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When Health Is Your Business: Pharmacies Must Stop Selling Cigarettes

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Upstairs on the VA hospital ward, I took care of patients who were dying, slowly and painfully, from smoking-induced lung disease. I spent rare breaks downstairs in the canteen where patients and care providers smoked, second-hand smoke filled the air and cigarettes were sold at enticingly low prices. As a medical resident in the mid-80s, I was being taught the shameful and paradoxical lesson that it was acceptable to sell cigarettes in the same health-care facility where I spent long hours learning to treat patients being killed by tobacco products.

We've come a long way from those times. VA hospitals no longer sell cigarettes, but many pharmacies have perpetuated this unconscionable practice, even as they clamor to take ever larger roles in health care. Pharmacy chains that fill prescriptions, provide vaccinations and offer medical services continue to send the contradictory message of selling deadly tobacco while purporting to be part of the healthcare delivery system.

We have made important progress in the fight against cigarette smoking, but we have a lot more to do before achieving a cigarette-free U.S. and eliminating the individual and public health scourge caused by smoking. The goal is within reach, but we cannot win the home stretch unless every business involved in health follows CVS Caremark's landmark decision to remove tobacco products from its more than 7,600 pharmacy stores. Describing it as "simply the right thing to do for the good of our customers and our company," CVS raised the bar for corporate social responsibility and challenged corporate America to join the call to action for linking better business to better health.

"Enough is enough!"

Acting Surgeon General Dr. Boris Lushniak exclaimed "Enough is enough!" 11 times during his remarks announcing the January 2014 release of the 50th Anniversary Surgeon General's Report on Smoking and Health. The U.S. cannot continue enduring the suffering and devastation caused by cigarette smoking. Cigarettes are responsible for 480,000 deaths every year, more than 20 million deaths since 1964. Smoking's annual economic burden exceeds $280 billion, including more than $130 billion in direct medical care costs and more than $150 billion in productivity losses. Tragically, 400,000 more youths and young adults started smoking in 2012 than started in 2002. Each year, two new young smokers replace every adult who dies early from smoking.

Smoking can be prevented. Anti-smoking campaigns, ranging from powerful State programs exemplified by California to national efforts including the CDC's Tips From Former Smokers campaign and the FDA's youth initiative, The Real Cost, are critical and have contributed to the dramatic drop in the U.S. smoking rate from 42 percent in 1964 to 18 percent today. But progress has slowed. If trends continue, the nation will not meet the Department of Health and Human Services' Healthy People 2020 objective to reduce cigarette smoking to 12 percent by 2020. The battle is difficult, in part because the tobacco industry spends more than $22 million per day on cigarette advertising and promotion -− and partly because health-related retail outlets continue to sell tobacco products.

CVS transforms the anti-smoking landscape:

CVS has taken an admirable step forward in the fight against smoking. As President and CEO Larry Merlo explained: "Put simply, the sale of tobacco products is inconsistent with our purpose." He envisions a better business future for CVS by trading $2 billion in predictable annual revenues from tobacco shoppers in exchange for potential growth opportunities through "helping Americans quit smoking and get healthy."

This Spring, CVS also will launch a national smoking cessation program.

The exciting news is that competitors and peers are under pressure to follow CVS' lead. CVS catalyzed public scrutiny of the missions and strategies of many health-related businesses. The anti-smoking movement has experienced a breakthrough metamorphosis, evolving from a primarily public health and medical cost crusade into a corporate branding and business positioning imperative. CVS' actions raised a key question: Will all businesses act responsibly, as CVS did, in their desired positions as purveyors of health products and services and match their actions with their rhetoric?

Toward a society free from tobacco-related death and disease:

The U.S. has achieved outstanding progress in the battle to decrease cigarette smoking, through cigarette taxation, public-area smoking bans, anti-smoking awareness campaigns and the increasing social unacceptability of smoking. But we won't finish the job if businesses that claim to be health-related put profits from selling deadly tobacco products above their purported commitment to the health of their customers.

The American Medical Association, American Heart Association, American Cancer Society and American Lung Association oppose the sale of tobacco products in pharmacies. The American Pharmacists Association's official policy urges the "discontinuation of the sale of tobacco products in pharmacies and facilities that include pharmacies," thereby extending tobacco sale bans to warehouse clubs, grocery stores and other chain stores.

While hospitals and many independent pharmacies have stopped selling cigarettes, numerous U.S. pharmacy chains and other "health" businesses still send the mixed messages that I observed so many years ago. Smokers are continuing to die, and young people are continuing to take up the deadly habit. CVS is voluntarily leading the call to action for changing course in America. Every business that is involved in health and health care must now do its part. Time is of the essence; tobacco is an epidemic that must be stopped.