On Thursday, I reported that Boston is poised to follow San Francisco's lead of banning the sale of tobacco products in pharmacies. Boston may expand that policy by also banning tobacco sales at stores on college campuses.
On Friday, Americans for Nonsmokers' Rights (ANR) - a major national anti-smoking group - issued an action alert expressing its support for Boston's proposed regulation of tobacco sales in pharmacies and on college campuses.
According to the action alert: "People go to their neighborhood pharmacies to stay healthy and get better when they're sick, not to buy products that can kill them. It makes sense that pharmacies should not sell an addictive, deadly product which is the #1 preventable cause of death in U.S. Boston is doing the right thing by helping eliminate tobacco sales in all health care facilities, including pharmacies, and helping lower the city's tobacco-related disease burden and healthcare costs."
This action is significant because ANR does not usually take policy positions on issues that do not directly involve secondhand smoke. Thus, ANR's support for the ban on tobacco sales in pharmacies is strong and noteworthy. It clearly sets the national anti-smoking movement behind the push for regulating tobacco sales in pharmacies.
In a Boston Globe editorial Sunday which supports the proposal, the Boston Public Health Commission executive director is quoted as rationalizing the regulations as follows: "It is not enough to say eat well, exercise, and don't smoke. You have to promote the conditions that promote people taking care of themselves." The editorial went on: "Tobacco, as its defenders like to point out, is still a legal product. But unlike candy or soda, it is intentionally addictive, and is lethal even when used as directed. Restricting its access is squarely within the public health department's mission."
In the mean time, I reveal today that San Luis Obispo County is considering a measure, being pushed by the local anti-smoking group, to ban the sale of tobacco products in bars.
According to an article in the Santa Maria Times: "Bars in the unincorporated areas of San Luis Obispo County would not be allowed to sell tobacco products if an ordinance revised by supervisors Tuesday wins final approval Sept. 16. The provision banning tobacco sales in bars was not part of the original tobacco sales licensing ordinance scheduled for a public hearing Tuesday but was added on the motion of 4th District Supervisor Katcho Achadjian. ... Achadjian asked to have the ban on bar sales added at the recommendation of Susan Hughes, program manager for the county's Tobacco Control Program, and the request of 2nd District Supervisor Bruce Gibson. Hughes said because tobacco advertising and marketing has become so restricted, the tobacco companies are targeting 18- to 24-year-olds through “bar night” promotions."
The Rest of the Story
I find this new aspect of the anti-smoking agenda problematic for two reasons. First, I do not see this as a legitimate area for government regulation. Second, I think these types of interventions frame the problem of tobacco use in the wrong way and will, in the long run, hurt the overall tobacco control cause.
As I explained previously, there is no substantial government interest in regulating the consistency of a store's product sales and stated mission. But that is all a ban on tobacco sales at pharmacies (or on college campuses) is doing. These policies do nothing to reduce youth access to tobacco, nor do they do anything to reduce adult access to tobacco. There are plenty of retail outlets at which consumers can obtain cigarettes and there is no evidence, or even reason to believe, that eliminating the sale of tobacco at pharmacies and/or on college campuses will reduce tobacco use.
Thus, these are not truly public "health" regulations. They do not regulate in order to directly improve the public's health. Instead, they prevent stores from selling products which regulators don't see as consistent with their underlying mission.
But what is the underlying mission of any store? In my opinion, it's to sell products that people desire and to therefore make money. Unless a store is non-profit, it's mission ought to be to make profit by selling products for which there is a demand. I don't believe for a minute that the mission of CVS is to make the world a better place in which to live by making people healthier. No - the mission of CVS is to make money by selling products that the public demands. There is a high demand for medication, so CVS sells it. There is a high demand for cigarettes, so CVS sells these products as well.
According to ANR, "People go to their neighborhood pharmacies to stay healthy and get better when they're sick, not to buy products that can kill them." This is obviously not true. People do go to their neighborhood pharmacies to buy products that can kill them. Has ANR any idea of how many packs of cigarettes are sold at pharmacies each day?
While I agree that it sends a bad message for pharmacies to be selling both pharmaceuticals and cigarettes, I don't think there is a substantial government interest in making sure that stores do not "send the wrong message." I don't think you ban the sale of certain legal products because it sends a wrong message.
I find the stated rationale behind all of these proposals to be fundamentally flawed. ANR argues that the proposal will "lower the city's tobacco-related disease burden and healthcare costs." I don't think there is any evidence to support that argument. There are too many places where people can obtain cigarettes. Banning cigarette sales in pharmacies will not reduce tobacco sales; it will merely shift where some people buy their cigarettes.
The Globe editorial argues that "You have to promote the conditions that promote people taking care of themselves." If we accept that, then doesn't the government also have to promote people taking care of themselves by not buying cigarettes at convenience stores? How does it promote people taking care of themselves if they buy cigarettes at convenience stores rather than pharmacies? Are cigarettes from convenience stores somehow less harmful than those purchased at pharmacies? This rationale is ridiculous.
The editorial also argues that "Tobacco, as its defenders like to point out, is still a legal product. But unlike candy or soda, it is intentionally addictive, and is lethal even when used as directed. Restricting its access is squarely within the public health department's mission." But how does banning the sale of tobacco in pharmacies address the addictiveness and lethality of tobacco products? If cigarettes from pharmacies are addictive and lethal, aren't cigarette purchased in other types of stores also addictive and lethal. And if cigarettes are so addictive, then won't smokers certainly buy cigarettes from other stores if they currently buy them at a pharmacy?
The argument being used to promote the ban on tobacco sales in bars is equally flawed. The problem, apparently, is that tobacco companies are sponsoring bar night promotions. But the marketing of cigarettes to adults is legal. Since banning tobacco sales at bars is not going to reduce smoking rates (young adults can easily purchase cigarettes at other places if they wish to smoke), the proposed regulation is ostensibly intended to somehow make policy makers feel better by knowing that bars aren't selling tobacco.
In all of these cases, I fail to see the substantial government interest that would justify government regulation. I don't see that there is a direct effect on protecting the public's health that will be advanced by these policies. Essentially, what these proposals do is make us feel better about the tobacco problem without actually doing anything to put a dent in tobacco use. I don't find that to be a good use of government regulation.
In addition to being a misuse of government regulation, these proposals are also problematic because they frame the problem of tobacco use in the wrong way. What these policies say is: "There's no problem with tobacco use. The problem is where people are buying their cigarettes. If we can restrict the places people buy cigarettes, we can all feel a lot better about this problem."
This, like many other aspects of the new tobacco control agenda, represents a feel-good approach that allows us to say that we are doing something, but without really addressing the underlying issues or developing and funding interventions that will actually make a difference in reducing tobacco use.