Dermatologist Offers Tips For Skin, Sun Safety

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Dermatologist Offers Tips For Skin, Sun Safety

TERRY GROSS, host:

This is FRESH AIR. I’m Terry Gross. It’s summer sun season, although you
wouldn’t know it in Philadelphia, where I live, because it’s been cloudy and
raining nearly every day.

That summer suntan that we used to think gave us a health glow we now know is
probably damaging our skin and maybe even leading us a step closer to skin
cancer, but those sunscreens with the SPF numbers, do you know what those
numbers mean?

Here to help us understand the sun’s effect on our skin and how to best protect
ourselves, without becoming shut-ins, is dermatologist Dr. Darrell Rigel. He
specializes in skin cancer, sun damage and aging problems of the skin. He’s
former president of the American Academy of Dermatology and former director of
the American Board of Dermatology. Dr. Rigel is also a clinical professor of
dermatology at NYU Medical Center.

GROSS: Dr. Rigel, welcome to FRESH AIR. So what does the SPF measure?

Dr. DARRELL RIGEL (Dermatologist): There are three kinds of ultraviolet
radiation: A, B and C. UVC is blocked by the ozone layers. We see very little
of it on the Earth’s surface, although we are seeing a little more with ozone
depletion.

That leaves us A and B. A is the kind of light you see at the black light era,
you know, light at the disco or something. That’s ultraviolet A. It’s the
nearest to violet. And B are the rays you really can’t see, but they’re more
involved with burning of the skin.

SPF just measures the amount of UVB that it’s blocking, the UVB protection
level is what it is, and it’s really a ratio of the amount of time you can stay
out in the sun with the sunscreen versus without the sunscreen and not be
sunburned.

So let’s say if you had typical skin, where you burned in 20 minutes, if you

had an SPF 10 on, it would take you 10 times that, or 200 minutes of exposure,
to burn. That’s a very simplistic explanation, but that’s the idea behind SPF.

GROSS: So the SPF numbers seem to be getting higher and higher. So if you get
into the real high numbers, like 100 or something, are you twice as protected
as you are if you were using an SPF of 50?

Dr. RIGEL: Well, you know, that’s one of those questions the debate goes back
and forth on. It’s almost the question: Is the glass half-full or half-empty,
or in this case, is it 98 percent full or two-percent empty?

An SPF 50, in theory, if it’s used correctly, and that’s a whole ‘nother issue,
would block 98 percent of the sun’s UVB rays. So that means only two percent

would get through. An SPF 100 would block 99 percent of the rays.

So you can say, well, there’s a not a lot of difference between 98 and 99
percent, but the reason you could argue it the other way is it’s twice as good,
is that only one percent’s getting through instead of two percent. So only half
the rays are getting through, and that’s really – it’s a bit of semantics, in a
sense, but that’s why as you get to the higher SPFs, the additional protection
is not that much, but there are reasons to have higher SPFs.

GROSS: Would you use a higher SPF? Do you think it matters?

Dr. RIGEL: Well, I personally do. I actually use either the 70 or the 85, and
I’ll give you my reasons why. When sunscreen is tested, it’s tested in a way
that’s really not used in the real world, and it goes back to the 1970s, when
sunscreens first began to be tested, where they used two milligrams per square
centimeter of body surface.

That doesn’t sound like a lot, but if – no matter what you look like, if you
were to put that on, everybody would look like Casper the Friendly Ghost or the
Michelin Man or something. You’d be white as a sheet. So realistically, nobody
uses sunscreen the way it’s rated, and that’s actually unfortunate. The FDA is
looking at different ways to re-label sunscreen. One of the things they should
look at is how they measure SPFs.

But all that aside, if you under-apply sunscreen, and most studies show that
people only apply about 20 to 50 percent of the rated amount, you’re getting a
lot less coverage, a lot less protection, rather, than you would see with the
actual SPF on the label. So the higher SPFs are much more forgiving, and that’s
really the argument for them.

People are going to skimp and under-apply anyway, but you’re getting – maybe if
you use a 75 or an 85 or a 100, you’re getting the protection of a 15 or a 30,
even though you’re under-applying.

GROSS: So can you give us a sense of how much we’re supposed to be putting on?
Like how greasy should we really be?

Dr. RIGEL: Well you know, that’s a great point, and typically to cover your
whole body, if you were covering your whole body at the beach, you’d use one
ounce. Now, one ounce is the amount of – I hate to use this analogy as a
position, but the amount of a shot glass. Everybody can relate to that size.

Most people under-apply sunscreen, and I always love the question. Typically
sunscreens come in three-ounce tubes or bottles because you can take them on
the – in your carry-on bag in the airlines now, right, because they have to be
three ounces or smaller.

GROSS: Right.

Dr. RIGEL: So theoretically, one tube should last for three complete body
applications, right? And I’ll get patients who will come in and say, you know,
I’ve this tube of sunscreen I’ve been using for three years, is it still good?

