Monday, March 14, 2011

My Op-Ed on Pharmacy Tobacco Sales Ban Highlights How Politics, Not Public Health, is Driving Many in Tobacco Control

Those of you who read my blog post on Thursday about the Fall River (Massachusetts) City Council's initial approval of an ordinance that bans tobacco sales in stores that have pharmacies (but not in the stores from which youth are most likely to buy cigarettes) will recognize my opinion piece published yesterday by the Fall River Herald-News, to which I offered a slightly modified version of my blog commentary.

In the piece, I note - sarcastically - that the Fall River City Council is to be congratulated for sending the clear message to youth that "they want people to die of lung cancer from cigarettes purchased at gas stations and convenience stores like Honey Farms and Cumberland Farms, rather than at large chain pharmacy stores like CVS, Rite-Aid, and Walgreens. ... It is truly a tragedy when someone dies of a smoking-related illness and it turns out that their cigarettes were purchased in a pharmacy."

This action by the Fall River City Council frames smoking in exactly the wrong way. It is not a problem because cigarettes are being sold in the same store as medications. It is a problem because cigarettes are killing hundreds of thousands of Americans each year.

Moreover, the action by the Fall River City Council will have no effect on youth smoking. Kids will still be able to purchase cigarettes at numerous other stores in the city, including gas stations and convenience stores where they are already more likely to be buying their cigarettes in the first place.

This is largely a feel-good measure: a law enacted to make it look like the City Council is tackling the smoking problem, but without the policy makers having to actually take a politically difficult action that would truly make a difference in lowering Fall River's very high smoking rates. In other words, the action is essentially a political one, not a public health-based measure. The political rhetoric of the City Council members may be advanced because of the initiative, but the rate of smoking among Fall River's youth will not decline one iota because of it.

The Rest of the Story

This op-ed piece highlights a much broader issue in tobacco control, beyond merely the merit of laws that ban the sale of tobacco products in pharmacies. The piece highlights the growing trend of what one might call "political correctness" in tobacco control. By that, I mean taking actions purely for political gain, not for tangible public health benefit.

I think the term "political correctness" is widely overused. Often opponents of an action use the term to attack any policy they oppose. As I see it, political correctness is the enactment of a policy purely for political gain (i.e., public approval), devoid of any true public health or public welfare justification.

Attacking policy makers who support workplace smoking bans on the grounds that they are acting out of "political correctness" is baseless in my view, because smoking bans have tangible and substantial public health benefits. However, enacting an ordinance that makes it appear that you are addressing a problem without actually advancing the public's health - such as banning tobacco sales only in pharmacies - is an example of what might rightly be called political correctness. The policy is achieving little other than political benefit for the policy makers. There is no tangible and substantial public health benefit, as there will be no effect on overall tobacco sales. The ordinance will merely shift sales from one type of store to another.

That shifting of tobacco sales affects the profitability of various businesses, but it does not affect the public's health. Advances to the political image of policy makers is coming at the expense of a loss of business by some stores. This re-distribution of tobacco sales profits is not justified by any public health gains. The public does not benefit. The politicians who enacted the law do benefit, by virtue of improving their public image: making it look like they are taking a tough stand for the protection of the public's health.

In recent months, I have commented on a range of similar policies which share this characteristic: they are feel-good policies which allow politicians to make it look to the public like they are taking a principled stand for the public's health, but which in fact have no significant public health benefits.

Examples include the following:
The list could go on, but these examples I think demonstrate my point.

The rest of the story is that there has been a disappointing and unfortunate shift in tobacco control activities: away from measures that may be less politically popular but which are evidence-based and actually make a difference in reducing smoking rates and towards measures that are politically popular but do little or nothing to reduce the burden of tobacco-related morbidity and mortality.

No comments: