‘They have vilified the sun – and me’
Professor Michael Holick, author of The UV Advantage, tells Brendan O’Neill how he was turned into a pariah for suggesting that a little bit of sunlight can be good for you.
‘I was treated almost as a villain, as if I had said something really outrageous.’ Michael Holick, professor of medicine and physiology at Boston University School of Medicine, is still sore about being asked to resign his professorship of dermatology in May 2004. His crime? He wrote a book called The UV Advantage, which suggests that exposing yourself to sunlight without sunblock for five or 10 minutes a day can be a good thing, providing us with Vitamin D and helping to strengthen our bones and protect against illnesses like type II diabetes and multiple sclerosis. ‘It was the “without sunblock” bit that they didn’t like’, he says. ‘Apparently it’s forbidden to tell people to go out without sunblock.’
One newspaper compared Holick to Copernicus, another scientist who got into a spot of bother over his views on the sun. But Copernicus said something truly radical – his assertion in the 1500s that the sun, not the Earth, was at the centre of our universe turned conventional wisdom on its head. Proponents of Copernicus’ theory were denounced as heretics and burned at the stake for daring to challenge the Bible’s claim that the Earth is flat and stationary (see Isaiah 5:26). All Holick says is that, while we should avoid tanning and staying in the sun for too long, we should recognise that sunlight ‘can maintain bone health and prevent rickets in children’. Hardly Copernican, convention-shattering stuff.
But Holick offended against a contemporary religion, one which says that sunlight causes skin cancer, that tanning is the irresponsible act of reckless individuals, and that we should, in the words of a sun-awareness campaign, ‘slip, slap and slop’ – slip on a shirt, slap on a hat and slop on some suncream before venturing out on a sunny day. On both sides of the Atlantic, government health campaigns warn of the apparent dangers of staying out in the sun. The UK Department of Health advises Brits to ‘stay in the shade or indoors’ on hot, sunny days – or ‘if you can’t avoid being out in the sun, apply sunscreen (factor 15+) and wear a t-shirt, hat and sunglasses’. British schoolkids are advised to play in the shade and to wear Legionnaire-style hats and long-sleeved shirts, while ‘Molewatch’ teams patrol beaches urging holidaymakers to ‘cover up’ (1).
Yet like the flat-Earthers who challenged Copernicus, the claims of the ‘sun awareness raisers’ often overlook the facts – which suggest that the link between sunlight and skin cancer is more complex than they allow. ‘The message that was initiated 20 or 30 years ago, with the advent of sunscreen, was a reasonable one’, says Holick. ‘Namely that you should not bake outside. But now it’s been taken to an extreme and people aren’t thinking straight anymore.’ We have become scared of the sun, reckons Holick.
It is clear from Holick’s book that he is no sun-worshipping tan god. It begins: ‘I do not advocate tanning.’ There are tables at the back of the book where Holick spells out exactly how long you may spend in the sun, depending on where you are on the planet and what time of year it is. The book’s main message is that humans get 90 to 95 per cent of their Vitamin D from the sun, and that therefore some unblocked exposure to the sun is necessary for Vitamin D upkeep.
Holick never imagined that saying this would have such ‘terribly serious consequences’. He says the sunscreen industry took out a paid advertisement in US newspapers the month before his book came out, personally attacking his reputation. He was called in by Barbara Gilchrist, chair of the Department of Dermatology at Boston University School of Medicine, and told that ‘your thinking is not in line with ours’. Holick groans that the sunscreen industry is ‘a major funder of the dermatology community in the US, especially the American Academy of Dermatology….’ ‘So I was asked to resign from the department’, he says, though he remains at Boston as a professor of medicine and physiology.
For Holick, one of the most grating things about being accused of behaving irresponsibly is that the much-talked-about link between sunlight and skin cancer is actually quite complex. Sun awareness campaigns focus on malignant melanoma, moles which turn cancerous. Yet these are a relatively rare form of skin cancer and the one least related to sunlight. The majority of skin cancers in America and in Britain are basal-cell or squamous-cell carcinomas, both of which are highly correlated with sun exposure and which commonly appear on the head, neck and arms – those parts of the body where skin is most likely to burn. These two cancers are more common in middle-aged or elderly men than in the young; they tend to grow slowly and are quite easily treated with surgery or radiotherapy.
