Boston Looks to Follow San Francisco's Lead and Ban Cigarette Sales in Pharmacies; Tobacco Sales on College Campuses Would Also Be Banned

According to an article in today's Boston Globe, the Boston Public Health Commission is prepared to enact regulations that would ban the sale of tobacco products at pharmacies as well as on college campuses. Boston is thus poised to follow the lead of San Francisco, whose ban on the sale of tobacco products sales in pharmacies will go into effect on October 1.

According to the Globe article, the reason for the ban on tobacco sales at pharmacies and on college campuses is that selling tobacco is inconsistent with the mission of these institutions: "the city decided to target sales at the 74 pharmacies in Boston ... because stocking tobacco, the leading cause of preventable death in the United States, is incompatible with the mission of a drugstore. 'Why, in a place where people go to get healthy and get information about staying healthy, would you want to sell something that has absolutely no redeeming value and ends up killing a lot of people?' said Ferrer, executive director of the Boston Public Health Commission."

The rationale for the ban on selling cigarettes in pharmacies was similar in San Francisco: "A pharmacy is a place you should go to get better, not to get cancer," [mayoral spokesperson] Ballard said. [Mayor] Newsom would analyze the effect of the new law before expanding it to other types of stores, Ballard said. ... While the law exempts some types of stores, Public Health Director Mitch Katz, who helped draft the legislation, said the intent was to focus the ban on the 'group where the case was the strongest.' 'We teach our children that supermarkets and wholesale stores are places you go to buy everything. When it comes to pharmacies, I feel that our children and our teenagers get a different message,' said Katz, who also suggested the ban could be broadened in the future."

A position paper prepared by pharmacists at the UCSF School of Pharmacy who support a ban on tobacco sales at pharmacies puts forward a similar rationale for these bans: "The sale of tobacco products, which cause death and disease, side-by-side with the sale of medications used to treat addiction to tobacco, conveys a disturbing message. Cigarette smoking is the leading preventable cause of disease and death in the United States. Approximately 438,000 deaths annually in the United States are attributable to smoking. ... It is a conflict of interest for pharmacies, providers of health care, to also profit from the sale of harmful products known to cause cancer, heart and pulmonary diseases."

The Rest of the Story

Before opining on the validity of the justification for banning tobacco sales in pharmacies and on college campuses, let us first establish that the purpose of the regulation is to eliminate the inconsistency between the mission of these institutions and the message sent by the sale of tobacco products, rather than the protection of the public's health.

First, there is absolutely no evidence that restricting the places where smokers may obtain tobacco products will have any effect on smoking. If smokers cannot buy cigarettes at pharmacies, they will simply go to other establishments - such as grocery stores, convenience stores, gas stations, and corner stores - to buy them. So the effect of the regulation will simply be to shift the places where people buy cigarettes, not to reduce the sale of tobacco.

The tobacco industry has in fact confirmed that it is not worried about any reduction in tobacco sales that would result from this regulation. According to the Globe article: "John Singleton, R.J. Reynolds Tobacco Co. spokesman, said that ... his firm, maker of Camel and Winston brands, does not believe the ban will significantly hurt sales... ."

Second, there is no evidence that prohibiting the sale of tobacco products in pharmacies or on college campuses will have any effect on youths' access to tobacco. Once again, youths can simply obtain their cigarettes elsewhere. Despite stringent restrictions on youth access to tobacco, a wealth of research confirms that these laws have no impact on youth smoking.

Thus, these regulations are not going to advance any direct protection of the public's health. They are not intended to directly improve the public's health. Instead, the intention is to prevent certain retail establishments from taking an action that is viewed as being inconsistent with their mission. In other words, the regulation is intended not to regulate the public's health, but to regulate the consistency of a mission of a store with its actions.

I just don't see the role of government in regulating the consistency of stores' mission and actions.

By the way, I am not disagreeing with the assertion that it sends a bad message when pharmacies sell tobacco products and medicines to treat smoking-related diseases. I accept the notion that pharmacies should not sell tobacco products. In fact, I have for many years been involved in efforts to convince pharmacies not to sell cigarettes. The difference is that we are seeking to convince pharmacies to voluntarily make the decision to halt tobacco sales. We are not pushing for legislation to ban the sale of tobacco products in pharmacies.

The use of government regulation of health hazards should be saved for situations where the regulation directly advances the government's interest in protecting the public's health. Regulating the consistency of retail stores' mission and actions is just too far beyond the protection of the public's health to justify. I don't think it is appropriate to regulate the messages that may be conveyed by the legal products that a store chooses to sell.

There are two reasons why I think this is an important issue.

First, if tobacco control practitioners over-use regulation, pursuing regulatory approaches that are not justified, then they risk losing public support for appropriate regulation of public health hazards. Public health practitioners do not want to create a public perception that we are over-regulating public health because we may lose support for regulations that do directly advance public health protection.

Second, by pursuing this regulatory approach, tobacco control practitioners are actually defining the problem of tobacco sales in the wrong way. Essentially, what this regulation says is that we have a problem not with the use of tobacco products because they kill over 400,000 people a year, but that we have a problem with people buying tobacco products at pharmacies.

Frankly, it doesn't bring me any consolation when a patient dies from tobacco-related disease to know that the individual purchased their cigarettes only at places where the sale of tobacco was consistent with the mission of the store. It wouldn't make me feel any better to know that the patient never bought cigarettes at a pharmacy or on a college campus. The problem is not where the person purchased cigarettes. The problem is that they died prematurely from a preventable, smoking-related disease. Banning cigarettes sales at pharmacies won't prevent these deaths.

Thus, in the long run, this type of regulation sends the wrong message. It sends the message that tobacco is a problem because people are purchasing it at pharmacies and on college campuses, rather than that tobacco is a problem because it is killing people.