Well, theoretically, if they were at the beach, it should have lasted for three
applications. So clearly they’re under-applying, but that’s typically how you
go through this exercise.

GROSS: Say you’re just, like, putting some on your nose or something like – how
thick a layer should it be? I mean, you can’t use the shot-glass analogy there
because you’re not covering your whole body.

Dr. RIGEL: Typically for the face, that should be a heaping teaspoon or a flat
tablespoon will cover your face. That’s typically what you’re looking for, face
and neck, to do that.

And you know, the trick what I do, is you don’t want to put it all on one side
and then start rubbing the other side because it’s very uneven. So I typically
take the right amount, and then I dab it around my face and my neck, and then I
rub it in. So I sort of spread it a little more evenly.

If you do that, you avoid the problem of having too much when you first put it
on, and it’s too gloppy, and then too little on the areas you’re finishing up
with. And sunscreens used to be called sunscreens and sun blocks, two different
things. Now they’re called organic and inorganic for the screens and the
blocks.

The organic ones are the ones we talk about, typically the sunscreens that
absorb the sun’s radiation, and the inorganics, or the old sun blocks, were the
ones that reflected, like zinc oxide or titanium dioxide. Those you can often
see on the skin when they’re there, but the sunscreens, typically, rubbed in
enough, you don’t have to see them and they’re working.

GROSS: After you’ve applied your shot glass-worth of sunscreen, how long will
it last?

Dr. RIGEL: It starts to degrade at about an hour. Many of the sunscreens by two
hours are pretty much gone, with the exception of some of the newer
formulations that will last four hours or longer.

The – you know, four hours for a sunscreen is pretty good because if you went
out, let’s say you were in daylight saving time in the summer, that would cover
you from 11:00 till 3:00, which will be most of the time when the rays are
strongest, and you might get by with one application.

But if you’re in the water or you’re sweating or you have clothes rubbing on
you in the areas where you are, something that is mechanically taking off some
of the sunscreen, you probably should re-apply every two to three hours.

GROSS: Okay, so the sunscreens protect you against the UVB rays, but there’s
the UVA rays. Are they damaging too, and are we getting any protection against
them?

Dr. RIGEL: Well, we are. I mean, that’s really where a lot of the current
controversy exists. As I mentioned, SPF on the sunscreen bottle currently just
measures UVB protection, and if we were talking 15 years ago, what we would
have said is that UVB is much more important than UVA, and in fact to get at
SPF 15 or higher, you’re putting enough sun-screening agents in the sunscreens
such that you’re getting some good UVA protection.

But that all changed about a decade ago, when a really nice study was done in
Canada, looking at six SPF 30 or higher sunscreens and measuring their UVA
protection, and it turned out their UVA protection was all over the map.

So it made us really rethink how we measure UVA protection, and in parallel to
this we started learning that UVA was more - we talked about it in the past,
they’d be the aging rays and things that cause the aging in their skin, and
they do, but they also lead to skin cancer.

So the real issue now is you have no way easily of knowing the best sunscreen
for UVA protection, and that’s what’s before the FDA right now, and believe it
or not, they have been working on this since 1978, 31 years, going back and
forth, and we’re hoping finally that they will come to some closure on this in
the next couple of months.

GROSS: So meanwhile, when you’re putting on sunscreen, and it says waterproof,
it makes you think, well, you could go swimming, and you don’t need to re-apply
it, do you need to re-apply it?

Dr. RIGEL: You do. It’s interesting: The whole term of waterproof in the new
FDA proposals will be removed, and they’ll be able to call things water-
resistant and very water-resistant as opposed to what they call things now,
water-resistant and waterproof.

That’s a whole ‘nother story, but it goes back to the 1970s when they were
first testing sunscreens, and they were tested in a lab, actually in
Philadelphia and Hershey, Pennsylvania, and in that lab they had a 40-minute
timer. So what they did is they put sunscreen on people, they put them in the
pool for one cycle of 40 minutes, and they came out and tested them, and if the
sunscreen still worked after 40 minutes in the pool, it was called water-
resistant, and if went through a second cycle, another 40 minutes or 80 minutes
total, it was called waterproof.

So the FDA adopted these things, and for, again, the bizarre reason why 80
minutes - it just happened to be twice the 40-minute timer, and that’s actually
still used when they do the tests on sunscreens. But since there’s no sunscreen
that’s truly waterproof, the terminology will be water-resistant and very
water-resistant to do that.

What’s interesting in the last several years, the sunscreen manufacturers have
come up with formulations that are much more resistant to breaking down.

I mean, the way sunscreens work is they, as I said, they absorb the ultraviolet
radiation. Actually, what they actually do is they turn the ultraviolet
radiation into a very soft red light, which you can’t see in the daytime
because it’s too bright, but it converts the UV to red, which is harmless, and
that’s how it offloads the energy. But after a while, the sunscreen will break
down from doing that.

