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  • 6
    Mar
    2013
    2:11pm, EST

    'Very red flag' over cancer center's rosy survival claims

    Jason Cohn / REUTERS

    Keith Hilborn holds a photo of his wife, Vicky, at his daughter's home in Summerville, Penn. Vicky Hilborn died of cancer in 2009 after attempting and failing to get oncology treatment from the Cancer Treatment Centers of America.

    By Sharon Begley and Robin Respaut, Reuters

    When the local doctor who had been treating Vicky Hilborn told her that her rare cancer had spread throughout her body, including her brain, she and her husband refused to accept a death sentence. Within days, Keith Hilborn was on the phone with an "oncology information specialist" at Cancer Treatment Centers of America.

    Hilborn had seen CTCA's website touting survival rates better than national averages. His call secured Vicky an appointment at the for-profit, privately held company's Philadelphia affiliate, Eastern Regional Medical Center. There, the oncologist who examined Vicky told the couple he had treated other cases of histiocytic sarcoma, the cancer of immune-system cells that she had.

    "He said, ‘We'll have you back on your feet in no time,'" Keith recalled.

    Vicky's cancer treatment was forestalled by an infection and other complications that kept her at Eastern Regional for three weeks. In July 2009, when she got back home, things changed. Despite Keith's calls, he said, CTCA did not schedule another appointment. As his wife got sicker, Keith, a former deputy sheriff in western Pennsylvania, was reduced to begging.

    The oncology information specialist "said don't bring her here," he recalled. "I said you don't understand; we're going to lose her if you don't treat her. She told me I'd just have to accept that."

    Vicky Hilborn never got another appointment with CTCA. She died on September 6, 2009, at age 48.

    CTCA is not unique in turning away patients. A lot of doctors, hospitals and other healthcare providers in the United States decline to treat people who can't pay, or have inadequate insurance, among other reasons. What sets CTCA apart is that rejecting certain patients and, even more, culling some of its patients from its survival data lets the company tout in ads and post on its website patient outcomes that look dramatically better than they would if the company treated all comers. These are the rosy survival numbers that attract people like the Hilborns.

    Beating the averages
    CTCA reports on its website that the percentage of its patients who are alive after six months, a year, 18 months and longer regularly tops national figures. For instance, 60 percent of its non-small-cell lung cancer patients are alive at six months, CTCA says, compared to 38 percent nationally. And 64 percent of its prostate cancer patients are alive at three years, versus 38 percent nationally.

    Such claims are misleading, according to nine experts in cancer and medical statistics whom Reuters asked to review CTCA's survival numbers and its statistical methodology.

    The experts were unanimous that CTCA's patients are different from the patients the company compares them to, in a way that skews their survival data. It has relatively few elderly patients, even though cancer is a disease of the aged. It has almost none who are uninsured or covered by Medicaid -- patients who tend to die sooner if they develop cancer and who are comparatively numerous in national statistics.

    Carolyn Holmes, a former CTCA oncology information specialist in Tulsa, Oklahoma, said she and others routinely tried to turn away people who "were the wrong demographic" because they were less likely to have an insurance policy that CTCA preferred. Holmes said she would try to "let those people down easy."

    Equally significant, CTCA includes in its outcomes data only those patients "who received treatment at CTCA for the duration of their illness" -- patients who have the ability to travel to CTCA locations from the get-go, without seeking local treatment first. That means excluding, for example, those who have exhausted treatment options closer to home and arrive at a CTCA facility with advanced disease.

    Accepting only selected patients and calculating survival outcomes from only some of them "is a huge bias and gives an enormous advantage to CTCA," said biostatistician Donald Berry of MD Anderson Cancer Center in Houston.

    The company defends its practices. Spokeswoman Pamela Browner White said CTCA's survival data are in "no way misleading, nor do they deviate from best practices in statistical collection and analysis." As for the Hilborns, she said, the company does not discuss individual cases.

    Cancer Treatment Centers of America got in trouble with regulators in 1996, when the Federal Trade Commission accused it of, among other things, presenting survival claims it couldn't support. The company entered into a consent decree with the FTC and, without admitting any of the allegations, agreed not to make unsubstantiated outcomes claims. The company also "implemented a voluntary, robust compliance program," White said.

    Asked if CTCA's current outcomes claims conform to the consent decree, Richard Cleland, the agency's assistant director for advertising practices, said: "No one at the commission can comment on non-public information."

    A 'free market' guy
    Cancer Treatment Centers of America, which estimates it treats 4 percent to 8 percent of U.S. patients with complex and late-stage cancer, was founded in 1988 by Richard J. Stephenson, who has served as chairman ever since.

    Stephenson, who declined to comment for this article, serves on the board of FreedomWorks, a non-profit group that advocates for small government and low taxes, and he is "very much a free-market guy," CTCA President and Chief Executive Stephen Bonner told Reuters.

    He also has a history of pushing limits. A graduate of Northwestern University Law School, Stephenson started out as an investment banker. In 1966 he became a trustee of Americans Building Constitutionally, an organization that helped wealthy individuals set up not-for-profit corporations and personal trusts to avoid paying federal income and inheritance taxes.

    In 1969, a California state court found the group's top official and six others guilty of grand theft or conspiring to commit grand theft. Stephenson had pleaded no contest to false advertising, a misdemeanor, and testified for the state, according to media reports at the time.

