12/2007

Properly Used Cigarettes Will Kill the User

By: Salomonson

New regulations in the workplace, smoke free hospital campuses and restaurants have

greatly discouraged tobacco use and reduced exposure to second hand smoke. Regulations in

advertising on television, radio and print ads have tried to reduce public exposure to cigarettes as

an item always present and glamorous. Big tobacco has admitted to the dangers of using tobacco

and has been forced to pay for anti-smoking ad campaigns against their own product. Which

leads to the question, as pharmacists are striving to position themselves as healthcare experts:

“Why are we still selling cigarettes to our patients?”

The Addicting of the Masses

Starting with the earliest days of regulated pharmacy history we have found our

profession to be manipulated by the tobacco companies. Through this manipulation we have, at

times, unwittingly assisted cigarettes in gaining the strong foothold in America that was heavily

developed during the past century.

In the 1890 edition of government recognized drugs, the US Pharmacopeia included

tobacco in its lists.1 Years later, in 1905, a piece of legislation now known as the Wiley Act was

being proposed to pass through Congress to forbid the interstate and foreign commerce of

adulterated and misbranded food and drugs. All drugs and foods had to abide by the purity and

quality standards set forth in the US Pharmacopeia and National Formulary.2

Making a false or misleading label would bring that item under the enforcement of the

Act. The Act was attempting to protect the public from being harmed by manufacturers that

were including dangerous and/or addicting additives to their products unbeknownst to

consumers. To combat this unfair practice, the Act also required that the presence of certain

additives of government concern to be disclosed as well as their amounts. Some of the

dangerous ingredients originally included in this list were alcohol, heroin, cocaine, chloral

hydrate, acetanilide3 and nicotine. The thought behind this was that the informed consumer

could make decisions on what they consumed by choice if they were at least properly aware of

the content.

Seeing that this Bill, under the mandate of needing to disclose nicotine content, was

going to bring cigarettes under the authority of government and would give opportunity to the

government to regulate cigarette sales, tobacco companies successfully lobbied to have tobacco

removed from the 1905 edition of the US Pharmacopeia as a drug. The tobacco industry was

able to argue that the delivery of nicotine via the use of tobacco, whether smoked or chewed, was

not used to cure, mitigate or prevent disease2 and should not be considered a drug.

In order to gain the support of tobacco-growing state legislators and to ensure the passage

of the Wiley Act, tobacco was deleted by the United States Bureau of Chemistry from the 1905

edition of the US Pharmacopeia. This allowed for the Wiley Act, also known as the Food and

Drug Act of 1906 to be signed by President Roosevelt and passed by Congress on June 30, 1906.

It was this Act that also paved the way for the replacement of the Bureau of Chemistry with

creation of a new agency that would become known today as the Food and Drug Administration

(FDA).4

Without restrictions of label disclosures, cigarette makers were able to continue to

manufacture their product without government interference of its chemically addicting and

harmful substances. So starting in the infancy of the movement to give the public pure and safe

products, pharmacy had lost the control to regulate cigarettes and aided in the promotion of what

would become one of the leading causes of death of the twentieth century.

During this time period of the early 20th century, cigarettes were not hugely popular and

this may have played a role in the regulators willingness to bend to establish support of the much

needed Wiley Act. Sales of cigarettes in 1901 were 3.5 billion compared to the over 6 billion

cigars sold.5 Cigars were seen as the tobacco of prestige and immigrants tended to smoke the

more inexpensive cigarettes. But the rumblings of health concerns, the effect of not being able to

stop smoking and the ill effects felt after having smoked heavily were already being voiced.

Several states attempted to ban indiscriminate smoking public places with little success. Even

with the lack of successful or enforceable laws the dangers of cigarettes were being recognized,

as 43 out 45 states did have some type of restriction against cigarette use and sales.

Cigarette use did not escape the attention of Henry Ford or his friend Thomas Edison.

The two men exchanged thoughts on the dangers of cigarette use. Thomas Edison in one letter to

Henry Ford remarks that he “employs no person that smokes.” In 1914, Percival I. Hill, the

president of American Tobacco engaged in a series of written exchanges threatening suit against

Henry Ford regarding some published newspaper statements regarding Mr. Ford’s thoughts of

the dangers of cigarette smoking. Obviously not deterred by the written exchanges, Mr. Ford

publishes an anti-cigarette book entitled, The Case of the Little White Slaver. The book consists

of the letters received by Mr. Hill and many case arguments as to how smoking is linked to

unsavory lifestyle, lack of motivation and statements of doctors.6

Even with the distant tolls of danger, smoking was gaining popularity and tobacco

companies were setting up shop in the United States. So much so, that in 1907 an anti-trust suit

was brought against American Tobacco by the United States Justice Department. In 1911,

