Comment www.thelancet.com Vol 377 April 16, 2011 1299 Group reports to this board and is jointly chaired by a Minister of State and the Chief Executive of the Wine and Spirits Trade Association. The Network comprises four academics (including two of us: NS and IG), six health non-governmental organisations, seven civil servants, and 14 representatives from the drinks and retail industry. Irrespective of the means the UK Government chooses to design and implement their public health strategy, the key test must be the impact on hard outcomes. We have seen a change of emphasis from setting targets for process measures to outcomes measures, an approach quintessentially applicable to alcohol. Alongside debates on the effectiveness of individual measures, an outcomes framework should be created that establishes the level of liver mortality that the UK aspires to achieve. *Nick Sheron, Chris Hawkey, Ian Gilmore Clinical Hepatology, Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK (NS); Faculty of Medicine & Health Sciences, Queen’s Medical Centre, University Hospital, Nottingham, UK (CH); and Royal Liverpool Hospital and University of Liverpool, Liverpool, UK (IG) Nick.Sheron@soton.ac.uk NS and IG are members of the Department of Health Responsibility Deal Alcohol Network. NS is Secretary of the Alcohol Health Alliance and a trustee of the Drinkaware Trust. IG chairs the Alcohol Health Alliance. CH chairs the Public Affairs Committee and is Past President of the British Society of Gastroenterology. The indoor tanning industry’s double game The incidence of cutaneous melanoma continues to rise in most populations with fair skin, because of increased exposure to ultraviolet radiation from sunlight and from tanning beds. 1,2 In June, 2009, the International Agency for Research on Cancer classified the entire ultraviolet radiation spectrum and artificial ultraviolet tanning devices as carcinogenic to human beings. 3 In reaction to this classification, the indoor tanning industry in Europe launched a counter offensive which seems based on ambiguous arguments. On the one hand, the industry denies any link between indoor ultraviolet tanning and skin cancer, 4,5 and makes a substantial effort to argue that vitamin D deficiency can cause increased risk of cancer and many other chronic diseases. 5 However, no well undertaken randomised trial has shown that correction of vitamin D deficiency can actually decrease the risk of cancer or any other chronic disease. 6 On the other hand, the industry seems to have adopted a strategy to charm public institutions in charge of regulations by offering assistance to produce better guidelines for the running of tanning salons. The European Sunlight Association (ESA) 4 —an organisation representing the indoor tanning industry—is a major stakeholder of the Joint Action on Sunbeds project led by the Product Safety Enforcement Forum of Europe (Prosafe). 7 The European Commission, through the Directorate General for Health and Consumers (DG SANCO), partly finances the Prosafe project and the ESA’s efforts to develop training materials, a code of good conduct for tanning studios, and information for consumers. 7–9 The announcements Published Online February 15, 2011 DOI:10.1016/S0140- 6736(10)61966-6 1 Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349: 1436–42. 2 NHS Information Centre. Statistics on alcohol, England 2009. 2009. http:// www.ic.nhs.uk/pubs/alcohol09 (accessed Jan 4, 2011). 3 WHO. Health and Statistics Information System: global burden of disease. 2008. http://www.who.int/healthinfo/global_burden_disease/estimates_ country/en/index.html (accessed Jan 4, 2011). 4 WHO. WHO European Health for All database. 2009. http://data.euro.who. int/hfadb (accessed Jan 4, 2011). 5 Jernigan DH, Monteiro M, Room R, Saxena S. Towards a global alcohol policy: alcohol, public health and the role of WHO. Bull World Health Organ 2000; 78: 491–99. 6 Academy of Medical Sciences. Calling time—the nation’s drinking as a major health issue. Jan 3, 2004. http://www.acmedsci.ac.uk/p48prid16. html (accessed Jan 4, 2011). 7 House of Commons Health Committee. Alcohol: first report of session 2009–10. Jan 8, 2010. http://www.publications.parliament.uk/pa/ cm200910/cmselect/cmhealth/151/15102.htm (accessed Jan 4, 2011). 8 Harvey Brown R. Forbidden substances. Chapter 6: alcohol policies in England, the United States, Sweden and Finland. August, 2003. http:// richardharveybrown.com/6alcohol.pdf (accessed Jan 4, 2011). 9 Abel EL. The gin epidemic: much ado about what? Alcohol Alcohol 2001; 36: 401–05. 10 Duffy JC, Latcham RW. Liver cirrhosis mortality in England and Wales compared to Scotland: an age-period analysis. J R Stat Soc 2010; 149: 44–59. 11 WHO. Global status report on alcohol 2004—country profiles. 2004. http://www.who.int/substance_abuse/publications/ globalstatusreportalcoholprofiles/en/index.html (accessed Jan 4, 2011). 12 Joliffe N, Jellinek EM. Vitamin deficiencies and liver cirrhosis in alcoholism VIII: cirrhosis of the liver. Q J Stud Alcohol 1949; 2: 544–83. 13 Terris M. Epidemiology of cirrhosis of the liver: national mortality data. Am J Public Health 1967; 57: 2067–88. 14 Jewell J, Sheron N. Trends in European liver death rates: implications for alcohol policy. Clin Med 2010; 10: 259–63. 15 Department of Health. Safe. Sensible. Social—consultation on further action (section 2.12, page 16). July 22, 2008. http://webarchive. nationalarchives.gov.uk/+/www.dh.gov.uk/en/Consultations/ Liveconsultations/DH_086412 (accessed Jan 4, 2011).