    Stephenson ventured into healthcare in 1975, when he and partners bought Zion-Benton Hospital in Zion, Illinois, renaming it American International Hospital. By the late 1980s, American International was facing financial problems and its "reputation had been severely damaged" by local press reports about its use of unproven cancer treatments, according to a 2004 court opinion on a successful petition by a former CTCA president seeking an increased valuation for his share of the company.

    In 1988, Stephenson founded CTCA. He was motivated, said CEO Bonner, by the difficulty he had identifying and obtaining the best therapies for his mother after she developed bladder cancer. She died in 1982.

    Stephenson began building what was to become a national network of cancer centers that would uphold "the Mother Standard," described on the company website as "a warm, nurturing approach (that) involves caring for patients as we would want care for our own mothers, fathers, sisters, brothers, and other loved ones."

    The hospitals also would seek patients "who were willing to travel to receive treatment" and "who were covered by private commercial insurance and could afford those expenses not paid by insurance," according to the 2004 court opinion.

    The tough cases
    Today, CTCA - with hospitals in Illinois, Oklahoma, Pennsylvania, Arizona and Georgia, plus an outpatient clinic in Washington state and headquarters in Schaumburg, Illinois - is the only hospital system in the country that specializes solely in complex and advanced cancers. It does not release revenue or profit figures.

    The company has treated about 50,000 patients since 1988, CEO Bonner said. (By comparison, the non-profit MD Anderson, a leading cancer center, treated about 115,000 patients last year.) CTCA expects 6,000 new patients and 15,000 to 16,000 continuing patients this year, he said, and is considering expanding in the Pacific Northwest, the Northeast and even Asia.

    At each facility, the standard cancer treatments - radiation and chemotherapy - adhere to national guidelines, Bonner said. "But because we see mostly patients with later-stage, complex cancers, they often need something else," he added - psychological and spiritual support as well as "holistic" interventions such as yoga, acupuncture and reiki, a laying-on of hands.

    More and more academic cancer centers offer such alternative medicine, which some insurers cover.

    "Patients who feel they are understood and empowered will have a better outcome," Bonner said. They'll summon the strength to continue therapy, "even if the last thing they want to do is another round of chemotherapy."

    The CTCA formula resonates with many patients. According to Healthgrades, a doctor- and hospital-ratings site, CTCA facilities consistently beat national averages in patient satisfaction.

    "We were very impressed with the personal attention," said Rose Weistock, whose husband, Harvey, was treated for non-small-cell lung cancer at the Zion hospital, now the Midwestern Regional Medical Center, after his local physician gave him three to five years to live. "You didn't feel like you were just a number," she said.

    CTCA flew the couple at no charge from their Maryland home to Chicago - complete with limo from the airport - to tour the hospital and undergo tests. Harvey, an accountant who had medical insurance through his job, began chemotherapy on that 2004 visit. The Weistocks appreciated the emphasis on what CTCA calls a cancer-fighting diet and on boosting the immune system through mind-body and spiritual practices.

    Harvey died in a Maryland hospital in 2005. The family sued CTCA, alleging that he died after receiving chemotherapy he couldn't tolerate, and settled out of court. Still, Rose's admiration for the hospital's personal attention remains unwavering.

    Hopeful pitch
    "They market hope," Gail Robison, a staff nurse at the Zion hospital from 2003 to 2007, said of CTCA.

    The marketing typically features CTCA's state-of-the-art care and holistic approach. Ads note that featured patients might not be representative: "You should not expect to experience these results."

    The ads also challenge viewers to "compare our treatment results to national averages." Doing so, on the company's website, shows that CTCA's reported survival outcomes regularly beat those averages.

    Experts in medical data who reviewed CTCA's claims for Reuters say those claims are suspect because of what they called deviations from best practices in statistics - in particular, comparing its carefully selected patients to those nationwide.

    "It makes their data look better than it is," said Robert Strawderman, professor and chairman of biostatistics at the University of Rochester. "So the comparisons used to suggest that CTCA has better survival rates are pretty meaningless."

    The selection process begins when a prospective patient first contacts CTCA, by phone or web chat, and speaks to an oncology information specialist. "The first thing you do is be kind and greet them, but you're qualifying them," said Carolyn Holmes, the former oncology information specialist. "You ask, ‘How old are you?' meaning, ‘Are you Medicare-age?'"

    Holmes says she learned to recognize callers with "Cadillac insurance policies" and those from poor zip codes. She said she tried to redirect undesirable patients away from CTCA.

    "You don't want them," Holmes said about Medicare patients. Medicaid? "Absolutely not." Other former employees confirmed her account of screening patients based on their means of payment.

    Holmes sued Southwestern Regional Medical Center, CTCA's affiliate in Tulsa, in 2012 for terminating her job after she says she experienced symptoms consistent with multiple sclerosis.

    CTCA denies any knowledge of Holmes's possible disability and claims she failed to satisfy performance standards, according to court records. The case is pending in Oklahoma federal court.

    CTCA spokesman White said that the company has an "insurance-screening process and established criteria" and trains its specialists to direct callers to other resources when CTCA is unable to offer treatment.

    CTCA accepts Medicare patients "in some hospitals," said CEO Bonner, and "a tiny bit" of Medicaid. It also has a fund, named for Stephenson's mother, that provides $2.5 million a year in charity care.

    Skewed pool
    The practices Holmes described result in a patient pool that looks very different from the nation's.

