Newer, better sunscreens have not been approved by the FDA | Hacker News Reader

Newer, better sunscreens have not been approved by the FDA

theatlantic.com

168 pointsderbOac191 comments

> At 36, I am just old enough to remember when sunscreen wasn’t a big deal. My mom, despite being among the palest people alive, does not remember bringing it on our earliest vacations, or hearing any mention of sun protection by our pediatrician.

> Now SPF is ubiquitous. You can find it in lotions, sprays, gels, oils, powders, and implements that look like grade-school glue sticks, as well as infused into skin-care products, lip balms, makeup, and clothing. Sun care has its own aisle at big-box stores, and beauty companies worth hundreds of millions of dollars have been built from the ground up by offering only products that block ultraviolet rays.

So we went from little to no sunscreen to ubiquity over a few decades, but over that time rates of skin cancer have increased per 100k.

https://www.ncbi.nlm.nih.gov/books/NBK247164/figure/skincanc...

Shouldn't rates have gone down? What explains this?

I recall reading a recent study (too lazy to look it up, tbh) that showed a link between skin cancer and sunscreen use, so your numbers may somehow support that suspicion.

That link proves that cancer causes sunscreen. See https://xkcd.com/925/

Perhaps because so many sunscreens contain benzene, a known carcinogen:

https://www.valisure.com/valisure-newsroom/valisure-detects-...

Why is this being downvoted so heavily? Is this a known conspiracy theory? Does anyone have evidence to the contrary? Or a secondary source for the allegation?

Valisure is being investigated by the FDA for the benzene thing, but their history is pretty reliable and dovetails with FDA findings. It's not clear why the FDA is going after Valisure for this particular independent test.

However, there is also a huge sunscreen "truther" movement that's been going on since the late 90's, bolstered by publications like Mother Jones. Google "sunscreen conspiracy" and you'll find tons of alternative medicine (aka nonsense) sites about it.

My guess is that the downvotes are coming from those who have heard of the latter and conflate it for the former. My personal opinion is that Valisure is on the up and up, but who knows.

Another perspective from Consumer Reports:

https://www.consumerreports.org/toxic-chemicals-substances/b...

They didn't find it in their testing, but noted recalls.

I'm also confused. This was a big news story a while back; it led to dozens of product recalls.

https://www.washingtonpost.com/health/2021/07/15/johnson-joh...

https://www.npr.org/2021/10/01/1042507194/coppertone-recalls...

https://www.cnn.com/2021/07/17/health/sunscreen-recall-cance...

Perhaps because my comment was so brief and had only one reference it lacked credibility.

People's willingness to engage in risky behaviour tends to increase with how safe they think they are. So basically they're staying out in the sun for longer, but either not using or reapplying enough sunscreen.

I don’t have them on hand but I believe some studies claimed that diet can have a negative affect on skin cancer resistance.

The cause is probably a mix of things. Tanning and clothing style/choice are both significant cultural changes. Active lifestyles are more in trend. People are also living longer, and increasing the window that you might have cancer.

There's some interesting psychological changes too. If you have sunscreen on, you might stay in the sun longer because you are "protected" but most sunscreens you need to reapply. Water also washes them off easily.

My grandparents always said they were on the beach under an umbrella. This is no longer common.

Yeah I can look at my aunts and uncles who all grew up farming and tell which ones wore long sleeves and hats in the fields. My mother now looks older than her older brother despite having a better diet.

> "The cause is probably a mix of things."

Thank you! So few people seem to understand that about things these days. Always looking for "the simple explanation" or "the one true answer" to any issue. It's rarely that simple in reality however. It's quite often "a mix of things" all contributing to the final effect being observed.

One explanation is a time delay.

Most typical skin cancers (BCCs and SCCs), like other features of sun damaged skin, tend to arise decades after high levels of chronic or accumulated intermittent sun exposure at a younger age. (However that be less true for melanoma.)

I had two BCC’s at a very young age (26/27). They were almost certainly caused by frequent (1-2x a week) usage of tanning beds for several years in my early 20’s. I stopped using the beds around 24 and besides the two BCC’s at 26 and 27 have not had any issues for a decade.

And I know the word “cancer” sounds bad, but it’s very relative. BCC/SCC are very very unlikely to kill you, think of them as an extremely slow growing pimple. They could possibly kill you if you let them grow unchecked for several decades. Melanoma, on the other hand, is a entirely different beast that will kill you quickly if you don’t catch it early.

BCCs are correlated with longer life expectancy.

just a note im case no someome hasnt seen those abbreviations before:

bcc → basal cell carcinoma

scc → squamous cell carcinoma

Better detection and screening for these cancers resulting in an apparently larger rate of incidence is an easy hypothesis to reach for.

Also cancer is often in line behind other things waiting to kill you. If you survive everything else, you die of cancer.

Melanoma is a type of cancer that often kills young people, like breast cancer.

What specific advances have been made in better detection and/or screening? Do we use better technology for this? If there was some sudden advancement then I'd assume we'd see a sudden jump in the graph. Rather, we see an incredibly smooth and steady increase.