The newer sunscreen formulations do last longer than two hours. We’ve done
studies which show that pretty much every two hours you have to re-apply, but
with some of the formulations, they do last four hours or longer and still give
you good protection.

GROSS: Well, if you’re just joining us, my guest is Dr. Darrell Rigel, and he’s
a dermatologist who specializes in skin damage caused by sun and in skin cancer
and aging problems of the skin, and he’s a clinical professor of dermatology at
NYU, past president of the American Academy of Dermatology. Let’s take a short
break here, and then we’ll talk more about skin issues and the sun. This is
FRESH AIR.

(Soundbite of music)

GROSS: If you’re just joining us, my guest is dermatologist Dr. Darrell Rigel.
We’re talking about skin and skin damage from the sun and how to prevent it.
He’s a clinical professor of dermatology at NYU, past president of the American
Academy of Dermatology. He specializes in skin cancer, sun damage and aging
problems of the skin.

Now, I’m from the generation where a lot of people used, when they were young,
sun reflectors, which is basically a piece of cardboard with something that
looks like tinfoil on it to reflect the rays of the sun onto your face so that
you get a quicker, more intense sunburn or more – more, hopefully, suntan. How
much did those of us who used these things damage ourselves?

Dr. RIGEL: Well, pretty big time. You know…

GROSS: Thank you.

Dr. RIGEL: Make you feel really good, right?

GROSS: Yeah.

Dr. RIGEL: You know, the idea behind that was you just got extra rays hitting
you. So think if you had direct rays, and you multiplied it by two or three
because you get the extra reflected ones, you’re going to get more intense
ultraviolet radiation.

I mean, these were basically the precursors to the tanning beds, if you think
about it, because tanning beds have UV intensity of 10 to 15 times that of
normal sunlight, and you obviously tan faster in a tanning bed. That’s why
people go there, but you also get your damage faster.

GROSS: So are you seeing a lot of patients who used sun reflectors and now have
various forms of skin damage or skin cancers?

Dr. RIGEL: Absolutely, and typically what you see is you get the person who
said, well, I protected the rest of my body, but I wanted my face to have
color, so I used a reflector, or I used a sunlamp, or I used – years ago
whatever the things – and now their in their 50s or 60s or whatever - because
those were big in the 1950s and 1960s - and you see the extreme damage they
have on the face, and they have pre-cancers. Well, they have aging, they have
pre-cancers, and they often have skin cancers.

GROSS: A lot of people are getting diagnosed with basal cell carcinomas and
being told that they don’t really have to worry a lot about it if it’s
diagnosed soon, and it’s superficial. Would you explain what they are and how
much we need to worry about them?

Dr. RIGEL: Sure. There are three basic kinds of skin cancer, and they have to
do with which is the cell that turns cancerous. The most frequent kind that we
see is basal cell carcinoma, and that’s the basal cell. It’s the lowest cell in
the epidermis, and it becomes cancerous from ultraviolet exposure.

There will be over one million newly diagnosed cases of basal cell carcinoma
this year in the United States alone. So it’s the most common cancer, and in
fact it’s almost as much as the sum of all other cancers combined.

So it’s very common. About one in six Americans or so will get a basal cell
sometime during their lifetime. They grow very slowly. They rarely, very
rarely, metastasize. Usually it’ll be if somebody has other problems with their
immune system, such as, you know, if they’re immuno-suppressed for transplants.

If you do catch them early, not a big deal. Even though they don’t metastasize,
though, they can become locally destructive, and one third of all basal cells
appear on the nose. So you can imagine it starts to eat away at your nose, you
have some issues in terms of your appearance, as well as potentially it can get
in deeper structures, get infected.

So you can’t let them go. You’ve got to treat them, but once you treat them,
they’re pretty much treated, and there are a variety of ways to do that.

Once you’ve had one basal cell, your chance of getting a second basal cell
sometime in your lifetime is about 50-50.

GROSS: In the same place, or in another place?

Dr. RIGEL: Well, anywhere, anywhere on the body, because you’ve proven, you’ve
proven you have the sensitivity to grow them, and you’ve proven you’ve been
successful at growing them. And it’s probably from the same sun you got 10 or
20 or 30 years or so before, it’s just they’re like dandelions. They’ll pop out
in different spots. Not the first one spreading but another one popping up.

GROSS: So how do you recognize that you have one and therefore go to see the
doctor about it?

Dr. RIGEL: The way you look for it on the skin, in terms of basal cells, it’s
typically a spot that’s just not healing. And the story - I had a spot –
remember, one third of them on the nose, so a typical story was it was on my
nose, I thought it was a pimple, but it never quite healed up. It crusted a
little bit, it bled, but it semi-healed and it came back. And again, they grow
very slowly, so often it’s several months before somebody comes to me for
having these diagnosed, but that’s, I guess, your typical story.

