Earlier this year, Outside contributing editor Rowan Jacobsen wrote a feature that questioned whether our efforts to avoid skin cancer have caused us to develop an unhealthy relationship with the sun and sunscreen. Looking at controversial new research that challenges established guidelines for sun exposure, Jacobsen suggested that more direct sunlight on our unprotected skin might actually be good for our health. The story struck a nerve, becoming the most popular article in the history of Outside’s website and provoking some pretty loud criticisms. Outside podcast contributor Stephanie Joyce talks to Rowan about his reporting, his response to critics, and whether skipping the SPF 50 is really a good choice.
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(audio from Everybody’s Free (to Wear Sunscreen)): Ladies and Gentleman of the class of 99: wear Sunscreen.
Peter Frick-Wright (host): You might recognize this tape. It’s probably the most unlikely summer jam of my youth.
It’s called “Everybody’s Free (to wear Sunscreen)”. And it’s just a bunch of things you should do. Advice.
(audio from Everybody’s Free (to Wear Sunscreen) plays in the background)
It’s 5 minutes long, with just a drum machine and some smooth backing vocals over a spoken word track.
It was a DJ here in Portland, Oregon, where I grew up, that cut it down to make it playable on the radio. And Portland kids like me started requesting it. Over and over. It went to number one in the UK, number 42 in the US. For one summer when I was 14 years old, it was all over the radio. A pop song’s worth of wholesome guidance.
But a lot of what people think they know about this song, is incorrect. There was a rumor that it was based on a commencement speech that Kurt Vonnegut gave at MIT. But it’s not. Some people might tell you that it was actually written by the director Baz Luhrman, who made the Leonardo DiCaprio version of Romeo and Juliet. But it wasn’t. And I think most people also think that that’s Baz Luhrman reading. But it’s not. “Everybody’s Free to Wear Sunscreen” is actually voice actor Lee Perry reading a hypothetical commencement speech first published in 1997, by Chicago Tribune columnist Mary Schmich.
There’s even a line that Mary wrote that’s often misattributed to Eleanor Roosevelt.
(audio from Everybody’s Free (to Wear Sunscreen)): Do one thing every day that scares you...
Frick-Wright: So we got a lot of things wrong about this song. But today, we’ve got a story about how maybe the song got something wrong, too.
Rowan Jacobsen: I'm Rowan Jacobsen. I've been a writer for Outside Magazine for quite a few years, and I recently wrote an article called “Is sunscreen the new margarine?”
Frick-Wright: Rowan’s piece about sunscreen asked whether we've developed an unhealthy relationship to the sun — and to sunscreen.
The article has since been viewed more than a million times, making it the most popular story in the history of Outside's website. It also provoked some pretty loud criticisms, from people who argued that Jacobsen had overstated the conclusions of what is still emerging science.
And so, since we’re now enjoying the longest, hottest, sunniest days of summer, we figured it’s the perfect time to revisit Jacobsen’s reporting and the response to it.
Frequent Outside podcast contributor Stephanie Joyce talked to Rowan about his story and why it might be time to evolve our understanding of sun exposure and sunscreen.
Stephanie Joyce: So maybe we can just start with a little bit about the history of sunscreen -- when was sunscreen developed?
Jacobsen: I think the first chemical sunscreen was invented in 1928, something like that. It was definitely in that era but no one had ever really used it. The first people that really used it were military people in World War Two. One of the early sunscreens was called Red Vet Pet which stood for like red veterinary petrolatum, as in like petroleum. It was like a reddish Vaseline-like thing that soldiers in the South Pacific could smear on their skin to protect it. So that was World War II, but it was really only in the 1950s that people started using sunscreen, the regular people.
COPPERTONE AD (1972): “Hollywood stars say there’s no tan like a Coppertone suntan…”
Joyce: And why did sunscreen become popular when it did?
Jacobsen: Because -- well it's funny, it didn't really take off of course until people started connecting sun exposure with skin cancer and that was really the 1960s when that information started to appear.