Furthermore, the graph is split between male and female and there's very few, if any, little increases that are synchronized across these categories. If technology was a factor I'd assume we'd see increases in both

> What specific advances have been made in better detection and/or screening? Do we use better technology for this?

The technology[1] and methodology used in detection has advanced significantly and repeatedly.

> If there was some sudden advancement then I'd assume we'd see a sudden jump in the graph. Rather, we see an incredibly smooth and steady increase.

You're ignoring the time it takes for technology to be adopted and implemented. No business, medical or otherwise, blindly purchases every piece of technology the moment it's made available on the market. In medicine, that process can actually be so slow that by the time a specific product reaches mass adoption, the current technology or methodology or medical understanding has already progressed, starting a new cycle of adoption. And that's all still ignoring the financial costs, which are often a barrier for smaller practices.

> Furthermore, the graph is split between male and female and there's very few, if any, little increases that are synchronized across these categories. If technology was a factor I'd assume we'd see increases in both

You're ignoring many factors here, most notably that women visit the doctor more often[2], spend more time per visit and more willingly express concerns[3], and increasingly so as care for women has become more accessible and less stigmatized[4]. Also, the graph is actually extremely synchronized between men and women, so I'm not sure how you came to that conclusion.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624041/

[2] https://pubmed.ncbi.nlm.nih.gov/15130263/

[3] https://newsroom.clevelandclinic.org/2019/09/04/cleveland-cl...

[4] https://swhr.org/about/history/timeline/

> The technology[1] and methodology used in detection has advanced significantly and repeatedly.

Thanks for the link! Your source mentions that "total body photography and dermoscopy have been the first to attain significant diffusion into clinical practice" but makes no other reference to actual adoption except to point out that "the accessibility of the skin to simple visual inspection and the relative ease of skin biopsy have retarded the adoption of high-tech diagnostic aids" which seems to point out that technological adoption has not actually made a huge difference?

I'm seeing a huge increase in research but no evidence of actual adoption. Anyone who's worked in this industry knows how large the gap between research and adoption can be

It's a good source, but not completely relevant since it brings no reference to any data on actual adoption of the technologies its discussing. It's also from 2008...

> You're ignoring the time it takes for technology to be adopted and implemented.

Yes, good point, thanks.

> You're ignoring many factors here...

I think you misunderstood my point. I was specifically not talking about the OVERALL trend, but rather the direction of the little bumps along the way. If we had a sudden technological advancement one year (whether large or small) we'd expect to see a positive bump for both male and female categories. Instead most of the bumps actually point the opposite way of each other

All those people tanning in the 90s aren’t going to get skin cancer right away - it takes a few decades to catch up.

The Canadian Cancer Society has a UV camera in a box. People stick their head in and it shows the hundred of freckles, blotches, sunspots under your skin you can't see now but will later. Then they ask you to put on sunscreen and where it is on your skin is opaque jet black.

impressive public-health comms technique, but again, will still 'show jet black' even if:

- you're wearing a sunscreen which is itself carcinogenic, and are being affected by this

- your sunscreen is destroying coral reefs

- your sunscreen washes off easily

- your suncreen is unpleasant to wear (making you unlikely to wear it)

- your body actually needed some sunlight anyway: https://www.outsideonline.com/health/wellness/sunscreen-sun-...

This is why public-health comms, a thing I have previously done in this tapas of careers, is very difficult to do in a way that does not itself cause some harm.

In this case, the visceral visualization of the effects of UV light overlooks the possibility (EDIT: leads the participant to overlook the possibility) that we were simply wrong about the 1:1 correlation between UV exposure and cancer.

Science is always changing, and deep-seated emotional reactions tend not to. One oft-overlooked goal of public health comms is to try not to generate so many of the latter that people can no longer accept the former.

'show jet black' is not the strategy of researching whole impact of sunscreen.

However once the impact of sunscreen is researched and it comes out positive you still need to convince people that applying sunscreen is a good idea. Just telling the information doesn't work that well. Demonstration like the one mentioned is better.

Yes, it works rather too well, in fact. So much so, that people subject to it will likely be slathering up, no matter what science finds out.

Again: Science changes; emotions do not; the job of public health comms is to generate emotions that roughly match science; but then science changes again, but the emotions do not.

The net result is that everyone's fear-compass is randomly pointing to findings from fifty years ago, which, incidentally, is why my last roommate couldn't cook.

The 31yo rock climber was terrified of salt. Why? His father had had a heart condition --- in nineties.

There are few things that could have brought the poor man more joy than ruining his dinner every night, which likely had the opposite effect than intended.

It's easy to spam links on this topic -- I went searching for this excellent summary:

https://www.nytimes.com/2012/06/03/opinion/sunday/we-only-th...

And found these two as well; I'm sure you can dig up plenty more

https://archive.nytimes.com/well.blogs.nytimes.com/2016/05/2...

https://www.nytimes.com/2011/05/04/health/research/04salt.ht...

And I'll quickly duck back in to say that while there is an abundance of recent examples, including the early 2020 attempts to limit public use of n95 masks(!), there isn't a solution to the health-comms predicament per-se.

You still have to communicate what you're assigned and, yes, the better you do your job, the worse the next person will have it, when (not if) the science changes.

Such is life.

Neat.