    At the Zion hospital, about 14 percent of patients were covered by Medicare and 4 percent by Medicaid in 2011, according to data the hospital submitted to Illinois health authorities. Over the previous 10 years, the Medicaid percentage was often in the single digits. Reuters was not able to obtain data from CTCA's other hospitals.

    In the database CTCA compares itself to, called SEER and run by the National Cancer Institute, 53 percent of patients were diagnosed at the Medicare-eligible age of 65 or older, and 14 percent are below the poverty level, an indication of those covered by Medicaid or uninsured.

    SEER includes patients "with and without insurance, with and without other serious medical conditions, at or not at cancer centers, treated by all types of doctors, not just oncologists, and even including those who never received treatment because the cancer was diagnosed too late," said Celette Skinner, associate director for Population Science & Cancer Control in the Harold C. Simmons Cancer Center at the University of Texas Southwestern Medical Center.

    Those factors all depress the survival of SEER patients, making CTCA's results look better by comparison.

    For instance, patients without insurance, whom state filings show CTCA rarely accepts, are only half as likely to undergo a screening test for cancer, says American Cancer Society statistician Elizabeth Ward. And screened patients are alive longer after diagnosis than are unscreened patients. That reflects the effect of screening, not treatment.

    Poor people, whom CTCA rarely treats, also tend to have worse health, such as heart disease and susceptibility to infection. Those "co-morbidities" are responsible for as many as half of all cancer deaths in the year after diagnosis, said Soneji Samir, an expert on cancer statistics at Dartmouth Medical School in Lebanon, New Hampshire. CTCA's patients "have less risk of other causes of death."

    CTCA makes every effort to adjust its data so comparisons to the national database are legitimate, said biostatistician Chengjie Xiong of Washington University School of Medicine in St. Louis, who performed CTCA's survival analysis as a consultant to the company.

    But "comparisons cannot be done between CTCA and SEER database on income level," he said in an email. That means "there are some differences" between the two patient populations.

    Xiong said he is doing new survival calculations using more recent data from CTCA, trying to make sure the comparison to the national database is rigorous. The new results, Xiong said, are expected to be posted on CTCA's website this month.

    For some cancers, CTCA will still have better survival rates, he said. For others, "the survival difference in favor of CTCA is no longer statistically significant" after adjusting for several differences between CTCA's patients and those in the national database.

    'Very red flag'
    CTCA also excludes from its survival calculations thousands of patients it does treat but who did not receive "treatment at CTCA for the duration of their illness."

    "‘The duration of their illness' is a very big and very red flag," said MD Anderson's Berry. CTCA's patients will "tend to be healthier" than those in the general population from which SEER draws its data, he said, adding: "Ability and willingness to travel is an independent factor" associated with longer survival.

    No federal or state law requires hospitals to report their cancer outcomes, let alone mandates how to do the calculations. But many healthcare providers voluntarily err on the side of inclusion.

    "We follow them for the duration of their illness and still report them even if they were treated elsewhere," said oncologist Alan Campbell, medical director of Spectrum Health, which runs medical practices and hospitals in Michigan. "Doing otherwise could skew your survival numbers."

    Other major cancer centers do not report outcomes at all, arguing that the statistics can be manipulated.

    CTCA also appears to exclude the vast majority of its patients when it calculates survival data. In survival results from 2004 to 2008 posted on its website, CTCA reported 61 patients with advanced prostate cancer, 97 with advanced breast cancer, 434 with advanced lung cancer, and 165 with advanced colon or rectal cancer. These are the four most common solid tumors. In the same period, CTCA treated thousands of patients at its Zion facility alone, according to filings with state regulators.

    "We agree that some of our sample sizes" are small "and have always stated this as a limitation of our study," said Xiong, the consultant to CTCA.

    "I'd have some concerns about why and wonder if some cherry-picking was going on," said Spectrum Health's Campbell.

    Moreover, while the standard reporting period for cancer survival is five years after diagnosis, CTCA on its website doesn't go that far; for the four most common tumors, it reports survival up to four years at most. And as Reuters found, the company's advantage often diminishes as the five-year mark approaches (see accompanying graphic).

    Soon after Keith Hilborn got Vicky back home, her local doctor cleared her to travel. Keith started calling the CTCA oncology information specialist he had first spoken to. "She said things like ‘We'll have to get back to you,'" Keith said.

    They never did. Vicky "was depending on me, and I couldn't get them to treat her," he said. "She never got a single cancer treatment from them."

    Hilborn received a statement from CTCA saying Vicky's care cost $319,902.20. "This was just for treating her infection," he said. "My local hospital could charge like that, too, if they flew you around and sent limos for you."

    He refused to pay, keeping the reimbursement Vicky's insurer had sent to him. CTCA sued him for payment and won. A sheriff's sale of his belongings is expected to raise money to pay the judgment. 

    130 comments

    Patient skimming is classic strategy for for profit specialty facilities. They only accept patients with good insurance coverage or can afford to pay and arent that sick. Dump the patients that will loose money on non-profits. This is the way these disgusting operations make money.

    Show more
    Explore related topics: cancer, featured, cancer-treatment-centers-of-america
  • 22
    Jan
    2013
    5:53am, EST

    Dermatologists blast tanning industry campaign to play down skin cancer fears

    Seth Wenig / AP

    Joe Bongioni makes sure he is covered with indoor tanning lotion, before stepping into a tanning booth in New York on March 24, 2010.

