The Bible condemns them. The ancient Romans shunned them. Today, twenty one percent of all Americans have at least one of them! Here are the results of Spanking FIT’s evaluation of the modern health science relevant to the tattooing craze; but, first some historical perspective:

History of Tattoo Taboos

The Book of Leviticus is one of the first five books of the Old Testament and is believed to have been compiled between the 7^th and the 3^rd centuries B.C.E. There, in Chapter 19 verse 28, it is written: “do not cut your bodies for the dead, or put tattoo marks on yourselves. I am the Lord.” Notice that Leviticus condemns tattooing alongside the practice of “cutting the body for the dead”, the latter referring to an extremely dangerous, although common, ancient custom of making deep gashes on the face or arms during times of bereavement. Despite Hollywood depictions of the ancient Romans as being a tattooed race, tattooing was generally frowned upon during the time of the Roman Empire. It was primarily reserved involuntarily for slaves and for convicts. There is, however, some evidence that members of the Roman Legion may have practiced it; but, only in conjunction with strict sanitary procedures. In 316 A.D., Constantine the Great, the first Christian Emperor of Rome, banned the practice of specifically tattooing the face; but, it was not until 787 A.D. that Pope Hadrian I issued a formal decree against all tattooing which had the effect of severely limited its practice throughout the Western world for centuries.

Later in the New World (specifically in the 16^th and 17^th centuries), Leviticus-quoting Puritans of New England claimed there was an association between tattooing and satanic rituals, and strongly condemned the Native Americans for their prolific tattooing practices.

Today, especially in the U.S.A. and including New England, tattooing is an extremely popular activity. According to recent 2012 Harris poll results (harrisinteractive.com), 21% of all U.S. adults have at least one tattoo. (That translates into over 50 million tattooed Americans!) 23% of U.S. women and 19% of U.S. men have tattoos. There’s a 30% tattooing rate for persons 25 and 29 years old, and a 38% rate for those between the ages of 30 and 39. Similar statistics apply in Canada. According to University of British Columbia News, a surprising 8% of all Canadian high school students have at least one tattoo, and 21% of those who don’t have one yet, want one.

Based on historical review, taboos against tattoos originated long ago in the social and religious teachings of ancient western and middle-eastern civilizations. But, were they totally irrational in nature; or, possibly based on the accumulated empirical knowledge of learned men over time? Let’s begin with current oversight and the known modern health hazards of tattooing.

Health & Safety Oversight of Tattooing-Is Anybody Watching?

Spanking FIT began by investigating whether or not national health and safety oversight regarding the practice of tattooing presently exists in the United States. Interestingly, despite active involvement on the part of the federal government in almost all health and safety matters, we found that there is no standardized certification for, and no governing body that supervises the health practices and safety of the nation’s tattoo parlors. (Please note that Spanking FIT is not advocating one) Although the U.S. Food and Drug Administration (F.D.A.) regulates tattoo inks, it does not regulate the actual practice of tattooing. In general, tattooing is regulated by local jurisdictions, only (i.e. cities and counties). Some major locations such as New York City do not even require licensing for tattoo parlors, although the individual tattoo artists themselves are required to be licensed. (Individual tattooists are required to pay fees and pass a three hour infection control course.) Throughout the U.S., very few requirements exist for inspection of tattoo parlors or for record-keeping . Regarding the tattooing of minors, it appears that most states do have prohibitions; but, law enforcement is considered by many to be lax, and seldom is there a requirement for informed consent in places that permit tattooing minors. Given the role that money from local businesses plays in city and county politics, these facts are hardly surprising.

Common health hazards of tattooing

The medical risks of injecting foreign substances into the skin are well known: bacterial, viral, and fungal infections, as well as allergic reactions. The likelihood of infection is especially higher if equipment is unsterilized and/ or needles are reused. Diseases such as hepatitis and A.I.D.S. may be transmitted. Blood splatters can contaminate inks sold in bulk economical containers. Furthermore, the human skin is itself teaming with organisms and individuals can easily become infected with their own bacteria through piercing of the skin. In addition, some inks may contain toxic chemicals. In the U.S., some commercially sold inks have been found to contain azo and plastic pigments used in car paint. These same pigments are outlawed in Europe on the grounds of being carcinogenic.

Infectious outbreaks traced to tattooing in the U.S.

Numerous infectious outbreaks have been traced to tattooing in the U.S.  For example in September of 2012, it was reported in the New England Journal of Medicine that 19 people who contracted a mycobacterium chelonae infection, and who became ill, were found to have received tattoos at the same parlor in Rochester, N.Y. The infection source was discovered to be contaminated premixed grey ink.  That same journal has reported methicillin resistant staphyloccus aureus (M.R.S.A.) infections that originated with tattooing.                 The federal Food & Drug Administration website (fda.gov) maintains that “inks used in certain tattoo kits cause infection”. They claim to have even found bacterial contamination in completely unopened bottles. They also warn of the possibility of blood poisoning or “sepsis” from contaminated ink.

Commercial tattoo parlors have for decades also been implicated as a mode of transmission for hepatitis B viral (H.B.V.) epidemics that usually are discovered when ten to twenty persons with acute symptoms are found to share one thing in common: each received a tattoo from the same artist in a relatively short time frame, and either the tattooist herself, or a preceding customer, was found to be positive for the H.B.V. virus. Faulty techniques identified include reusing of needles or dyes, inadequate equipment sterilization, or other breeches of aseptic technique such as licking of needles or testing them out on the back of a hand.