"UV Light Camera Development - Cancer Society" [2018] https://www.smiledealers.com/news/uv-light-camera-developmen...

How do I do this at home?

I tried to figure this out a few years ago, but I remain noob. I found stuff like this:

https://maxmax.com/maincamerapage/uvcameras

I'd like to use my phone's camera. I once read that cameras now have built-in UV filters. Because voyeurs were taking "naked" pictures at the beach. But I couldn't figure out if I could cannibalize one of my old phones, turning it into a UV camera.

At 42 I remember the pre-sunscreen days as well. At the beginning of summer we would all go to the pool and get a nasty burn. Within a week we were at the pool all day every day and would not have a burn again until the next year. On average we would be getting around 3 painful but not serious burns per year (one at the start of summer, one when we went to the amusement park, one when we went out on a boat or something) despite hundreds and hundreds of hours of direct sun exposure each summer.

These days I rarely spend much time outside in the sun, and when I do I almost always burn. I am not in the sun enough to maintain a tan. When I go on vacation I can build up to about 4 or 5 hours of full sun exposure without burning in about 2 weeks (if I get outside a few weeks before to kickstart things), just in time to come home and lose my tan completely. As a result, I get sunburns more often now than I did as an 8 year old when I spent more than 40x more hours in the sun every year (roughly 4+ hours per day for 100 days of summer weather, vs today where it's maybe 20 minutes every few days).

I guess my hypothesis is: much less cumulative exposure can result in more damage to DNA if it is punctuated by periods of intense exposure when compared to consistent intense exposure.

42 as well. Once you got a “base” it wasn’t really an issue. And I’d be out all day riding bikes and playing 8 hours a day. Everyone had a farmers tan. That said, I now use sun screen like crazy but it’s mainly about vanity as I confront aging. I also make sure my daughter is protected with sun screen, it’s like being bilingual, she’ll thank me later.

53 here. My Mom said when I was a baby in the stroller she'd pull back the blanket a little at a time so my legs could get some sun. I have blue eyes, was very blond as a kid, but not super pale. During the summer we went to the beach quite often. I don't recall ever having a sunburn. I'm sure I had sunscreen on at some point but it probably washed off with the salt water.

I think my geekiness of being inside from early teens onward counteracted any extreme sun exposure I may have experienced as a child. And I'm male so I didn't sunbathe like girls did at the time with baby oil to increase the sun damage to tan faster.

I'm not sure where you guys grew up, but I'm 46 and remember putting on sunscreen as a kid, as did most of my friends. Even with sunscreens (which sometimes you forget to refresh...) you occasionally would get a nasty sunburn.

On the other hand i remember being in Australia and all the British tourists would follow the strategy you layed out. So after the first day on a boat trip they all looked like xcooked lobsters. While all the other nationalities would just put on sunscreen and be fine. You would also still get a significant tan even with 30+ sunscreen.

The rest of us are probably from the northern hemisphere which doesn't have uv-c exposure due to the ozone hole. Totally different up here!

Reasonable question. There appears to be a shift in the relative incidence rates based on age since 2000 (https://jamanetwork.com/journals/jamadermatology/fullarticle...).

Skin cancer rates were always weighted towards older (average age at detection is ~65), but at the same time skin cancers are one of the more common cancers found in young people. Since 2000 where appears to be a decrease in incidence of younger ages, and an increase of those at older ages.

EDIT: Just to add on, I don't know if this age shift effect accounts for everything, but I think it's interesting and relevant.

Are you suggesting that the skin cancer rates are a lagging indicator and the explosion in cases is the result of the lax attitudes of a few decades ago as described in the article?

One thing the article didn't mention is that even just 30 years ago sunscreens were nowhere near as effective as they are today. SPF 15 was extremely common and 30 was kinda rare and usually left you looking like you were whitewashed. Today it's nothing at all to find SPF 50 on the shelf. And if you use them properly they actually work, unlike some of the formulations of old. You can be out in the direct sun all afternoon and still come in still mostly pale.

> Are you suggesting that the skin cancer rates are a lagging indicator and the explosion in cases is the result of the lax attitudes of a few decades ago as described in the article?

That seems logical, skin cancer is not a next-day result of overexposure, sunburn is.

Cancer rates are a lagging indicator. You get sunburned today, you get cancer in 30 years. The people getting skin cancer now were not wearing sunscreen in 1990.

And we all remember how the sun was invented in 1991.

The whole in the ozone was a big deal in the 80s.

In Argentina.

Actually Australia had it the worst. I remember estimates that the MAJORITY of Australians will have had skin cancer in their lifetimes

Excuse you. NZ and Pacific islands had it the worst.

Aussie sun is a joke compared to NZ sun.

The ozone hole is scary, and certainly anecdotally it feels like it severely affected UV levels, however apparently the science says the hole didn’t actually affect UV in NZ very much: “While the ozone hole does not directly affect ozone concentrations over New Zealand, when it breaks up in spring it can send ‘plumes’ of ozone-depleted air towards us. This briefly decreases column ozone levels by around 5 percent, about the same amount as normal daily variation (Ajtić et al, 2004).”[1]. I read that a 5% decrease in column ozone leads to a 2.5% increase in UV, which is not that significant.