‘There may be a million squamous or basal-cell cancers in the US a year’, says Holick, ‘but that’s like the bread and butter of a dermatologist’s work. They can be treated. Of the more dangerous melanoma, there are around 50,000 cases in the US each year, and around 8,000 die. It is still quite rare that a young woman will wind up with melanoma and die. If she does, often the melanoma has developed on a part of the body not exposed to sunlight.’ Melanomas commonly appear on these ‘non-sun exposed’ parts of the body, like the back of the legs, the soles of the feet and the buttocks. Indeed, there is a similar incidence of malignant melanoma in Japan as there is in America and Britain, and the Japanese are not known for spending long hours sunbathing. In Britain, as in America, melanomas account for less than 10 per cent of skin cancers; there are around 4,000 cases a year in Britain, causing around 1,500 deaths.
Holick points out that when melanoma is sun-related, it is more common among certain types of people. ‘It’s associated with those who have a markedly high number of moles’, he says. ‘We also suspect there is a genetic contribution, from a family history of the disease. It is common in people who have red hair and in those who sunburn. The number of sunburning experiences increases your risk of melanoma. So some susceptible people who don’t get moderate sun exposure, and then rush out on the weekend to burn and bake for several hours, are putting themselves at high risk.’
Yet the over-simplistic notion that Sunlight Is Bad For Everyone has become conventional wisdom. Holick notes that where the sun was once seen as a source of health and vitality, it now tends to be viewed as a mortal threat lurking in the skies, potentially poisoning our skin. ‘Over a couple of decades the sun has been vilified’, he says. Children’s outdoor school activities, like sports days and outings, can now be called off if the wicked sun is out. Derby City Council in England recently advised headteachers: ‘Give consideration to postponing or cancelling [external activities] in periods of excessive sun and high temperatures.’
Where the suntanned might once have been seen as healthy, outdoor types, today they are likely to be viewed as irresponsible. Sara Hiom, described by the Observer as ‘the pale-skinned information manager at Cancer Research UK’, has launched a ‘struggle against the tanning culture’. She runs the SunSmart campaign, aimed at educating sunbathers about the allegedly deadly danger they are putting themselves in. Hiom says we need to ‘get back to that Victorian way of thinking where the sun is something to be avoided’ (2). One London expert has suggested that parents who allow their children to get sunburned should be prosecuted for neglect. In both the criticisms of young holidaymakers (especially the kind who lounge around in southern Spain for two weeks) and of parents who let their kids out to ‘burn’, it is easy to detect distinct moral undertones to what is presented as medical advice.
Holick says there is a powerful conformism on the issue of sunlight and skin cancer, ‘and if you question it….well, look at what happened to me’. He pins much of the blame on the ‘sunscreen industry’, which makes financial gain from panics about skin cancer. No doubt there is some opportunism among sunscreen manufacturers and dermatologists; indeed, in the 1990s Professors Sam Shuster and Jonathan Rees of Newcastle University accused some of their academic colleagues of ‘making a living out of perpetuating the skin cancer scare’ (3). But the sunlight scare also speaks to a broader climate of health panic today, where the authorities increasingly seek to police personal behaviour in the name of public health. As with smoking, drinking and diet, sunbathing has become another apparently medical issue through which some very morally-loaded judgements are made about people’s lifestyles and behaviour. And if getting us to conform to the model of the healthy citizen means scaring us witless about melanomas that most of us are unlikely ever to get, so be it.
What about Holick? Couldn’t he be accused of playing the scare game, too? One of his main arguments is that avoiding the sun makes us potentially Vitamin D deficient, which will ‘increase our risk of developing most of the serious chronic diseases that afflict people later in life, including many common cancers’. Where the anti-sun brigade tells us that going out in the sun in anything less than Victorian garb will put us at risk of cancer, Holick says that staying indoors will also put us at risk of cancer in the longer term. It is an indictment of our fearful, irrational times that one of the few ways you can challenge a panic is by launching a counter-panic; so those who question the obesity obsession claim there is a growth in eating disorders instead, while those who challenge the scare over the MMR vaccine raise the spectre of a measles epidemic if the MMR take-up rate continues to fall.
Holick denies that he is counter-panic mongering. Instead, he says, we need to start having a ‘rational discussion about something that, let’s face it, we have to live with – the sun’.
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