We Screen The Sunscreens!

Yesterday, we asked you what your sunscreen policy was, and got a spread of answers. Apparently this one was quite polarizing!

One subscriber who voted for “Sunscreen is essential to protect us against skin aging and cancer” wrote:

❝My mom died of complications from melanoma, so we are vigilant about sun and sunscreen. We are a family of campers and hikers and gardeners—outdoors in all seasons—and we never burn❞

Our condolences with regard to your mom! Life is so precious, and when something like that happens, it tends to stick with us. We’re glad you and your family are taking care of yourselves.

Of the subscribers who voted for “I put some on if I think I might otherwise get sunburned”, about half wrote to express uncertainties:

• uncertainty about how safe it is, and
• uncertainty about how helpful it is

…so we’re going to tackle those questions in a moment. But what of those who voted for “Sunscreen is full of harmful chemicals that can cause cancer”?

Of those, only one wrote a message, which was to say one has to be very careful of what is in the formula.

Let’s take a look, then…

Sunscreen is full of harmful chemicals that can cause cancer: True or False?

False—according to current best science. Research is ongoing!

There are four main chemicals (found in most sunscreens) that people tend to worry about:

• Abobenzone
• Oxybenzone
• Octocrylene
• Ecamsule

Now, these two sound like four brands of rocket fuel, but then, dihydrogen monoxide (DHMO), which is also found in most sunscreens, sounds like a deadly toxin too. That’s water, by the way.

But what of these four chemicals? Well, as we say, research is ongoing, but we found a study that measured all four, to see how much got into the blood, and what adverse effects, if any, this caused.

We’ll skip to their conclusion:

❝In this preliminary study involving healthy volunteers, application of 4 commercially available sunscreens under maximal use conditions resulted in plasma concentrations that exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens. The systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings. These results do not indicate that individuals should refrain from the use of sunscreen.❞

Now, “exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens” sounds alarming, so why did they close with the words “These results do not indicate that individuals should refrain from the use of sunscreen”?

Let’s skip back up to a line from the results:

❝The most common adverse event was rash, which developed in 1 participant with each sunscreen.❞

This was most probably due to the oxybenzone, which can cause allergic skin reactions in some people.

Let us take a moment to remember the most common adverse event that occurs from not wearing sunscreen: sunburn!

You can read the full study here:

Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients—A Randomized Clinical Trial

None of those ingredients have been found to be carcinogenic, even at the maximal blood plasma concentrations studied, from applications 4x/day to 75% of the body.

UVA rays, on the other hand, are absolutely very much known to cause cancer, and the effect is cumulative.

Sunscreen is essential to protect us against skin aging and cancer: True or False?

True, unequivocally, unless we live indoors and/or otherwise never go about under sunlight.

“But our ancestors—” lived under the same sun we do, and either used sunscreen or got advanced skin aging and cancer.

Sunscreen of times past ranged from mud to mineral lotions, but it’s pretty much always existed. Even non-human animals that have skin and don’t have fur or feathers, tend to take mud-baths in sunny parts of the world.

If you’d like to avoid oxybenzone and other chemicals, though, you might have your reasons. Maybe you’re allergic, or maybe you read that it’s a potential endocrine disruptor with estrogen-like and anti-androgenic properties that you don’t want.

There are other options, to include physical blockers containing zinc and titanium dioxide, which are generally recognized as safe and effective ingredients.

If you’re interested, you can even make your own sunscreen that blocks both UVA and UVB rays (UVA is what causes skin cancer; UVB is “milder” and is what causes sunburn):

How to Make a Safe and Effective Sunscreen from Scratch – medically reviewed by Dr. Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT

Qigong: Breathing Is Good (Magic Remains Unverified)

In Tuesday’s newsletter, we asked you for your opinions of qigong, and got the above-depicted, below-described, set of responses:

• About 55% said “Qigong is just breathing, but breathing exercises are good for the health”
• About 41% said “Qigong helps regulate our qi and thus imbue us with healthy vitality”
• One (1) person said “Qigong is a mystical waste of time and any benefits are just placebo”

The sample size was a little low for this one, but the results were quite clearly favorable, one way or another.

So what does the science say?

Qigong is just breathing: True or False?

True or False, depending on how we want to define it—because qigong ranges in its presentation from indeed “just breathing exercises”, to “breathing exercises with visualization” to “special breathing exercises with visualization that have to be exactly this way, with these hand and sometimes body movements also, which also must be just right”, to far more complex definitions that involve qi by various mystical definitions, and/or an appeal to a scientific analog of qi; often some kind of bioelectrical field or such.

There is, it must be said, no good quality evidence for the existence of qi.