Personally I believe the NZ sun is harsh, but looking at country measurements shows UV levels in NZ are not as bad as we might think.

That said, as a NZer, I am extremely pleased that everyone banned ozone depleting chemicals.

[1] https://www.stats.govt.nz/indicators/ozone-hole/

That's not an estimate, that's reality: 2/3rds of Australian will get some form of skin cancer.

https://www.sunsmart.com.au/skin-cancer/skin-cancer-facts-st...

It's not quite as dramatic as that sounds though, because the really dangerous type (melanoma) has "only" ~5% incidence.

Could there be a lurking variable here?

I blame tanning beds in part. My cousin and I are the same age, but they used tanning beds quite heavily whereas I have not. They look significantly older than I do now and they're more at risk for skin cancer as we have genetic factors at play.

> So we went from little to no sunscreen to ubiquity over a few decades, but over that time rates of skin cancer have increased per 100k

UV exposure patterns have changed significantly. Long-distance vacation travel to sunny locations is much more common now. Tanning beds are much more common. Both holidays and deliberate tanning often take people from indoor office life to the opposite extreme of sun exposure.

People also dress differently in the sun than they did in the past. Even in my old family photos, it's interesting to see people relatively more covered up in the sun (long pants, long sleeves, big hats) in older photos relative to our modern shorts and t-shirt style today.

Some of this can be seen in statistics where melanoma rates on the torso are increasing much faster than average.

It's also theorized that people who wear sunscreen become more cavalier about sun exposure in general. Sunscreen doesn't provide perfect protection and it needs to be reapplied over time. A lot of people put some sunscreen on and then assume they're good for the rest of the day, or they wash a lot of it off in the pool, or they miss spots, and so on.

> People also dress differently in the sun than they did in the past.

Temperatures in those sunny areas have increased as well on average over the last few decades.

I don't think that contradicts the GP? They were giving possible explanations as to why skin cancer rates may have increased despite the widespread availability of sunscreen.

Sure and I was positing why they may have increased.

By enough to make people change their dress significantly? Could you provide some proof of such temperature changes?

> Tanning beds are much more common.

I think they were common, say 80's/90's, but I don't see them much anymore.

I remember meeting a woman once - early 20's and very attractive - except her skin was extremely wrinkled. She told me her parents had owned a tanning salon and she used it all the time. and a bit later that's how things ended up.

> I think they were common, say 80's/90's, but I don't see them much anymore.

I think you might just have aged out of the group that uses them. Young people tend to use them a lot. Something like 1 in 5 people in their 20s have used one in the past year in many western countries.

The statistics are pretty horrific. Looks like you're increasing your lifetime risk of skin cancer by a good 20% by doing this.

Where are those statistics from? I was wondering because using a tanning bed has always been a low-class thing and something to be ridiculed when I was in my early 20ies (I’m 36).

German Wikipedia [0] has it at its highest 80ies/90ies, the stats they mention are for 14-45 year olds: 2012: 14.6 %; 2015: 11 %; 2018: 8.8 %

[0]: https://de.wikipedia.org/wiki/Solarium

In the english version, there's a study of the average over multiple anglo and European countries, perhaps Germany was significantly lower than the average:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117411/

Yeah, but that stops with 2012 data, and for "last-year-exposure" the data is actually pretty thin for university students and adolescents: https://i.imgur.com/1Xly88x.png (Supplement, eFigure)

> early 20's > extremely wrinkled

Do you know if she also smoked cigarettes? In the past I have noticed early twenty’s with abnormally wrinkled skin from years of smoking.

Yeah. I'm also gonna call BS on the "tanning salon" thing. If all it took was copious amounts of UV to f you up that bad every white man outdoor laborer in the south would look like Keith Richards by age 30. I'm sure it didn't help but if your body looks like it has X years of wear and tear on it it's because you've put X years of wear and tear on it. A dedicated individual is more than capable of doing in one year what a normal person does in 2-3. Back when I was flipping shitbox cars, like $500 shit I'd bought off the kind of people who drive those cars, finding personal paperwork that included the prior owners DOB amongst the trash and thinking to myself "no fuggin way dis bitch dat young" happened like once per five cars. And then you'd take stock of the needles, smokes, etc, etc, and it would all make sense.

> every white man outdoor laborer in the south would look like Keith Richards by age 30

Um, a lot do.

I don't know if she was a smoker. I know smoking affects your skin's ability to heal.

also, thinking again, she could have been 25-27?

She had very dark brown skin and fair or blonde hair. It was just prematurely old-looking skin.

The fact that she talked about it - volunteered the information - meant she was self conscious about it or people asked or she knew the look people gave her.

Lots of confounding factors, from skimpier swimwear to Caribbean vacations to potentially better detection.

Theres not just one kind of skin cancer. For this kind of things it matters to make a distinction between the benign ones and deadly ones.

"Shouldn't rates have gone down? What explains this?"

I think with a lot of diseases it's better diagnosis so you get more cases. I feel the same is true for autism. When I grew up nobody knew about autism so the autism rate was basically zero. We just had weird people.

It's the cheap vegetable oils. Up to the 80s even McDonalds would use beef fat for their fries. Now? Let's call it just a correlation between that and cancer. I know it's causal but we'll leave that as an exercise for the reader.

