and that we're due for a correction in that thinking, because there's too much evidence that UV light is, in fact, healthy. [1] https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure... [2] https://news.ycombinator.com/item?id=18890475 https://news.ycombinator.com/item?id=18890475

gniv 7y ago
Thanks for linking to that article. I'd like to quote from the same paragraph that you quoted, about the outdoor workers: “The risk factor for melanoma appears to be intermittent sunshine and sunburn, especially when you’re young,” Sunburn is the real culprit. And according to my dermatologist, a sunburn now can cause melanoma 20 years hence. Do not get sunburnt!
- A_Parr 7y ago
  Sunburn is cell death due to DNA damage. It's a fail-safe that tries to limit the chance of things like melanoma by killing damaged cells off before they can reproduce. The real culprit is the small chance some cells didn't die off and an even smaller subset manage to replicate with damaged DNA. The actual sunburn is just an indicator that you've exposed a number of skin cells to those odds.
cactus2093 7y ago
Seems like obvious selection bias. People who sunburn easily (and are thus more susceptible to melanoma) are less likely to take jobs that require working all day in direct sun.
- 7y ago

lhl 7y ago

Even for melanomas, the dangers of sun exposure have been misguided. It turns out getting regular sun exposure (not burning) appears to actually lower your risk: "Overall the clearest relationship between reported sun exposure and risk was for average weekend sun exposure in warmer months, which was protective (OR 0.67, 95% CI 0.50-0.89 for highest versus lowest tertile of exposure)" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046902/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046902/

pravda 7y ago

>The fact of the matter is that the vast majority of Americans should be getting a lot more sun exposure, not less. Not if you don't want to look like leatherman (or leatherwoman) when you are in your 40s! There are strong aesthetic benefits of never letting sunlight impinge upon your skin. Women used to carefully cover exposed skin when outdoors and their skin would remain smooth and youthful into their 50s.

fyfy18 7y ago
The point is to have more regular sun exposure, not stay locked up in an office for 6 months, then spend a week on a beach for 4 hours at a time. To end up looking like that you need to do some serious sunbathing or outdoor work without covering yourself. You aren't going to end up looking like that just from walking outside for 30 mins a day, especially not at latitudes further from the equator.