By Dr. Daniel A. Hussar who is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.
The potential consequences of smoking cigarettes are well known but the tobacco-related carnage continues unabated within our society. On November 10, the Centers for Disease Control and Prevention issued a press release that includes the following observations and statistics:
March, 2010 issue of The Pharmacist Activist. Continuing communications have identified a number of what I consider to be advantageous reasons for the particular chain to discontinue the sale of tobacco products. However, to date, my efforts have not been successful. None of these companies have changed their policies, and none of the CEOs has been willing to meet with me. In fact, there has been turnover in the executive ranks of each of these four companies since I began communicating with them, with the result that there have now been eight CEOs who have either not responded to me at all or have declined to meet with me in a written response. The highest executive officer currently serving at each of these companies is identified below:
"Tobacco use remains the leading preventable cause of death and disease, including cancer, chronic obstructive pulmonary disease and other lung disease, in the United States. Smoking and exposure to secondhand tobacco smoke kill an estimated 443,000 Americans each year. For every 1 smoking-related death, another 20 people live with a smoking-related disease….Approximately 26 percent of heart attacks and 12-19 percent of strokes are attributable to smoking."
It has seemed almost impossible to capture or describe the impact of these consequences in a manner that motivates sustained action that will substantially reduce disease and deaths attributed to smoking. Every year statistics similar to those above are communicated, but ignored or quickly forgotten by most. Some years ago I was a participant in a meeting on tobacco-related problems in which a physician speaker made the following statement:
"The tobacco industry should be treated as a criminal enterprise that thrives on addiction and murder."
Some find it convenient to ignore this observation because it is legal to produce and sell tobacco products. However, many years later I remember this statement verbatim because of its boldness in identifying the addiction and other destructive health consequences that result from using tobacco products. Although some may take exception to an allegation of "murder," there can be no debate that death is a consequence. The statement serves as a reminder for me to persist in efforts to discourage the use of tobacco products and to discontinue their sale in pharmacies.
Cigarettes in pharmacies
Except in San Francisco, Boston, and several other cities that have taken actions to prohibit such sales, it is legal to sell cigarettes in pharmacies. However, this does not mean that selling cigarettes in pharmacies is the right thing to do and I strongly contend that such sales are contradictory to the role of pharmacists as health professionals and providers of medications and information that promote and improve the health of patients and communities. Indeed, it is hypocritical to promote such a message at the same time that products that can cause harm and death can be purchased just steps from the prescription counter.
Most independent pharmacies do not sell cigarettes whereas most chain pharmacies do. Accordingly my efforts to have the sales of cigarettes discontinued have primarily been directed to chain pharmacies. In speaking with numerous chain pharmacists and other employees, I found that the vast majority agreed with my concerns but felt they have no authority or influence with respect to this decision. They identified the CEO of their company as the only individual with the authority to make a decision to discontinue the sales of cigarettes. It was at this point that I decided that my efforts should be directed to meeting personally with the CEOs of four of the largest chains that sell tobacco products - CVS, Rite Aid, Walgreens, and Walmart. Just these four companies operate more than 20,000 pharmacies and, therefore, account for a large percentage of the tobacco sales in the United States, as well as a corresponding percentage of the victims of resultant disease and death.
Communications with chain CEOs
My first communication with the CEOs of these four chains encouraged them to be a leader among chain pharmacies in discontinuing the sale of tobacco products, and also requested the opportunity to meet with them. My experiences in communicating with these four chains are described in more detail in the
CVS - Mr. Larry Merlo
Rite Aid - Mr. John Standley
Walgreens - Mr. Gregory Wasson
Walmart - Mr. Mike Duke
My lack of success in what I have been attempting to accomplish could be attributed to naivety in anticipating affirmative responses to what I considered to be appropriate requests, or written off as an exercise in futility. However, I can't ignore the realization that hundreds of thousands of our family members and neighbors are dying every year from the consequences of smoking cigarettes. It is no consolation to hear that they made the choice to smoke or if they couldn't buy their cigarettes in pharmacies that they would buy them somewhere else. Indeed, most smokers have tried on multiple occasions to stop but the addiction to nicotine that has been described as "second to no other" is so powerful that they have not been successful in quitting.
Smoking kills! Certain pharmacies have enabled and even promoted the purchase of these products that are known to cause addiction, disease, and death. Most importantly, this is a potentially deadly disservice to their customers. It also is a betrayal of the role of the profession of pharmacy as an advocate for wellness and restoration and improvement of health. As noted above, there is only one individual at CVS, Rite Aid, Walgreens, and Walmart who has the authority to make a decision that his company will no longer sell cigarettes. I urge these individuals to make this decision and to be leaders among chain pharmacies in providing an example that I am confident other pharmacies that sell tobacco products will follow. If, however, they continue to permit their companies to sell these products, they, at the very least, are contributors to the sequence of events that, for many, will be the cause of death. They will become known as MERCHANTS OF DEATH.