by Edward Shanahan
A rudimentary sign posted to the entrance of the CVS store on
North King Street not long ago apologized for inconveniencing
customers who were unable to purchase tobacco products.
Seems the city Board
of Health had suspended the CVS license for a period of time,
although the sign was vague as to the reason, but it was the
result of selling cigarettes to a minor, not the first violation
this year for the chain outlet.
Which got me to wondering
why CVS or any drug store is licensed to sell cigarettes in
the first instance. While the store sells everything under the
sun, and then some, it is best known as a drug store, one, in
fact, so successful that it has gobbled up virtually every independently
owned and operated pharmacy in the East.
In fact, as of September,
CVS operated a total of 4,135 retail stores in 32 states. That’s
big.
We think of drug stores
or pharmacies as businesses dedicated to maintaining or improving
health. Physicians provide those of us who are ailing with prescriptions
for medications that we take to CVS where trained pharmacists
fill the prescription with expensive drugs.
They go out of their
way to ask us if we have any questions about our prescriptions
and, even in their ads, they want us to chat with their pharmacists
about our most personal health concerns.
At the same CVS pharmacies
are active purveyors of cigarettes, which are known to be terrible
for our health, fatal for tens of thousands of customers each
year.
Why, in the name of
good health and sound public policy, is CVS or any other drug
store licensed to dispense medicine to promote good or better
health allowed to sell cigarettes at all, which ruins our health
or kills us, whichever comes first.
Good question, says
Cindy Suopis, tobacco control coordinator for the Northampton
Board of Health. "I don’t know the answer."
She said both the North
King Street and Main Street CVs stores have "had a problem"
more than once this year with selling cigarettes to minors.
The citizens of the
Commonwealth spend substantial sums - some $43 million since
1993, according to a spokesman for the state Tobacco Control
Program - trying to combat smoking through public service ads
and educational programs that encourage or even scare people
into quitting smoking.
But state health officials
turn the other cheek and ignore the fact that drug stores are
among the major outlets for tobacco products, especially cigarettes.
The cynic could argue
that because money for tobacco control programs comes from taxes
on cigarettes health officials have a stake in selling more
and more cigarettes to generate revenue to combat smoking.
But even by state bureaucracy
standards that kind of thinking is too far-fetched.
As a consequence, CVs
and supermarkets such as the Stop & Shop, which operate
pharmacies in their stores and sell cigarettes as well, are
able to have it both ways.
While in the front of
the store they sell cigarettes that will kill you, they also
work the other side of the aisle - and elsewhere in the store
fill that prescription that can aid or restore your good health.
It’s
all the same to CVs or the Stop and Shop - good health or bad,
life or death - no big deal, just so long as the cash continues
to flow.
"There’s a huge
disconnect of pharmacy products for getting people healthy and
getting people sick," said Sarah Curi, a staff attorney
for the Tobacco control Resource Center at the Northeastern
University Law School. This has caused "professional tension"
among pharmacists, she said, who "feel this conflict acutely."
Yet, despite the repugnance
that pharmacists reportedly have for drug stores selling tobacco
products, there has been no wholesale revolt against the practice
by members of the Massachusetts Pharmacists Association.
In fact, several requests
by downstreet.net left with the association’s executive vice
president’s office for a comment on the pharmacy-tobacco sales
issue went unanswered.
According to Curi, independent
pharmacies are more likely than chain drug stores to voluntarily
give up tobacco sales when the issue is confronted.
She also blames the
lobbying efforts of the tobacco companies. "The tobacco
industry really is the evil empire."
While there is a "grassroots"
interest in addressing this issue, said Curi, her research found
no political jurisdiction in the country which bars pharmacies
from selling tobacco products, although California is in the
forefront of the effort to do so.
The Commonwealth is
certainly complicit in allowing pharmacies to sell tobacco products,
despite long-term public policy which tries to discourage, or
even combat tobacco use through its tobacco control program.
Yet, Roseanne Pawelec,
a spokesperson for the state Department of Public Health, said:
"I don’t think anyone here would be comfortable" with
prohibiting pharmacies from selling tobacco products. "I
guess our efforts are more broad based," such as educational
efforts to underscore the dangers from smoking.
