March 14, 2016
Putting Risk Into Perspective—And Not Overreacting
By Michael D. Shaw
Cancer is scary, there’s no doubt about it. After all, the CDC identifies “malignant neoplasms” as the second leading cause of death in virtually all demographic cohorts. While we humans like to think that our decision-making process is cerebral, in truth, it is nearly always limbic. Thus, fear is a prime motivator. Fear sells.
Back in 2009, this column analyzed the ridiculous Hollywood meme that the location used for The Conqueror (1956) contributed to the deaths of cast and crew. Sadly, this was classic junk science, using dead celebrities to not only sell magazines, but to pave the way for a most ill-advised financial compensation scheme. The Radiation Exposure Compensation Act (RECA)—passed in 1990—provides for money (typically $50,000) to be paid to victims of certain cancers, who simply have to prove that they lived in a list of counties during a particular time period.
For an updated version of the government indiscriminately playing on cancer fears, one need look no further than an FDA News Release, entitled “FDA proposes tanning bed age restrictions and other important safety measures.” The specter of skin cancer against a backdrop of callow youth is very much in play.
While prudence is a virtue, wholesale age restrictions and draconian risk acknowledgement forms reek of regulatory overreach. Frankly, it is difficult to reconcile such borderline hysteria on tanning beds with the same FDA’s bizarre practice of keeping many dangerous drugs legal, as long as a Black Box warning appears in the accompanying literature.
With dozens of previously approved drugs taken off the market, the FDA is perhaps better suited to writing regulations, than actually protecting the public, in a meaningful, proactive manner.
If a semi-annual risk acknowledgement form—as proposed by the FDA for tanning bed use—is such a good idea, one wonders why certain far greater risks do not trigger similar treatment. After all, if the subject is cancer, how about numero uno—in terms of deaths? That would be lung cancer, and smokers are 25 times more likely to develop lung cancer than non-smokers, not to mention a host of other diseases.
Then there’s alcohol. In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen. Based on data from 2009, an estimated 3.5 percent of all cancer deaths in the United States (about 19,500 deaths) were alcohol related. Never mind auto accidents.
Oh wait…The Association for Safe International Road Travel (ASIRT) states that more than 37,000 people die in car crashes each year (in the US), while an additional 2.35 million suffer injuries or disabilities. That 37,000 includes more than 1600 people under age 15.
Why no semi-annual risk acknowledgment forms?
As to tanning beds, they’re more than cosmetic. Vitamin D taken through the skin has been shown to have superior bioavailability when compared to vitamin D taken orally or intravenously.
Although most public outreach campaigns on melanoma awareness and prevention target college students and teens, the majority of skin cancer deaths occur in men over age 50, according to the National Cancer Institute’s Surveillance Epidemiology End Results Data. Specifically, 56.4 percent of melanoma mortality is in men over age 55. In the SEER database, melanoma mortality data show that 79.8 percent of all melanoma mortality is in those over age 55; and that 70.7 percent of those fatalities are in men—or, 4.1 per 100,000 in men, vs. 1.7 per 100,000 in women.
Do we really need more forms? Do we really need more regulations? I could post columns for the rest of the year on how health regulations (and related agency policy) have either drastically under-performed, or worse, have had unintended consequences.
We must keep sensationalism out of public health, or suffer the fate of the boy who cried “Wolf.”