"Now is the time for retailers, perhaps spurred by policy makers, to eliminate sales of cigarettes and other tobacco products by institutions that also have pharmacies," write CVS Caremark Chief Medical Officer Troyen A. Brennan, MD, MPH, and Steven A. Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California, San Francisco, in a new viewpoint published online in the Journal of the American Medical Association.  

While 50 years of tobacco control efforts have greatly reduced the prevalence of cigarette smoking, from approximately 42 percent of U.S. adults in 1965, to 18 percent today, the authors argue that more interventions are still needed. Reducing the availability of cigarettes, as well as reinforcing the "social unacceptability of smoking," particularly in pharmacies which are increasingly known for promoting health, are key steps in this direction.

Pharmacies are moving into the treatment arena with the advent of retail health clinics. According to the authors, there are more than 1,600 such clinics operated by Walgreens, CVS Caremark, Rite Aid, Target (which does not sell cigarettes), Walmart, and many chain grocery stores. "Yet nowhere else in health care are tobacco products available in the same setting where diseases are being diagnosed and treated," they write.

In light of these trends, the authors note that CVS has decided to cease tobacco sales, which currently produce more than $1.5 billion in revenues annually, in a phased approach over the next year. "The financial gain is outweighed by the paradox inherent in promoting health while contributing to tobacco-related deaths," they write.

While the authors acknowledge that CVS' decision may not lead many people to stop smoking, they point out that if other retailers follow this lead, tobacco products will be more difficult to obtain. "Any and all efforts to promote public health and reduce the burden of disease are greatly needed," they write. "Reducing smoking rates would have those effects, and removing cigarettes from retail pharmacies and grocery or department stores that contain pharmacies can only help in that regard; it would certainly contribute to the denormalization required to further reduce smoking rates. In lieu of regulation, pharmacies, grocery chains, and mass retailers that wish to promote the goal of better health should recognize the fact that selling tobacco products contradicts the commitment to heath care."

"CVS is setting an important example putting public health above profit," said John Gordon Harold, MD, MACC, president of the ACC. "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 ACC 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."

Keywords: Prevalence, Public Health, Health Promotion, Pharmacies, Tobacco Use Disorder, Cost of Illness, Smoking Cessation