Ladies and gentlemen, at this time, we’ll bring this meeting of the House Health and Human Services Committee to order. I want to begin by welcoming our pages that are with us today. We have Christina Stone from Wake County sponsored by Representative Dollar. If you would stand and let them know who you are. We also have Jake Thomason from Davidson County sponsored by Representative Rayne Brown. Good to have you all with us today and I hope that your week is a very good one here at the General Assembly. Our House Sergeant at Arms today are Fred Heinz, Barry Moore, John Brandon, and Reggie Sills. Now, Ladies and gentlemen, our meeting today will adjourn by 10:50. There’s another meeting in this room so we’re going to move right along and we’re going to begin with House Bill 29. Representative Horn. [SPEAKER CHANGES] Thank you, Mr. Chairman. Good morning, ladies and gentlemen. Is it cool or what that I get to present a bill that was in the Governor’s speech last night. This hopefully will go very quickly. House Bill 29 creates a new offense for possession of pseudoephedrine by someone that’s been previously convicted of a meth related charge. As you all know, pseudoephedrine is the only ingredient that you have to have in order to make methamphetamine, so if someone that’s been making meth has pseudophedrine on them, there’s a pretty good reason to believe that they have no good purpose. Second part of the bill is to extend the incarceration for meth cookers that do it in the presence of children or the aged or infirmed. With that I ask for your support of the bill. [SPEAKER CHANGES] Questions from members of the committee? Representative Blackwell. [SPEAKER CHANGES] I don’t know if this is for you, Representative Horn, or for staff. It’s sort of a picky question in a way. In the portion of the bill that deals with the presence on the property or where the meth is being manufactured of a minor or a disabled or elder adult, what difference, if any, does it make if the minor, the disabled, or elder adult is the person charged with the crime itself or is somehow engaged in the manufacturing process themselves as opposed to being sort of like an innocent resident or person that’s present. Do we make any distinction for that situation? [SPEAKER CHANGES] Representative Stevens. [SPEAKER CHANGES] I think the intent is if they’re the person making the meth, they’re going to be sentenced. But we’re talking if there are innocent persons there while the meth is being made. The fume are, of course, the most toxic part of the meth anyway. It’s to aggravate the punishment for exposing those infirmed, elderly or children who have no option to get out. That’s the purpose of the aggravation. [SPEAKER CHANGES] Other questions for the committee, Representative Earle? [SPEAKER CHANGES] What is the pseudoephedrine product? [SPEAKER CHANGES] Sudafed. [SPEAKER CHANGES] So that means that you can not have Sudafed, else you would be charged with something? [SPEAKER CHANGES] If the chair might respond. I know that some of the products that you’re probably familiar with that would be considered, and I believe would be, and you can help me with this if you like. Sudafed, Claritin, Zyrtec, Benadryl, Actifed. Those are… Representative Horn. [SPEAKER CHANGES] I’m sorry, Mr. Chairman. There are 15 branded medications that contain sudafed that are available behind the counter. [SPEAKER CHANGES] Representative. [SPEAKER CHANGES] So you’re saying that you cannot have one of these products if you have been, I’m just reading the summary here, if you have been convicted of possession, you cannot have one of these products for a cold or for anything else you would, what would happen? [SPEAKER CHANGES] Representative Stevens. [SPEAKER CHANGES] That’s correct, and it would be a specific separate felony. However, we have been assured
as we study this throughout the interim session, that there are various other medications that do not contain sudafed that would be able to be used for colds and allergies. Pediatricians especially said that. [SPEAKER CHANGES] Questions from the chair, I’ll say while Representative Stevens, you’re an attorney and some of these folks are probably not. You might want to explain a little bit about a class H felony. I’ve a little bit of research. I think that might include things such as maybe arson, bomb threat, breaking and entering, embezzlement. Those are things that would be considered class H felonies I do believe. Representative Stevens. [SPEAKER CHANGES] ...and they were okay with it. The citizen commission found this to be appropriate. [SPEAKER CHANGES] But this...excuse me. [SPEAKER CHANGES] Representative Earle. [SPEAKER CHANGES] Can