So if something is growing, bleeding, crusting or changing on your skin, see
your dermatologist.

GROSS: And same kind of thing on your ear – do you get a lot on your ear?

Dr. RIGEL: You can, and it’s sort of interesting. Men get skin cancers on the
ear about six times more frequently than women, and that’s primarily due to
hairstyles, right?

GROSS: Oh, of course.

Dr. RIGEL: So that’s universal across all countries that you see that. On the
ear, often what you’ll get is a squamous cell carcinoma, which again, that’s
the squamous cell, the intermediate kind that turns cancerous.

There are about a quarter of a million cases of squamous cell carcinoma each
year in the United States, and again, if you see a red, rough, scaly spot on
your ear, which you also could see on the face at other times too, or the backs
of the hands are a typical site for squamous cell, that’s typically what you’d
see and obviously have it looked it.

The squamous cell carcinoma, again, is typically, as with the basal cell, with
people who have had chronic sun exposure. So they are people who spend a lot of
time outdoors, haven’t protected themselves. It’s not from one sunburn, but
it’s a lot of outdoor exposure for those two types of skin cancer.

GROSS: And with melanoma, the most deadly of them, if it’s not caught early, is
melanoma also caused by the sun, among other things?

Dr. RIGEL: Well, absolutely. The vast majority of melanomas can be traced back
to sun exposure. The difference with melanoma it appears is not the chronic sun
exposure as much as the sunburn that does you in, and you can look at a whole
bunch of studies with melanoma that in terms of intense ultraviolet radiation
does you in, sunburns, blistering sunburns. All those things increase your
risk. The more of those you’ve had over life, the greater your risk, tanning
beds, where the UV intensity is so much greater than it is in normal sunlight.

And melanoma is really – it’s again, a cancer of the melanocytes, the pigment
cells. So in most melanomas you see a brown or a brownish-black or almost a
black spot that’s growing early on, and typically in early melanoma what you
see is a brown spot that’s got several different shades of brown.

Instead of being nice and round or oval, it almost looks like it has little
pods sticking out, like a spider almost or something, or a little lobster or
something, but the easiest way to recognize early melanoma is A, B, C, D, E.

A is asymmetry. Early melanoma typically is not symmetric because one part of
it starts to grow a little different than the other part of it. So you get that
asymmetry.

B is border. On normal moles, typically they have a very clear-cut border. You
can see where the mole stops and the skin starts. With early melanoma, that
border is either ragged, irregular or indistinct.

C is color. Most run-of-the-mill moles, they can be light, they can be dark,
but they’re pretty uniform in color, while melanoma will have multiple shades
of brown or some blacks, even some blues sometimes.

And then D is the diameter of being six millimeters or a quarter of an inch or
the size of a pencil eraser. So if you have the asymmetry, irregular border and
uneven color and diameter greater than a pencil eraser, and now we’ve added E
to that, evolving, so it’s changing on top of that, those are suspicious signs
to see your dermatologist and get the early melanoma removed.

GROSS: And if you get it removed early, you’re probably in the clear?

Dr. RIGEL: Basically, yeah. Melanoma, the variable that best measures how
you’re going to do is how thick the melanoma is - in other words, how far it
goes down vertically.

A melanoma that’s only gone down one millimeter or less, that’s a 25th of an
inch, basically 95-plus percent of the people who have that will survive and do
well. A melanoma that’s gone down three millimeters, or an eighth of an inch –
it’s not much difference between a 25th of an inch – the survival is only 50-
50. If you go down to four millimeters, which is roughly a sixth of an inch,
then the survival drops down to about 30 percent.

So those couple-of-millimeters difference is the difference between life and
death in melanoma, and that’s why it has to be detected early. A melanoma the
size of a dime on your skin, which is not that big, has a 50 percent chance of
having already spread, and once melanoma spreads, basically nothing works.

So that’s why it’s such a lethal cancer, that it spreads rather early in its
course.

GROSS: Is it worse for your skin to sunburn it when you’re a child than it is
when you’re an adult?

Dr. RIGEL: Well, it’s always bad to sunburn your skin. Let’s start with that
premise first. And you know, by the fact that your skin burns is a sign you’ve
had ultraviolet exposure and it’s damaged you. and actually there’s data to
show that people who have even one sunburn, if you can - they do some studies
where they’ll take people’s rear ends that don’t normally see the sun, and
they’ll give them ultraviolet radiation exposure for just one light sunburn,
and you can see DNA damage and genetic damage in the skin for four to five days
just from one exposure in a place that’s never been exposed.

So you know, that is a major issue associated with - but there are papers that
were written 20 years ago that suggest that the sunburns you had prior to the
age of 18 were worse than the sunburns you had afterwards in terms of risk, but
it turns out that’s not true.

There have been several studies come out in the last, well, three or four years
that show basically whenever you get the sunburn, it’s harmful to you in terms
of subsequent skin cancer risk.

