Note: When you finish reading this article you may be moved to take action. At the end of the article I therefore suggest something that you can do.

Last week I wrote about the firing of Boston University dermatologist, Michael F. Holick, MD, PhD. Dr. Holick was sacked for suggesting, in his book The UV Advantage, that people seek out a few minutes of unblocked sunlight a couple of times per week. The goal is to boost the skin's production of vitamin D, thereby reducing the risk of contracting various diseases, including cancer. The ancient grandmotherly advice to "get a little color in your face" may not be all wrong!

It is commonly believed that exposure to sunlight leads to skin cancer, including deadly melanoma. No one believes this more ardently than leaders of the dermatology profession. For example, a leading dermatologist, Roger Ceilley, MD, has proclaimed, "We're going to have millions more cases of skin cancer in the next decade" if people forgo sunscreen (Fackelmann 1998).

Yet the relationship may not be that simple. There is evidence that a moderate amount of unblocked sunlight is actually beneficial to most people, reducing the risk of many diseases – including, paradoxically, melanoma itself. For example, in often-cited research on US Navy personnel in San Diego, researchers from the University of California School of Medicine found that more melanoma occurred among desk workers than among sailors who worked outdoors (Garland 1990).

Over a ten-year period, 1974-1984, the researchers identified 176 cases of melanoma among active-duty white male Navy personnel. The risk of melanoma was then determined for occupations that were grouped into three categories of sunlight exposure: (1) indoor, (2) outdoor, or (3) indoor and outdoor.

Compared with the US civilian population, Navy personnel in indoor occupations had a higher age-adjusted incidence rate of melanoma (10.6 per 100,000). But persons who worked in occupations that required spending time both indoors and outdoors had the lowest rate.

Another intriguing finding was that incidence rates of melanoma were higher on the trunk of the body than on the more commonly sunlight-exposed head and arms. This alone calls into question the notion that exposure to sunlight equals increased rates of melanoma.

The UC San Diego researchers concluded that there was a protective role for brief, regular exposure to sunlight. They also pointed to laboratory studies showing that vitamin D suppresses the growth of malignant melanoma cells in tissue culture. They suggested that vitamin D could inhibit previously initiated melanomas from becoming clinically apparent (Garland 1990).

But ideas such as these have made some dermatologists very angry indeed. Boni E. Elewski, MD, current president of the American Academy of Dermatology, has argued that even a few minutes of sunlight exposure can be dangerous, and that people can get all the vitamin D they need through supplements. This is a strange recommendation indeed, since orthodox doctors usually urge the laity to shun food supplements. (Incidentally, I can find no published scientific papers by Dr. Elewski on the topic of vitamin D.)

Despite dermatologists' vehement opposition to the idea, it is not at all clear that small amounts of unblocked sun exposure could be a significant cause of melanoma. As even the Skin Cancer Foundation states, "Epidemiologic studies have suggested that intense intermittent exposure resulting in sunburn, especially in childhood, is most likely to lead to melanoma development." (Skin Cancer Foundation 2004) But full-blown intermittent sunburn is not at all the same thing as getting a bit of sun on a winter afternoon in the northern latitudes.

Of course too much of a good thing can be dangerous. But the essential point that Holick makes is that by moderately increasing our exposure to sunlight, we can probably decrease our risk of many forms of cancer, as well as diabetes, seasonal affective disorder (SAD), multiple sclerosis, and other illnesses. Interested readers should take a look at the maps of disease distribution and mortality at the website of the SUNARC Foundation of San Francisco.

Click or go to http://www.sunarc.org

What these maps clearly show is that, as a general rule, the death rates for breast, colon and ovarian cancer, as well as incidence rates for multiple sclerosis, decrease as one moves south. For example, the breast cancer death rate in the south is about half of what it is in the north and northeast. Dr. William B. Grant, founder of SUNARC, has published a paper in the journal Cancer, in which he argues that these differences are due to sunlight and vitamin D (Grant 2002).

If he is correct, then this is very good news indeed for the "worried well." Brief but regular sunlight exposure could turn out to be a healthful measure that is easy to implement, cost-free and accessible to almost all. And ironically, despite the fervent objections from photophobes in the medical profession, it might even decrease the risk of melanoma.

Growth of Intolerance

Yet the moral climate these days has become polluted by dogmatism, bigotry and petty-mindedness. Science is supposed to be an island of rationality in a sea of intolerance. Yet intolerance is rearing its ugly head here as well.

