Obesity the biggest threat to public health say GPs

Health Minister Mary Harney’s ‘no-brainer’ plan for an outright ban on sun beds has led to cries of humbug and accusations of hypocrisy. The Minister mooted the move when she seemed to blurt out what the Irish Cancer Society described as “a bold move” at the Lance Armstrong sponsored Global Cancer Summit in Dublin this week.

While beauty salon and sun bed industry sources reacted with predictable hullaballoo, the Minister met with raised eyebrows and calls for consistency even closer to home. Critics were quick to clamour and point to the Minister’s u-turn on the cervical cancer vaccine which they claim puts the lives of thousands of young women at risk. Minister Harney’s sun bed stance also left her exposed to accusations that in the cancer stakes an outright cigarette ban would make more sense than picking on sun beds in the interest of public health. Cigarette smoking is linked to thousands of cancer deaths in Ireland annually, by contrast with a reputed 90 from skin cancer.

Former Minister Jim McDaid who has crossed swords with Minister Harney and parted company with Fianna Fail over the cancellation of the cervical cancer vaccine was unrepentant and scathing in his views this week again.

“The cervical cancer vaccination is a matter of life and death, to abandon such a preventative measure is a huge mistake and there is absolutely no excuse for the Minister’s policy of rowing back on the vaccine last September. Between 70 and 80 women die from cervical cancer here each year and this could be prevented. Instead, thousands of sexually active young women are needlessly being put at risk and  ultimately the State may be held responsible and legally liable for these fatalities in years to come, as it has a vaccine at its disposal. For many women it’s already too late and the saving for not vaccinating 12 year olds is €7m and a total of €45m for all girls between 12 and 17, it would be well worthwhile and I am not going to change my stance on that,” commented the Donegal deputy, while acknowledging the Minister had a tough job.

An even frostier response from those in the sun bed business greeted the Minister’s ban proposals.

“Quite frankly the Minister doesn’t seem to know what she is talking about. Ireland has by far the lowest sun bed usage in Europe and I think Mary Harney has really made a booboo on this one as there is already an EU directive in place which they spent years drafting. She might as well try banning people sitting out in the sun as there is four times more UV rays in the sun in Ireland as it stands than from a sun bed lamp, not to mention the higher ratios when people go on holidays to the Canaries,” reasoned David Tracey of Tanzone in Dublin. “The World Health Organisation have natural sunlight and red wine on the same carcinogenic list as sun beds. We’ve always had an over 18 policy, German manufactured sun beds with rigorous safety standards and well trained staff, so the idea of 7 year olds on sun beds is a total urban myth, what the Minister should be tackling is coin operated and home hire sun beds which are unregulated, unsupervised and open to abuse.”

This view is at odds with an ad hoc survey conducted by the Irish Cancer Society this week in the wake of the Minister’s outright ban call, a proposal which she said was a “no-brainer.” The ICS found scant regard for guidelines or supervision in the eight sun bed providers in two beauty salons, two gyms, two tanning shops and two DVD shops in the Dublin region. However, even the Cancer Society seem to be taken by surprise by Minister Harney’s proposal, as she already promised to ban sun beds for under 18s more than three years ago, with no action to date. Minister Harney’s abhorrence of sun beds does not seem to  have filtered down through her Department either. Bizarrely, Junior Health Minister, John Moloney, has performed the official opening of a beauty salon In Portlaoise which offers sun bed treatments as part of its services, and this would appear to be odds with this latest drive to rid the country of sun beds entirely.

Norma Cronin, Health Promotion Manager, Irish Cancer Society said, “We understand that the Department of Health and Children is preparing legislation to ban sun bed usage in under 18 year olds, which has been promised since June 2006. This is to be welcomed. The legislation will also include additional requirements such as mandatory warnings and the use of consent forms. Once this legislation is in place, we should be looking at a complete ban on sun bed usage. Sun beds cause skin cancer. There is no such thing as safe sun bed usage.”

But this is stoutly disputed by Donal Coade who operates the Planet Beach franchise in Ireland. “Nobody is highlighting the benefits of UV rays which is used in the treatment of children with jaundice and vitamin D deficiency. It is also very helpful in combating skin ailments like psoriasis and acne as well as enhancing the mood and help prevent seasonal  adjustment disorder, known as SAD, especially as Ireland has one of the highest suicide rates in Europe. Yes, there should be strict standards and regulation, but moderation and information is the key. There are suggestions that sunscreen lotions may be linked to Alzheimer’s, is the Minister proposing a ban? Excessive drinking leads to liver failure and other serious health problems, but does that mean that we should stop everyone drinking,” challenges the operator of the new contempo-spas. Planet Beach also emphasise that they don’t permit under 18s to use their equipment, restrict sessions to a maximum of one every 48 hours and scan skin types to determine safe usage levels.

Ironically, the showdown on sun beds comes in a week that scientists at the University of Ulster are to investigate a possible link between Alzheimer’s disease and sunscreen. Sun worshipers are constantly told of the importance of using sunscreen, but now the Irish university is to take the lead in groundbreaking research into whether human engineered nanoparticles, such as those found in sunscreen, can induce neurodegenerative disease such as Alzheimer’s and Parkinson’s. Pathologist and toxicologist Professor Vyvyan Howard and Alzheimer’s expert Dr Christian Holster have been awarded €350,000 to carry out a three-year research project.

The latest cancer research figures for Ireland show that an average of 10,999 men and 10,510 women were diagnosed between 2000 and 2004 with 5,921 male and 5,340 female cancer deaths annually.* The most common  male cancers are prostate, colorectal, lung and lymphoma while among women they are breast, colorectal, lung and ovarian cancers. (*Donnelly DW, Gavin AT and Comber H. Cancer in Ireland: A summary report, April 2009.)