I ask you why the legislation? It just seems to me if for whatever reason that you had this for a cold or whatever, or whatever reason other than doing drugs, then it seems to be kind of harsh to have somebody to be a felon because they happen to have some medication that would be kind of for innocent reason. [SPEAKER CHANGES] Representative Faircloth. [SPEAKER CHANGES] This is an attempt to get at the manufacturers of methamphetamine who are continuing to do this. If we don’t cut off their supply of the one ingredient they have to have to make this drug, then it’s very difficult to slow them down, and this simply doesn’t affect anybody except those who are in the business of manufacturing methamphetamine. [SPEAKER CHANGES] Further questions. Representative Horn. [SPEAKER CHANGES] I’d like to also add that this bill has the support of the Attorney General, the FBI and the North Carolina Sheriff’s Association. It’s been pretty well vetted across the board and I’d go back to point out as I said in the beginning, the only one ingredient you have to have to make methamphetamine, you have to have pseudoephedrine, everything else, for the most part, everything else can be substituted out. It’s fairly clear to law enforcement and to many that if you’re...let me add one more thing. Methamphetamine is the singular most addictive drug presently known. It’s a one and done. If you try it, you’re hooked. It’s fairly clear to many that if you’ve been making meth, and you have pseudophedrine on you, the odds are pretty good it’s not there because you’ve got a headache. Now, is there a guarantee? Of course not, but my guess as anecdotally is that’s the price you pay. [SPEAKER CHANGES] Any question, Representative Hurley? [SPEAKER CHANGES] I just have a comment. A few years ago, the bill was done that when we go to buy that, we have to sign, we have to show our driver’s license and everything. This would not include someone who was using this and it was on record that we had bought it legitimately. [SPEAKER CHANGES] Is that a question or comment? [SPEAKER CHANGES] Just a comment. [SPEAKER CHANGES] Representative Earle. [SPEAKER CHANGES] Another question. My question, I guess, is based on what you just said about having to sign for it, so this is having it and you didn’t sign for it? Is this what this is doing? Or is this if you even go and sign for it, it’s stil...and I’m not encouraging drug use or any of this, I’m just trying to look at the thing of innocent people that may end up having it that went and signed for it. If it’s that addictive, then why don’t we ban the whole drug from being… [SPEAKER CHANGES] We tried that. [SPEAKER CHANGES] Representative Horn. [SPEAKER CHANGES] I appreciate that question much more than you may realize. As they say in some parts of the world, one step at a time, but in this particular case, we are dealing with those people that have a track record of making methamphetamine. We’re zeroing in on those that have been convicted of making methamphetamine and we’re saying to them that you are no longer allowed to possess the one ingredient that we know you have to have to make methamphetamine. In addition,
If you make Methamphetamine in the presence of those that have no choice; children the elderly and the disabled, your sentence will be aggravated. That's the two parts to this bill. [SPEAKER CHANGES] Representative Murray [SPEAKER CHANGES] I have a question for the bill sponsor. Are the individuals who are convicted of these Methamphetamine offenses in the implex[??]system to prevent them from purchasing at the retail level? [SPEAKER CHANGES] To my knowledge that was not part of the implex system that has been implemented. I've asked that question of the implex operators to whether that can be added...I don't...I hate to tell you I don't remember the answer, I don't remember I got an answer. [SPEAKER CHANGES] If I could continue Mr. Chairman, the reason I ask that because the implex system is set up to prevent over-purchasing of pseudo-ephedrine beyond what would be needed for an individuals use. [SPEAKER CHANGES] Correct. [SPEAKER CHANGES] The reason why I ask the question that way is because this is a situation and what this bill targets in my opinion is when someone else goes to purchase pseudo-ephedrine properly and it's a legal transaction, and then takes that pseudo-ephedrine and gives it to someone who is intending to make Chrystal-meth amphetamine out of it. So that's what this bill seeks to target is someone who gets the active ingredient to make Chrystal-meth from another person who purchased it legally. That is the way I see this legislation and it is an un-addressed area in the current