GROSS: Dr. Darrell Rigel is a clinical professor of dermatology at NYU Medical
Center and former president of the American Academy of Dermatology. Coming up,
a new biography of Donald Rumsfeld. We’ll talk with the author, former
Washington Post Pentagon correspondent Bradley Graham. This is FRESH AIR.

(Soundbite of music)

GROSS: This is FRESH AIR. I’m Terry Gross.

Let's get back to our interview about how to protect yourself from the summer
sun. My guest is dermatologist, Dr. Darrell Rigel. He specializes in sun damage
and skin cancer. He's former president of the American Academy of Dermatology
and is a clinical professor of dermatology at NYU Medical Center.

Has the sun gotten more dangerous because of the depleting ozone layer?

Dr. DARRELL RIGEL (Dermatologist): Well that's another controversial point. I'm
one of those who believe that it has. Again, if you look at the data on
melanoma rates in areas where there's clearly been some ozone depletion - so
for example, in the southern part of Chile, which is an area that normally you
wouldn’t expect to have too much skin cancer, but over the last 15 years - is
they map each year the ozone hole. They get their ozone hole in early spring,
which for them is October, and you see sort of a peak each year going higher
and higher, and higher for skin cancer rate. And certainly, in Southern
Australia and Tasmania and that area in Southern New Zealand, in fact, you do
see some rates higher than you'd expect and increases more rapidly than you see
elsewhere in the world. So I think that is contributing, but it’s really not
the only factor and probably not the major factor, certainly in the U.S. at
this point.

GROSS: Then what is?

Dr. RIGEL: Well when you look at the data in the U.S., I think the one
measurable factor is the use of tanning beds. And what's interesting is if you
look at the data for both man and for women by age and compare though the data
from the late 1980s to the late 1990s, almost all the increase of melanoma in
men and in women where people, 45 and older, and again it was expressing the
damage that they did 10 or 20 or 30 years earlier. But the young people, the
rates were pretty steady and you're still seeing that same trend in young men.
But in women you're starting to see a marked increase in women in both
melanoma, in their 20s, 30s, and into the early 40s which you don't see in men.
And the one factor that is different between men and women - young women - is
the use of tanning beds.

And the tanning industry is very large. There are about oh, a quarter of a
million tanning beds in the United States. At least the tanning industry's own
data is that about a million Americans go to a tanning bed everyday. I mean
that's phenomenal number when you think about it. But that has to add up over
time and the tanning industry really started in the U.S. It's been 20 years or
so. Probably the first tanning bed in the U.S. was about 30 years ago, but
really it was in the 90s when it started to ramp up a little bit. So we’re just
beginning to see the results of the tanning exposure from tanning beds as
again, with that latency of 10 to 20 years, we’re beginning to see the effects
of it. But they're now studies coming out showing if you use the tanning bed,
your risk of melanoma is greater, your average age that you get your melanoma
is younger, the risk of getting a second melanoma is greater, you tend to get
melanomas in areas where the sun might not normally shine but does shine when
you're in the tanning bed. And I could go on and on with these studies. So
there's clearly an association. I call the tanning beds, actually tanning
coffins. I think that's a better description for them.

(Soundbite of laughter)

Dr. RIGEL: But the reality is that it’s not a good thing to do and it's very
analogous to cigarette smoking in the sense that it always pays to stop.

GROSS: Are fair skinned people - well I know that fair skinned people are more
prone to sunburn, but does that mean they're also more prone to skin cancers?
And conversely, are dark skinned white people and people of color less prone to
skin cancers if they’ve been in the sun?

Dr. RIGEL: Well that's a great question and it’s a very important one for a
number of reasons. First of all, in general, the fairer skinned you are the
more easily you sunburn, the less easily you tan, the greater the risk of
getting skin cancer. However, even the darkest skinned individual's at risk.
They just have a lower risk than the fair skinned individual. Roughly the data
on melanoma is that the risk of a Hispanic American getting melanoma is about
one-sixth that of a Caucasian, and of an African-American it’s about 125th that
of a Caucasian. But note that it’s not zero. What is interesting in people of
color is that they typically will get their melanomas in little different
distribution. So often they get them on the palms and soles and not get them as
much in other areas. They can, but that's typically where you see them. And why
this is interesting, the incidents or the risks of getting melanoma on the
palms and soles is the same across all races, whether you're Oriental,
Hispanic, African-American descent or Caucasian, you're risk is about the same
for that.

Of interest though, is that certainly the Caucasian's, you're likely to get
melanoma in other places, but if you just looked at melanoma at the palms and
the soles the incidents is about the same across all races. And this has led
scientists, especially Dr. Boris Bastian, who is a dermatologist researcher at
the University of California in San Francisco to hypothesize that there may be
more than on kind of melanoma, and he has some genetic studies that he's doing
to support that. So we may find that there's one kind of melanoma that's - you
see more often that's more sun-dependent and there's other kind that may be due
to more genetic predisposition. We’re only scratching the surface of this
research, but in fact, it's interesting and it might play out quite positively
in the future.

