To many dermatologists, tanning is a risky flirtation with deadly skin cancer. So Dr. Michael F. Holick, a professor at Boston University's medical school, knew he was courting controversy with his new book about "the exaggerated warnings on the peril of sun exposure," which he decided to unveil at an Indoor Tanning Association meeting in Nashville.
But Holick, a respected researcher on sunlight's role in boosting vitamin D levels, never expected to be pressured out of dermatology altogether. The chairwoman of the dermatology department at BU's School of Medicine requested his resignation in February after she bluntly criticized his conclusions and suggested his ties to the tanning industry may have influenced his research.
"I read better things in ladies' magazines," said Dr. Barbara Gilchrest, the department chairwoman and an authority on melanoma, the deadliest form of skin cancer. Holick's book "is an embarrassment for this institution and an embarrassment for him," she said in an interview.
Holick's resignation is largely symbolic because he will remain director of BU Medical Center's Vitamin D lab while continuing to teach with no loss in salary. But he said he believes he is being punished for challenging one of the dogmas of dermatology.
Holick contends that public health officials have been so insistent on painting sunshine as the enemy that they can't stand to hear about the substantial benefits of sunlight, including promoting strong bones and easing depression.
Gilchrest "is like many in the dermatology profession that are just hellbent on making sure people don't get any sun," Holick said.
Indeed, Holick's book, "The UV Advantage," has provoked an unusually harsh reaction even before it reaches bookstores next month. The backlash underscores how sensitive the tanning issue has become. The American Academy of Dermatology, which represents 14,000 dermatologists worldwide, calls Holick irresponsible, saying that going unprotected into the sun for health benefits is like "smoking to combat anxiety."
But some dermatologists say Holick's arguments shouldn't be dismissed so quickly.
The author of more than 100 published papers, Holick has helped develop treatments for the skin condition psoriasis in addition to his studies of the way sunlight spurs the body to produce vitamin D, a mineral key to strong bones and the prevention of osteoporosis. Though not originally trained as a dermatologist, he was invited to join the BU dermatology faculty because so much of his research focused on skin conditions.
"He's an incredibly creative person who's made some really fundamental observations and discoveries in several areas," said Jim Leyden, professor emeritus of dermatology at the University of Pennsylvania in Philadelphia, who has known Holick for 25 years. "He's very creative and ahead of his time."
Right or wrong, "The UV Advantage" is likely to get a good deal of attention, in part because the Indoor Tanning Association has hired a publicist to promote it. The owners of tanning salons, whose service has faced many of the same health criticisms as traditional tanning, are so pleased with Holick's pro-sun arguments that the association is donating $150,000 for his research over the next three years.
Perhaps just as important, Holick's pro-sun message is more appealing to consumers than the dermatologists' "always wear sunscreen" mantra, and that may be the dermatologists' biggest fear.
"At the end of the day, the position he is putting forward is irresponsible and could potentially set back years and years of work" in skin cancer prevention, said Alan Geller, a researcher in the BU medical school's dermatology department.
For years, dermatologists have preached that there is no such thing as a "safe tan," arguing that the browning of the skin is the body's attempt to defend itself against the sun's ultraviolet rays that can cause cancer. That simple message has made gradual inroads: Today, roughly one-third of teenagers say they regularly use sunscreen when they go out in the sun for extended periods, Geller said.
Holick argues that the link between tanning and skin cancer is not nearly so clear. Although sunburns make skin cancer more likely, Holick contends that moderate sun exposure could actually reduce the risk of prostate and breast cancers, based on epidemiological studies suggesting a lower incidence of those cancers in sunnier climates.
His studies also indicate that a few minutes of sun exposure to bare skin several times a week can help reduce a widespread vitamin D deficiency in northern cities, where people are indoors or bundled up for large portions of the year. During the summer in Boston, he calculates, a fair-skinned person would generate enough vitamin D from spending 5 to 10 minutes in the midday sun three times a week.
But Holick said dermatologists consistently reject his advice. "It's easier for them to say just don't be exposed to sunlight instead of providing the thoughtful, intelligent recommendation that maybe a little sun is good for you," he said.
BU's Gilchrest acknowledges that many people are vitamin D deficient, but she said the risk is very small compared with the danger of melanoma, which is expected to strike 55,000 Americans this year. Vitamin D deficiency "is hardly an epidemic. What I see every single week is people with skin cancer," she said. Moreover, she said, people can get all the vitamin D they need from eating fish or drinking more milk.
Once Holick gets out of his research speciality concerning vitamin D, Gilchrest said, his science verges on "silly,", including his contention in his book that the evidence linking melanoma and ultraviolet light exposure is uncertain. "The melanoma capital of the world is Australia, which is a very sunny area with a large number of" fair-skinned people who are most at risk, she said.
She said she was troubled that Holick was not more forthcoming with her about the tanning industry's financial support for "The UV Advantage." She said the industry connections could have biased his book, which includes a section titled "Guidelines for Indoor Tanning."
After several discussions with Holick about her problems with the book, including a formal debate last winter, Gilchrest requested he leave the dermatology department.
"I would ask anyone to resign his appointment in the department if I felt that person was conducting himself in a way that was professionally irresponsible, potentially dangerous to the public, [and] not conforming to what I think are very high standards for reporting of scientific information," Gilchrest explained.
Holick, who has faculty appointments in several other departments at the medical school, says he had no desire to stay in a department where he wasn't wanted. He strongly denies any financial conflict in his research and says the tanning association did not directly support the book. Still, he did not appeal Gilchrest's request; he simply removed the references to being a dermatology professor from the final version of his book.
But he said the crush of interview requests from media outlets suggests he will get a chance to make his case to the public anyway. In fact, he said, the dermatologists' criticism "is doing me a great favor because they are now raising this to a level that I hadn't expected."
Scott Allen can be reached by e-mail at firstname.lastname@example.org.