In the grand scheme of things sun beds appear to be the least of Mary Harney’s challenges concerning cancer care and far from the most pressing problems facing the health services. In view of the Minister’s procrastination in curbing the use of sun beds for minors her promise of an outright ban rings hollow.** There is a propensity for tanning throughout Europe and in places like Germany and Poland there are solariums on every street corner, so in an EU context an outright ban stands no chance in the present climate. It appears the Minister had a rush of blood at the Cancer Summit and in a bid to impress Lance Armstrong and the assembled luminaries put forward a proposal for which she has no real intentions of delivering. If Mary Harney wants to find a place to start in preventing cancer deaths she could easily restore the cervical  cancer vaccine which she committed to in August last year, before a disgraceful  about turn only weeks later.

According to a survey of Irish GPs in the current edition of the Irish Medical Times , the greatest  threat to public health here is not swine flu, binge drinking, suicide or even smoking and sun beds but over eating. Fighting the flab is the biggest public health risk say doctors in the audit in which 60% cited obesity as the greatest health threat to the Irish population. This was followed by tobacco use at 14% and alcohol abuse at 11% of respondents. The survey reveals that on a weekly basis obesity is causing more people health problems which require a visit to their GP.  (The full survey is available at www.imt.ie)

**The leader writer in The Irish Times on Thursday, August 27^th commented as follows:

“Some politicians are particularly skilled at extracting positive publicity from improbable situations. And Minister for Health Mary Harney is one of them. By remarking on what she would like to do - rather than what is likely to happen - in connection with the public use of sunbeds, she garnered a significant amount of publicity this week and managed to distract attention from the slow progress being made by her department in the production of legislation.

The International Agency for Research on Cancer recently recommended that sunbeds be moved to the “highest cancer risk category” as they had been found to be more dangerous than previously thought. Eye cancers were identified as a particular problem. And the danger was greatest to children and young adults, as long-term exposure to UV radiation increased the risks involved. The likelihood of developing a melanoma rose by 75 per cent if tanning devices were used before the age of 30.

Back in 2006, as part of a broad anti-cancer strategy involving reductions in tobacco and alcohol misuse, Ms Harney pledged to restrict the use of sunbeds. But it took two years for the Department of Health to invite submissions from interested parties on the possible content of the legislation. Small wonder the Irish Cancer Society expressed concern over the delay and called for early regulation of the industry.

Industry groups have consistently disputed research findings. They insist that careful use of sunbeds does not involve a health risk. They draw attention to the number of people employed in the sector. And they note that some companies already operate a voluntary, over-18s policy. The fact remains that many customers are not aware of the potential dangers. And there has been a growing tendency for girls as young as six or seven years of age to acquire artificial tans before their First Communion. The need for strict regulation is unquestionable.

The Minister struck a populist note in Dublin earlier this week. She said she would love to see a ban on sunbed use by people of all ages because of their link to skin cancer. But all she could offer in concrete terms was a promise that legislation protecting under-18s will be drafted soon. People use sunbeds because they think a tan makes them look more attractive. But false tan lotions are so good these days that they can achieve the same result. Users of sunbeds will probably look older prematurely. They may get skin cancer. Those risks should be fully explained to clients at all tanning centres. Legislation is urgently required.”

In response to a series of questions concerning the proposed outright ban on sunbeds and other areas of cancer prevention policy the Department of Health stated:

“The Department is aware that sunbeds have recently been reclassified as a

group 1 carcinogen by IARC (International Agency for Research on Cancer, 29

July 2009) which is an expert body under the WHO. This higher risk

categorisation places sunbed use on a par with cigarette smoking.

Work is underway to finalise the Regulatory Impact Analysis (RIA).

The Minister’s first priority is to proceed with the legislation

restricting the use of sunbeds to those 18 years and over.

However as outlined recently, her clear preference would be to end the use

of sunbeds for everyone. The Minister has asked the Department to

investigate if such a ban was possible.

“On the wider issue of cancer control, the priority in relation to cervical

cancer has been the rollout of CervicalCheck - the National Cervical

Screening Programme. Cervical screening is a method of preventing cancer by

detecting and treating early abnormalities which, if left untreated, could

lead to cancer in a woman’s cervix (the neck of the womb). A successful

national programme has the potential to cut mortality rates from cervical

cancer by around 80%.

“CervicalCheck was launched in September 2008 and provides free smear tests

to women aged 25 to 60 who are eligible for screening. In 2009, the

Government will spend €43m on the Programme. Uptake has been very strong

and more than a quarter of a million women have now been screened.

If a HPV vaccination programme were to be introduced, it would be many

years before it would have an effect upon cervical cancer incidence.

Vaccinated women would still be advised to continue accepting their

invitations for cervical screening as the vaccination would not prevent

all types of cervical cancer.  The Minister has indicated  that she is

committed to keeping the introduction of a HPV vaccination programme under

active review.

“Ireland has led the way in Europe and beyond in implementing legislation to

address the tobacco epidemic (A fact acknowledged at the recent global

cancer summit). There is widespread agreement that the smoke free at work

legislation has been hugely successful since its introduction 5 years ago.

This is a positive progressive health measure which has brought immediate

and long term positive benefits to workers and the general public.

“From 1 July, 2009 additional measures were commenced to further

de-normalise tobacco and to protect both children and adults from the

dangers of tobacco consumption. From that date there is no advertising or

display of tobacco products in retail outlets; all tobacco products must be

out of view and stored within a closed container only accessible by the

retailer; all retailers of tobacco products will be required to register

with the Office of Tobacco Control and self-service vending machines will

be permitted in licensed premises or registered clubs only.

The Department is also progressing further measures including the placing

of combined pictorial and text warning messages on tobacco products.”