Writer’s note, lest 41% of you want my head now: I’ve been practicing qigong and related arts for about 30 years and find such to be of great merit. This personal experience and understanding does not, however, change the state of affairs when it comes to the availability (or rather, the lack) of high quality clinical evidence to point to.

Which is not to say there is no clinical evidence, for example:

Acute Physiological and Psychological Effects of Qigong Exercise in Older Practitioners

…found that qigong indeed increased meridian electrical conductance!

Except… Electrical conductance is measured with galvanic skin responses, which increase with sweat. But don’t worry, to control for that, they asked participants to dry themselves with a towel. Unfortunately, this overlooks the fact that a) more sweat can come where that came from, because the body will continue until it is satisfied of adequate homeostasis, and b) drying oneself with a towel will remove the moisture better than it’ll remove the salts from the skin—bearing in mind that it’s mostly the salts, rather than the moisture itself, that improve the conductivity (pure distilled water does conduct electricity, but not very well).

In other words, this was shoddy methodology. How did it pass peer review? Well, here’s an insight into that journal’s peer review process…

❝The peer-review system of EBCAM is farcical: potential authors who send their submissions to EBCAM are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job. It goes without saying that such a system is prone to all sorts of serious failures; in fact, this is not peer-review at all, in my opinion, it is an unethical sham.❞

~ Dr. Edzard Ernst, a founding editor of EBCAM (he since left, and decries what has happened to it since)

One of the other key problems is: how does one test qigong against placebo?

Scientists have looked into this question, and their answers have thus far been unsatisfying, and generally to the tune of the true-but-unhelpful statement that “future research needs to be better”:

Problems of scientific methodology related to placebo control in Qigong studies: A systematic review

Most studies into qigong are interventional studies, that is to say, they measure people’s metrics (for example, blood pressure, heart rate, maybe immune function biomarkers, sleep quality metrics of various kinds, subjective reports of stress levels, physical biomarkers of stress levels, things like that), then do a course of qigong (perhaps 6 weeks, for example), then measure them again, and see if the course of qigong improved things.

This almost always results in an improvement when looking at the before-and-after, but it says nothing for whether the benefits were purely placebo.

We did find one study that claimed to be placebo-controlled:

A placebo-controlled trial of ‘one-minute qigong exercise’ on the reduction of blood pressure among patients with essential hypertension

…but upon reading the paper itself carefully, it turned out that while the experimental group did qigong, the control group did a reading exercise. Which is… Saying how well qigong performs vs reading (qigong did outperform reading, for the record), but nothing for how well it performs vs placebo, because reading isn’t a remotely credible placebo.

See also: Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago ← this one explains a lot about how placebo effect does work

Qigong is a mystical waste of time: True or False?

False! This one we can answer easily. Interventional studies invariably find it does help, and the fact remains that even if placebo is its primary mechanism of action, it is of benefit and therefore not a waste of time.

Which is not to say that placebo is its only, or even necessarily primary, mechanism of action.

Even from a purely empirical evidence-based medicine point of view, qigong is at the very least breathing exercises plus (usually) some low-impact body movement. Those are already two things that can be looked at, mechanistic processes pointed to, and declarations confidently made of “this is an activity that’s beneficial for health”.

See for example:

• Effects of Qigong practice in office workers with chronic non-specific low back pain: A randomized control trial
• Qigong for the Prevention, Treatment, and Rehabilitation of COVID-19 Infection in Older Adults
• Impact of Medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial

…and those are all from respectable journals with meaningful peer review processes.

None of them are placebo-controlled, because there is no real option of “and group B will only be tricked into believing they are doing deep breathing exercises with low-impact movements”; that’s impossible.

But! They each show how doing qigong reliably outperforms not doing qigong for various measurable metrics of health.

And, we chose examples with physical symptoms and where possible empirically measurable outcomes (such as COVID-19 infection levels, or inflammatory responses); there are reams of studies showings qigong improves purely subjective wellbeing—but the latter could probably be claimed for any enjoyable activity, whereas changes in inflammatory biomarkers, not such much.

In short: for most people, it indeed reliably helps with many things. And importantly, it has no particular risks associated with it, and it’s almost universally framed as a complementary therapy rather than an alternative therapy.

This is critical, because it means that whereas someone may hold off on taking evidence-based medicines while trying out (for example) homeopathy, few people are likely to hold off on other treatments while trying out qigong—since it’s being viewed as a helper rather than a Hail-Mary.

Want to read more about qigong?

Here’s the NIH’s National Center for Complementary and Integrative Health has to say. It cites a lot of poor quality science, but it does mention when the science it’s citing is of poor quality, and over all gives quite a rounded view:

Qigong: What You Need To Know

Enjoy!