penalties for Chrystal-meth. [SPEAKER CHANGES] Representative Horn. [SPEAKER CHANGES] Absolutely correct, Representative Murry. The term 'Smurfers" is very popular these days. And that's someone that buys their legal limit of pseudo-ephedrine containing medication and sells it...either gives it or sells it to someone who should not be having it, and they'll make Meth-amphetamine out of it. So this bill is to those people that are caught making meth-amphetamine or have made Meth-amphetamine; they've got pseudo-ephedrine regardless of how they got it. Shame on you, we're gonna get'cha. [SPEAKER CHANGES] Representative Stevens. [SPEAKER CHANGES] As I said earlier there was a interim study committee that looked at Meth, and it started with exactly what you are talking about; trying to make the purchase of Meth illegal or make it a prescription drug and there were lots of impediments to that. As a result the committee...this was one of the recommendations that committee looked at and recommended. Specifically the committee recommends the General Assembly enact legislation that creates a criminal offence for the purchase of pseudo-ephedrine by a person who had a prior conviction and requires the attempted purchase of pseudo-ephedrine to be blocked on the National precursor log. The person whose been convicted of Meth. So again there are alternative medications they can get, this is otherwise a lawful medication. But for those people who have gone to the trouble to make Meth, this is the one ingredient that stops them from making it. [SPEAKER CHANGES]Representative Dollar is recognized. [SPEAKER CHANGES] Thank you Mr. Chairman. It does seem to me...you know section one applies to a very very narrow group of individuals. I'm not quite sure how that would be enforced but you know the bulk of the bill is really seems to me strengthening the penalties on a policy that has already been well established in the General Assembly. And it looks like a lot of the language, particularly on page two, is more in the realm of what the judiciary committee needs to look at. And with that Mr. Chairman I would make a motion for a favorable report for house bill twenty-nine with a referral to the judiciary sub-committee C. [SPEAKER CHANGES] Thank you Representative Dollar, if you would hold that message just for a second, I've got one question. Representative Insko. [SPEAKER CHANGES] Oh thank you Mr. Chairman. I actually have a series of questions. We've got pretty far down into the weeds with that last...so I think this is a question for staff. Partly to help educate me. Could you tell me what drugs...what is the implex system and what drugs to people currently have to sign for? What drugs to people currently have to sign for and what drugs have we mentioned that are....
Based that people don't have to sign for. [SPEAKER CHANGES] Is directed that to staff? [SPEAKER CHANGES] If Representative Horn wanted to answer that, that was something that was discussed. There was a special agent from the SBI who came and gave several presentations. I did not staff the methamphetamine select committee, but I know there was a special agent from the SBI who gave several presentations or at two presentations on the IMPEX systems. It has to do with, with the registration of pharmaceutical drugs and prescriptions and Representative Horn's indicated he can answer that. [SPEAKER CHANGES] Representative Horn? [SPEAKER CHANGES] The IMPEX system's a national precursor log exchange. It's a industry funded program that, that is on, that is contemporaneously, I don't know if the word contemporaneously is right, but it's online, instantly before a pharmacist can dispense certain medications, they are required to check the IMPEX system. The law establishes a limit as to how much an individual may purchase of these medications, in this case pseudoephedrine containing medications. I indicated earlier that there were fifteen of them. There's a limit on what one is able to purchase. Should you request or attempt to purchase beyond that limit, the IMPEX system says, refuses the sale and the pharmacist is not allowed to consummate the sale. You don't get the stuff. [SPEAKER CHANGES] Representative Insko? [SPEAKER CHANGES] This doesn't have anything to do with the control substance reporting system? [SPEAKER CHANGES] No, ma'am. [SPEAKER CHANGES] So there, if I understand it correctly, all of the drugs that contain pseudoephed, you don't have to sign for everything, all of those. There's only, there are only. [SPEAKER CHANGES] Well there are fifteen medications involved in, in restricted sale. The liquid and or, no the gel cap and, the gel cap and liquid pseudoephedrine containing medications