American Tobacco controlled 92% of the world’s tobacco sales. But on May 29, 1911 the

United States Supreme Court ruled American Tobacco a monopoly in violation of the Sherman

Anti-Trust Act of 1890 and was broken up into American Tobacco Co., R.J. Reynolds, Liggett &

Myers Tobacco Company, Lorillard and British-American Tobacco. 2

One of the first official publications proclaiming the strong link between lung cancer and

smoking was written by Dr. Isaac Adler in 1912, entitled, Primary Malignant Growths of the

Lungs and Bronchi: A Pathological and Clinical Study.7 Lung cancer was seen primarily in men,

as fewer women smoked during this time. And Dr. Adler also saw the correlation that many of

the patients with lung cancer were smokers. In 1914, the rate of lung cancer was 0.6 per 100,000

with 371 US cases reported. 2

But the future of cigarettes was about to take off with the coming of World War I. R.J.

Reynolds had introduced Camel brand cigarettes in 1913, now seen as the first modern cigarette.2

War rations were awarded according to market shares and with Camel holding one-third of the

domestic market, this advantage would help to secure the company’s future as well as help to

addictively manufacture a loyal customer base to the Camel brand. During World War I,

cigarettes were provided to soldiers in their military food rations free of charge. The cigarette

manufacturers used the ploy of the convenience of the cigarette as compared to traditional pipes

and cigars for when the soldiers were out in the fields of battle or hunkered down in the trenches.

During the war effort some noted comments made by United States military leader General John

J. Pershing were:

You ask me what we need to win this war. I answer tobacco as much as bullets. Tobacco is as indispensable as the daily ration; we must have thousands of tons without delay. 2

To help support this request the United States War Department bought out the entire

output of Bull Durham cigarettes allowing the company the right to proudly advertise, "When

our boys light up, the Huns will light out." 2 And with that, an entire generation of United States

soldiers returned home from warfront addicted to cigarettes and loyal to their brands.

In 1924, over 73 billion cigarettes were sold and with the male market captured, Lucky

Strikes aimed its advertising ploy at the female waistline and began the very successful campaign

urging women to “reach for a Lucky instead of a sweet.” The rate of adolescent women smokers

tripled between 1925 and 1935 and gave Lucky Strikes 38 percent of the American cigarette

market. The lung cancer death rate in 1925 drastically rose from 0.6 to 1.7 per 100,000. 2 Many

of these cases were men that had picked up smoking during World War I.

8

Even with the rising concern of the health risks, smoking was common for both men and

women in the United States throughout the 1930s and 1940s. The connection with throat

irritation and cough were obvious. Recognizing this side effect, tobacco companies began to tout

their brands to be superior by stating their cigarette brands gave no throat irritation or cough.

Tobacco was big business and Big Tobacco was not going to wait for the negative concerns

about their product to get louder before doing something about it.

Doctor Knows Best

Feeling the threat of the public rising up and to help combat the rising health concerns,

Big Tobacco decided to enlist the help of another medical profession to keep the masses in line

and smoking. In 1933, Chesterfield cigarettes began to have its ads published in The Journal of

the American Medical Association (JAMA) and the New York State Journal of Medicine. At the

time a majority of physicians were smokers, so the cigarette companies devised advertising

directly to medical doctors to help assure consumers about the safety of their brands. There were

even guidelines and published studies of brands to change patients to when they complained of

throat irritation and cough.

The United States involvement in World War II brought great relief to cigarette

manufacturers. Roosevelt declared tobacco a protected crop and General MacArthur used his

pipe to pose for war pictures.2 And millions of cigarette packs were again included free of charge

in soldiers’ food rations. By the end of the war in 1945, cigarette sales were at an all time high.

Riding on this wave of good fortune and success but still aware of the rising concern

with health issues, in 1946 R.J. Reynold Tobacco Company began Camel’s now infamous,

“More doctors smoke Camels than any other cigarette” campaign. During this course of the ads,

R.J. Reynold employed public relations firm, Hill & Knowlton. One tactic devised by Hill &

Knowlton was during a physician’s convention, where they showed doctors being surveyed as

they entered the convention hall. The surveyors stopped the doctors and asked them what brand

of cigarette they happened to be carrying. Many of the physicians to R.J. Reynolds delight were

carrying Camel cigarettes. What the public did not know is that Hill & Knowlton had stocked

the hotel rooms with cartons of Camels for all the doctors attending the convention. “The more

doctors smoke Camels” campaign ran heavily for eight years in magazines and on radio until

1953.

9

Even as JAMA simultaneously ran cigarette ads, in 1950 some of the first major studies were

being published in JAMA on the link of cigarettes to lung cancer. Even though Big Tobacco

hoped that the public would stay unaware of the medical journals’ published studies they were

not able to divert public attention from the popular magazine, Reader’s Digest, when they ran the

article, “Cancer by the Carton” in 1952.