    By Bridget Huber, FairWarning

    A new campaign by the tanning industry to promote the safety of sunbed use has come under fierce attack from the American Academy of Dermatology, which is accusing the industry of making claims that are “ridiculous” and unsupported by scientific evidence.

    In the latest exchange between the two sides, the dermatologists blasted the newly formed American Suntanning Association for disputing the medical consensus that tanning indoors increases the risk of skin cancers, including melanoma, the deadliest kind.

    “The recent statements by the American Suntanning Association (ASA) are ridiculous and there is no data to support them,” the dermatology group said in a statement. “Indoor tanning is dangerous.”

    In a statement responding to the charge, the tanning association said: "The public does not benefit from the continuation of a protracted, sound-bite oriented fight between professional sunbed salons and anti-UV (ultraviolet light) lobbying groups about the relative safety of UV exposure. We promote a fair and balanced message about UV exposure.’’


    The creation last month of the tanning association, made up of 1,400 salon owners, steps up the $5 billion industry’s campaign to defend itself against mounting evidence of the harms caused by indoor tanning. Already, industry members have mounted an extraordinary effort to portray doctors and other health authorities as conspiring to unnecessarily scare the public about tanning, as FairWarning reported in August.

    The tanning association describes its strategy in a document bearing its letterhead that was posted last month on TanToday, an online industry forum: “Promoting the indoor tanning industry will require retention of scientists throughout the world to help us debunk the scientific reports being used against us, and a major PR and lobbying campaign to bring the truth about indoor tanning to the government and to the public at large.” 

    Alex Howe, a spokesman for the group, said the passage is not the group’s official position. He did not respond to follow-up questions about why the statement was prepared.

    However, the tanning association has hired a major public relations firm, is planning a lobbying campaign, and, Howe said, will work with what he characterized as “the many scientists who already support a balanced message about UV exposure.”

    In a podcast last week, Doug McNabb, a board member of the tanning association described the new group’s goal: “The sort of mission of the organization that we all agreed on was that our main objective has to be to get more people in tanning beds. … The direction we’re going to take is going to be around media relations and regulatory relations that direct people to indoor tanning salons.”

    Deceptive statements?
    The World Health Organization says ultraviolet light from sunbeds causes cancer. DeAnn Lazovich, a cancer epidemiologist at the University of Minnesota Cancer Center, whose own research has linked sunbed use to melanoma, said the industry’s long-running efforts to cast doubt on the science are just “smoke and mirrors” and an attempt to continue selling a service linked to cancer.

    “They say, ‘Tan responsibly,’ but I think it is irresponsible for them to promote their product when we know it is a cause of skin cancer,” said Lazovich, whose work previously has been attacked by the tanning industry.

    Jerod Stapleton, an assistant professor of medicine at the Cancer Institute of New Jersey who has studied the tanning industry, said many of the contrary studies cited by indoor tanning proponents are not peer reviewed and appear to rely on cherry-picked data, have methodological flaws or have been funded by industry. “It’s an interesting way of going about it,” he said. “If you don’t like what the science says, just go do your own.”

    The tanning association has hired the prominent public relations firm Global Strategy Group, which lists high-profile companies like Goldman Sachs, General Electric and the New York Yankees among its clients, to represent it.

    Howe, the salon association’s spokesperson, would not respond to questions about the group’s legislative strategy. But the industry wants to persuade the Food and Drug Administration not to tighten restrictions on sunbeds, as the American Cancer Society and other groups are advocating.

    Even before the new group formed, the industry was trying to prevent states and local governments from passing laws making it illegal for teens to tan indoors. At least 30 states already have imposed some limits on teen tanning and Vermont and California ban anyone under age 18 from using a sunbed.

    The industry has argued that tanning is a good source of Vitamin D, which is created by the body in response to UV light. It blames dermatologists for scaring people about exposure to the sun and inducing an epidemic of vitamin D deficiency in the process.

    As FairWarning has reported, tanning’s proponents – including a network of non-profit organizations with ties to tanning salons – tout the vitamin as a panacea for ills ranging from autism to breast cancer. However, the Institute of Medicine, part of the National Academy of Sciences, says there isn’t enough evidence to say the vitamin provides any benefits other than improving bone health and disputes the notion that there is an epidemic of vitamin D deficiency.

    UV light for medical treatments
    As the statement last week from the American Academy of Dermatology noted, in 2010 the Federal Trade Commission reached a settlement with another industry group, the Indoor Tanning Association, over allegations it made misleading statements about the health benefits of sunbeds. The FTC says that under the settlement, the ITA agreed to refrain from making deceptive statements. 

    Separately, the Texas Attorney General has sued a salon chain for claiming sunbeds reduce the risk of cancer and provide other health benefits. That case is set to go to trial in September.

    The dermatologists group, in its recent statement, specifically criticized the American Suntanning Association for claiming that research pointing to indoor tanning’s ill effects is misleading. The ASA maintains that much of this research wrongly lumps in sunbed use at professional salons – which it contends is less risky – with sunbed use at doctor’s offices and homes. When the use of sunbeds in salons is considered on its own, “the risk virtually disappears,” the salon group said. 

    The dermatologists dismissed that claim, saying ultraviolet light is used in treatments for some skin conditions, including psoriasis and atopic dermatitis. The “crucial disparity,” the dermatologists’ group said, is that the procedure is done by a medical doctor with appropriate training and expertise. “This type of medical care is not provided at an indoor tanning salon, where operators have minimal knowledge about the potential side effects of UV light,” the statement said.

