Young Doctor Becomes Crusader To Keep Teens Out Of Tanning Beds

Originally published on June 5, 2014 4:12 pm

The FDA has just put in a place some new guidelines for indoor tanning beds and booths, but the state of Missouri is going even further.

A bill signed into law today by Missouri Governor Jay Nixon requires anyone under 17 to get parental consent before using a tanning bed or booth.

The person behind the law is Dr. Brundha Balaraman, a dermatology resident at Washington University School of Medicine in St. Louis. She pushed for seven years to get the bill approved by state lawmakers.

“We have a social responsibility to educate people and protect children,” Balaraman told Here & Now’s Jeremy Hobson. “I truly hope and want to push the FDA to seriously consider banning the tan and I hope it doesn’t take another 20 years.”


  • Dr. Brundha Balaraman, dermatology resident at the Washington University School of Medicine.
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The governor of Missouri is expected to sign a bill today that would require anyone under 17 to get parental consent before using a tanning bed. Now that might sound like just another headline to you, but to Dr. Brundha Balaraman, it's the end of a seven-year journey. She's a dermatology resident at Washington University School of Medicine in St. Louis. And she's with us now. Brundha, welcome.

BRUNDHA BALARAMAN: Thank you. Thanks for having.

HOBSON: Well, take us back to the beginning of this fight. You were 23 years old in medical school at the time that you got interested in these tanning booths and the risk of skin cancer. How did that happen?

BALARAMAN: So I was a medical student at Washington University in St. Louis and I was involved in an organization called SPOTS, or Sun Protection Outreach Teaching by Students. We went to schools in the community to teach children and teenagers about skin cancer and sun protective measures. And after our presentations, you know, the classroom could approach us and ask questions or give us feedback. And during this time, I met a teen girl who was battling melanoma that arose on her leg. She frequently used tanning beds, but was never, ever warned about the risks of skin cancer from these devices. And she went on to tell me that she would have never used a tanning bed if she knew she could get melanoma.

HOBSON: So, what did you was the problem at that point? What was it that you could do about it?

BALARAMAN: Well, I think there was a lot of miseducation happening in the state of Missouri. Consumers including, you know, teenagers, were not adequately informed about the risks of skin cancer. And her story, you know, made me sad because this otherwise healthy young girl was now forever stuck with this diagnosis of melanoma and its consequences, the least of which are doctor visits every six months for surveillance and the constant fear of the cancer coming back. And this could have been prevented if there was a ban for children under 18, or if she had accurately informed about the risks of skin cancer prior to using tanning beds, or if there were requirements for parental consent.

And informed consent can also be very challenging. I felt like I had to go to medical school to truly understand what it means to have melanoma and the weight of that diagnosis. I can't imagine that children or teenagers or even adults unfamiliar with medical language would be capable of understanding the magnitude of the health risks associated with indoor tanning and melanoma. Melanoma is one of the most aggressive cancers. It truly becomes a lifetime diagnoses and for some a death sentence. And it's heartbreaking to give this diagnosis to young people and even worse see them die from it.

HOBSON: Well, tell us what you decided to do because you and some colleagues decided to do a study about this and actually posed as customers at tanning salons.

BALARAMAN: Right. Upon hearing this girl's story, I was shocked and honestly disgusted to learn that tanning facilities were not disclosing health risks to people. So we conducted a phone survey of tanning facilities throughout the state of Missouri to determine whether they followed FDA guidelines and provided consumers with accurate information. So another medical student and I pretended to be teenagers wanting to tan. We called each facility twice. We had a standard script with a few variations where we asked a series of open-ended questions, such as - hi, I'm going on vacation in a few weeks. I'd like to get a tan. How old do I have to be to tan? Or, my 10-year-old sister really wants to tan too, can she come with me?

HOBSON: And what did they say?

BALARAMAN: And, you know, the results were appalling, quite honestly. We found that tanning bed consumers were not informed or misinformed about the health risks. Two-thirds, or about 65 percent of tanning facilities claimed they would allow a child as young as 10 years old to tan often without parental consent. Eighty percent claimed that indoor tanning would prevent future sunburns, which is just not true. Forty-three percent claimed that there was no risk associated with indoor tanning, which is also not true. And 56 ultimately said it would be OK to tan without eye protection despite FDA guidelines.