JFYI (to have a glimpse/anecdote on the past):

https://news.ycombinator.com/item?id=28865164

Umm, others already mentioned behavior changes involving more vacation and more tanning, but people also changed their diets. Most diets focus on high carb and low fat, which is unfortunate for cancer. Cancer feeds on sugars and many simpler carbs break down to glucose. Additionally, many processed foods contain quite high levels of sugar. When humans were eating less sugar, cancer cells grew more slowly. As others mentioned, cancer tends to be the thing that kills you most slowly, but it still could be delayed a bit.

It’s worth mentioning that some doctors I’ve met have started advocating low-meat keto for their cancer patients, so while I am completely an amateur with health topics, I feel I am on somewhat firm footing here.

*in US.

Honestly, I was expecting an article about some ingredients being harmful to coral reef hence disallowed, or similar.

Instead, the issue is slow process of FDA.

> The FDA hasn’t added a new active ingredient to its sunscreen monograph [...] in decades.

Also, what makes this article interesting (a "man bites a dog" kind of story) is that the US is more strict than EU in this area; in 95% of cases for all kinds of items sold, it's the opposite.

The same FDA which made it all-but-impossible to test for SARS-CoV-2 in early 2020? I'd believe it.

https://twitter.com/random_eddie/status/1232075455295037440

Kind of startling that people didn't hear about this and are doubting the veracity of the claims... I thought this story was well known by now.

https://www.science.org/content/article/united-states-badly-...

I thought this was common knowledge and a common complaint a cross the political spectrum.

My understanding was that this was primarily due to the CDC not the FDA. The test the CDC developed was defective yet they mandated it.

It is a known fact that FDA has basically stopped doing its job. From food safety to PFAs, from drug approvals to baby formula shortages, everything can be blamed on the paralysis that exists within the agency. American consumers at at the mercy of corporations at the moment. https://www.politico.com/interactives/2022/fda-fails-regulat...

The other wild portion of this is that if you go to northern EU (Norway/Sweden/Finland) sunscreen is like, insanely expensive. Like at least triple the price of what you would pay in the states for the same product.

Maybe part of that is that there's not much sun there so sunscreen is a niche product not a staple?

The opposite actually. Having a high latitude, summers are more intense.

But why? Angle of the sun is lower. Sunrays go through more atmosphere.

Is it because people are mostly vertical when they are in the sun?

Nvm. I'm dumb.

That's crazy, especially because sunscreen in the us is absurdly expensive. $30 for a 8oz tube is borderline criminal.

I'm not sure if you're looking at some crazy marked up amazon price, but my local grocery sells it for less than 1/3 of the price you mention: https://www.heb.com/product-detail/h-e-b-ultra-sunscreen-spf...

Man.. i should start trading aus sunscreen for finnish mozzie repellent. Any finns into global small-scale logistics?

Didn't they ban all the chemicals that are easily washed off and hurt the natural environment?

Yes, at least that was the reason I was told it was very expensive. I'm not sure if it's a country wide ban or EU wide ban.

How do these new filter chemicals compare in terms of safety for coral reefs? When I went to Hawaii there were signs everywhere about only using mineral-based sunscreen (i.e. physical filters).

https://savethereef.org/about-reef-save-sunscreen.html

I am surprised about so much cancer and so little environment talk.

The reason I don't wear sunscreen and have spent hours looking at ingredients just to buy none is that I don't want to pollute our waters.

After tourist season there is a oily film swimming on our Alp lakes. People are literally walking hours enjoying the nature just to pollute the source of all that.

These lakes aren't that big. And their fresh water source is very limited in the summer months. No idea how the animals react tho, not sure if anyone specifically looked at good visited mountain lakes

I haven't really looked too much into this one in particular, but do you know how zinc oxide sunblock fares environmentally?

To follow this. Many natural hot springs that are open to the public have a straight up no sunscreen allowed rule. 3 hours into the high desert with no sunscreen and that is how it should be.

2 hour jet flight to destination, one hour drive into the desert in an off-road vehicle, followed by undoing the ecological damage by not wearing sunscreen!

Couldn't you just put it on and not swim? As a redhead I wear sunscreen just pulling weeds in my yard, or going on a walk with my dog.

Did you mean "not swim, bathe or shower?" The stuff goes somewhere.

So much for consumer choice and free markets. I wonder why there aren't more attempts at consolidating regulatory information across countries.

If some sunscreen or baby food is available in Europe I'd feel pretty comfortable using it, but I'm denied the opportunity to do so. It would be great if these kinds of items were made available for purchase with some sort of disclaimer. My guess is that in both the cases of sunscreen and baby food, regulations are in place in order to protect local national interests.

Something that I've always found a bit concerning is when there are major inconsistencies between global regulatory agencies. There's demographic differences to account for, but how is it possible to arrive at such drastically different conclusions? And if you arrive at drastically different conclusions, someone is probably going to be more correct while the other is going to be more wrong.

Sometimes the problem is more that the data is not really solid yet, so the risk/reward tradeoff is less obvious. Also the agencies may not be seeing the same data (in itself, a problem).