Astonishingly, advocating even a few minutes of exposure to Old Sol these days is enough to get you black balled by your profession, regardless of prior accomplishments. "Any group, organization, or individual that disseminates information encouraging exposure to UV radiation, whether natural or artificial, is doing a disservice to the public," Elewski menacingly told The Scientist (www.biomedcentral.com). Read that sentence over. This is what we've come to in America, circa 2004. One would have to go back to the McCarthy era or to the 1930s—when (to paraphrase the poet W.H. Auden) "intellectual disgrace stared from every human face"—to find an equivalent.

There is much in this current debate on sunlight that is reminiscent of the longstanding feud over dietary fat. First, Dr. Robert Atkins was excoriated by almost the entire medical profession as a fraud and a quack. Then there was a grudging admission that his diet may work sometimes, but for reasons other than those he postulated. Now, after the public in its millions has deserted the orthodox position on weight loss, the medical profession is running full tilt to catch up. Recently I awoke to the following headline: "Longest scientific study yet backs Atkins diet." Two clinical trials conducted at the Philadelphia VA hospital and at Duke University, published in the prestigious Annals of Internal Medicine, have found that subjects on the Atkins diet shed significant amounts of weight without harmful effects on blood fats and sugars (Coghlan 2004).

My purpose here is not to weigh the merits and demerits of the Atkins low-carb diet. Rather it is to point out that all too often science is ruled not so much by cool reason as by pride and prejudice. The reaction to Dr. Holick's research is a case in point.

Demonizing sunlight (and those who advocate moderate exposure) is a manifestation of dogma rather than science. Perhaps a certain narrowness of vision is an inevitable result of professional over-specialization. Dermatologists spend their days looking for melanoma, an insidious and deadly disease. After a while, they begin to see UV exposure (which is indisputably dangerous when carried to extremes) as the sole source of this evil. Dermatologists are not asked to worry about non-cutaneous forms of cancer, or about diabetes, seasonal affective disorder (SAD), or any of the other illnesses that may be prevented by judicious UV exposure. They just care about skin disease. As the old saying has it, ‘to the hammer, everything looks like a nail'.

A Question of Sponsorship

Much of the animus against Prof. Holick stems from his friendly relationship with the Indoor Tanning Association (ITA), a society that represents people working in that burgeoning industry. Holick is said to have unveiled his new book during a meeting of the ITA, which has also hired a publicist to promote it and has contributed $150,000 to his research.

While his association with the ITA may have been professionally unwise, Holick has denied that his research is influenced by any financial conflict. I have no reason to believe otherwise. It is unlikely that a distinguished and accomplished researcher would compromise his honesty for a few grants. One needs to look at the totality of the man's accomplishments. To me, these all add up to an honest lifelong search for the truth.

Besides, there is something hypocritical in this criticism of Dr. Holick. Of course, it would be better if all research could be independently funded, thereby eliminating the need for researchers to go cap in hand to those who have a vested interest in the outcome of their research. But it certainly seems ironic that leading dermatologists should rebuke Holick so roundly for his ties to the indoor tanning industry when in truth most medical research today is supported by interested parties of one kind or another. Imagine what would happen if all researchers with ties to the pharmaceutical industry were asked to resign. There would be hardly any top doctors left in America's medical schools and research laboratories. Are dermatologists willing to accept that funding of research from, say, the chemical sunscreen industry should also be prohibited? I haven't heard those sentiments expressed by those who are now harrumphing over Dr. Holick's connections to indoor tanning.

The Case of Dr. Healy

Are we in for a new round of medical McCarthyism? Dr. Holick's case is similar to that of another medical professor who was also recently fired for unorthodox views. Dr. David Healy was removed from his post by the University of Toronto's Centre for Addiction and Mental Health (CAMH), after he wrote a book that was highly critical of the pharmacological approach to mental illness (Kendall 2004).

He stated the following: "Scientific progress in psychiatry has been stalemated because Big Pharma's marketing efforts have overwhelmed the field." This powerful statement points to a far more serious and pervasive problem than Dr. Holick's grant from the tanning lobby.

Signs of Fairness

However, there are still a few encouraging signs of elementary fairness in American medicine. Some vitamin D experts have rallied to Holick's side and have agreed that he should not have been forced to resign. "If he was fired for his opinion, which is based on science, then it would appear to be a violation of the principles of academic freedom," said James Fleet, PhD, who studies nutrition and vitamin D at Purdue University. Whether small amounts of sunlight can boost vitamin D intake without raising the risk of cancer "is an issue worth debating," Fleet has said.

Similarly, Reinhold Vieth, PhD,of the University of Toronto, who has worked with vitamin D since 1974, said that the shunning of Dr. Holick represents a "narrow-minded" approach to health. "It's like a horse with blinkers, and the only thing they [the orthodox dermatologists, ed.] see is melanoma."