The state issues licenses
to some 9,000 pharmacies in the Commonwealth through its Division
of Professional Licensure and the seven member Board of Registry
in Pharmacy.
Asked if the issue of
the propriety of drug stores selling tobacco products has come
up, a spokesperson, Christine Zybert, said there is no regulatory
mention of it. "It isn’t an issue for the board,"
she said, "because pharmacies are looked up as businesses,
not health-care facilities."
Meanwhile, tobacco sales
are licensed and regulated by the state Department of Revenue
and local boards of health, according to Douglas Wood-Boyle
of the state Tobacco Control program in Boston.
Is there a conflict
in permitting state-licensed pharmacies to sell health-impairing
tobacco products? "What can I say," says Wood-Boyle.
"You’re right."
At least one member
of the three-person Northampton Board of Health has raised the
issue of why pharmacies continue to sell tobacco products, according
to Cindy Suopis, city tobacco control officer.
During discussions of
the board dealing with tobacco sales to minors, Dr. Richard
Brunswick, a relatively new member, asked that the CVs drugstore
chain provide the board with a statement of its position on
tobacco use.
The response from the
company was not particularly helpful in aiding the board in
its discussions about the issue of pharmacies selling tobacco
products, he said.
In a recent interview
with downstreet.net, Dr. Brunswick said it is a subject that
merits a good deal more study and discussion, and thus he is
not ready to take a position.
"It hasn’t yet
been discussed to the level you’re bringing it up," he
told me, as we sat in his living room around a table covered
with copies of reports, surveys, and articles about the appropriateness
of pharmacies selling cigarette products. "I’m getting
the lay of the land."
He said that most
of the information arrayed on the table had come from Northeastern’s
Tobacco Control Resources Center, which he had contacted in
advance of our meeting.
Brunswick, a family
physician, who has worked for both the former Kaiser Permanente
HMO in Florence and Veterans Administration Medical Center in
Leeds, said: "I think, in public health issues, there is
always a tension between what is best for the public and what
the public expects and is ready for."
Thus, he said, he is
not prepared to say pharmacies should be barred from selling
tobacco products.
The pharmacy-tobacco
issue is not a new one in Massachusetts nor around the country,
as the material on Brunswick’s table confirmed.
A 1998 article in the
Journal of the American Pharmaceutical Association said: "Various
studies have shown that most pharmacists consistently disapprove
of the sale of tobacco products in pharmacies." The article
then went on to cite a 1985 survey of Mississippi pharmacists
and a 1989 study of Georgia pharmacists; another, a 1992 poll
of Minnesota druggists and a 1995 opinion poll of pharmacists
found that the vast majority who responded agreed that pharmacies
should not sell cigarettes.
Included in the paperwork
was material for a campaign in California urging all pharmacists
in chain drugstores "to stop the sale and promotion of
tobacco." The campaign was supported by the California
Pharmacists Association, the California Medical Association
and the California Lung Association.
A public opinion survey
conducted in 2000 by the California Medical Association Foundation
found that 72.3 percent of respondents disagreed or strongly
disagreed with the statement that: "I am in favor of tobacco
products being sold in drugstores." Among the comments
were the following:
"It sends mixed
messages and undermines the credibility of the pharmacist."
"You are supposed
to go to the drugstore for health products not health problems."
"Pharmacies are
places to improve you health, not destroy it."
Another article from
a 1992 issue of "American Pharmacy" stated that "The
American Pharmaceutical Association, the American Public Health
Association, the American Medical Association and several other
professional societies have adopted resolutions asking pharmacists
to stop selling tobacco products."
Meanwhile, according
to Cindy Suopis, the city’s part-time tobacco control coordinator
for the last five years, the local anti-smoking campaign continues
to be have mixed results. "Northampton is known for smoke-free
restaurants, it was kind of a pioneer. I think we’re succeeding
in keeping the regulations intact."
However, she says: "I
don’t think that as a city, or state or country we’re making
much progress with kids. We’re not finding a way to crack that
nut."
And that is what was
behind the apology taped to the entrance of the CVs store. They
were embarrassed, not that cigarettes were available for sale,
but because they weren’t.
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