Medscape interviewed Tom Frieden, MD, MPH, Director of the US Centers for Disease Control and Prevention (CDC), about the announcement that CVS Caremark Corporation will stop selling tobacco products at its 7600 stores by October of this year. We asked Dr. Frieden what this will mean for smoking prevention and cessation efforts nationwide.
Medscape: The big news today is that CVS Caremark Corporation has decided to stop selling tobacco products by October of this year. What is your reaction to this news? Do you believe that this will put pressure on other retailers to do the same?
Tom Frieden, MD, MPH, Director, US Centers for Disease Control and Prevention
Dr. Frieden: We're delighted that CVS has done this. It's a great step. I think they've recognized that trying to be both a healthcare facility and selling tobacco is just a paradox that's unhealthy and untenable. And I join Secretary of Health and Human Services Kathleen Sebelius in hoping that others will follow their lead.
Medscape: When I practiced long ago, hospital patients (and staff) could smoke inside the hospital! In 2014, we could never even imagine such a scenario. For pharmacies to take this step seems like a natural, necessary, and perhaps long overdue progression. Pharmacies have become more of a healthcare setting than a retail sales setting, with onsite urgent and chronic care clinics, and pharmacists offering immunizations and counseling. When pharmacies decide not to sell tobacco products, is the primary benefit the reinforcing of the social unacceptability of tobacco?
Dr. Frieden: I think that is important. In fact, one of my first jobs was in a mental health hospital where we were still using tobacco as a behavior modification modality -- as in, "If you behave well you can get 5 cigarettes." It's a very shameful history of the healthcare sector. When we look back at advertisements from the 1950s of doctors recommending one brand or another of cigarettes, they look completely anachronistic to us. And I think that in a few years we'll look back on pharmacies selling tobacco in very much the same way.
It's important that this happened for 2 broad reasons. First, the fewer places that sell tobacco and advertise it in their stores, the fewer kids who smoke, it appears. Second, we don't want the halo of healthcare provision to rub off in any way on the deadliest legal product that we have out there -- tobacco.
Medscape: Do you think that other retailers (pharmacies, grocery stores, or big-box stores) will follow CVS's lead?
Dr. Frieden: I'm optimistic that others will follow the lead of CVS. I think CVS has done a great thing in deciding that it will no longer sell tobacco products, and I hope others do follow their lead.
Medscape: To back up a little, how many people in the United States still smoke? How much illness and death is related to smoking in 2014?
Dr. Frieden: More than 40 million Americans still smoke, and tobacco use remains the leading preventable cause of death in this country. It causes 480,000 deaths per year and many times that number of severe illnesses. The Surgeon General's report just released a number of new statistics on this; your readers may want to review the very latest facts.
Medscape: You recently wrote an opinion piece that was published in JAMA on tobacco control progress and potential. Can you talk a bit about what else should be happening in the United States to reduce/prevent smoking?
Dr. Frieden: Broadly, there are 2 things that we need to do. First, we need to implement what we know works; in all too many places that's not yet happening. Second, we need to find new ways to help people quit smoking and prevent kids from starting. So we need to both maximize our currently proven interventions and continue to innovate new ways to protect our communities and our kids from smoking. Unless we take urgent action, 5.6 million kids alive today will be killed by tobacco.
Medscape: There is a whole armamentarium of tobacco prevention and cessation resources provided by the World Health Organization, called MPOWER. Would you describe that initiative and tell us what you believe the United States could expect if we implemented some or all of the MPOWER measures?
Dr. Frieden: If the United States implemented the recommendations in MPOWER, we would have millions of fewer smokers in this country. Even CDC's "Tips" campaign, which we were able to run for only 12 weeks in its first year, resulted in at least 100,000 Americans permanently stopping smoking. If we were able to fully implement all of the aspects of these initiatives, we could drive our tobacco rates down enormously. And just to put it another way, if the national rate of smoking in the United States were as low as in some of the communities that have been most effective in smoking prevention and cessation efforts, there would be 15 million fewer smokers in this country, and that would save millions of lives in the future.
Medscape: That is very impressive. Do you have any final comments for Medscape's clinical readers?
Dr. Frieden: Yes. I have one key thing to say: Everyone who wears a white coat as a healthcare provider should be an advocate for tobacco prevention and control. That means a few things. First, ask patients about smoking, counsel smokers to quit, and prescribe US Food and Drug Administration-approved medications for every adult, nonpregnant smoker who wants to quit. Second, be involved in your community and your worksite to help make it one of the places that is protecting kids against tobacco, to stop this horrendous epidemic that we're still living through. This is an epidemic of illness, disease, and death caused by tobacco. Why do this? Because most Americans who've ever smoked have already quit; because most smokers want to quit; and because every smoker can quit, and every kid can grow up smoke-free.