> but I'm denied the opportunity to do so.

regulatory capture is the phrase that comes to mind.

The fact that the regulatory agencies in different countries consistently come to different decisions is a good indicator that their decisions are not science based.

Because science is the same in different jurisdictions.

The common explanation is the great asymmetry in bad press if an agency kills 1000 people by approving something dangerous vs if it kills 1000 people by not approving something beneficial.

You're making a universalist assumption (all people are the same). But people are different in different countries, both genetically and culturally. They have different activities, diets, sun exposure, diseases, and so on, on average.

And all drugs have benefits and side effects.

So it's not out of the question that some drugs are more worthwhile for some populations than others, and regulators made different decisions for good reasons. It's going to depend on the specifics. So you can't make a generic argument as a shortcut to show that something must be wrong.

That said, there's more life than averages. I think it would be great to allow people to buy drugs that were approved in a different country.

While that's true in general, there are different ethnic groups in different countries, and it might be possible this may have some differences in some cases.

Even with things like Covid, different ethnic groups (i.e. Pasifika / Māori in NZ compared to European ethnic groups) were more susceptable to issues, due to a variety of reasons.

Science only provides information. It doesn’t tell you how to use it.

Say a product kills 1 in 100,000. Different cultures will assess the risk very differently, especially depending on circumstances.

Thalidomide is the counter example.

There are some counter examples, like Thalidomide, and in a field where regulators (used to) trust each other and just accept what other countries' regulators said, aviation, the 737 Max (which nobody tested properly because the FAA didn't do their job and let Boeing self-certify, meanwhile EASA and other air regulators accepted the FAA's stamp of approval, not knowing it wasn't worth anything).

Also, different regulators have different thresholds - for instance many things that pass in the US food-wise wouldn't in the EU - be it chlorinated chickens, "false"/misleading labels, etc., and vice versa in some hilarious cases like Kinder Surprise (banned in the US because non-edibles inside food aren't acceptable to the FDA, meanwhile in the EU people just... teach their kids that you open it to get the toy, and eat the rest).

You're also not allowed to have the best toothpaste in the world. Toothpaste with Novamin can't be sold in the US. Thankfully the internet makes it easy to get the good stuff anyhow.

For those that are curious, here's[1] a mildly deep dive into the history of Novamin sales in the US.

[1]: https://medium.com/@ravenstine/the-curious-history-of-novami...

Discussed here:

The curious history of NovaMin toothpaste (2018) - https://news.ycombinator.com/item?id=26644350 - March 2021 (37 comments)

This is no longer the case. I read the link jkubicek posted and it mentions you can get it on amazon.

Sensodyne repair & protect with novamin (pack of 6): https://www.amazon.com/Sensodyne-repair-protect-novamin-pack...

That's a store in India selling what they were able to purchase in India. Sensodyne doesn't sell it to retailers in the US.

BioMin is supposedly an equivalent substance that is approved in the US.

https://drcollins.com/products/biomin-restore-toothpaste

I believe novamin was approved but they can't sell it combined with fluoride. Since this product is fluoride-free it's allowed.

"NOTE: BioMin® F is not currently available for sale in the US. Although the Fluoride levels in BioMin® F are well below OTC levels in normal toothpaste, Flouride is classified as a drug in the US and has not yet been approved by the FDA."

Crazy...

In case someone goes down this rabbit hole, Nanohydroxyapatite and fluoride seem to prevent caries best together, better than either alone.

Japanese apagard is what I use. Novamin has an analog of hydroxyapatite in it.

In addition to choosing the toothpaste, it’s important to use the right brushing technique and schedule, which is critical since toothpaste does the bulk of the work after the physical process of brushing is done: don’t rinse with water (just spit instead) and arrange brushing so that you don’t eat or drink afterwards.

Where do you buy it from?

I check a few places but this amazon seller tends to always have it cheapest.

https://www.amazon.com/Apagard-Premio-toothpaste-nanohydroxy...

I just picked up some CariFree CTx4 Gel 1100. It has Nanohydroxyapatite, Fluoride, and Xylitol.

I'm actually quite annoyed that none of the half dozen dentists I've seen in the last 15 years have mentioned Nanohydroxyapatite as a compliment to fluoride.

Thanks for the recommendation, I had never heard of it. And I had the same experience in regards to the hydroxyapatite. No dentists told me, I just discovered it on pubmed and then went googling like crazy.

BioMin is every bit as good as Novamin. You are allowed to have comparable toothpaste in the US.

How well studied is Novamin safety wise?

Did some googling and found a study that doesn’t corroborate that.

“…concluding that there are no significant difference of remineralization process obtained by using traditional toothpaste and Novamin.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068624/

Well it worked wonders for me, when nothing else did. Data size of 1, but still a datapoint.

That's a single metareview paper which was started by an undergraduate. Maybe people find that valuable, but other studies on the topics that used actual experimentation present somewhat mixed reviews trending towards clinical relevance.

https://onlinelibrary.wiley.com/doi/full/10.1002/jbm.b.34737

There is a small not so black market of distributors for these, notably Biore UV which is easily accessible on Amazon - as well as ebay and other ecomm channels.

