HealthNovember 14, 2016

The pharmacist’s role in public health and tobacco sales

Some of us are old enough to remember when cigarette commercials aired on television. Oh, how alluring those ads were! If you can close your eyes and conjure images of the Marlboro Man or the Virginia Slims woman, you probably also remember the ideas those images represented: Strong, healthy, successful individuals.

And it was easy to emulate them! Cigarettes were readily available — you could buy them from vending machines in hotels and restaurants, at grocery stores, gas stations, and pharmacies.

Oh, how times have changed! Time and science have given us data that demonstrate the negative impacts of tobacco use. Television ads for tobacco are no longer allowed, although print ads persist. Children are taught from a young age that tobacco use is to be avoided. The correlations with cancer and birth defects are well documented.

During this same period, pharmacists have made great strides in demonstrating their value as healthcare providers and public health advocates. We are more commonly viewed as part of the care team, dispensing advice on more than medications, including providing disease management, lifestyle (diet and exercise) tips, immunizations, and monitoring patients. We know tobacco use is bad for our patients.

So, why do some pharmacists still sell tobacco?

Revenue: Cigarettes have an average retail price of $7.04 per pack in the United States. Plus, smokers are likely to have health problems that will make them regular customers at the pharmacy counter.

When CVS announced its decision to stop selling tobacco, it was widely reported that the chain would forgo nearly $2 billion in annual sales. Although, if you consider that the tax per pack of cigarettes ranges from less than a quarter to more than $6, it’s fair to say that the $2 billion in sales represented far less in actual revenue. And the free publicity CVS got from the announcement may have won over new customers.

Customer loyalty: The customer who comes in for his or her pack of cigarettes is likely also a customer who’s buying his or her prescriptions, OTCs, and incidentals. There’s a risk of offending customers if they perceive the decision to stop selling tobacco as a judgment of their behavior.

Is it time for a change?

As pharmacists, our mission is patient care. Can we reconcile that mission with also being our patients’ source for a product that is known to be addictive and harmful? Or do we break with tradition to be a source for our patients to improve their health?

Recently, the CDC published data in the American Journal of Preventive Medicine that found 66% of adults were supportive of a ban on the sale of tobacco products in retail pharmacies. The study found that:

“The sale of tobacco products in retail pharmacies has the potential to undermine the promotion of patient health. More than 16 million Americans currently live with a smoking-related illness, and cigarette smoking can complicate chronic disease management and increase the risk of adverse drug events. Fortunately, approximately seven in ten cigarette smokers want to quit. Although pharmacies can serve as a conduit for patients to obtain evidence-based cessation support, the concurrent sale and advertisement of tobacco products might counteract these resources by triggering cravings, stimulating impulse purchases, and hindering smokers’ quit attempts.”

The study concluded by stating:

“Most U.S. adults favor prohibiting tobacco sales in retail pharmacy stores. Eliminating tobacco product sales in these settings may reinforce pharmacy stores’ efforts to promote wellness and further cultivate social climates that reduce the desirability, acceptability, and accessibility of tobacco.”

The release of the data prompted the American Heart Association to release the following statement:

“The tremendous public support reflected in this survey for the removal of tobacco products from retail pharmacies’ shelves should be the final push they need to stop selling these products once and for all. Our nation’s pharmacies are playing an increasingly important role in promoting health, and it is inconceivable to understand how any business involved in the healthcare delivery system can continue to sell a variety of tobacco products that are responsible for the deaths of millions of Americans.

”Two thirds of American adults, including nearly half of cigarette smokers and nearly half of smokers of other tobacco products, support removing all tobacco from pharmacies. We appeal to the remaining pharmacies to follow the lead of those who have already taken this bold action for the health of their customers. These national leaders and all pharmacies that have banned tobacco products deserve our highest praise. And for those pharmacies who haven’t, the message from the public you serve is clear: If you promote health, you should not be in the business of selling products that can lead to addiction and death.”

Are we going to wait for regulations that prevent us from selling tobacco in our pharmacies, or are we going to take action in the best interest of our patients?

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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