The FTC accused the tanning association of making false claims. The result was a 2010 settlement barring the group from making misleading statements or unfounded health claims. Advertisements suggesting that tanning improves health by providing vitamin D also sparked the Texas case against Darque Tan, a chain with more than 100 salons.
Yet the threat of sanctions has had a limited impact. Some even say the FTC agreement gave the Indoor Tanning Association carte blanche to make any vitamin D health claims it wants, as long as it displays a disclaimer. "The FTC suit was a triumph," Robbie Segler, president of Darque Tan, wrote on the online industry forum TanToday in 2011.
The focus on vitamin D shifts the debate from tanning's risks to its potential health benefits in a manner reminiscent of early tobacco marketing, said David Jones, a dermatologist in Newton, Massachusetts. He coauthored a 2010 paper comparing tobacco and tanning advertising that found that cigarette makers once portrayed their products as healthy. "The tanning industry is doing the same thing," he said.
Vitamin D plays a widely acknowledged role in bone health and immune function, and according to the National Cancer Institute, there is evidence that it could reduce the risk of colorectal cancer. Whether it can prevent other cancers, though, is not yet known.
Taking another page from the tobacco playbook, the tanning industry attacks research linking sunbeds to cancer. Industry leaders insist the relationship between melanoma and UV exposure is not well understood. But DeAnn Lazovich, a cancer epidemiologist at the University of Minnesota, says the latest research "provides even stronger evidence" that UV light from sunbeds is carcinogenic.
Altered tobacco ad used in an salon employee training video to suggest that doctors once shilled for the tobacco industry and now shill for sunscreen companies. FairWarningThe industry also takes aim at its critics' integrity. The D-Angel video, using vintage cigarette ads that featured doctors, tries to portray the medical profession in general as having shilled for the tobacco industry. While the American Medical Association pocketed industry money, and some tobacco companies claimed that doctors endorsed their brands, Levy makes the dubious assertion that the medical profession broadly endorsed smoking as healthful. He contends that physicians continue to endanger public health in the interest of profit. "It's no longer tobacco that they're selling," Levy says in the video. "Today, it's chemical sunscreen and [an] anti-UV message designed to tell you that any sun exposure is bad for you. It's the same thing as doctors being arm-in-arm with Big Tobacco."
Levy is a pivotal figure in defending the tanning industry. While a vice president of Smart Tan, he also served as an officer of a nonprofit vitamin D advocacy group called the Vitamin D Foundation and was the executive director of a the Vitamin D Society, a Canadian group.
Yet the close ties between the tanning industry and the web of nonprofit groups that promote the health benefits of Vitamin D often are not readily apparent. The website for the Vitamin D Foundation, for example, discloses no industry affiliation, though tax documents reveal that its top personnel were all people in the business. In addition to Levy, they include the CEO of Beach Bum Tanning, a chain with 53 salons, and the president of the Joint Canadian Tanning Association, who also owns a large chain of salons.
These groups funnel money to vitamin D researchers and organizations that reinforce the industry's claims about the vitamin's health benefits. One such organization is the Breast Cancer Natural Prevention Foundation, which promotes vitamin D for breast cancer prevention. The founders include Dr. Sandra K. Russell, an obstetrician-gynecologist who appeared in advertising for Smart Tan wearing her white lab coat.
Dr. Sandra Russell, a Michigan doctor, has appeared in pro-tanning publicity materials. She recently helped start a nonprofit group that promotes vitamin D and sunlight for cancer prevention. FairWarningSuperman vs. Clark Kent
In promoting the health benefits of UV-induced vitamin D, the tanning industry must tread carefully—after all, health claims were central to the FTC complaint, the Texas Attorney General's case and the congressional report that blasted the industry. But the FTC cannot police what salon employees say when they are off the clock, and the D-Angel training program takes advantage of that.
In the training video, Levy is explicit about what employees can say at work and what they should say only on their own time. He encourages the D-Angels to follow what he calls the "Clark Kent/Superman" model. At the salon, employees should be Clark Kents who refrain from making health claims about vitamin D. Beyond salon walls, however, he urges employees to be superheroes who expose the lies about tanning and vitamin D. "Outside the salon, you can be a D-Angel," Levy says. "You can promote a message to your friends and neighbors that Sun Scare is just like Big Tobacco. They're lying for money and killing people."
But the reality for salon employees is more complex, says Lisa Graubard, a 15-year industry veteran who managed three salons on the New Jersey shore. Graubard, who lives in Lakewood, New Jersey, is not anti-tanning but says salon employees need better training. "There are definitely salons in the industry that are like, 'We're not going to use the c-word,'" she said, referring to the cancer risk.
Graubard acknowledged that some of her own customers kept tanning even after developing skin cancer. One man, she recalled, came to tan still bandaged from melanoma surgery. Graubard left the business after years of tanning left her face discolored.
The clientele at Graubard's salon grew increasingly younger; eventually girls as young as 14 were begging to tan without the legally required permission slips. She'd say no, but a chain salon down the street was known to turn a blind eye to the rules. "Consent? It was like a joke," she said.
Meghan Rothschild, a self-described "splotchy white girl" from Northampton, Massachusetts, says tanning gave her a confidence boost that she still misses today, eight years after being diagnosed with melanoma at age 20. She was angry with herself when she got the news. "The only thing I could think of is, 'You did this to yourself, you idiot,'" she said.
Today, Rothschild blames an industry she says downplays tanning's risks, along with inadequate regulations that leave the decision of whether to tan up to youth who don't always understand the consequences.
Schools teach kids to avoid alcohol and tobacco, Rothschild said. "But the kids aren't smoking anymore. They are using tanning beds. The tanning booth is going to be the cigarette of our generation."
FairWarning (www.fairwarning.org) is a nonprofit, online investigative news organization focused on safety and health issues.