Dr. Holick's response has been rather mild-mannered. He has said that he was "disappointed" and "surprised" when asked to step down simply on account of the fact that his opinions differed from those of some of his colleagues. "If you don't follow that party line, then they'll make every effort to squelch everything you have to say," he said.

This year another 1.3 million Americans will develop life-threatening cancers. Nearly 600,000 will die. Dr. William Grant, founder of the SUNARC Foundation, estimates that 47,000 of those deaths will result from internal cancers that could have been prevented by adequate UVB exposure and consequent vitamin D synthesis (Grant, personal communication).

As a recent leading article in Fortune magazine has pointed out, the war on cancer has so far been a failure.

Click or go here for Fortune reference:
http://cancerdecisions.com/040404.html

We simply cannot afford to throw away such accomplished and creative scientists as Michael Holick. In my opinion, Dr. Gilchrest and Boston University should reverse this misguided decision, pin a medal on Dr. Holick's labcoat, and get down to the business of finding innovative ways of preventing this terrible disease. The public deserves nothing less.

To order a copy of Dr. Holick's book, The UV Advantage, click here.

ACTION ALERT

The Dermatology Department at Boston University invites the public to send comments, suggestions and concerns. Those wishing to comment on the case of Dr. Holick should click here.

I have received copies of dozens of letters so far and urge those of you who have not yet expressed your opinion on this matter to do so now. I would appreciate receiving a copy of any of your comments and letters and with your permission may print some of them in a future issue. Send copies to me at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

--Ralph W. Moss, Ph.D.

References:

Allen S. BU advocate of sunlight draws ire. Boston Globe, April 13, 2004. Retrieved May 16, 2004 from:
http://www.boston.com/news/

Coghlan, Andy. "Longest scientific study yet backs Atkins diet." NewScientist.com news service, May 18, 2004. Retrieved May 18, 2004 from:
http://www.newscientist.com/news/news.jsp?id=ns99995003

Dennis LK, Beane Freeman LE, VanBeek MJ. Sunscreen use and the risk for melanoma: a quantitative review. Ann Intern Med. 2003 Dec 16;139(12):966-78.

Elmets CA, Ceilley RI. Amelanotic melanoma presenting as a pyogenic granuloma. Cutis. 1980 Feb;25(2):164-6, 168.

Fackelmann, Kathleen. Melanoma madness. The scientific flap over sunscreens and skin cancer. Science News, Vol. 153, No. 23, June 6, 1998, p. 360 (on the Berwick controversy). Retrieved May 18, 2004 from:
http://www.sciencenews.org/pages/sn_arc98/6_6_98/bob1.htm

Garland FC. Occupational sunlight expoure and melanoma in the U.S. Navy. Arch Environ Health 1990;45:261-267.

Goldacre MJ, Seagroatt V, Yeates D, Acheson ED. Skin cancer in people with multiple sclerosis: a record linkage study. J Epidemiol Community Health. 2004 Feb;58(2):142-4.

Grant WB. An estimate of premature cancer mortality in the United States due to inadequate doses of solar ultraviolet-B radiation, Cancer. 2002;94:1867-75.

Grau MV, Baron JA, Sandler RS, et al. Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst. 2003 Dec 3;95(23):1765-71.

Holick, MA. Vitamin D: Importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. American Journal of Clinical Nutrition, 2004 (March 2):79:362-371.

Kendall, Joshua. Talking back to Prozac.Boston.com (Boston Globe online), February 1, 2004. Retrieved May 11, 2004 from:
http://www.boston.com/news/globe/ideas/articles/2004/02/01/talking_back_to_prozac/

Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003 Jun;120(6):1087-93.

NIH Clinical Center, National Institutes of Health. Facts about dietary supplements: Vitamin D. Retrieved May 11, 2004 from:
http://www.cc.nih.gov/ccc/supplements/vitd.html

Skin Cancer Foundation. The Case Against Indoor Tanning. Retrieved May 18, 2004 from:
http://www.skincancer.org/artificial/index.php

SPIS MedWire. Vitamin D may have preventive properties against cancer. The Scientist, August 24, 2000. Retrieved May 16, 2004 from:
http://www.biomedcentral.com/news/20000824/09/

Click or go here for my obituary of Dr. Atkins:
http://www.cancerdecisions.com/041803_page.html

Some useful websites:

Indoor Tanning Association's website
http://www.indoor-tanning.org/

James C. Fleet's website
http://www.sla.purdue.edu/gerontology/people/faculty/fleet.htm

Michael Holick's website
http://www.bmc.org/womenshealth/mentor_holick.html

Reinhold Vieth
http://icarus.med.utoronto.ca/patho/faculty.asp?FacultyID=229

William B. Grant, PhD. Sunlight Nutrition and Health Research Center
http://www.sunarc.org