    Related: Embattled tanning industry fights back, taking its cues from Big Tobacco

    FairWarning is an investigative news organization based in Los Angeles that focuses on on safety and health issues.

    More from Open Channel:

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    Follow Open Channel from NBCNews.com on Twitter and Facebook 


    192 comments

    Besides being dangerous, indoor tanning always looks ridiculous. It makes people look like walking oranges.

    Show more
    Explore related topics: cancer, health, tanning, featured, skin, indoor, melanoma
  • 23
    Aug
    2012
    3:50am, EDT

    Embattled tanning industry fights back, taking its cues from Big Tobacco

    Smart Tan Magazine

    Joe Levy, executive director of the International Smart Tan Network, a salon association. He is point man in the industry's campaign to shift the conversation from indoor tanning's health risks to its purported benefits.

    By Bridget Huber
    FairWarning

    A doctor in a white lab coat stands at the pearly gates. The voice of God booms, “And your good deeds?” The man responds, “Well, as a dermatologist, I’ve been warning people that sunlight will kill them and that it is as deadly as smoking.”


    Follow Open Channel on Twitter and Facebook.


    His smug smile fades as God snaps, “You’re saying that sunlight, which I created to keep you alive, give you vitamin D and make you feel good, is deadly? And the millions of dollars you received from chemical sunscreen companies had nothing do with your blasphemy?”

    A bottle of SPF 1000 sunscreen materializes in the dermatologist’s hand. “You’ll need that where you’re going,” God says.

    The scene is part of a training video for tanning salon employees made by the International Smart Tan Network, an industry group. FairWarning purchased the video from Smart Tan's website for $75. 

    The tone is tongue-in-cheek but it’s part of a defiant campaign to defend the $4.9 billion industry against mounting evidence of its questionable business practices and the harm caused by tanning. And, in an extraordinary touch, it is portraying doctors and other health authorities as the true villains – trying to counter a broad consensus among medical authorities that sunbed use increases the risk of skin cancer including melanoma, the most lethal form.


    To sway public opinion, the industry is drawing on its vast network of outlets; there are more tanning salons in the U.S. than there are McDonald’s restaurants. Some salon operators are putting trainees through a “D-Angel Empowerment Training” program that uses the video. It is intended to give employees talking points to use outside the salon to argue that tanning is a good source of vitamin D, and thus a bulwark against all manner of illness, including breast cancer, heart disease and autism.

    The industry has also gone on the offensive with tactics that appear cribbed from Big Tobacco’s playbook to undermine scientific research and fund advocacy groups serving the industry’s interests.

    Central to the industry’s message is the idea that tanning’s critics -- such as dermatologists, sunscreen manufacturers and even charities like the American Cancer Society -- are part of a profit-driven conspiracy. These critics are described as a “Sun Scare industry” that aims to frighten the public into avoiding all exposure to ultraviolet light. The tanning industry blames this group for causing what it calls a deadly epidemic of vitamin D deficiency, and tries to position itself as a more trustworthy source of information on tanning’s health effects.

    New Jersey tanning mom denies charges of child endangerment

    What tanning’s proponents rarely point out is that the notion of a vitamin D epidemic is disputed, and that even if you need more of the vitamin, you can safely and easily get it from dietary supplements and certain foods.

    Even as they themselves use techniques cigarette companies pioneered, some in the tanning industry compare the Sun Scare group to the tobacco industry. “The Sun Scare people are just like Big Tobacco, lying for money and killing people,” Joseph Levy, executive director of Smart Tan, said in the D-Angel video.

    Feeling the heat
    The indoor tanning industry’s image has taken a beating since 2009, when the International Agency for Research on Cancer designated UV-emitting tanning devices as carcinogenic. The American Academy of Pediatrics and American Academy of Dermatology urge minors not to use sunbeds.

    California and Vermont prohibit youths under 18 from tanning indoors, and New York this month imposed a ban for those under 17. Thirty-three states regulate teen tanning to a lesser extent, according to the research firm IBISWorld.

    'I feel weird and pale': 'Tan mom' reveals new tan-free look

    The Federal Trade Commission and Texas Attorney General have tried to rein in marketing messages that misrepresent tanning’s risks. The Texas lawsuit is pending, but the FTC reached a settlement with the industry’s largest trade group, the Indoor Tanning Association, in 2010.

    Still, misleading messages continue to be the norm, Democrats on the House Energy and Commerce Committee reported in February. Undercover investigators phoned 300 salons and found 90 percent of the employees they spoke with said tanning did not pose a health risk. What’s more, 51 percent denied sunbeds increase cancer risk. Industry groups say the questions were posed in a leading way and that investigators would have been more fully informed of risks had they visited salons in person.

    Despite the bad press, the indoor tanning industry is holding steady. It showed slow but continued growth over the last three years, and revenues are expected to edge up to $5 billion by 2017, according to IBISWorld. White women ages 18-21 are the leading customers: 32 percent of them tanned indoors in 2010, including 44 percent in the Midwest, according to the Centers for Disease Control and Prevention. An estimated 28 million Americans tan indoors each year.

    The changing demographics of melanoma
    At an age when most feel invincible, 25-year-old Chelsea Price of Roanoke, Va., lives life in three-month increments. In January 2011, she was diagnosed with Stage III malignant melanoma.