are not restricted. [SPEAKER CHANGES] Representative Dollar, I think it's time for your motion, and this has already been to judiciary C, so I believe we're moving to the floor. [SPEAKER CHANGES] We'll revise the motion for a favorable report for House bill 29. [SPEAKER CHANGES] And the motion has been made by Representative Dollar for a favorable report for House bill 29. All members in favor say aye. All opposed no. The ayes have it. Thank you gentlemen. Thank you, Representative Stevens. House bill 18, we have a proposed committee substitute and would entertain a motion that we take up the PCS for HB 18. Moved by Representative Murry, seconded by Representative Cotham. Representative Holloway. [SPEAKER CHANGES] Thank you mister chairman. Good morning. House bill 18 titled Youth Skincare Prevention Act. It's a bill that came out of the child fatality task force. It simply moves to change the law that no one less than fourteen years of age can use a tanning bed to no one less than eighteen years of age. It's a public health bill. It's a public safety bill. Altered by the light of a tanning bed may be fifteen times stronger than natural sunlight. UV radiation is one of the primary causes in development of skin cancers, including melanoma, a particularly aggressive skin cancer. Incidents of skin cancer is increasing. Radiation is cumulative over your lifetime. The earlier the exposure, the higher the risk of developing skin cancer. Mister Chairman, I'd like to have Dr. Kelly Nelson come forward for a presentation. [SPEAKER CHANGES] Dr. Nelson? If you would please, for the record, if you would state your name and who you are. [SPEAKER CHANGES] Good morning everyone. I'm Dr. Kelly Nelson. I'm the director of the melanoma clinic at Duke University. [SPEAKER CHANGES] You do have a powerpoint? Okay. Committee will be at ease. All right, you may proceed. [SPEAKER CHANGES] All right. Let me just try out my maneuverability here. I really appreciate the opportunity to speak to you all today. My entire practice at Duke focuses on patients who have personally had melanoma, or if you are at very high risk for
developing melanoma. And unfortunately, an entirely too large portion of my practice involves the care of you people, and specifically the care of young people who have used tanning beds. I'm very, very grateful to have the opportunity to share my thoughts with you this morning about this very important bill. I want to make clear that there is no debate in the scientific community that UV exposure is related to skin cancer, but I want to make sure we're on the same page. The vast majority of skin cancer are basal cell skin cancer and squamous cell skin cancer, that you can see pictures up here from 2 of my patients. Most of the time, these are fairly easily managed, but particularly in places on the body that don't have a whole lot of extra geography, they can be challenging. I want to give you a fair warning, the next slides may be a little difficult to look at, but these are surgical defects from 2 young people who used tanning beds in their teen. These are the holes in their faces left after a specialized skin cancer surgeon cut out the skin cancer. You can imagine that even in the most skilled surgical hands, the repair of these holes is going to leave a permanent scar on their face. But, most likely, these patients are not going to pass a way from their skin cancer. Melanoma is an entirely different story. these are all pictures from my patients who had advanced melanoma. The delay in diagnosis was for various reason, but these are all very significant threats to their lives. The gentleman in the middle passed away about 4 months after I saw him as a new patient, the other 2 patients are still under my longitudinal care. And so this is really why I feel so strongly about support of this bill, because this patient died from melanoma. and not only do patients die from melanoma, but patients who are entirely too you to die, die from melanoma. But, what we're talking about here today, is the difference between tanning bends and sun exposure for young people. Obviously we can't put a bill forth that would prohibit all children from protecting themselves from the sun, but we can try to protect them from using tanning beds at too young of an age. And so I wanted to give you some context at how tanning beds are different from regular sun exposure. The radiation produced from the sun incorporates a broad spectrum of radiation, or energy. And the spectrum range from X-rays, which are at the far left hand of the scale, which you see on the screen, to visible light, which is at the far right hand of the scale. What we're really here