Cold Iron Truth

Tanning is the new tobacco


I was driving to work the other day, perched up in my pickup truck (somehow you knew that) and noticed a fancy race car in front of me with a vanity tag. It read HRTATTK 4. Well, I thought after four heart attacks maybe I would splurge on a special car too (more likely a newer truck). Then I noticed smoke coming out of the driver’s window, and I could see this guy in his side view mirror, presumably Mr. “Heart Attack 4,” puffing away on a cigarette. Wow.

Then I got to work and saw my secretary, who works with her oxygen on, out back puffing a cigarette. Wow.

It turns out that cigarette smoke contains substances that act as a monoamine oxidase (MAO) A inhibitor, prolonging the dopamine high in the brain (Proc Natl Acad Sci U S A. 1996 Nov 26;93[24]:14065-9). Makes sense and may explain the above smoking behavior. I truly believe cigarettes are as or more addictive than any other dopamine enhancing drug.

More than 50 years ago, a national campaign against smoking was launched after the 1964 Surgeon General’s report concluded that smoking was a major health hazard. (Looking back, one of the few losses of not having to pull journal articles from the stacks in the library, is that medical students and residents can’t shake their heads in wonder at the cigarette ads in old medical journals.) The impact of the national antismoking campaign has been dramatic, but smoking remains the leading preventable cause of death in the United States and globally, according to the Centers for Disease Control and Prevention.

A woman wearing a wide-brimmed hat applies sunscreen to her arm. karenfoleyphotography/Thinkstock
Dermatologists and the American Academy of Dermatology have known, and have relentlessly educated and lobbied for many years, about another easily preventable cause of death: malignant melanoma and squamous cell carcinoma of the skin. It seems obvious that it should be much easier to discourage tanning than smoking cigarettes, but strong evidence is emerging indicating that tanning may well be addictive, increasing dopamine levels in the brain (Photodermatol Photoimmunol Photomed. 2009 Feb;25[1]:12-9).

With reports confirming an epidemic of skin cancer, including a study showing a dramatic increase in skin cancer diagnoses in the United States in 2006, from 1992 (Arch Dermatol. 2010;146[3]:283-7), dermatologists had good footing on which to start a major prevention campaign. The American Cancer Society got on board, and in 2014, acting surgeon general Boris Lushniak, MD, issued a call to action to prevent skin cancer along with Howard Koh, MD, the assistant secretary of health, in “The Surgeon General’s Call to Action to Prevent Skin Cancer” in 2014, and the campaign was on.

Well, I am delighted to pass on a report from Leonard Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society, who recently described in his March 2018 blog what may the first signs of the effectiveness of efforts to promote protection from ultraviolet ray exposure (JAMA Dermatol. 2018;154[3]:361-2). He writes: “In young white women ages 15 to 24, the incidence of melanoma has declined an average of 5.5% per year from January 2005 through December 2014. Not 5.5% over those ten years but 5.5 % PER YEAR. That’s remarkable, to say the least.”


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