ECLIPSE AD (1982): “The sun has dried much hardier things than you… so imagine what it can do to your skin, needless drying, wrinkling, burning. Enter Eclipse…”
Jacobsen: And it was ironic because the same time researchers were actually noticing pretty strong correlations between sun exposure and reduced risk of all these other internal cancers, but that kind of got pushed to the side and the message became you have to protect yourself from the sun, and of course that picked up really in the 1970s and 1980s and has just continued-- the message has gotten stronger and stronger each decade.
FDA AD: Don’t need to use sunscreen on a cloudy day? Wrong!
Jacobsen: Now, the official American Academy of Dermatology recommendation is there are no times when you should be exposing your skin to the sun without sunscreen or other protection.
Joyce: So in your piece you talked to a number of scientists who are questioning that idea, that wisdom that all sun exposure is bad.
Tell me a little bit about what you learned about how likely it is that we're going to get skin cancer and how likely it is that that skin cancer is actually going to kill us.
Jacobsen: Yeah, and it's two very different answers to those questions, but there's sort of some built-in confusion there because there’re different types of skin cancer.
Most of the fatalities and skin cancer come from melanoma, but melanoma is actually fairly rare. It's like, something like three people per hundred thousand died from melanoma, where hundreds are dying from cardiovascular disease and hundreds more from cancers and other diseases. So people will talk about skin cancer, and then they’ll talk about melanoma and sometimes they get conflated. Like if they want to talk about how deadly it can be, they talk about melanoma. But if you want to talk about how common it is and how it's connected very closely with sun exposure. They talk about skin cancer, but those of us who are not experts don't tend to get them sorted out. So in our minds we start to think skin cancer is really common and it's really deadly.
Joyce: I definitely think that.
Jacobsen: Yeah, right, and it's not true. The common ones are not deadly and the deadly ones are not common.
Joyce: Why do we have that impression?
Jacobsen: I think in the authorities’ minds, the thought is why do people need any sun exposure? It could only hurt them. Because they haven't been looking at the benefits of sunlight. So if there's only negative things then it makes sense to tell people to get none; like smoking right? There's no upside to smoking. So tell people don't ever smoke. But then of course it turns out there are lots of upsides to sun exposure.
Joyce: One of the scientists who you talked to for your piece, who’s been singing the praises of sunshine for years, in TED Talks and conferences, is Richard Weller.
Richard Weller TED Talk: I mean, I'm a dermatologist. My day job is saying to people, "You've got skin cancer, it's caused by sunlight, don't go in the sun.
Joyce: Tell me about him.
Jacobsen: I just met him in person. I was just at a conference in Washington DC last week, which was the first International Conference on Sun Exposure and Human Health, and he was one of the 20 scientists who had gathered to talk about this. He's super smart, very quick, balding, so he has to think about sun exposure, but he’s just very outspoken. He's not hesitant to speak his mind if he thinks the official story is off, which he does in this case.
Joyce: And he's obviously gotten a lot of pushback for that which I want to come back to but why don't we just start with what does his research actually show -- what kind of research has he done? And what does it show about sun exposure?
Jacobsen: So he studies the effect of sunlight hitting skin --this is one of the various things -- he said sunlight hitting skin affects levels of nitric oxide in the blood. The reason that matters is because nitric oxide is a vasodilator. It dilates your blood vessels so that your blood pressure drops. So high blood pressure is the number one cause of early death in the world. So anything that can lower blood pressure is going to significantly lower deaths from the whole syndrome of cardiovascular diseases.
Weller TED Talk: Well, I'm an experimental dermatologist, so what we did was we thought we'd have to expose our experimental animals to sunlight. And so what we did was we took a bunch of volunteers and we exposed them to ultraviolet light.
Jacobsen: He did these studies where he took a bunch of grad students and shines sunlight on their skin and then as a control group he shines heat on their skin, but not sunlight, because some people have thought that it's been known -- Let me back up a little. So, there's these observational studies that have been done for years showing that people in the lower latitudes closer to the tropics have lower blood pressure than people in higher latitudes. People at lower latitudes are healthier in basically every way than people at higher latitudes, but the lower blood pressure one was really obvious.
