Date: 1987-06-29
Speaker: DAVID GIBBONS (democrat)
Chamber: H

Deputy Associate Director for Natural Resources. Office of Management and Budget. Washington. DC. DEAR DR. GIBBONS: It was a pleasure to meet you last Friday and to have an opportunity to discuss some of the issues relating to the potential effects of increased ultraviolet radiation. I found the meeting quite interesting because it gave me an added perspective on the complexities surrounding this topic. I also ended up with a great deal of respect for your incisiveness and ability to focus on the essential issues in the midst of a deluge of information. For this reason. I am troubled by the point of view you related indicating that skin cancer is a selfinflicted disease. and therefore. we need not protect people against increased UVB radiation because they should be responsible for protecting themselves. I have thought about this issue a great deal in the past few days. and I feel that my response to this portion of the discussion was quite inadequate. considering the serious implications of this perception. I must admit. that coming from a cancer hospital and research institute. I was caught unprepared for this line of reasoning. I suppose this is because we are inevitably faced with the responsibility of dealing with the results of increased UVB exposure. regardless of its cause. and we do not have the option of ignoring people whose cancers are selfinflicted. Whether the attitude you expressed is your personal view or merely one that has been expressed publicly by others. I think it deserves to be addressed in a more substantive manner than I was able to do last Friday. Therefore. I would like to try and pinpoint the reasons for my discomfiture with this analysis of the situation. First. the majority of the skin cancer patients we see at the M.D. Anderson Hospital and Tumor Institute cannot be characterized as belonging to the leisure or sunworshiping sets. Most of our patients with skin cancer are farmers. ranchers. oil field workers. and people who work on offshore oil rigs. It is true that we see the more serious cases of skin cancer because we treat many people who have failed to be cured by surgery. However. I feel that I am doing our patients a great disservice by leaving uncontested the impressionthat skin cancer is a problem limited to the suntan seekers. This is clearly not the case.. however. I am unaware of any recent study that attempts to characterize the skin cancer population as to what proportion of cases might have resulted from voluntary or recreational sunlight exposure. Second. if we take the cold. economic point of view. skin cancer has an economic impact regardless of how it is acquired. It costs us in loss of human productivity and in medical expenses. irrespective of whether it is selfinflicted or inadvertently acquired. Third. part of the increased exposure of our population to UVB results from the demographic trend of people moving southward. This was viewed as being purely voluntary in our discussion last Friday and attributed to people retiring in the South because of the pleasant climate. It is important to realize that this Is not the only reason for the demographic shift in population. and it may not even be the major reason. My impression is that the southward movement also resulted from a depressed economic situation in the manufacturing centers of the northeastern United States in the 1970s. and that the migration was augmented by the high price of heating fuel during a few very cold winters. If these impressions are correct. the view that people are moving southward voluntarily because they want to enjoy the sunshine is not a fair assessment of the situation. Many people have moved because of economic necessity. rather than because they want to play golf year round. Finally. there is a scientific issue that needs to be addressed. We are assuming that the increase in the incidence of skin cancers over the past few decades is due to a voluntary increase in exposure to UVB radiation. This increase is clearly not due to measurable reductions In ozone concentrations. and therefore is generally attributed to voluntary changes in behavior that lead to more sunlight exposure. e.g.. clothing styles. tanning. recreational activities. Although this is the simplest explanation and quite logical. it is not an explanation based on scientific evidence. nor is it the only possible explanation. Consider. for example. the hypothesis that some other agent that is increasing in our environment increases the susceptibility of the skin to UVBinduced cancers. For example. suppose some bath soaps contain Ingredients that remove dead skin. thereby permitting the penetration of more UVB. The increasing emphasis on personal hygiene and resulting increase in bathing practices could also account for the increasing incidence of skin cancer. without invoking a voluntary increase in exposure to UVB radiation. Thus. there is possibility that voluntary behavioral changes are not the only cause of the increasing incidence of the common skin cancers. and other explanations need to be considered before condemning people for having "selfinflicted" skin cancers. This is an unproven assumption that may be incorrect. Furthermore. with malignant melanoma. we do not know whether increased exposure to UVB radiation in adult life can increase the risk of this more serious form of skin cancer. Recent~evidence suggests that sunlight exposure during early childhood may be determining factor in the relationship between UVB exposure and malignant melanoma. I regret that I was unable to marshall these arguments on the spot last week. which would have given the audience an opportunity to respond. However. I think that these arguments are Important. and I hope you will consider them. nonetheless. If you wish additional discussion or clarification of these or any related issues. please do not hesitate to call on me. Sincerely.