Medical Community Applauds CVS' Plan to Halt Tobacco Sales

Troy Brown, RN

February 06, 2014

Clinicians and medical societies alike are commending CVS Caremark's decision to stop selling tobacco products in its pharmacies by October 2014, as announced yesterday in a company statement.

CVS Caremark Chief Medical Officer Troyen A. Brennan, MD, MPH, and Steven A. Schroeder, MD, from the Smoking Cessation Leadership Center, University of California, San Francisco, discussed the move in an opinion piece published online February 5 in JAMA.

Smoking is responsible for more than 480,000 deaths each year in the United States, with an estimated $132 billion in direct medical costs and $157 billion in lost productivity, the authors write.

"It has been 50 years since the first Surgeon General's Report linked smoking and poor health, increasing our understanding of the devastating health and financial burdens of tobacco use. As pharmacists step up to provide care to their patients, we cannot continue to sell known health hazards in our pharmacies," Steven T. Simenson, American Pharmacists Association president and community pharmacist, said in a statement. "To improve the health of all Americans, pharmacy professionals must step up and join the many pharmacies before them who have removed tobacco products from their shelves."

Increases in tobacco taxation, legislation to create smoke-free public areas, and growth in support for smoking cessation have helped, but reduction in the smoking rate has slowed in the last decade, the authors write.

Public health advocates have also focused on making smoking less socially acceptable. The ban on smoking in outdoor public spaces in New York is a highly publicized example of "denormalizing" tobacco use, but selling cigarettes in pharmacies "renormalizes" them by sending the message that they must not be that unhealthy if they are available where medicines are sold, the authors write.

Tobacco products are typically kept in the front of stores near the checkout counter, and the fact that they will not be there is making a strong statement, Mary O'Sullivan, MD, director of the Smoking Cessation Clinic at Mount Sinai St. Luke's Hospital in New York City, told Medscape Medical News.

"Public Health Above Profits"

"For once, the big bucks aren't the winner...the patient is the winner here," Dr. O'Sullivan said.

The sale of tobacco products produces more than $1.5 billion in revenues annually for CVS, but that gain is "outweighed by the paradox inherent in promoting health while contributing to tobacco related deaths," Dr. Brennan and Dr. Schroeder write.

"Today's decision by CVS Caremark is an important step forward in reducing access to these deadly products, and we applaud their courage to put public health above profits," American Heart Association Chief Executive Officer Nancy Brown said in a statement. "We recognize that $2 billion in tobacco sales represents a significant sum for CVS Caremark, and that makes this decision even more admirable."

"CVS is setting an important example putting public health above profit. Tobacco use remains the leading preventable cause of disease, disability and death in the U.S., including an estimated 40 percent of all heart disease cases. The [American College of Cardiology] agrees with CVS that this is the right thing to do and tobacco products have no place in a setting where health care is delivered," American College of Cardiology President John Gordon Harold, MD, said in a statement.

"A Bold Step"

For pharmacies to sell tobacco products was always an error, Dr. O'Sullivan said. "Pharmacists are medical providers. You can't sell something that is responsible for so many deaths in a pharmacy — it's just absolutely unthinkable."

"We know that policies that restrict access to tobacco products, reduce exposure to tobacco advertising, and limit the places that people smoke have a direct effect on reduced smoking rates, especially among youth," John R. Seffrin, PhD, chief executive officer of the American Cancer Society, said in a statement. "[T]hat's what makes this move so significant: community pharmacists play a key role in health and wellness and CVS Caremark has taken a bold step to demonstrate its commitment to healthy lifestyles and the prevention of disease."

"The tobacco industry controls so much. They control advertising, they are so able to insinuate themselves into the lives of young people, the lives of everyone," Dr. O'Sullivan said.

"The Lung Association commends company leaders for their forward-thinking decision to prioritize the health and well-being of current and future customers and employees and for helping create a tobacco-free generation of youth," Harold Wimmer, national president and chief executive officer of the American Lung Association said in a statement. "We urge more retailers to take note of CVS Caremark's actions and join in efforts to help reduce access to tobacco and tobacco use, and eliminate tobacco-caused deaths and disease."

"CVS Caremark should be commended for its courageous decision to stop selling tobacco products in all of its pharmacy stores. The oncology community is extremely grateful that CVS Caremark recognized that support for tobacco use has no place in any health care facility and took action. We hope this is an inspirational example of corporate responsibility for others to follow," American Society of Clinical Oncology President Clifford A. Hudis, MD, said in a statement.

"They should promote electronic cigarettes at the same time they remove conventional cigarettes," Sally Satel, MD, resident scholar, American Enterprise Institute for Public Policy, Washington, DC, told Medscape Medical News. Dr. Satel is a practicing psychiatrist and lecturer at the Yale University School of Medicine, New Haven, Connecticut.

CVS made no mention of electronic cigarettes in their announcement.

Dr. Brennan is a salaried employee of CVS Caremark and also holds stock and stock options from CVS Caremark and the University of California, San Francisco. Dr Schroeder, Dr. O'Sullivan, and Dr. Satel have disclosed no relevant financial relationships.

JAMA. Published online February 5, 2014. Full text

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