To alleviate the burden that tobacco places on the U.S. health care system, the federal government should ban the sale of tobacco products in pharmacies and similar health care contexts.
The tobacco epidemic is one of the biggest public health threats the U.S. has ever faced. According to the CDC, cigarette smoking costs the U.S. nearly $200 billion in annual health care expenditures and kills 435,000 people per year. Yet while total cigarette sales have decreased recently, pharmacy cigarette sales have seen an unprecedented increase and are expected to triple their market share by 2020. The sale of tobacco products within a health care context is incongruous and poses a significant conflict of interest.
To be specific, patients visit pharmacies to improve their health. Selling tobacco in a pharmacy implies that tobacco is not dangerous, when in fact tobacco consumption is a major risk factor for non-communicable diseases, which are now the leading cause of death in the U.S. As a result, Boston and San Francisco have banned the sale of tobacco in pharmacy settings such as Walgreens that sell drug prescriptions (not just health products in general). However, they also excluded from the ban settings like supermarkets that have in-house pharmacies.
While some may object at this distinction, supermarkets draw the general population and are not health-promoting businesses. By contrast, if a pharmacy markets itself as an institution that improves health and sells tobacco products at the point of purchase to consumers who purchase smoking cessation products, then there is a clear conflict of interest. With a lack of coordinated national policy against cigarette sales in pharmacies and their detrimental economic impact, the U.S. is in need of cost-effective, sustainable prevention policies.
The ban of tobacco products in pharmacies would yield much-needed economic benefits for the U.S. health care sector. Considering that the total economic cost of each cigarette pack is $10.47 and sales are rising fastest in the pharmacy industry, the ban of cigarettes in pharmacies nationwide would serve to alleviate the economic burden caused by the 315 billion cigarettes sold each year in the U.S. People are less likely to pick up smoking or buy cigarettes from pharmacies if health-related businesses are forbidden to sell them. If fewer individuals pick up smoking, total health care-related expenditures in the U.S. on tobacco-related illnesses would be reduced. This is critical because the more successful a pharmacy is at selling tobacco products, the more money it makes selling medications used to treat tobacco-related diseases.
Pharmacies will contend that cigarette sales constitute a significant portion of their sales. Yet when Canada banned tobacco sales in pharmacies, the number of pharmacies actually increased following the ban. In addition, 88 percent of independent pharmacies in California reported no loss of business when they eliminated tobacco sales. Finally, opponents will argue that pharmacies are still allowed to sell products with adverse-health effects such as alcohol. However, these products have a clear safe level of consumption; with tobacco, there is no safe level of consumption and thus it should not be sold in health-promoting institutions.
The FDA was recently given control over sales and ads of the tobacco industry; using this leverage, it could make it obligatory for any institution that sells tobacco to have a license. Pharmacies that advertise themselves as health-related businesses should be forbidden from receiving a license. Wholesale retailers with in-store pharmacies would have to sell tobacco products far away from their pharmacies. Finally, the U.S. should further explore the relationship between pharmacies and total cigarette sales so that it can make more viable health policy decisions for its citizens and create a healthier, tobacco-free environment.