I fly frequently to Japan, and always stock up on Biore UV, and lately with the USD to JPY, it makes more sense too stock up more. :)

Lots of items from amazon.co.jp also have free shipping to USA, it's nice.

If you can't enter Japan, but still feel the need (it sounds silly, but maybe on layover) you can fly through Haneda which has all shops accessible for transfers. Narita can too depending which terminal you fly in, ANA yes, JAL no.

I'm always dubious purchasing things like this via Amazon. I'll buy tech gear there or miscellaneous accessories but for something that I'm ingesting or applying to my skin I'm reluctant, especially with it falling into a gray area. Am I being unreasonably paranoid?

I really don’t think you’re being paranoid at all. We’ve seen countless times that even well meaning sellers who are ethical get their products mixed with unethical sellers at the Amazon warehouses. I don’t buy anything I put on or in my body, or that sits close against my body, from Amazon. Aside from that no memory cards or things like power bricks that plug into my expensive laptops.

> Am I being unreasonably paranoid?

No. I treat anything I buy on Amazon as a counterfeit until I can prove that it is not. Sometimes it takes a few days of research per product, intensive physical inspection, and contacting the manufacturer to check lot/serial numbers.

I'd love to delegate this onerous task. Perhaps it's a viable startup idea?

Amazon at this point is AliExpress with a huge price Markup for like half of their products. If you wouldn't put on something straight from China you shouldn't be trusting Amazon.

There is no real control within Amazon

I'm 40 and it was common when I was a child, on family trips to the beach or similar style vacations. Every family in my neighborhood functioned approximately the same when it came to sunscreen. It was common with other children at school, and among teachers, and so on. There was nothing special at all about the area where I grew up, a white lower middle to middle class area. It was very common knowledge by the late 1980s to wear sunscreen while at the beach. That's an exceptionally low quality set-up by the article's author.

Agreed, by 86 we wore it anytime we'd be outside more than a half hour. I remember not all the parents at the public pool made their kids put it on, but a lot did.

Amazon blocks "bemotrizinol" from its search. Tsk tsk.

https://www.google.com/search?q=site%3Aamazon.com+%22bemotri...

ebay: when you want to buy something despite regulations against it. In california this is often necessary! Not only does it find lots of results, they will facilitate importing it from Australia for you.

apparently the keyword to look for is 'Tinosorb', that's what the european beauty products list bemotrizinol as (from my brief research)

Just search for “watery essence”.

Hack your own sunscreen: zinc powder, coconut oil, olive oil. I bought a lifetime supply of zinc for $10. It is edible and free of toxic endocrine disrupters. Goal is not to block everything since you need vitamin D.

Zinc powder? You mean zinc oxide I hope?

Yes of course.

Care to share your recipe?

The simplest recipe is what I mentioned, but some people use carrot seed oil or other more exotic oils that have natural SPF. I find mixing coconut and olive oil give it the ideal consistency with natural SPF all easily obtainable from any grocery store. The chelated zinc oxide powder is the only thing you probably need to mail order.

I'm going to try this, the prices on commercial zinc sunscreens are often exorbitant.

This is pretty popular with surfers in Central America. Zinc Oxide cream, like what you use for a baby's diaper rash, is WAY cheaper than sunscreen (Priced high for the tourists), and it's pretty much available at any pañalera (diaper store, if you can believe it, more like what you'd call a 'dollar store' up north with the other things they sell anyways - many small towns have one). It just makes you look like a ghost for the first hour or two and gets on any fabric clothing in a way that's hard to wash out.

The other thing that we do is just make sure we get to the beach at ridiculously early hours like 4-5am even before the sun comes up to go surfing so we don't burn ourselves to shit as well as to avoid tourists.

Surfing in the dark at 4am? Is this safe?

In Hawaii I know there are a lot of sea urchins and sharp lava, so visibility is a good thing for safety.

Alot closer to the equator it's different for sure. The sun is fully up at about 6 tops every morning with more consistency and less variation.

> Zinc Oxide cream

I've wondered about creating my own sunscreen that way, but the internet discouraged me. From what I've read, Zinc Oxide for babies isn't a nanoparticle, it doesn't block the sun efficiently. I haven't had the chance to research it further.

I'm probably not as white as you, and we're all acclimatized to the sun out here enough to know when to avoid it and when to enjoy it - Hard to speak for your skin profile or nanoparticles or whatever but all I know is that what you're talking about is a huge factor in messing the reefs up around here.

A huge factor is timing. We call white people who get burned going out at peak sun hours 'camarones' - shrimp, because they go from white to red. Funny. Doesn't matter what your skin is, though, when the sun is literally right above you at noon, get under shade or inside and eat your lunch.

I'm surprised that's what you got from the internet. My internet first and formost warns about nanoparticles in sunscreen.

Yes it stays atop the skin and reflects rather than absorbing into your skin and bloodstream. It is best for the beach in your non-fancy bikini. Removing it from the skin is done by wiping with a towel rather than soap and water.

> coconut oil, olive oil

That's what I would use if I was going to fry myself in the sun, just from the sound of it. Is it safe to use?

The skin is a semi permeable membrane. So I don't put anything on it I am not prepared to eat. I have been using this mix for well over a decade, and ancient civilizations used it for millennia.

