This Thursday, the Boston Public Health Commission enacted regulations that ban the sale of tobacco products at pharmacies and on college campuses. This makes Boston the second city in the nation to ban tobacco sales at pharmacies (San Francisco is the first) and the first to ban tobacco sales on college campuses.
In an article published in the Roslindale Transcript, the executive director of the Commission explains the rationale behind the regulations: "Tobacco exposure continues to be a significant factor that contributes to preventable sickness and death. The board’s actions will help reduce young people’s exposure to tobacco products, and ensure that they are not exposed to products that make them sick when they go to places like pharmacies to get well."
The Rest of the Story
Based on the Commission's reasoning, we apparently don't have a problem with young people being exposed to products that make them sick, except on the rare occasion that they are in a pharmacy. When they go to a convenience store, we don't care if they are exposed to products that make them sick. When they go to a grocery store, we don't care if they are exposed to products that make them sick. When they are outside of a college campus, we don't care if they are exposed to products that make them sick.
This rationale makes no sense at all to me.
If the Commission feels that it has the appropriate authority to regulate young people's exposure to products that are harmful, then why exercise this authority only when it comes to pharmacies and college campuses?
Though not intended this way, what the Commission is basically saying to young people is this: "We don't care if you smoke and we don't care if you are exposed to tobacco products. We just don't want you to be exposed to tobacco products when you are in a pharmacy or at a store on a college campus. Outside of that, you can have all the exposure that you want and it's not a problem."
To my mind, it is no consolation to know that in the future, when patients die of lung cancer, we will be able to say: "Well at least they didn't purchase their cigarettes at a pharmacy."
How does it make it better to know that people are buying their cancer-causing products at convenience stores and gas stations rather than pharmacies?
And what public health justification is there for regulating the types of places where people obtain the products that may cause them to die from cancer? Why is it any better that people should purchase their cigarettes at a gas station or convenience store rather than a pharmacy?
The biggest problem with the regulations, other than the lack of a compelling government interest in regulating the places where this legal, though harmful product is sold, is that it frames the problem of tobacco use in the wrong way. It frames the problem as one of the sale of healthy and unhealthy products in the same store. Not only does there not seem to be any compelling government interest in ensuring that a healthy and unhealthy product are not sold in the same establishment, but this framing of the issue doesn't convince me that it is a public health issue in the first place.
By that definition of the problem, is it not also problematic that pharmacies are selling junk food, candy, and soda? Is it not also a problem that Boston Medical Center has a Dunkin Donuts inside it? Shouldn't the Commission ban the presence of junk food stores inside a hospital, of all places? And shouldn't the Commission ban the sale or serving of alcohol on college campuses? To be sure, the sale and serving of alcohol on college campuses in Boston has led directly to many serious injuries, illnesses, and even deaths. But at least the smokers on these campuses won't be able to buy their cigarettes at campus stores any more.
I've seen hundreds of my patients die from smoking-related disease. But not once did it occur to me to think that there might be some consolation in knowing that the situation might have been made somewhat more bearable through the knowledge that they didn't purchase their cigarettes at a pharmacy.