to talk about today is ultraviolet radiation, which is what is at hand when we're talking about tanning bed exposure. And there is very significant differences between the UV radiation that your skin sees in the tanning bed, compared to what happens when you're laying out on Myrtle Beach. Specifically, natural sunlight is predominately UV-B. UV-B radiation enables your skin to produce vitamin D, It also generates the sunburn response, that many of us are all too familiar with for not used to being out in the sun. UV-A exposure, on the other hand, is what you predominately get when you get you're in a tanning bed. And as we heard earlier, tanning beds give you about 15 times more UV-A you'd get from sunlight. UV-A is more tightly linked to the development of skin cancer. So just to be sure we're clear, natural sunlight is UV-B, tanning beds is UV-A. Natural sunlight helps you skin produce vitamin D, it also produces a protective sunburn response, UV-A does not. So those are the differences in terms of what we're talking about. But most importantly, not many of us would choose to take off our clothes and lay outside on a fine February morning like today. However, it would not take you too far to find a tanning bed to get that same amount of exposure. So children have access to tanning beds throughout the entire year. What does this mean for your skin? I'm going to go through this a little bit quickly, but do you see the blue cell there in the enlarged box? That's a mole
…melanocyte, and what the melanocytes when your skins exposed to the sun, it produces little packets of pigmentation called melanin and your melanocytes are intimately linked to about 15 or 20 keratinocytes and when your sun, when your skin is exposed to the sun your cells say I’m getting exposure to something I don’t like and I need to protect myself. And so, when your melanocytes make those packets of pigment, your keratinocytes which make up the predominant part of your skin they take that melanin and they put it on top of their little heads to protect their nuclei which is where all your genetic information is stored. That’s what a tan is. That’s why we say there is no safe tan, because your skin is responding to radiation damage and trying desperately to protect itself. This is what happens to your skin over time. Over time your skin texture changes, you can see that the texture becomes more rough, the pigmentation becomes more irregular and it gets wrinkly. This is a gentleman who was a truck driver for many years and the light, the glass of the driver’s side window blocked the UVB rays but it didn’t block the UVA rays so you can see that one half of his face is profoundly photo aged while the other has been relatively protected. So, there’s a great twin study, identical twins, the twin on the right tanned regularly, the twin on the left protected her skin from the sun, so you can see the difference. We’re really not here to talk about cosmetic implications; we’re here more to talk about saving lives. When you look at the SEER registry which is a National Melanoma Cancer Registry, you can see that the rate of melanoma diagnoses is going up for young women. The graph on the left, young women are the open circles, whereas young men are the closed circles and you can see that the rates have gone up dramatically from 2000. That corresponds to the same shift in terms of utilization of tanning devices, the figure on the right with the red line. What you see is that over time the use of these high speed intensity and high pressure tanning bed devices has increased over the same time scale. This is what it means for our patients when they’re diagnosed with melanoma. We need to take out a safety margin of about an inch of skin down to the underlying tissue and the 17 year old girl who used tanning beds that was down to the bone here on her temple. I reached out to several of my patients who had used tanning beds at a young age and asked their permission to share their stories with you today and they were all incredibly passionate about being able to share their experiences. These are images from Gretchen; she’s a woman in her early 40s who began using tanning beds as soon as she could drive when she was 16. On the upper left you can see two well healed scars, and here. These are both from previous melanomas that were diagnosed before I started taking care of her. Although these look subtle, these were both invasive melanomas on her that if left unchecked could have caused threat to her life. Each of these required surgery in my office on the day they were diagnosed and then an additional safety margin surgery just like you saw on that young women’s scalp that