I'm sorry, I didn't mean whether it's safe toxicologically, but rather as "does oil increase the likelihood of burns"?

These oils actually have natural but low SPF. The ancient Greeks and Egyptians simply used olive oil. The zinc oxide adds much more SPF by reflecting.

In the article it briefly mentions L’Oreal. They have a patent on another set of filters mexoryl and mexoryl xl, both are great and allowed by the FDA. You can buy it with their La Roche Posay brand.

I'd avoid everything L'Oreal like the plague.

Why?

too many ingredients in general and specifically of questionable tolerability.

Thalidomide still casts a huge shadow across the FDA: https://www.smithsonianmag.com/science-nature/woman-who-stoo...

It is the founding myth. As such it is institutionally very conservative about approving stuff.

Now the question does become: what is the opportunity cost of that stance. How many people have died or had bad outcomes because medicine deemed safe in Europe was not approved by the FDA.

> It is the founding myth

It’s not a myth and not involved in the FDA’s founding, so that statement makes no sense.

> myth, n. a traditional story, especially one concerning the early history of a people

The word “myth” does not necessarily mean “untrue”.

No, it just means compound words sometimes mean something different than the sum of their parts. In particular a "founding myth" is neither a myth nor necessarily involved in the founding.

Substitute "an important event in the history of" if you are confused.

I used to wear sunscreen daily. Now I just wear a hat with a brim.

Sunscreen is a scam. Sun is good for you unless you aren't able to tan.

"Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by 0.6-2.1 years. "

https://pubmed.ncbi.nlm.nih.gov/26992108/

Vitamin D deficiency is far riskier for sedatory indoor people then skin cancer is. I wouldn’t be surprised if we look back at this time and laugh at how we were blocking too many UV rays.

It’s amazing how rejuvenated one feels after just a few minutes in the sun. Like 10 minutes. The sun is not going to kill you from a few minutes exposure to it.

One of those seems far more dangerous. And not treatable with I single pill.

treating the symptom of vitamin d deficiency by taking a hormone orally isn't dealing with the root of the problem.

I suppose the FDA's opinion here doesn't matter anymore? Wild, layman postulation here, but I don't see any meaningful difference between the FDA and the EPA, if the EPA was executive overreach than I suppose the FDA is too and companies should feel relatively comfortable about using any chemical that they wish.

I'd be curious to hear the inside of both meeting rooms, inside the FDA and inside chemical producers. Very curious what those meetings are like after last week.

What are they, and where can I buy them in the US?

Doesn't seem to be available on Amazon in the US or Canada. I'm also curious.

I just ordered this to try it out:

https://a.co/d/1VD95bP

I still feel that the best sunscreen is to just be in the shade with cold beer while sun is at it's harshest.

Isn't vitamin D going to get mentioned? Has sunscreen growth coincided with plummeting levels of vitamin D?

How often do people go to the dermatologist to have their moles checked?

Considering most are booked 12-18 months out, if they are even accepting new patients, probably not a lot.

Considering most are booked 12-18 months out

I'm pretty annoyed about how far out I have to book doctors these days, but forgive me if I doubt the 12-18 months number. I recently booked a dermatologist checkup and it was four weeks. Maybe if you are only willing to take one specific Doctor. What city are you in?

Happened to me in canada they ended up cancelling the appointment so the wait time was reset

> most are booked 12-18 months out

Err, I hate to sound trite, but citation please? I live in the Bay Area of California, and my wife gets her dermatologist appointments in an annoying but reasonable timeframe - nothing like 12-18 months. Not even 12-18 weeks.

I was able to get into a dermatologist in just a few days, I'm in the US.

I didn’t book, but was told yesterday I could have an appointment beginning of August to have moles inspected.

This - same situation in Germany. And they are not booked out b/c they treat so many people with maladies. It's just that most dermatologist are glorified beauticians who can cut and inject. So, they prefer to make rich people more attractive. Usually with a focus on women. Proof: Check out dermatologist websites. They usually advertise themselves on them like the primary product with pictures you'd expect on Tinder but not on a physician's website.

Usually a GP can do a scan for you and spot suspicious looking moles during your annual checkup.

I go every year.

> Dobos emphasized to me that she thinks the FDA’s strict regulation of sunscreen products is generally beneficial to the American public, but that the agency’s slow progress on new ingredients doesn’t match the urgency of skin cancer’s threat to public health.

This line is where this got interesting to me, as it's not hard to find examples of the US being lax with product/chemical safety compared to Europe in other areas, so I was skeptical of a case to be more rash in this area. So pairing it with the issue of skin cancer makes it more compelling. But they still gloss over chemical absorption in this article, which is a factor that seems like it could use more investigation per https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759112/ (tldr: sunscreen -> less skin cancers seems well supported, but effect of chemicals in body is not understood).

TL;DR: The FDA hasn't yet approved some ingredients used in other countries.

Damn. If we can't get that two million sunblock, we're all gonna have a real bad day.

Anecdote: As a pale-skinned male, I used to lather myself in sunscreen. Then I cut out seed oils. I no longer burn. Totally stopped using sunscreen.

Why did you cut seed oils in the first place?

Reply on news.ycombinator.com