    FairWarning

    Chelsea Price of Roanoke, Va., a former tanning salon patron, was diagnosed with Stage III malignant melanoma in 2011.

    Price’s first reaction was giggles. Her doctor, a kidder, had seemed unconcerned about the mole he’d removed, even reassuring her that he did it just to be safe. “I wish I was joking,” he said when he delivered the news.

    After two invasive surgeries, Price shows no sign of melanoma today. But Stage III melanoma has a high rate of recurrence, so Price has a skin exam, CT scan and blood tests every three months to make sure she’s still cancer-free. “It dictates my life.”

    Like many melanoma patients, Price is young, female and a former indoor tanner though it’s impossible to say with certainty whether the time she spent in sunbeds caused her illness. Price tanned indoors for just a couple of months each year and she never sunburned, “I am the person who did it safely and in moderation, but yet I’m here,” Price said.

    Price is hardly alone. Skin cancer is the most common cancer in the U.S. and diagnoses of melanoma, though still rare, have increased steeply over the last 40 years. Melanoma among white women ages 15-39 has shown a particularly striking rise, up 50 percent from 1980 to 2004, according to the National Cancer Institute.

    What caused the NJ tanning mom's leathery look?

    The typical melanoma patient has changed in a generation, says Dr. Bruce Brod, associate professor of dermatology at the University of Pennsylvania. Twenty years ago, Brod’s melanoma patients were mainly middle-aged men. Today, he treats mostly young women for the cancer. “I think that’s thanks to the tanning salons,” Brod said.

    Misleading messages
    To neutralize its critics, the Indoor Tanning Association mounted an ad campaign in 2008 that claimed there were no compelling links between tanning and melanoma. It also praised UV light as a good source of disease-fighting vitamin D. The campaign’s architect was Richard Berman, the public relations executive whose work to defend the alcohol industry, and discredit unions and Mothers Against Drunk Driving, earned him the nickname “Dr. Evil” among his critics.

    FairWarning

    In 2008, the Indoor Tanning Association launched an ad campaign downplaying indoor tanning's health risks.

    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, Mass. He co-authored 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, but evidence that vitamin D prevents cancer is inconclusive. The National Cancer Institute says there is evidence that the vitamin may reduce risk of one cancer, colorectal cancer, but even those results are inconsistent.

    Sowing doubt
    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.

    The 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 UV 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 two non-profit vitamin D advocacy groups – The Vitamin D Foundation and the Vitamin D Alliance – 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 their 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 advertisements for Smart Tan wearing her lab coat and a stethoscope.

    TanningTruth.com

    Dr. Sandra Russell, a Michigan doctor, in a pro-tanning ad from a 2007 issue of Tanning Trends magazine. Russell recently helped start a nonprofit group that promotes vitamin D and sunlight for cancer prevention.

    Superman v. 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 the Sun Scare people are just like Big Tobacco, 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, N.J., 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 said she would 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.

    Courtesy of Meghan Rothschild

    Meghan Rothschild of Northampton, Mass., was 20 when she was diagnosed with melanoma, the deadliest form of skin cancer. Rothschild now speaks to high school and college groups about the dangers of sunbeds.

    Meghan Rothschild, a self-described “splotchy white girl” from Northampton, Mass., 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.’”

    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 is a nonprofit, online investigative news organization focused on safety and health issues.

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    444 comments

    As a former tanning salon owner, I know the dangers incurred with indoor tanning.The chances of early cataracts,I had mine removed at 50. The increased risk of skin cancer, my daughter had on her breast, and must go every 3 months to have more frozen off. The appearence of wrinkles at an earlier a …

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    Explore related topics: cancer, campaign, health, industry, tanning, sunlight, featured, skin, melanoma, fair-warning
  • 10
    Aug
    2012
    5:23am, EDT

    Calif. sues major veterans charity for millions, alleges fraud and self-dealing

    By NBC News wire services

    California's attorney general sued a major veterans charity on Thursday, accusing the officers and directors of engaging in self-dealing and fraudulent fundraising, and paying excessive compensation.

    The suit seeks to remove the officers and recover $4.3 million that it claims was improperly diverted from Help Hospitalized Veterans. The charity in Winchester, Calif., was founded in 1971 to provide therapeutic arts and craft activities for patients receiving care in Veterans Affairs hospitals, military hospitals and state veterans homes, according to its website.


    "What makes this case so egregious is our military servicemen and women are willing to sacrifice their lives for our country and for us as Americans, and when they are in need of help and support we should give it to them and not manipulate charitable people and then personally profit from them," state Attorney General Kamala D. Harris told The Associated Press.

    The charity raised more than $108 million in contributions over the last three years, it said in tax filings and on its website, with 33.8 percent going toward its programs. The suit alleges that it filed "false and misleading" tax returns that inflated program expenses and reduced its actual fundraising costs to "less than 30 percent."

    Afghan suicide bomber kills senior Army leader, 2 majors


    Follow @NBCNewsUS

    Based on its reported fundraising, Help Hospitalized Veterans ranks among the top 1 percent of charities in the United States. The group once was endorsed by retired Gen. Tommy Franks, who later distanced himself from the charity.

    At the same time, it has ranked for more than a decade at the bottom of lists by watchdog groups that rate nonprofit organizations based on their financial management and abilities to use most of their donations toward their causes. CharityWatch says about 35 percent of Help Hospitalized Veterans' funds go toward programs to aid veterans. The recommended standard is about 65 percent.