left her with two additional scars that were about 5 inches in length. This is Abby, she began using tanning beds in high school before prom and continued using tanning beds in college and before her wedding. The large scar there on her left is from her first invasive melanoma which she also needs surgery on her lymph nodes. The first day that I saw her I diagnosed an additional invasive melanoma there on her right upper back. Thankfully she’s doing well but she was very, very excited for me to be able to share her story with you. And this is, these are pictures from Melissa. These are all melanomas. She started using tanning beds when she was 15 and she went basically every day during the winter and summer months from the time she was 15 and these are all melanomas and I still take care of her. She said every time I diagnose a new melanoma on her, her mother cries because her mother drove her to the tanning bed when she was young before she got her license. To wrap it up, tanning beds are different than sunlight. It means different things when young skin is exposed to tanning bed radiation. They offer no health benefit, especially to young people. We have many other tools at our disposal to care for patients who have medical conditions that may need UV exposure. Tanning beds do not typically fall
Top of our list for the care of young people, which is who we're talking about today. Tanning beds have been linked to melanoma. Melanoma can be deadly, particularly if it's not diagnosed early. Young people really need protection, and that's what this bill is about. So we hope that you'll help them by approving HB18. Thank you.[SPEAKER CHANGES]Thank you, Dr. Nelson. Representative Hollo.[SPEAKER CHANGES]Thank you, Dr. Nelson. I'd also like to call Anne Bowman to also speak.[SPEAKER CHANGES]Anne Bowman, representing Aim at Melanoma, I believe. If you would, identify yourself for the record, and you may proceed.[SPEAKER CHANGES]Hi, my name is Anne Bowman. I'm a 34-year old melanoma survivor, and I'm also the Charlotte chapter president of Aim at Melanoma. I first used a tanning bed when I was 16 years old. I went occasionally before spring break to get a base tan or i went before a prom or a sorority formal because I thought I would look prettier with a healthy glow. In December 2010 my dermatologist removed a mole and three days later I found out that it was melanoma, that I had cancer. I was 32 years old. My children were 2 1/2 and 9 months old. I saw an oncologist who performed a wide local excision to remove the melanoma. And I have a picture of my surgery scar. My mole was the size of a pencil eraser, and it was only .86 millimeters in depth. So it was considered very small in terms of melanoma. And you can see I've got one more picture. I've got a 6-inch incision scar on my lower back. I also had to have lymph nodes removed from my groin to see if the cancer had spread. I was very fortunate. The cancer had not spread and I'm Stage 1B. But I will live with melanoma every day for the rest of my life. I will never be considered cured of melanoma, and the worry that it will spread will never leave. In the past two years, I've had an EKG, a chest X-ray, lung function tests, a mammogram, an ultrasound, two MRIs of my spine, an MRI of my liver, and a colonoscopy, all to rule out the spread of melanoma. Those procedures were not only incredibly expensive, they were incredibly worrisome as I awaited test results. But even with all of that, I know that I'm incredibly fortunate to be Stage 1B. A lot of the people that I've met through my work with Aim at Melanoma are facing Stage 3 and Stage 4 melanoma. And I watch the devastation that this disease causes every day. In this past week, two women that I was connected with both lost their battle with melanoma. They were both in their early 30s. They both leave behind small families. And they both had a tanning bed history. I can't go back to my 16 year old self and tell her to stay out of the tanning bed. But I can and I will be an advocate for our youth and their health. I have no doubt that this bill will save lives. And I'd love to answer any questions, if you have any, about my experience as a melanoma patient or in the melanoma community.[SPEAKER CHANGES]If you'll hold your questions at this time. Chair has been advised that there might be a couple of public speakers that would like to speak against. If that's the case, if you would, come forward at this time. I've not been given any specifics about that. And if you would, would ask that you try to limit your comments to two minutes or less.