Two years after the American Academy of Dermatology's Seal of Recognition program was launched, six products have been recognized for their sun protection benefits.
In an interview, Dr. James M. Spencer, who oversees the program, said that he expected the list of recognized products “to be somewhat larger” by now. He acknowledged that part of the slow start may stem from controversy the program generated at the AAD's annual meeting in 2008, most notably by the late dermatopathologist A. Bernard Ackerman.
“He did not feel that sunlight causes melanoma,” recalled Dr. Spencer, who also chairs the AAD's Melanoma/Skin Cancer Committee. “If you have that position, why would you want to encourage people to wear sun protection products? He also felt that [the Seal of Recognition program] was a conflict of interest financially; that it tainted the AAD. We're all sensitive to that. Potential conflicts of interest come up in practice all the time. Professionalism means putting your duty ahead of your personal benefit.”
Dr. Spencer of Mount Sinai School of Medicine, New York, went on to emphasize that while he is sensitive to the arguments against the program, “at the end of the day it's like giving a medication: We weigh the risks versus the benefits. The benefits are, if we can get people to use effective sun protection products more, that's a benefit. The risks are that it may make us appear like we've sold out somehow. We have to weigh those two against each other. To me, the benefits to society of driving sun protection products outweigh any potential risks. Life's full of decisions like that, isn't it?”
To have a product considered for the program, the manufacturer must pay a $5,000 application fee, followed by a $10,000 annual license fee upon approval of the application.
“This program was never intended to be a fund-raiser,” said Dr. Spencer. “If there's any money left over [from the application fees] after program expenses, it goes solely to public education for skin cancer.”
Loosely modeled after product endorsement programs established by the American Dental Association and the Skin Cancer Foundation, the AAD's Seal of Recognition program has a twofold purpose, Dr. Spencer said: to let consumers know that the product they're buying has a sun protection benefit, and “to raise awareness about the importance of sun protection. According to recent surveys the use of sunscreen is going down.”
Each product undergoes a review every 2 years to ensure that it still meets evidence-based criteria as set forth by the AAD. “It is a fairly high hurdle for a product to have these independent studies, to be reviewed and accepted,” Dr. Spencer said.
The Seal of Recognition program reflects the academy's efforts “to do everything possible to reduce the incidence of skin cancer on all fronts. Among those fronts is to encourage the use of effective sun protection products. That's the genesis of this effort,” he said.
The ongoing debate about the benefits of vitamin D and the call by some clinicians to seek out unprotected exposure to the sun is not helping the Seal of Recognition program from a public relations standpoint, either. “Dermatologists need to be aware that sun protection has become a controversial issue, specifically because of vitamin D,” he said. “Weighing the evidence overall, our advocacy of regular sun protection is still the way to go, and I would encourage our colleagues to continue their advocacy for sun protection.”
By accepting application fees from companies that manufacture sun protection products, the Seal of Recognition program “can be misinterpreted as a conflict of interest by the medical or general public,” said Dr. Peter C. Lombardo of the department of dermatology at Columbia University, New York. A recent article about professional medical associations and their relationships with industry calls the propriety of endorsing commercial products “highly suspect” (JAMA 2009;301:1367-72).
“My objection is that money is involved in the granting of the seal, and this is where the misconception of the AAD's motives arises,” said Dr. Lombardo. “If this were not the case, I would have no objection to [the program]. I believe the AAD is the premier academic institution of America's dermatologists and as such it should be 'like Caesar's wife': above reproach.”
Ron Cummings, founder and owner of Newport Beach, Calif.–based AminoGenesis Skin Care, called the Seal of Recognition program a “long-overdue” development. “What made this good is that it was a third-party verification process, extremely documented and very rigorous,” he said. “You had to put together a formula that was great, and we were able to do that. Consumers have responded very well, because when they use a product with this AAD seal, they know that it has some level of credibility behind it. It's a certain level of assurance.”