Despite an abundance of recorded case examples linking commercial tattooing to diseases such as hepatitis, Spanking FIT was surprised by the fact that very few large-scale epidemiological studies formally investigating this link have been conducted in the U.S. (Many have been conducted abroad.) The exceptions are noted in the next section:

Is commercial tattooing a significant source of hepatitis C infection?

The New York Study & C.D.C. reaction

In January 2013, Fox News ran the following headlines in its online health section (foxnews.com/health/): “Hepatitis C Linked to Tattoo Ink”. Their news item was based on a serious research publication: “Association of tattooing and hepatitis C virus infection: a multi-center case control study” by K. Carney, et al., published in Hepatology, also in Jan. 2013. The article reporters for Fox explained that the hepatitis C virus (H.C.V.) infection is the most common blood-borne infection in the U.S. affecting over three million people. It is a leading cause of liver cancer, liver cirrhosis, and resulting liver transplantations. In 2007, hepatitis C surpassed H.I.V. as a cause of death in the United States. These New York based researchers conducted a large case-controlled study where they compared a sample of 1,930 patients who tested positive for H.C.V. with another sample of 1,941 “controls” who were H.C.V. negative. The samples were obtained from two sources: New York V.A. Health System, and N.Y.U.-affiliated Bellevue Hospital. The researchers used the data to look back retrospectively and compared the frequency of patient exposure to certain risk factors in the positive versus the negative sample, including tattooing. What was exceptional about this study was the quantity of data originally acquired. It was large enough so that meaningful comparisons could be made even after removing patients with a history of IV drug use and those who had received blood transfusions prior to 1992, when screening criteria were non-existent or weaker. (Both IV drug use and blood transfusion are considered significant causal factors for becoming H.C.V. positive.) Using the basic statistical technique called logistic regression, the researchers inferred from their data set that the odds of someone being tattooed among the H.C.V. positive patients were about five times greater than for the H.C.V. negative.

A couple of weaknesses immediately stood out to us: (1) the researchers did not inquire in their patient survey whether or not there was any health care employment history on the patient’s part. Such employment is regarded as a risk factor for H.C.V. (2) Even more importantly, their survey did not inquire into the tattooing source, so that among H.C.V. positive patients were those who received tattoos from “non-professional” sources such as prison incarceration. Nevertheless, Scott Holmberg, M.D. who is Branch Chief at the Centers for Disease Control (C.D.C.) is quoted as saying: “In the U.S., there have been no reports of hepatitis C outbreaks linked to tattoo parlors.” He recommends that people have their tattoos done by “trained professionals, only.” On the C.D.C. website (cdc.gov) he states “homemade tattoos under unsterile conditions may confer a risk (e.g. Australian prison).” It appears that an inference may be made from Dr. Holmberg’s statements that obtaining a tattoo “professionally” from a commercial tattoo parlor is safe.

The Texas Study & its implications

Since very few Americans obtain their tattoos in Australian prison, Spanking FIT decided to conduct a careful literature search to see if any epidemiological work had been previously performed regarding specifically commercial tattooing. We came up with: “Commercial tattooing as a potentially important source of hepatitis C infection” by R.W. Haley, et al. of the University of Texas that was published in Medicine, March 2001. This study was conducted over twelve years prior to Dr. Holmberg’s statements! The Texas study sample consisted of 626 patients at South Western Medical Center who were undergoing treatment unrelated to H.C.V. The researchers used logistic regression to identify and quantify risk factors. Four major risk factors for H.C.V. infection were identified: (1) IV drug use for one year or longer, as expected (2) whether or not the subject was a male ancillary hospital worker. Primary hospital work did not seem to confer risk. (3) beer consumption, and (4) tattoos obtained from a commercial tattoo parlor. Tattoos from other sources were considered separately. It is interesting to note that in this study, blood transfusion experience was not revealed to be a significant risk factor. The researchers concluded that subjects who were “professionally” tattooed at commercial parlors were between six and seven times more likely to be H.C.V. positive than the rest. They estimated the population attributable risk factor for H.C.V. infection of commercial tattooing at 30%. Applying that statistic to the three million H.C.V. infection number, and you infer a staggering 900,000 Americans who were infected as a consequence of receiving a so-called “professional” tattoo!

Now, the Texas study is not without its statistical flaws, either. For example, it is mentioned that out of the 420 patients without tattoos who were not IV users, and who were not beer drinkers, and who had no relevant hospital employment, 5 were H.C.V. positive. The study does not state how many were positive among those with tattoos and with the same conditions applied. That information, if yielding statistically significant results, would have led to a more direct and convincing comparison than theirs based on logistic regression. Perhaps, sample size was insufficient to do so? They didn’t say.

Spanking FIT’s health advice to those personally considering getting a tattoo (or to parents of “tweens” wanting one)

The sexiest and healthiest body art is attainable naturally through physical exercise. Just read: “How to Safely Acquire Six Pack Abs“. or “Healthy Body Art for the Boys & Girls” in our Fitness &Workouts category. Flat abs, tight butts, and naturally developed bosoms are far greater turn ons than the arrows, humming birds, and world map designs acquired at tattoo shops. The ancient Romans and Hebrews clashed vigorously over many social issues including nudity and sex; but, they were in agreement on one thing: tattooing should be taboo! What’s your opinion?  Doctor Garrett

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