In the beginning of the 1950’s, only about two percent of cigarettes smoked were filtered

as compared to the fifty percent by the end of the decade. Anxious smokers were worried and

gladly changed over to the newest safety guard offered by cigarette manufacturers. Kent brand

smokers were safe guarded by the revolutionary Micronite filter, touted to be the greatest health

protection in cigarette history. The Micronite filtered cigarette protected its consumer’s health

with asbestos. 2

Finally…A Frank Statement?

So by the early 1950s, industry strategists and public relations firms decided that images

of physicians in their tobacco advertisements were no longer being viewed as credible enough to

cover up the growing concern about the evidence pointing to cigarettes. Once again public

relations firm, Hill & Knowlton’s help was enlisted to keep America’s confidence that cigarettes

could not be causing health issues.

Hill & Knowlton went to work during the winter holidays of 1953 and devised a plan of

uniting the major tobacco companies together. It was decided that the different brands could no

longer advertise against each other as to causing less throat irritation and cough. The new goal

had now become to band together to gain control not only over the media but more importantly,

to control the scientific community by becoming a major sponsor of medical research.

Hill had ingenuously decided that denials of the harms of smoking would only insult and

alienate the public. The firm understood that their client, Big Tobacco, had a consumer base that

was addicted and looking for any possible explanation, other than cigarettes, that may be causing

health concerns. The firm also understood that the bad publicity and attacks on cigarettes were

not going to end any time soon. So the best approach to ease the anxieties of the smoking public

was to join the ranks of scientific research. The newest plan to handle the current situation was

going to be to create debate and to keep alive doubts as to whether or not cigarettes were indeed

harmful and the cause of lung cancer.

Big Tobacco for the remaining fifty years of the century would carry on a charade of

being a committed participant of tobacco research with the formation of the Tobacco Industry

Research Committee (TIRC). TIRC’s position was that “there was more to know.” The research

program would of course show Big Tobacco’s concern for its customers; all the while the

research conducted was reported to be independent, but in fact was completely controlled by the

industry. TIRC announced its formation to the public via 450 different newspapers on January 4,

1954 with the advertisement titled, “A Frank Statement to Cigarette Smokers:”10

"RECENT REPORTS on experiments with mice have given wide publicity to a theory that cigarette smoking is in some way linked with lung cancer in human beings. Although conducted by doctors of professional standing, these experiments are not regarded as conclusive in the field of cancer research. However, we do not believe that any serious medical research, even though its results are inconclusive should be disregarded or lightly dismissed. At the same time, we feel it is in the public interest to call attention to the fact that eminent doctors and research scientists have publicly questioned the claimed significance of these experiments. Distinguished authorities point out: 1. That medical research of recent years indicates many possible causes of lung cancer. 2. That there is no agreement among the authorities regarding what the cause is. 3. That there is no proof that cigarette smoking is one of the causes. 4. That statistics purporting to link cigarette smoking with the disease could apply with equal force to any one of many other aspects of modern life. Indeed the validity of the statistics themselves is questioned by numerous scientists. We accept an interest in people's heath as a basic responsibility, paramount to every other consideration in our business. We believe the products we make are not injurious to health. We always have and always will cooperate closely with those whose task it is to safeguard the public health. For more than 300 years tobacco has given solace, relaxation, and enjoyment to mankind. At one time or another during those years critics have held it responsible for practically every disease of the human body. One by one these charges have been abandoned for lack of evidence. Regardless of the record of the past, the fact that cigarette smoking today should even be suspected as a cause of a serious disease is a matter of deep concern to us. Many people have asked us what we are doing to meet the public's concern aroused by the recent reports. Here is the answer: 1. We are pledging aid and assistance to the research effort into all phases of tobacco use and health. This joint financial aid will of course be in addition to what is already being contributed by individual companies. 2. For this purpose we are establishing a joint industry group consisting initially of the undersigned. This group will be known as TOBACCO INDUSTRY RESEARCH COMMITTEE. 3. In charge of the research activities of the Committee will be a scientist of unimpeachable integrity and national repute. In addition there will be an Advisory Board of scientists disinterested in the cigarette industry. A group of distinguished men from medicine, science, and education will be invited to serve on this Board. These scientists will advise the Committee on its research activities. This statement is being issued because we believe the people are entitled to know where we stand on this matter and what we intend to do about it."

And once again healthcare and now science were used as pawns to keep tobacco use going.

