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.’’

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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.

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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.”

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.

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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.

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.

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.

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.

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.

Most states have laws prohibiting kids and teenagers from patronizing tanning salons because of the skin cancer risk it poses. But are tanning salons following the rules.

Today's investigative reporter Jeff Rossen wondered the same thing, and sent a couple young NBC staffers out with hidden cameras  to put them to the test.

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Watch the video above or read what they found here.