Weller TED Talk : Australians have about a third less heart disease than we do -- less deaths from heart attacks, heart failure, less strokes.
Jacobsen: And some people said, well, it's because it's warmer, people are more relaxed. You know, they had all these reasons why it might be and Wller thought maybe it's just actually the UV light. It's the actual sunlight. And so that's what he proved with this test is that it really is as simple as sunlight hitting skin that lowers your blood pressure. So it's going to reduce all of your rates of cardiovascular disease.
Joyce: Which is huge. I mean that seems like a big deal, unlike the recommendations say, sunlight actually might be good for you.
Jacobsen: In this one case, yes, so it's definitely true some sun exposure does increase your risk of skin cancer. No one argues with that. But so his question was, what are the risks and benefits?
Weller TED Talk: Yes, sunlight is the major alterable risk factor for skin cancer, but deaths from heart disease are a hundred times higher than deaths from skin cancer. And I think that we need to be more aware of, and we need to find the risk-benefit ratio.
Jacobsen: There's a way that scientists measure this, it's called disability adjusted life years or DALYs, or D-A-L-Y. Basically it's a measure of all the life years lost because of some condition and cardiovascular diseases are far and away the number one the biggest source of DALYs, of Life years lost. It’s like 14 and a half percent globally of lost life years are due to cardiovascular disease and sun exposure is like 0.1%. So like for every person, every life year lost because of sun exposure, you lose like a hundred forty-five life years from cardiovascular diseases, so that his argument is that if more sun would mean less cardio diseases, it's well worth it.
Joyce: What are the other things that scientists have shown are improved by sun exposure?
Jacobsen: So here's where we should back up a little and talk about the sort of the other piece of this puzzle, which is that are we talking about sun exposure or we talking about vitamin D? Because what's often been studied is the connection between vitamin D and various illnesses. When Sun hits your skin, it produces vitamin D, and there's tons and tons and tons of evidence that people with high vitamin D levels have lower rates of all these different diseases and then conversely people with very low vitamin D levels have much higher rates of all these diseases and that's why we've all been told to take Vitamin D supplements.
But there have been a bunch of studies, big studies, about vitamin D supplementation. And it's failed almost every time -- like it's turned out that if you're getting your vitamin D through a pill, your rates of all these diseases are not improved. Which means that the people who had high levels of vitamin D in their blood and low rates of disease, it wasn't the vitamin D. The vitamin D was just a marker that they're getting lots of sun exposure.
Joyce: Yeah, I mean that seems super interesting because we are now understanding like that the vitamin D isn't responsible for this, or something else is, and that something else it sounds like is maybe sun exposure. That's what we're exploring.
Jacobsen: Right. This conference I was just at, one after the next the scientist would get up and present their findings. So we got to really go through a lot of different diseases that there's a connection. They like to have a lot of evidence under their belts before they start to really make like overall recommendations, but there is plenty of evidence showing that people exposed to sunlight have lower rates of all these diseases and the mechanisms are starting to appear.
Here's a really interesting one I just heard about myopia. So shortsightedness. In China in 1983, 20% of kids were myopic, develop myopia, and 20 years later, 2003, 80% of kids in China are myopic, and what's changed in that time, is that China and other countries in Southeast Asia, which pretty much have the same rates of myopia, they've gotten super serious about education; the kids are in school all day every day. They're never outside. And people thought maybe it was from like too much close reading or do or like looking out laptops and cellphones and books all day, but it turns out it's lack of exposure to sunlight that when kids are outdoors and sunlight goes in their eyes, those UV rays hitting their retina produces dopamine and dopamine stops the lengthening of the eyeball which is what causes myopia. So the cure for myopia is kids being outside, you know for a few hours each day, and that just doesn't happen in China anymore.
Joyce: Right. I mean there's been this huge shift, not just in school children, most people work indoors and I think you know one of the facts that I found most counterintuitive, maybe ironic in your piece, is that outdoor workers actually have less skin cancer than indoor workers. Why would that be?