GROSS: Now you know we’ve been talking about skin problems including skin
cancers that are caused by exposure to the sun. One of the things that you
specialize in is the aging skin. So while we’re on the subject of aging skin,
what do you think of anti-wrinkle creams?

Dr. RIGEL: The reason your skin wrinkles is because the tissue that supports
the skin, what we call the connective tissues, weakens over time. And they're a
bunch of things that can weaken it, sun exposure is one. If you take the skin
and let's say - I'm not advocating doing this, if you did a biopsy of the skin
of a baby's rear end, something that's never seen the sun, and you use special
stains on that biopsy to see the - what we call the elastin tissue or the
fibrous tissue underneath the skin - the supporting tissue, it would look like
almost like a deck of cards that you cut in half and half shuffle and half
pushed together so you’d have a whole bunch of interleaved parallel fibers that
were perfectly lined up.

If you took the same type of biopsy, let's say on a 50-year-old who on their
forearms and had a lot of sun over the years, it would look like a ball of
spaghetti because all the fibers would be disoriented and pulling and
array(ph). And that's really one of the reasons why your skin wrinkles, why it
ages, why it loses its tone, all those things, what you see. So you know in a
sense that's probably the biggest issue you have, and these anti-wrinkles
creams are at least allegedly designed to try to give you back some elasticity
to your skin. It's very hard to do it and it's not even with you know the
Vitamin A derivatives, Retin-A and the other, retinoids which are Vitamin A-
like substances, it helps a little bit. You know if you have fine lines and
wrinkles with the cream-wise, maybe you get a five percent improvement or a 10
percent improvement. It's not going to work for deep lines really at all. It
might work for those little fine lines around your eyes and help a little bit
for that, but once you’ve got the deep lines, no cream is going to work very
effectively.

GROSS: Well Dr. Rigel, thanks so much for talking with us.

Dr. RIGEL: It’s been my pleasure to be here.

GROSS: And have a good summer.

Dr. RIGEL: You too.

GROSS: Thank you.

GROSS: Dr. Darrell Rigel is a clinical professor of dermatology at NYU Medical
Center and former president of the American Academy of Dermatology.

Coming up, a new biography of Donald Rumsfeld. We'll talk with the author,
former Washington Post Pentagon correspondent, Bradley Graham.

This is FRESH AIR.
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New Biography Examines Rumsfeld's 'Rules'

TERRY GROSS, host:

Donald Rumsfeld has pretty much kept out of the public eye since resigning as
secretary of defense in 2006. A new biography examines his life and career in
great detail. The book is called "By His Own Rules: The Ambitions, Successes
and Ultimate Failures of Donald Rumsfeld." My guest is the author, Bradley
Graham. He's a former Pentagon correspondent for the Washington Post and
covered Rumsfeld during his tenure as secretary of defense. Graham says the story of Donald Rumsfeld is an exceptional personal drama that has had profound
consequences for the U.S. and the world.

Bradley Graham, welcome to FRESH AIR. If you were summarizing your book with
one headline, what would the headline be?

Mr. BRADLEY GRAHAM (Author): I think it would have to play off this notion of
Rumsfeld as a tragic figure. You know somebody with a lot of potential who
undid himself. And so I’d probably come up with a headline something like
brilliance, undone by arrogance. He had so much talent going into this job. He
was so well prepared for it. He's the only one who ever had been given a second
chance at being secretary of defense. You know he was secretary under Gerald
Ford too and at that point he was the youngest secretary of defense. Under
Bush, he became the oldest secretary, and for all his skill and knowledge, he
ended up six years later very unpopular and ultimately compelled to step down
from office.

GROSS: It’s hard to remember the days when a lot of people thought of him as
like a stud, you know, a stud or an uncle, when he was really popular among
some people during the early days of the war.

Mr. GRAHAM: Oh I know. The Afghanistan War and the 9-11 attacks really
transformed Rumsfeld. It's hard to remember, but he, just before then, was
really in political trouble. He had in his first months as secretary had
alienated a lot of military brass, members of Congress, others in the Bush
administration. There was a lot of speculation that Rumsfeld would become the
first Bush cabinet casualty. But the Afghanistan War transformed him into a
secretary of war and put Rumsfeld into the position of playing a leading role.
He was - he became the public face and voice of the U.S. military at war. And
these press conferences that he gave allowed him to put on display his skills
as a spokesman. You know he very quick-witted and blunt and knowledgeable, also
amusing an entertaining.

