Why Did CVS Decide to Stop Selling “Poison?”

Frederic W. Grannis, Jr, MD

When the media reported earlier this year that giant drugstore chain CVS had announced that it would stop selling tobacco products, it appeared to be a sudden, independent, and ethically responsible business decision. In fact, there is important background and subtext. Activists and policymakers in many areas have been working tirelessly under the radar for many years to persuade drugstores and drugstore chains to stop selling cigarettes. They deserve recognition.

While I read the news, one of Steve Earle’s songs began to play in my consciousness. In the introduction to “Christmas in Washington,” Earle talks over a repeating bell-like guitar chord progression in E-flat about individuals like Joan Baez, Abbie Hoffman, and Illinois Governor George Ryan who “could have been in this song” because they exemplified courageous, honorable behavior. We all know the kind of people Earle refers to; they share common character traits. They are the stubborn ones; principled, unyielding, and fearless; the ones who won’t back down or sell out. Often characterized as nutcases, zealots, or just plain “pains in the ass,” these are the folks who stand in front of tanks and refuse to move to the back of the bus. They march and picket and sit-in. They go to jail rather than compromise principles or betray comrades. They don’t shy away from confrontation with priests, judges, and presidents; they are not put off by scorn, ostracism, or penury. The reason that the CVS news brought Earle’s monologue and song to mind is that I have had a passing virtual acquaintance and e-mail correspondence with just such a person; one who could have been in Earle’s song.

Terence Gerace “Could Be in This Song”

In mid-July 2010, Dr. Terence Gerace initiated a personal campaign to shame CVS into stopping the sale of tobacco products. He spent long hours each and every day picketing CVS drugstores in Washington, DC. His one-man picket lasted at least 149 days. I am certain that most of the thousands of passers-by who stopped to talk with Gerace on his solo picket line felt that his was a fool’s errand. This is America after all; an unrepentant corporatocracy where CEOs rule the roost and giga-companies buy elections and virtually employ politicians who routinely stonewall legislation in the public interest. They knew that crusaders rarely succeed; Michael Moore does not prevail over General Motors. Gabby Giffords cannot convince her colleagues to pass rational gun laws.

But Gerace was not deterred by the impossibility of his goal, nor did he heed admonitions regarding its futility. He kept up his lonely demonstration against CVS week after week in sweltering Washington, DC heat.

When not picketing, he posted to a Web site explaining why CVS should stop selling tobacco products and even wrote a song on the subject.[1]

It is tempting for me to report that this David laid Goliath low single-handed, but such is not the case. In reality, committed activists have been hectoring drugstores about tobacco sales for decades.

As best I can determine, the tobacco control community first decided to go after pharmacy chains after the discovery of correspondence between Rite Aid and Lorillard executives and the Council for Tobacco Research revealed that Rite Aid had been working behind the scenes to defeat legislation that called to raise the age for purchase of cigarettes in the state of Maryland. “Rite Aid,” noted a New York City Consumer Affairs report, “has the worst rate of recidivism: 24% of the Rite Aid locations inspected by the Department of Consumer Affairs sold tobacco to minors a second time.”[2]

Anne Landman is another admirable gadfly, one of the few journalists to have taken on drug chains-and my former boss-in her blogs. She reported how the Pharmacy Partnership, a California coalition, ran an ad in the New York Times in 1999 directing Rite Aid customers: “To help a persistent cough, go to aisle 8. To get a persistent cough, go to aisle 14.”[3]

Christine Fenlon, director of Pharmacy Partnership, said, “Alongside remedies for influenza, colds, and indigestion, Rite Aid offers its customers a dangerous and addictive drug that kills, not cures.”

Eckerd Drugs has also been targeted by tobacco control organizations. Lisa Sarasohn reported that, in 2000, the company fired Elizabeth Estes after she refused to train employees to upmarket customers by urging them to double up on cigarette purchases.[4] In Sarasohn’s opinion, Estes’s “refusal to engage in pushing an addictive, lethal drug demonstrates her courage and her moral character.”

While large drug chains have been reaping profit by selling harmful tobacco products, independent pharmacists in the United States have long acted responsibly and selflessly by refusing to sell cigarettes.

In 2004, in New Orleans, John Gans, CEO of the American Pharmacists Association, and Satu Siiskonen, manager of professional affairs for the International Pharmaceutical Federation, expressed support for a ban on sales of tobacco products in pharmacies, “an achievable tobacco control strategy that will benefit public health.”[5]

In a September 8, 2004 press release, the International Pharmaceutical Federation resolved that “pharmaceutical organizations should diligently pursue policies that tobacco products are not sold in pharmacies, and that licensing bodies should not license pharmacies that are located in premises in which such products are sold. Recognizing their role as medication experts, pharmacists are active in patient counseling, medication therapy monitoring, and identifying and solving medicine-related problems. They have a responsibility to encourage and help people to give up smoking or other uses of tobacco.”[6]

Dr. Gerace pointed out to new CVS president Larry Merlo, in a letter from March 1, 2011, that “the American Pharmacists Association’s House of Delegates resolved on March 15, 2010 to (1) urge all pharmacies to discontinue selling cigarettes, and (2) to urge federal and state governments to only fund prescription drug programs in pharmacies that do not sell cigarettes.”

