Pharmacy tobacco sales and changing social norms

Fifty years have passed since the U.S. Surgeon General first warned about the dangers of smoking: cancer, heart disease, emphysema. Since then, other conditions related to tobacco use have made the list: cancers of the bladder, breast, colon, cervix, kidney, ovary, pancreas, and rectum, as well as oral cancers and leukemia.

The latest Surgeon General’s Report [http://bit.ly/SGR50th] states that smoking rates have dropped since 1965 from a high of 44% of Americans to around 18% today. This has not deterred the tobacco companies from spending over $8 billion on marketing campaigns this year. And some state averages remain miserable. Ohio is still one of the worst states for lighting up. Kentucky and West Virginia are even worse. The Bluegrass State found that its percentage of smoking has actually risen since 1995.

Not only is tobacco more addictive than alcohol or marijuana; deaths resulting from its toxic delivery system outnumber all deaths from HIV, the use of illegal drugs and alcohol, motor vehicle injuries, suicides, and murders combined.

The good news this year is that CVS, the second-largest pharmacy chain in the United States, is kicking the habit by banning all sales of tobacco-related products in its stores. This is especially good news for pharmacists, and many hope that others will follow the CVS example.

Pharmacist and public health advocate Fred Mayer, a Drug Topics board member, said it best: “You can’t advertise yourself as the best pharmacy in town while you sell cigarettes that kill people.”

Asthmador for better breathing

The 1950’s were the golden age of cigarettes, with the likes of Arthur Godfrey and Edward R. Murrow promoting and glamorizing smoking. Both paid the price, dying of lung cancer.

Back then, cigarettes were even promoted on health grounds, with such advertising claims as “Three out of four doctors recommend Lucky Strike.” Drugstores sold Asthmador cigarettes as aids to better breathing. Hospitals were not embarrassed to sell cigarettes on their premises.

Even Ronald Reagan got into the act as an advertising spokesman for Chesterfields.

As a pharmacist, I was active in the tobacco war, both inside and outside the pharmacy, telling patients and others that “smoking is hazardous to your health and wealth.”

In 1993, a man purchased a prescription of nicotine gum from me for $36 dollars. “Man,” he said, “that’s the price of three cartons of smokes.”

I replied, “Consider this. If all the people who smoked threw all their cigarette money down the sewer, they would only be out the money.” 

I used the same logic when lecturing to physicians in China, adding, “You pay for cigarettes twice: when you get them, and when they get you.”

Change is in the air

When I was a volunteer for The American Cancer Society’s Great American Smokeout, held every November, I asked a Walgreens manager for permission to place a Smokeout poster in his front window.

“Take it to the girl up front,” he said. When I showed it to the girl, she said, “He’s just trying to ruin our cigarette sales.”

Long before the CVS announcement, Target, Medicine Shoppe, and many independents were not stocking tobacco. Now change is in the air.

FDA’s new anti-smoking campaign includes images of wrinkled skin to show the costs associated with cigarette smoking. San Francisco and Boston now prohibits tobacco sales in pharmacies citywide. The American Pharmacists Association urges colleges of pharmacy to use as experiences sites for their students only pharmacies that do not sell tobacco products.

I suspect that the topic of voluntary prohibition of tobacco is now being discussed in corporate boardrooms. The rest of us need to exert a greater awareness that cigarettes do not belong in any pharmacy, particularly not in pharmacy-clinics.

Since 1976 Gallup has asked Americans to rate the honesty and ethical standards of all professions. Pharmacists used to achieve the highest marks. Is this the time to prove ourselves once more?

Nicholas Hoeslis a community pharmacist and author in Cincinnati, Ohio. Contact him atnhoesl@yahoo.comandwww.laughterdoc.com.