Yesterday, CVS Caremark announced that its 7600 stores will stop selling tobacco products. Company leadership said that selling tobacco is not consistent with being a health company. This decision, which takes effect in October 2014, will result in 2 billion less revenue.
I am no business person, (though, as an observer of humans, I follow business news), but giving up 2 billion dollars in revenue seems like a bold and courageous move. Forbes journalist Matt Herper explains the business aspects. He teaches us that CVS’ model is changing. Not only are pharmacies like CVS turning into health care delivery portals, with Minute-clinics staffed by physician extenders, but also, the company plans greater partnerships with hospitals and health systems in the future.
You can see why selling tobacco doesn’t fit in a health model. Praise was near unanimous. President Obama, Michal Bloomberg, the AMA, the American Cancer Society and many other health organizations offered high fives. My Twitter feed buzzed with kudos.
My thoughts on the decision are similar. I think it’s a pretty amazing call, especially if it nudges other pharmacies and grocery chains to follow suit.
Cigarettes and other tobacco products are special. In the category of damage done to humanity, they reside in a class by themselves. Everyone knows that smoking kills. Smoking causes irritable endothelium, sticky platelets and promotes plaque buildup in the arteries to all organs. Promoting diffuse blood vessel disease causes dementia (from strokes), heart attacks and heart failure (from coronary artery disease), kidney disease, bowel rotting, and loss of limbs, to name just a few. Smokers who get emphysema and COPD often suffer a slow and breathless death. But there is more; vascular and lung disease are not the worst outcomes of smoking. The worst are the cancers. Smoking is causally linked to many of the most gruesome cancers, like head and neck cancer. (And remember–it’s not just the disease that’s so bad, it’s our treatments too.)
So for me, smoking is horrible not so much because it kills but because it causes suffering. Terrible suffering. There is fear, loss of dignity and independence and pain. And this too: In the US, dealing with human suffering is an especially acute problem. We are good at life-prolonging care, but not so good at relief of suffering. Few patients get the benefit of compassionate skilled palliative care. In my city of one million, here in tobacco central, there are hundreds of cardiology, oncology and other life-prolonging specialists, but only a handful of palliative care doctors. The human suffering wrought by smoking is immense.
Keep the chips and soda:
A final note about health companies selling unhealthy products. My friend and social media mentor, Dr Bryan Vartebedian, wrote that CVS did not go far enough. He called for the health company to stop selling soda and chips. He points to another scourge of health: obesity from over-consumption of junk food. “You can’t make money peddling savory snacks while at once setting the pace for a healthy lifestyle. And condemning one vice works for the press release, but not as a brand offering health solutions, ” he wrote yesterday.
Of course it is right and just to emphasize the coming public health crisis of obesity, especially in children. We are in big trouble as a nation if things don’t change.
But I respectfully disagree that chips and soda can be grouped with cigarettes on the banned list. My argument centers on the notion of dose. There are no healthy doses of cigarettes. But chips and soda can be consumed in a manner that does not destroy our bodies. Make no mistake, I’m not advocating for junk food, I’m just saying that it’s unrealistic to expect Americans to transform themselves to plant-eating acolytes of Dr Esselstyn. If chips and soda are that bad, it would follow that we should ban McDonalds and Burger King and dare I say, Chick-Filet. And where is that line? Are baked chips ok? What about granola bars?
I tell patients this all the time:
Pizza isn’t the problem; eating the entire pie is. Beer isn’t the problem, drinking the entire six-pack is. Same with cookies, birthday cake and M & Ms.
Deep in the hills of Southern Indiana, about 80k into a 120k ride, sits a CVS store. It’s a hot summer day; your body and mind drained of fluid and glycogen. Your brain can think of only one thing–it comes in a red can and is carbonated and sugary. No it is not healthy, surely not healthy, but it is no cigarette.