The Cult of Dermatology

In the early 1950s, a UFO doomsday cult believed that the world would be destroyed by a great flood on December 21, 1954, and that aliens would come to rescue the faithful. A group of researchers infiltrated the group to observe what would happen when the prophecy failed. The researchers turned their experience into the classic book When Prophecy Fails. They wrote that throughout history, cult members become even more devoted after their prediction is a dud, often believing that failure occurred because they weren’t pious enough.

I recently went on a group tour of Southwest Italy, where I was surprised to find an authentic cult member also on the tour. For context, the coastal areas we visited, like Capri and Amalfi, experience an interesting weather phenomenon. The thermometer shows mild temperatures while the air feels much hotter, even though the humidity remains low. The incongruity is a result of the Mediterranean receiving strong, direct sunlight in summer due to its latitude and clear skies. For us normal people, we handle the situation by drinking lots of water and finding shade.

This dermatologist on my tour, however, emerged each day from her hotel room covered head to toe, like she was trying to protect herself from mosquitoes in the Amazon. Despite the shade provided by her wide-brimmed hat, she also wore sunglasses to prevent any solar information from reaching her eyes and brain — a self-inflicted ciliary ganglionectomy as Dr. Jack Kruse likes to say. The only item missing from her explorer costume was the mosquito netting hanging from her hat. It’s hard to believe people pay a lunatic like this for health advice.

Like the UFO cult, we already know her prophecy is a bust:

• Indoor workers have a much higher risk of melanoma than outdoor workers.
• Almost 80% of melanomas are found in areas that get almost no sunlight exposure. Melanoma is not linked to sun exposure.
• Sunlight exposure dramatically reduces the risk of cancers such as breast and prostate. UVB light interacts with skin to create vitamin D metabolites crucial for bone health, immune function, and lowering cancer risk.
• The most common sun-driven skin cancer by far, basal cell carcinoma, almost never metastasizes, grows slowly, and has a 0% fatality rate.
• Squamous cell carcinoma can be dangerous, but it usually grows slowly and is treatable if caught early.

Over the past few decades, dermatology has transformed itself from a modest specialty into a profit-driven industry. Dermatologists used robust PR campaigns to rebrand themselves as skin cancer vigilantes. They promoted widespread screenings that inflated public anxiety and led to a surge in costly, often unnecessary procedures. Private equity firms seized the opportunity to acquire dermatology practices, over-biopsy and misdiagnose, and aggressively target vulnerable populations for treatment, such as nursing home residents. In spite of everything, rates of melanoma continue to rise.

I can’t say whether rank-and-file dermatologists, like my fellow tour member, are in on the con or are true believers. On the other hand, the power brokers driving this scam remind me of the cult leaders who end up having sex with all their female followers. The entire purpose of cult was to screw people over.

If a person wants to be fanatical about actual skin health and overall cancer risk, I have some ideas. You could make sure that every day you’re outside at key circadian moments. You could install circadian-friendly light bulbs in your house, use candles for illumination at night, or better yet, shut it all down after sunset and sleep in total darkness behind blackout curtains. You could place strict limits on your and your kids’ blue-lit screen time, especially at night, and make sure you have auto-dimming apps like f.lux installed on all your electronic devices.

Regardless, the pattern of zealots doubling down on failure isn’t unique to millennial cults. The more a group — from religious to political — invests in a shared narrative, the harder it is to abandon it, especially when the alternative is admitting error. I wonder how my dermatologist explorer will react when she sees over time that nothing she’s done has helped her patients, her family, or herself. I imagine she’ll just refuse to leave the house during daylight hours altogether.