HOBSON: And was it your sense that these people were being disingenuous or that they simply didn't know better?

BALARAMAN: I think it was perhaps a combination of both. I think the employees that work at tanning facilities aren't always adequately trained in the operation and the risks associated with tanning beds. And the bottom line also is that, you know, they're trying to sell a product.

HOBSON: So after all of these years, you were finally able to get some legislation passed. It's now sitting on the governor's desk in Missouri. What does your bill do?

BALARAMAN: Our bill aims to educate the public about, you know, risk of skin cancer, particularly melanoma. And it ensures that before children get into a tanning bed, that, you know, parents are involved. They have to be present at a tanning facility and provide consent before their child can use a tanning bed.

HOBSON: And do you think that goes far enough?

BALARAMAN: So, you know, passing legislation is a challenging process, and it took seven years to accomplish, and we faced a lot of hurdles. I thought it would have been an easy win to save lives and educate the public, but this simplistic view was quickly corrected. You know, first of all, the odds were against us. Only about five to seven percent of all introduced bills make it to the governor each year in Missouri. One of the biggest challenges we faced was educating our lawmakers about the public issue at hand. Similar to tanning bed consumers, lawmakers, unless personally affected, were not always informed about the risks with tanning beds. And during my many visits to the state capitol, legislative aides and secretaries would tell me that they themselves used tanning beds without knowing the risks.

HOBSON: Well, do you think that it would have been possible to get them banned altogether for people under 18?

BALARAMAN: You know, after seven years of negotiations, the original bill, which I drafted seven years ago, called for a ban for individuals under 18 and enforcement of FDA guidelines. It's now been diluted to parental consent for individuals under 17. The current bill is a compromise. It's a huge compromise. But it's still a good first step. It's far from what is needed. Tanning is very prevalent in the Midwest and often parents engage in it and are likely equally misinformed about the health risks.

HOBSON: What do you think about some of the restrictions that are in the Affordable Care Act? For example, there is an increased tax on tanning salons.

BALARAMAN: I mean, I think it's a deterrent for some but I still think, you know, studies have shown that it doesn't keep kids and people out of tanning beds. Without, you know, without a federal law, every individual state is charged with the responsibility to establish state laws for minimum age requirements and to enforce FDA guidelines. And, you know, in regards to this public health issue, the legislative process thus far has been reactive and not proactive. And honestly, it just takes too long at the state level to quickly address this rising public health issue.

HOBSON: What about the FDA's new guidelines, Brundha? The agency just said that it would require manufacturers to put a warning on the devices, tanning beds that say they shouldn't be used by anyone under the age of 18. Even if they're not actually banned from using it, at least there would be a warning.

BALARAMAN: So last week, after two decades of discussion, the U.S. Food and Drug Administration reclassified tanning beds as class-two devices. Prior to this, tanning beds were considered class-one devices with minimal manufacturer oversight - same as Band-Aids and tongue depressors. This again is a good first step, but in my mind, it doesn't keep kids out of tanning beds. For example, a teenager who pays for tanning services and is about to get into a tanning booth is still going to tan, despite the black box that she sees on the device after the fact, assuming she understands it in the first place.

HOBSON: What's your next battle?

BALARAMAN: Well, I mean, cancer happens every day. People die from cancer every day. But fortunately for us, most skin cancers including melanoma are preventable. And, you know, we have a social responsibility to educate people and protect children. And I truly hope and, you know, want to push the FDA to seriously consider banning the tan. And I hope it doesn't take another 20 years.

HOBSON: Brundha Balaraman is a dermatology resident at the Washington University School of Medicine in St. Louis. She is the woman behind a bill that is sitting on Governor Jay Nixon's desk. You can read more about it at It would require that all people under 17 that want to go to a tanning bed get authorization from their parents. Brundha, thanks so much for joining us.

BALARAMAN: Thank you for having me.

HOBSON: And again, the word from the governor's office today is that he will sign that bill today. We'll keep following the story. HERE AND NOW is a production of NPR and WBUR Boston in association with the BBC World Service. I'm Jeremy Hobson.


I'm Robin Young. This is HERE AND NOW. Transcript provided by NPR, Copyright NPR.