There is a lot of money to be made selling cigarettes if you have no scruples. CVS has announced that stopping tobacco sales will cost them $2 billion. Independent pharmacists and their professional organizations have refused to sell cigarettes despite the enormous competitive financial pressure on them from giant chains. They stuck by their principles, voluntarily relinquishing profits from tobacco product sales, simply because it was the right thing to do.

Few other nations allow tobacco sales in pharmacies. North of the border in Canada, pharmacists have been kicking butts out of their pharmacies for more than a decade, starting in Ontario in 1994. The only province still selling tobacco is British Columbia.[7]

In my home state of California, Prescription for Change has been an advocate for tobacco-free pharmacies since 1995.[8] Policy groups in Berkeley and San Francisco deployed an alternative strategy. On July 20, 2005, Marcia Brown-Machen and her colleagues in the Berkeley Health Department’s Tobacco Control Program first advocated a statewide law to prohibit sales and advertising of cigarettes in pharmacies and drugstores in the state. In San Francisco, a law prohibiting tobacco sales in city pharmacies was enacted in 2008. Boston followed suit the next year. Rite Aid responded by closing all 72 retail outlets in San Francisco rather than complying with the law, but other chains, including CVS and Walgreens, stayed open.

Gerace did not just plan to shut down CVS sales; he envisioned a domino effect, with other drug chains toppling after CVS stopped selling tobacco products. I hope that he was correct in this prediction. One chain Gerace does not have to concern himself with is Target. Target stopped selling cigarettes in 1996.

Why did CVS finally decide to stop selling “poison?” I am not so naïve as to believe that CVS acted as they did because they believed it was in the public interest. I am sure that they have expectations that the decision will prove to be good business in the long term. Did Terence Gerace’s lonely protest represent a last straw that triggered CVS’s new policy? Did his letter to the CVS CEO tip the scales? What part did the passage of the San Francisco legislation play in this process? I don’t know the answers to these questions, but I sure would like to think that the work of these principled activists played a meaningful role. Perhaps CVS CEO Larry Merlo would be willing to comment on why he made his decision?

Now it is time for all of us to join Terence Gerace, Elizabeth Estes, Anne Landman, and others who could have been in Earle’s song in toppling the remaining dominoes. And if naysayers caution that “you can’t beat city hall,” pay them no mind.

References:

1. Gerace TA. Toxic Tobacco Law. http://www.toxic-tobaccolaw.org/13news.shtml. Accessed July 11, 2014.

2. Radziejewski J, Mullin S; New York City Department of Health Office of Public Affairs. New York City consumer affairs commissioner Gretchen Dykstra and city health commissioner Tom Frieden slam Rite Aid and the rest of the “filthy fifty” cigarette vendors. http://www.nyc.gov/html/doh/html/press_archive02/pr16-403.shtml. Accessed July 11, 2014.

3. Landman A. Another sickening partnership: the CEO of City of Hope profits from causing and curing disease. The Center for Media and Democracy’s PR Watch. http://www.prwatch.org/news/2008/12/8022/another-sickening-partnership-ceo-city-hope-profits-causing-and-curing-disease. Accessed April 14, 2014.

4. Sarasohn L. Eckerd fires tobacco foe. Mountain Xpress. http://mountainx.com/opinion/0228sarasohn-php/. Accessed July 11, 2014.

5. International Pharmaceutical Federation. FIP statement of policy. The role of the pharmacist in promoting a tobacco free future. http://www.fip.org/files/fip/news/tobacco-final2.pdf. Accessed July 11, 2014.

6. Bickerweg A. Tobacco-free pharmacies. International Pharmaceutical Federation (FIP). http://www.fip.org/tc_tbactivities. Accessed July 11, 2014.

7. The Lung Association, British Columbia. Make BC pharmacies tobacco‐free urge leading BC health advocates. http://www.bc.lung.ca/mediaroom/news_releases/nr_15_2011.html. Accessed July 11, 2014.

8. Lumpkin B. Activists targeting sales of cigarettes. The Berkeley Daily Planet. http://www.berkeleydailyplanet.com/issue/2001-07-26/article/6034?headline=Activists-targeting-sales-of-cigarettes--By-Ben-Lumpkin-Daily-Planet-staff. Accessed July 11, 2014.