He came across as anything but the conventional bureaucrat in the sense that
you know he avoided euphemisms like collateral damage, but spoke about actually
killing the enemy. He became so popular that with millions tuning in to watch
his news conferences that Bush nicknamed him Rumstud(ph) and U.S. News & World
Report dubbed his style Rum punch. But there was more than just theatrics
involved in his performances because this surge in popularity that he enjoyed
helped strengthen his own primacy within the Pentagon, in that he would often
appear at the Pentagon podium with the Joint Chief of Staff, General Dick
Myers, and he overshadowed Myers considerably in these news conferences,
seemingly relegating the role of chairman to one of more sort of a military
assistant to the secretary.

GROSS: Now you write in your book that unlike some people in the Bush
administration, Donald Rumsfeld didn’t really believe in the principle of
invading Iraq to spread democracy through the Middle East. He said at the time
that he believed Iraq had weapons of mass destruction and we had to go in and
take care of that. But knowing what we know now, about how flimsy that evidence
was, that there was actually weapons of mass destruction in Iraq, it’s hard for
me to believe that he really believed it at the time. I mean again, considering
how flimsy the evidence was, how much of it came from sources who were
completely unreliable, who the CIA knew was unreliable - do you feel like you
have any further understanding, any deeper understanding of what Rumsfeld
really believed at the time about WMD in Iraq?

Mr. GRAHAM: I think he really did believe it. And it’s one of the great
paradoxes about him, particularly even more than any of the other senior
administration officials, because for years he had warned others about the need
to avoid what he called the sort of poverty of expectations and sort of try to
gauge into the future and anticipate things that might happen. He was very fond
of passing around an essay from a book on the Pearl Harbor attack that made
just this point, that one should be very careful about falling into the traps
of believing the conventional wisdom, the conventional intelligence, and always
challenge and press for more. And Rumsfeld was known for asking lots of
questions and for doubting and challenging. But strangely, he did not press on
this point or certainly didn’t press enough on this issue of weapons of mass
destruction, maybe because it just seemed so unrealistic that Saddam Hussein
would not have them, given the way he was acting, and given how all the major
intelligence groups in the world were asserting that he most likely did.

GROSS: There were complaints within the Pentagon about Donald Rumsfeld's
leadership. What were some of the things he did that upset the Pentagon
leadership most? What were their biggest complaints?

Mr. GRAHAM: Well one was his seeming dismissiveness of the Joint Chiefs of
Staff which is comprised of the heads of the military services, the Army, Navy,
Air Force, and Marine Corps. Rumsfeld came into office very determined to
assert civilian control. He had the view that the military under the previous
Clinton administration had gotten too much of what it wanted and that civilians
had not been able to exert the kind of decisive leadership that they should.
And in subsequent months and years the sense that the chiefs had of being
marginalized only increased. They felt left out of a lot of the war planning
and not really consulted in the way that they felt they should have been. But,
in addition to Rumsfeld's short circuiting the joint chiefs, it was, there was
a lot of concern about his style in dealing with senior military. He often came
across as abrasive, as impatient, as arrogant.

He defends his manners saying that the big leagues, as they were in, these
senior officers with stars on their shoulders should have been able to take his
questioning and his challenging. But, they felt that it bordered really on the
discourteous and they really resented his manner in many of their contacts with
him.

GROSS: My guest is Bradley Graham, he's written a new biography of Donald
Rumsfeld. It's called "By His Own Rules: The Ambitions, Successes, and Ultimate
Failures of Donald Rumsfeld.” Graham is a former Pentagon correspondent for the
Washington Post and he covered Rumsfeld when Rumsfeld was Secretary of Defense.
When Rumsfeld was arguing on behalf of invading Iraq and talking about how they
had weapons of mass destruction and, you know, they couldn't get away with
that, a photo started circulating all over of Rumsfeld shaking Saddam Hussein's
hand. And this was during the Reagan administration when Rumsfeld was the
special envoy to the Middle East. And he had paid a visit to Saddam Hussein,
who – and Saddam Hussein had already gassed the Kurds. So, we knew that he not
only had WMD, but that he had used it. So, there's a picture of him shaking
hands. What kind of deal was he trying to make then with Saddam Hussein?

Mr. GRAHAM: There was interest at that point, in 1983, in restoring ties with
Iraq and Saddam Hussein on his part was interested as well. I mean, relations
had been put on ice by Saddam Hussein in the Iraq-Iran war. It's not clear how
much Rumsfeld knew about Iraq's use of chemical weapons at that point. But, he
was under instruction certainly to facilitate resumption of ties with Saddam
Hussein and very happy to do so.

GROSS: And this had to with oil?

Mr. GRAHAM: Well, oil was a consideration and they did discuss, during
Rumsfeld's meetings in Iraq, the opening of the flow of oil and even
construction of another pipeline. But, basically the Reagan administration was
interested in the resumption of ties as a sort of counterbalance to Iran's
influence in the region.