[SPEAKER CHANGES]Mr. Chairman, since we just heard a 15 minute presentation that I feel needs to be refuted, I would ask for a few more moments please? I will be as brief as I possibly can.[SPEAKER CHANGES]This was part of the presentation, these were not public speakers. But the Chair will try to be lenient. But I do ask that you be respectful. We do need to be out of here in 15 minutes.[SPEAKER CHANGES]Very good. Thank you, Mr. Chairman, members of the Committee. I'm Joseph Levy. I'm Scientific Advisor to the American Suntanning Association and Executive Director of International Smart Tan Network, which is the educational institute that trains professional tanning facilities in North America. For 21 years I've developed those training materials. And I am our industry's representative to the American Society for Photobiology. We're here as a constructive force in this issue. We believe strongly that the parental consent standard that is in place in North Carolina works and should be continued. That is the spirit of what brings us in here today. Dermatology Professor Dr. Jonathan Reese of England once stated that melanoma is an issue where politics and science have become intertwined, sadly, that an amicable separation is desired. We just heard a tremendous amount of misinformation about melanoma and about photobiology, about UV light. The doctor who just testified, Dr. Kelly Nelson, said that natural sunlight is predominantly UV
be and that just isn’t the case. Sunlight is 95% UVA and about 5% UVB during the summer. The UV portion of it. The UV portion changes throughout the day because of the solar angle. It is all UVA at dawn and dusk. It is about 5% UVB in the middle of the day in the summer. That is what a sunbed is. A sunbed you heard was 15 times stronger, a typical is about 10 to 12 milliwatts per square centimeter in intensity, sunlight is about 4 to 5 milliwatts per square centimeter in intensity. A sunbed is 2 to 3 times as intense, but intensity is not what you measure. It’s intensity multiplied by the duration of exposure equals the total numbers of photons. In the United States we have exposure schedules for tanning equipment that we’ve worked with the government to produce that delivers three quarters or less of what would induce a sunburn. It is the most conservative exposure schedule in the world. They’re using misinformation to advocate this bill. You heard it said that melanoma is increasing implied particularly in young women. This is the National Cancer Institute’s date, and I believe I’ve sent this to all of you. In 1975, men over the age of 50 and women under the age of 50 had virtually identical incidence rates of melanoma. Since that point, men over the age of 50 have increased 500%, much faster than women under the age of 50. In fact, melanoma incidents, according to the National Cancer Institute, for women under the age of 18 is 0.5 per hundred thousand and hasn’t increased greatly. The study that is mostly used to suggest that there is a 75% increase in risk from sunbed users actually doesn’t study tanning salons. It studies the three different types of sunbeds that are out there. There is medical applications of sunbeds, because sunbeds are used by dermatologists to treat psoriasis in their offices. There is home units. And then there are professional tanning salon units. If you separate that data, the tanning salons don’t increase risk in a significant fashion. The medical use of phototherapy, which doctors are lobbying right now to increase the access to calling it safe, doubles the risk of melanoma and in fact, the National Cancer Institute considered dermatological use of sunbeds a class one carcinogen. You’ve heard sunlight called a carcinogen and UV called a carcinogen. What you need to understand is that list includes substances like birth control pills, red wine, salted fish, sawdust, many other items. Calling UV a carcinogen and dangerous is incredibly misleading because as a carcinogen, it is the only item that we need in order to live and be healthy. It also is the only item in that list that doesn’t have a direct increasing relationship with melanoma and with cancer. Melanoma is more common in people who work indoors than in those who work outdoors. People who work outdoors get 3 to 9 times more UV. It occurs most commonly on parts of the body that don’t get regular sun exposure. You saw one of the slides was a melanoma on the bottom of the foot. In African-Americans, melanoma occurs most commonly on the bottom of feet. It does not have a direct relationship with sunlight. It is a complex relationship with UV if at all. That is why Dr. Bernard Ackerman who founded the field of pathology in dermatology and has trained most of the pathologists in the United States today, has