Jacobsen: Right. It's melanoma -- like outdoor workers have half the rate of melanoma of indoor workers which yes, which seems like it flies completely in the face of everything we've always been taught about skin cancer, but well, I think there's a couple things going on that one. I want to see the data a little more clearly because people with darker skin have much lower rates of melanoma. And so if a higher percentage of outdoor workers are Hispanic then they would naturally have lower rates of melanoma, but there's a lot of information out there showing that constant non-burning exposure to the sun reduces the incidence of melanoma and reduces the amount of it that's fatal. So it seems like melanoma is kind of like the spring break disease, you know, you're indoors for most of the year you get really pale and then you just blitz your skin in the sun in Cancun for a week. And then you go back to your little closet. That is the perfect recipe for melanoma.
Joyce: Yeah, and that's one thing I think is so interesting is like you're not arguing that we should all go out and get sunburns today. Sunburns are definitively bad and we know that.
Jacobsen: Right, some sun burning is when you're like destroying your melanin cells and then they have to rebuild and their rebuilt DNA is screwed up. So they rebuild wrong and they become cancerous. So sunburn is clearly bad. Everyone agrees on that across the board. The group of scientists that I was just with were trying to come up with what would be a good blanket recommendation for sunlight. They won't be safe for everyone. They're kind of in two groups. Most people were in a group that said just don't burn, as long as you don’t burn, it should be beneficial. The other group want to be more conservative and say everybody should get 10 minutes a day without you know, any sunblock and with at least like 35% of your skin exposed. But yeah, but everyone agreed don't burn -- that's when things get bad.
Joyce: Interesting. So yeah, I mean obviously there's a big difference between trying to get enough sun in the winter and London where like if you need ten minutes with 35% of your body exposed, good luck? That sounds pretty awful.
Jacobsen: That's the thing. It makes no sense like that. There's no way I'm going to be exposing 35% of my body in Winter Island Vermont, right? It's not going to happen. I'd be losing parts of my body.
Joyce: Yeah,whereas of course, in Australia, like that might be possible all year round.
Joyce: So now I want to talk about sunscreen because I think there's a bit of a leap between sun exposure being good and sunscreen being bad. And I think that's where a lot of the people who criticized your article found fault. So tell me how do we get from a little Sun being good to sunscreen being the new margarine?
Jacobsen: Right and I think a lot of the people who believed that I was slamming sunscreen is a lot of that. I'm not sure they got beyond my cheeky title. I did have that cheeky title which threw sunscreen under the bus a little bit, but sunscreen is definitely better than sunburn. Everyone I've talked to also agrees on that one, but the question is like are we over-using? Are we being told to use too much sunscreen? Then there are also suspicions about other elements of sunscreen. And again it all kind of comes down to this question of risk versus reward, like what are the rewards of applying sunscreen versus the risks? And it's not clear, so there I think I think there's going to be a lot more attention paid to the risk side of it.
Sunscreen formulations have changed a lot; first there were these really thick sort of like Vaseline-like ones; then in the 70s and 80s we got ones that were much clearer, but they only they only block the UVB rays. There's two different types of ultraviolet radiation: B and A. B is the one that makes you burn and also can cause skin cancer and so the sunscreens of the 70s and 80s block the B so you didn't burn. But turns out the UVA rays also can give you skin cancer and those sunscreens didn't do anything to block the UVA, so they may actually have been worse than nothing in that they were allowing people to spend much more time in the sun without burning but they're still getting a hundred percent exposure to all those UVAs that can lead to melanoma.
Joyce: Let me just clarify that because you know, one of the people — Angela Lashbrook wrote a critique of your piece for the outline and one of the things that she brought up is that you know, one of the things you she thinks you actually got really right in the piece is that there isn't a lot of data that shows that sunscreen does prevent — even now — that really bad type of cancer. Is that true?
Jacobsen: Heavy sunscreen users definitely have higher rates of melanoma. But if you can spin that all kinds of ways you want it doesn't mean sunscreen gives you melanoma. What it probably means is that the people using lots of sunscreen are spending a lot more time in the sun than people who aren't, so it only makes sense that actually sunscreen use would correlate with higher melanoma. The evidence that sunscreen helps prevent melanoma is quite good. Again that goes back to like, what's the right amount of sun exposure? And so now that we're being told to put on so much sunscreen -- is that preventing us from getting what would be an optimal amount of sun? And it's going to be different for every person.
