AAD Seal of Recognition™: Proceed with Caution
I have been following the debate regarding the American Academy of Dermatology (AAD) Seal of Recognition™ program with great interest. The AAD promotes this program as an “Academy-driven public health initiative that was conceived to educate the public about the dangers of exposure to the sun, provide a reliable method for choosing sun-protection products and to fund the advancement of new and the expansion of existing skin cancer reduction programs now and in the future.”
At times, I have found myself on both sides of the aisle — the pro and anti camps. And even though the Canadian Dermatology Association and the Skin Cancer Foundation offer similar programs, the U.S. dermatology community should be cautious for several reasons.
THE PRO SIDE
On the pro side, I feel that this program is fairly well-balanced. In order to be awarded a Seal, the sun-protection product’s manufacturing data, which has already been reviewed by the Food and Drug Administration, must be reviewed by an independent panel of experts to assess if it also meet the AAD’s stringent set of evidence-based criteria.
Also, the AAD isn’t planning to charge completely outrageous fees for the Seal. The cost to submit a product for assessment will be used to cover the administrative costs of the program and anything left over will go toward educating the public regarding skin cancer risks.
However, I am afraid that the AAD may be heading down a slippery slope. Which product will our professional organization endorse next? Will this be limited to over-the-counter products or will we endorse prescription medications in the future? What about cosmetic or surgical procedures? I shudder to think that a certain cosmetic laser resurfacing procedure will be endorsed over another, or that a certain topical corticosteroid preparation will get a seal of approval over another preparation.
We also must consider the credibility debate in this case. As a dermatologist, I make sunscreen recommendations every day to my patients, friends and family members. But what if my sunscreen of choice doesn’t have the AAD Seal of Recognition — not because it’s not a good product, but because the manufacturer decided not to apply for the program? Will I lose credibility in the eyes of my patients? What about the credibility of the sunscreen manufacturer? Will the public know that the product without the Seal may be equally as good? Will the manufacturer of the product without the Seal lose credibility in the eyes of the consumer?
As I pondered the AAD’s decision to go ahead with the Seal of Recognition program, I remembered a deeply tanned young woman I diagnosed with a basal cell carcinoma.
“Doc, but I use sunscreen every day,” she told me. I explained to her that things aren’t that simple: The sun she got as a little girl probably played a big role and/or she may have a genetic predisposition for skin cancers. It’s also possible that she didn’t use enough sunscreen or used it incorrectly.
But what if the sunscreen she used had the AAD Seal of Recognition? How would I explain to her that our professional society, one to which almost every dermatologist belongs, endorsed a product that couldn’t help her prevent her skin cancer?
I am not against the program in general terms. I think it’s important for dermatologists to take a central and public role in the fight against skin cancer. But we need to ensure that we also educate the public about sun avoidance, not simply sun protection.
This last point, I believe, is vital and perhaps it should be required that the manufacturers using the Seal should mention this in their advertising and product packaging. Our patients must also know that even if they follow all the necessary steps, the risk of cancer like malignant melanoma still exists. I believe that only through an open and honest discussion with the public, is it possible to continue with this program and ensure that the credibility of our professional society isn’t tarnished.