written two books. One of the books he says, and I’ll quote right out of it, and I’ve never met Dr. Ackerman. He say, paradoxically business is sometimes more academic than academia. That Smart Tan got it, but the skin cancer foundations like the American Cancer Society, the American Academy of Dermatology does not get it. Ackerman promoted sunburn prevention, not sun avoidance, not sun hysteria, and he’s not alone. I’ve also sent you a, sorry I’m fumbling aound for it. [SPEAKER CHANGES] ?? if I can just intervene for just a moment. I want to give you about 30 seconds to wrap up and I’m sorry if that seems unfair, I had no knowledge, the chair had no knowledge that you had a presentation to make and I do want to allow time for our committee members to ask questions. [SPEAKER CHANGES] And that is exactly the point. This discussion needs to take place on a higher level. The American Suntanning Association would like to have this discussion on higher level to discuss the science. We believe the science merits a balanced perspective. Dr. Arthur Roads, melanoma researcher from Chicago, I’ll close with this, wrote an essay called Melanoma’s Public Message that says we need to stop concentrating on these anti-sun dogmatic campaigns. Rhodes had a colleague that was a doctor, whose wife was a doctor, and the colleague had a lesion that was on his back and figured, I don't’ tan, I don't’ take my shirt off, this can’t possibly be melanoma because I’m not a tanner. His wife, who is a doctor, concurred. It was a melanoma. He died of the melanoma. Melanoma is increasing most commonly in older men, not in younger women, and I will share that with you from the National Cancer Institute and anybody who
studying this in earnest, so this deserves much broader discussion. It is not a slam dunk. The scientific community is not all in unison on this issue, as you've heard earlier. That's why we'd like to have a broader discussion on this. Thank you very much. [SPEAKER CHANGES]Thank you sir. And I will open it to the committee members at this time. Representative Avila. [SPEAKER CHANGES]Thank you, Mr. Chairman. And I would like to use what ever parliamentary process there is to postpone the vote on this bill, in order for us to have a more clear and in-depth discussion. As a scientist, the next hour would not give me enough time to evaluate the information from both sides of these issues. And I would propose that postponement until the next committee meeting. [SPEAKER CHANGES]Noted. Representative Holley? [SPEAKER CHANGES]This bill came out of the Child Fatality Task Force, so it's had time to be aired in public. This is a public health bill. This is a public safety bill. The longer we delay, the more potential for more cancers, including melanoma, which will kill children. Now the science is contradictory, if you want to call it that, but this bill is supported by the American Cancer Society, the North Carolina Advisory Committee on Cancer Coordination and Control, the North Carolin Child Fatality Task Force, the North Carolin Dermatology Association, the North Carolina Medical Society, the North Carolina Oncology Association, the North Carolina Pediatrics Association aimed at melanoma, and the American Society for Dermatological Surgery Association. I ask for your support of this bill. [SPEAKER CHANGES]Representative Avila. [SPEAKER CHANGES]Mr. Chairman, I respectfully ask for a vote on my motion, to postpone for further discussion at the next meeting. Okay. Motion on the floor to postpone the vote until the next meeting. [SPEAKER CHANGES]Mr. Chairman. [SPEAKER CHANGES]Mr. Chairman. [SPEAKER CHANGES]Representative Lewis. [SPEAKER CHANGES]Inquire in the chair. [SPEAKER CHANGES]Yes. [SPEAKER CHANGES]What time do we need to move to vacate this room? [SPEAKER CHANGES]The chair's plan was to vacate about 10:50. We've got another meeting at 11 o'clock. [SPEAKER CHANGES]Representative Insko. [SPEAKER CHANGES]Thank you, Mr. Chairman. [SPEAKER CHANGES]This is about the motion? [SPEAKER CHANGES]Yes it is. I likely will vote for this bill, I'm in support of it, but it is very disturbing to me to hear testimony from people I believe have legitimate credentials that is so contradictory. You don't vote on these kinds of data to find out what's right. This is not something we need to argue about, and I agree, we need more time. I want us to take responsible votes, so I would support Representative Avila's motion. [SPEAKER CHANGES]We'll take a vote on Representative Avila's motion. All in favor of postponing a vote until the next meeting will signify by saying Aye. [SPEAKER CHANGES]Aye. [SPEAKER CHANGES]Opposed no. The ayes have it. This meeting's adjourned.