GROSS: Did - in your interviews with Rumsfeld - did you get any inkling into
whether he felt at all hypocritical about working with Saddam Hussein as an
ally, during the Iran-Iraq war? You know, going to Iraq, shaking his hand,
trying to make a deal about a pipeline after Saddam Hussein had already used
gas against the Kurds - and, you know, flash forward to after 2001 and he's
making the argument that, no, we have to invade Iraq because Saddam Hussein has
WMD. Did you get a sense of whether he felt that there was any contradiction
there?

Mr. GRAHAM: Certainly the existence of the photos of that meeting were an
embarrassment to Rumsfeld 20 years later when the U.S. was planning to go to
war, but I never got the impression that he regretted it. It was a case in his
mind of U.S. policy having changed over those two decades.

GROSS: President Bush officially accepted Donald Rumsfeld’s resignation right
after Election Day in 2006. Bush had, shortly before that, asked for the
resignation. Was Donald Rumsfeld surprised when he was asked for his
resignation and was he ready to resign?

Mr. GRAHAM: From what I was able to learn in conversations with Rumsfeld
himself, with his wife Joyce, and with others in the administration, he
expected that he would have to leave particularly if the elections resulted in
a change of power in Congress. What he didn’t anticipate was how swift the end
would come. Bush seems to have made his decision several weeks before the
election, or at least set up a very small group within the White House to plan
the replacement for Rumsfeld. And they decided to have it take place on the day
after the election. Rumsfeld was not a part of that planning and so the end
came very suddenly for him. He has not expressed any resentment about that but
his friends and family thought he deserved better. But in any case he knew
pretty much that he’d be leaving.

GROSS: From your conversations with Donald Rumsfeld, did you get the impression
that he had any doubts about how he handled the war in Iraq, or the war in
Afghanistan for that matter?

Mr. GRAHAM: He was very dismissive. He said, oh, that’s, you know, that’s a
favorite press question and he didn’t really want to get into it. I think part
of that really is because he himself isn’t sure. He hasn’t worked through in
his own mind what he thinks about some of these questions. He’s writing his own
memoir, which is due out in the fall of 2010. And he’s struggling. He’s really
struggling. He’s trying to remember a lot of things. And I don’t think he’s
resolved in his own mind really what to think.

GROSS: Bradley Graham is the author of a new biography of Donald Rumsfeld
called “By His Own Rules”. Coming up music from Mali, this is FRESH AIR.
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Oumou Sangare: Star-Studded Sounds Of Mali

TERRY GROSS, host:

Oumou Sangare is a singer from Mali who’s gone from an outsider, who sang about
taboo subjects like polygamy and forced marriage, to a major national
celebrity.

Milo Miles has a review of her new album.

MILO MILES: “Seya” is Oumou Sangare’s first album in six years and it’s a
landmark. It shows she’s not just the finest female singer in Mali, but the
African queen of soul. “Seya” is also the culmination of a musical evolution
that was under way when Sangare first recorded in 1989. Like Amadou and
Mariam’s “Welcome to Mali,” also released this year, “Seya” represents a fully
mature, new type of African popular music. It is neither folkloric nor fusion.
It neither caters to western sounds nor ignores them.

It could only be created within today’s global culture. Yet every moment of
“Seya” reflects the joyful seriousness and serious joy of Oumou Sangare’s
personality. That’s why she’s the queen.

(Soundbite of song, “Kounadya”)

Ms. OUMOU SANGARE (Singer): (Singing in Foreign Language)

MILES: As she always has, Sangare offers lyrics well worth reading. She
addresses native social tensions either through frank admonition — girls
shouldn’t be sold into marriage before they have breasts, or sly animal fables
— dogs shouldn’t get mad at turtles because they can’t bite the shell. No
matter what mode she chooses, Sangare sounds a bit more polished, a bit more
precise and at ease than ever before. The sessions feature guest players
including African stars like drummer Tony Allen and guitarist Djelimady
Tounkara, as well as American horn veterans Fred Wesley and Pee Wee Ellis. But
nobody takes over a tune, the queen commands seamless integration.

(Soundbite of song, “Wele Wele Wintou”)

Ms. SANGARE: (Singing in Foreign Language)

MILES: Like many African performers who establish an international career,
Sangare has become almost a one-woman industry at home. She’s involved in
charities, car imports, running a hotel and being a full-time fashion plate.
The title song is all about spreading fun around, being sexy and selecting
fabric and clothing designers.

(Soundbite of song, “Seya”)

Ms. SANGARE: (Singing in Foreign Language)

MILES: Oumou Sangare has earned the right to celebrate her stardom. Besides,
she sounds humble in the face of good fortune and evokes community far more
than ego. But where do you go from the top? What comes after the big time?
Sangare is an unusually careful and deliberate creator. “Seya” presents
masterful music and a superb summation of her achievements. But Sangare’s
greatest challenge will be to find the next step.

GROSS: Milo Miles reviewed “Seya” by Oumou Sangare. She begins a U.S. and
Canadian tour July 2nd in Chicago.

I’m Terry Gross.
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.