Joyce: Right -- sort of along the lines of what you're talking about, another point that Dr. Weller brings up is that sun exposure guidelines are written for white people.
Jacobsen: That's the other really interesting thing, which I didn't know anything about until I got into this article. So Richard Weller, he has a practice in Scotland, but he also spends part of his year in Ethiopia, working in clinics in Ethiopia. And he says he's never seen a single skin cancer in Ethiopia. Skin is measured on a scale of type 1 through type 6 with type 1 being super super super pale, never tan, like you can't make a tan if you're type 1, and type 6 is like really dark. If you've got type 5, type 6 skin you basically don't get skin cancer. It's you get a type of melanoma occasionally that's not associated with sun exposure but skin cancer is just not a worry for you. And so the problem of course is that we're not seeing different recommendations about sun exposure based on skin type. It's just one size fits all and really those recommendations are being tailored to people with type 1 or type 2 skin.
Joyce: Not only that, you know you mentioned in the piece that the cosmetic industry pushing sunscreen on people with darker skin who might not actually benefit from that in any way.
Jacobsen: Right. There's a push -- like people with lighter skin. I've pretty much got the message that they need to use sunscreen; people with darker skin don't tend to use it as much correctly. But now they're like the Last Frontier for expanding the industry. So they're definitely a lot of products being tailored to people with darker skin and really not necessary from everything I've been told by the scientists.
But then the other thing that really the shoe that's dropping now with sunscreen is are all these ingredients in sunscreen really safe for you? And this has been a debate for a long time and now it looks like you know the like the opinion is shifting toward like maybe a lot of this stuff isn't safe for you and that was actually where my title came from was because it just it all kind of reminded me of the way the public discussion had went with margarine and with some of these other like artificial products that were recommended to us in the name of good health that turned out to not really have been thought through thoroughly.
So oxybenzone which is kind of like the one that people are most worried about here. It's been considered a like five-star endocrine disruptor for a long time and there's a fair amount of research linking it to various diseases. So the companies are already scrambling to get oxybenzone out of their formulations, but of course, it's the thing that makes that nice invisible sunscreen work. The other option is to go with more of like the zinc or titanium based sunscreens, the mineral ones which are much more of a thick physical creamy layer on your skin.
Joyce: And I mean right now, I guess if the option is between burning, getting a sunburn, and putting these chemicals that may be harmful on our skin. We know that sunburns are really bad for you. We don't necessarily know exactly the impact of putting these chemicals on our skin.
Jacobsen: Right, but then we do have a third option.
Joyce: What's the third option?
Jacobsen: The third option is wear a shirt -- wear a shirt and a hat.
Joyce: Right, wear a shirt and a hat, don't maybe expose yourself to the sun in the middle of the day.
Jacobsen: Yeah, or do for 10 minutes in the day, but then after that put your hat back on.
Frick-Wright: That was Rowan Jacobsen talking with Stephanie Joyce.
You can read Rowan’s feature on Outside Online. Just google: “Sunscreen is the New Margarine,” which became its own search term shortly after the story was posted back in January.
This piece was produced by Stephanie Joyce and edited by Mike Roberts.
It was brought to you by Honey Stinger. Making fuel for athletes of all kinds using delicious honey and organic ingredients. Find them at HoneyStinger.com/hivelife.
The Outside Podcast is a production of Outside Integrated Media and PRX. We’ll be back next week.
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Outside’s longstanding literary storytelling tradition comes to life in audio with features that will both entertain and inform listeners. We launched in March 2016 with our first series, Science of Survival, which was developed in partnership with PRX, distributors of the idolized This American Life and The Moth Radio Hour, among others. We have since expanded our show and now offer a range of story formats, including interviews with the biggest figures in sports, adventure, and politics, as well as reports from our correspondents in the field.