    On a mission: Jogging across the US in name of veterans

    The California lawsuit said the charity's president, Michael Lynch, received excessive compensation of $900,000.

    The complaint said that former president Roger Chapin, who during a 2008 U.S. congressional hearing about his management of the charity called himself the "the most honest person in this room," retired the following year with a nearly $2 million pension plan. The suit alleges that the group's board members retroactively spiked Chapin's earnings to justify the inflated amount for his retirement.

    Social impact investing catches on in the US

    Chapin is also accused of diverting the charity's funds through a separate charity called Conquer Cancer and Alzheimer's Now.

    Chapin was accused of paying himself more than $493,000 from the cancer charity. That charity received the money from American Target Advertising, a fund-raising firm run by conservative political fundraiser Richard Viguerie, who is not named in the suit.

    More charity news in NBCNews.com's Giving section

    'It's surprising it's taken this long'
    Viguerie, who is identified in the suit as Chapin's long-time friend, is said to have deposited funds into the account of Conquer Cancer and Alzheimer's Now from $800,000 that Help Hospitalized Veterans had lent ATA and was not repaid.

    "It's surprising it's taken this long for something to happen with all the serious problems that were brought up in the (2008 congressional) hearing," said Daniel Borochoff of CharityWatch, which monitors the financial records of nonprofit groups. "What's more, this information did not filter down to donors."

    But he added: "Mr. Chapin spun a complex web to confuse well-intentioned donors and make it difficult for regulators to untangle."

    Afghan officials: 3 US special forces troops slain

    Calls to Help Hospitalized Veterans and Lynch's office were not returned. Viguerie did not immediately respond to phone and email messages seeking comment. Reuters was unable to contact Chapin on Thursday evening.

    Borochoff said the complaint sends a strong message to unscrupulous charities.

    "It's about $2 billion that is raised on behalf of veterans charity, and unfortunately a lot of that's being wasted and not being used to help our veterans," Borochoff said. "It's really ludicrous what's going on. It's out of control, there's such great waste. It's a national disgrace that people are allowed to exploit veterans for their own personal financial benefit, or benefit of their company."

    More Southern California coverage from NBCLosAngeles.com

    According to Charity Navigator, a third of the 50 military veterans charities it evaluates rate poorly and 20 percent either got a zero for their financial management or a "donor advisory" tag, which indicates the organizations are being investigated by authorities.

    That compares to 2 percent for other kinds of charities, said Ken Berger, the president of the Washington-based group that evaluates 5,500 charities.

    Reuters and The Associated Press contributed to this report.

     

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    335 comments

    Nothing like a "good cause" to make a few people rich. Even as a veteran myself, I will not be shamed into giving to these types organizations. When I am ready to donate to a good cause, I'll cut the middle man and give it to those that need it.

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    Explore related topics: cancer, charity, military, california, veterans, alzheimers, featured, help-hospitalized-veterans
  • 17
    Feb
    2012
    6:53am, EST

    Studies: Health risk from toxic pavement sealant greater than previously believed

    Coal tar sealant is applied at a study site at the University of Texas in Austin.

    By Robert McClure
    InvestigateWest

    When you think of pollution, you might picture an industrial center like Camden, N.J., or Jersey City. But new research shows that when it comes to a potent class of cancer-causing toxic chemicals, many American parking lots are a lot worse.

    New studies paint an increasingly alarming picture – particularly for young children – about how these chemicals are being spread across big swaths of American cities and suburbs by what may seem an unlikely source – a type of asphalt sealer. These sealants are derived from an industrial waste, coal tar.

    Four new studies (links are at the end of this article) announced this week further implicate coal tar-based asphalt sealants as likely health risks.  The creosote-like material typically is sprayed onto parking lots and driveways in an effort to preserve the asphalt. It also gives the pavement a dark black coloring that many people find attractive.


    Coal tar is a byproduct of the steelmaking industry. In 1992, the U.S. Environmental Protection Agency declared that it would not be classified as a hazardous waste, even though it met the characteristics of one, because it could be recycled for uses that include coating asphalt. That meant steel mills didn’t have to pay for costly landfilling or incineration of the waste.

     

     

     

    Only in recent years have scientists discovered the ill effects of this practice.

    Coal tar sealants are used most heavily in the eastern United States, but were applied in all 50 states until Washington state banned the products last year. More than a dozen local governments, including Washington, D.C., and Austin, Texas, also have banned the coal tar sealants in favor of the other major type of sealant, which is asphalt-based.

    Asphalt-based sealants contain about 1/1000th the concentration of the cancer-causing chemicals that coal tar-based products do. Home Depot and Lowe’s stores have dropped the coal tar sealants from their product lines, but still some 85 million gallons of the coal tar-based sealants are applied annually in the United States.

    The new research, published in peer-reviewed science journals, focuses on a class of chemicals found in coal tar and known as “polycyclic aromatic hydrocarbons,” or PAHs. Previously, researchers believed that people’s exposure to PAHs came primarily through food, which contains trace amounts produced primarily from smoking food or cooking it at high temperatures in practices such as grilling, roasting, and frying. PAHS are produced when any organic matter burns.

    The new research shows:

    • It appears that children – especially those from 3 to 5 years old – living by coal tar-sealed parking lots and driveways are getting a bigger dose of PAHs from house dust than from their food. The kids who put their hands in their mouth most often are likely receiving 9 ½ times more exposure through house dust than through food, according to research led by E. Spencer Williams, a Baylor University human health risk assessment expert. That’s just from the house dust. When the kids are outside in the yard or playing on coal tar-sealed pavement, they likely are picking up much larger doses.
    • While researchers previously theorized that airborne PAHs come mostly from power plants, factories and cars’ and trucks’ tailpipe emissions, U.S. Geological Survey researchers measured large amounts vaporizing into the air off coal tar-sealed parking lots.  The concentrations coming off parking lots in suburban Austin, where the researchers are based, were higher than in centers of heavy industry, including Jersey City and Camden, N.J.; Chicago; London and Manchester, England; and Guangzhou, China. The Austin parking lots tested were three to eight years old. Much more off-gassing occurs in the first few years after the sealants are applied, researchers said.
    • Concentrations measured four feet above the coal tar-sealed lots in some cases exceeded health-protection guidelines recommended by a European Union science panel to protect against cancer. The United States has no similar guidelines.
    • Extrapolating from the 85 million gallons of coal tar sealants laid down annually and the out-gassing rates measured in Austin, Geological Survey researchers calculated that nationwide, more PAHs are getting into the air from coal tar-sealed parking lots, driveways and playgrounds than from all the auto and truck exhaust.

    “That’s a lot,” said Barbara Mahler, a USGS scientist involved in the research.

    Researchers previously had shown that coal tar-sealed parking lots were shedding tiny bits of the material, which was washed by rain into nearby waterways – killing, sickening and maiming aquatic creatures such as salamanders, minnows and, importantly, bugs at the base of the food chain. The chemicals kill tadpoles, cause tumors on fish, stunt growth of aquatic creatures and reduce the number of species able to live in a waterway.

    As a result of being washed into waterways by stormwater, these chemicals’ concentrations have been rising over the last two decades, even as levels of most contaminants are headed down, Geological Survey researchers showed.

    The chemicals are getting into the house dust, researchers think, when small bits are eroded off pavement and tracked into nearby homes.

    Scientists also had previously demonstrated that toxic constituents of coal tar were showing up in the dust of homes adjacent to parking lots and driveways, raising questions about health effects on children in those homes, especially toddlers who frequently put their hands in their mouths. Coal tar is known to cause cancer in humans, as well as genetic mutations in lab animals.

    One of the new studies helps quantify that risk. Kids who are average in terms of how often they put their hands into their mouths are getting 2 ½ times as many PAHs from house dust as from food, while those in the 95th percentile of hand-to-mouth behavior – they do it more than 94 percent of other kids – get 9 ½ times as much from the dust.

    Researchers still would like to know how much of a toxic dose those same kids are getting when they play outside in yards next to coal tar-sealed asphalt, or on the asphalt itself. The level of cancer-causing chemicals in the dust on the asphalt itself has been measured at about 37 times the levels found in house dust.

    “Those concentrations are a good bit higher and this study doesn’t include that at all,” said Williams, the Baylor researcher. “That may be important because just one little fingerful could be a relevant dose,” meaning one that worries health experts.

    While researchers have known about contamination of water and dust, the findings about air pollution are new. Significant amounts of PAHs continue to vaporize off coal tar-sealed lots even years after the sealant is put down.

    “When we look at a seal-coated parking lots, in any direction we look we see these really strongly elevated concentrations,” said Peter Van Metre, a U.S. Geological Survey scientist based in Austin. Of the dust on the coal tar-sealed pavement, he said: “It would just take a tiny amount of that to be a large enough dose for it to be significant.”

    Companies that sell and use the coal tar sealants have previously disputed the growing body of evidence of the coal tar sealants’ danger being amassed by scientists from the Geological Survey, the University of New Hampshire, Baylor and other institutions.

    Repeated attempts this week to reach an industry representative, Anne LeHuray, executive director of the Pavement Coatings Technology Council, for comment on the new studies were unsuccessful. In an email on Thursday, LeHuray said she was tied up at a meeting of the pavement council in Memphis.

    Generally, the pavement council has attacked previous coal tar research on technical grounds.

    Read previous articles on coal tar sealants:

    Study sees parking lot dust as a cancer risk

    State bans coal tar sealants in big win for foes

    The pavement council has fought bans – sometimes successfully – when they have been proposed by local and state governments. In addition to the local governments that have forbidden use of the coal tar sealants, some governments have placed restrictions on their use, including the state of Minnesota and the California Department of Transportation. Restrictions also are in effect in more than 40 Illinois municipalities.

    U.S. Rep. Lloyd Doggett, a Democratic congressman from the Austin area, has previously filed legislation calling for a nationwide ban on coal tar sealants. He plans to refile the legislation, a Doggett spokeswoman said, but is currently embroiled in a redistricting fight.

    Tom Ennis, an Austin city official who helped get coal tar sealants banned there, has now launched a campaign to support a nationwide ban.

    “You’re looking at a big urban air quality” problem, Ennis said. “It’s completely unacceptable and something needs to be done.”

    The studies announced this week appeared in the science journals Environmental Science and Technology, Chemosphere, Atmospheric Environment,  and  Environmental Pollution.

    InvestigateWest is a non-profit journalism center based in Seattle. If you value this kind of in-depth, independent news reporting, please consider making a tax-deductible donation to support further work of this kind.

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    162 comments

    This is not a new story. They have known about this for years. And when it rains it goes into your water. Think about it.

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