The Changing Awareness

The tail end of the fifties brought the beginnings of lawsuits against the tobacco industry,

which were mostly dismissed. True to their agreed front of steering clear of references against

each other, in 1954 Marlboro introduced the cowboy figure that, “Delivers the goods on flavor”

and Winston introduced its filter tipped cigarettes that emphasized taste, not health. In 1955, the

Federal Trade Commission ruled that cigarette makers could no longer make reference to the

“throat, larynx, lungs, nose or other parts of the body” or to “digestion, energy, nerves or

doctors”11 in its ads. Unfortunately, in 1956 the lung cancer rate in white males was up to 31.0

in 100,000 with 29,000 deaths.2 Also, this same year marked the end of revolutionary Kent

Micronite asbestos filter.12

The first time the Public Health Service took a firm position on the link between smoking

and health dangers was in July of 1957. Surgeon General Leroy E. Burney put out the “Joint

Report of Study Group on Smoking and Health” which finally declared that, “prolonged cigarette

smoking was a causative factor in the etiology of lung cancer.”

Starting in 1964, the Surgeon General began routinely issuing reports pertaining to the

consequences of smoking. There would be 29 such reports issued to the United States public

during these years through 2006 starting with the first in 1964 entitled, “Smoking and Health:

Report on the Advisory Committee to the Surgeon General of the Public Health Service.” This

first report declared that smoking is a cause of lung cancer in men and is a suspected cause in

women.

This landmark report from the Surgeon General was answered with the gift of a $10

million dollar grant for tobacco research being accepted by the American Medical Association

(AMA). The grant was funded by six cigarette companies and was a strong enough incentive for

the AMA to silence a report they had planned to issue. It would be ten more years before the

AMA would issue an official stance regarding smoking and health.

But the next ten years would bring about many changes for the tobacco industry.

American Tobacco’s parent company dropped ‘tobacco’ and became American Brands and R.J.

Reynolds dropped ‘tobacco’ as well and became a subsidiary of R.J. Reynolds Industries. The

companies decided that diversity was the way to go and Philip Morris acquired Miller Brewing

Company. The early seventies also saw the sponsorship start of Winston car racing and

Marlboro Cup horse racing.

Cigarette advertising was banned on television and radio in 1970 and stronger health

warnings were placed on packs of cigarettes. To continue an escape from the FDA, a voluntary

agreement was entered to include the yield of nicotine and tar in all advertisements. Inclusion of

cigarettes in military K-ratios was finally discontinued in 1975.13

Finally…a “new” drug?

In 1980, the FDA approved the Merrell Dow Pharmaceuticals product, nicotine

polacrilex gum, better known as Nicorette, as a new drug. Even with the approval of this new

drug, it would take almost 15 years and the testimony of FDA commissioner Kessler that

cigarettes are a drug delivery system for nicotine, and for tobacco to finally come under the

jurisdiction of the FDA.

This period was important because it brought the dangers of smoking and some of the

tactics used by the cigarette companies under fire. Non-smokers rights were finally being

addressed with regulations requiring designated non-smoking sections to be available, all the

way up to present day bans on smoking in most public areas. Public transportation, airflights and

government buildings are all smoke free. The percentage of adult smokers was on the decline,

and of those that did smoke, the percentage of heavy smokers (24+ cigarettes/day) had declined

bringing most smokers into the fewer than 15 cigarettes/day category.14

The public was very aware and the government finally caught on in 1993, when the U.S.

Environmental Protection Agency officially declared cigarette smoke a carcinogen. In 1995, the

cigarette companies finally admitted that in order to increase addiction, they had for years had

been purposefully controlling the nicotine level in cigarettes. Shortly thereafter, the FDA

declared that nicotine is a drug and cigarettes are a drug-delivery device; the move was upheld in

court and finally gave the FDA the right to regulate tobacco-product sales.15 Sadly, this took

almost ninety years and untold smoking-related diseases and deaths later.

The FDA was then able to issue a rule requiring photographic identification for anyone

appearing under age 27 and attempting to buy tobacco. This was one of the efforts to try to curb

youth smoking. Trends have shown that among those people that do not smoke by the age of 25,

will probably never pick up the habit. Almost all smokers start the habit before the age of 18, the

age at which they are first able to legally purchase cigarettes. Cartoon characters, like Joe Camel

disappeared and provisions to regulate vending machines and self-serve displays came into effect

to discourage easy access to children. In 1997, Liggett Group publicly stated that (1) smoking is

addictive and causes cancer; (2) the industry targets its advertising toward youth, under 18; and

(3) it would turn over documents supporting the admissions.15

Pharmacy to the Rescue?

Admissions, regulation and watching the impact on the healthcare system has brought the

business of smoking cessation and the role of pharmacy into the forefront of being able to help

our patients diseased from years of smoking, wanting to quit smoking or needing to be advised to

quit. Environmental Tobacco Smoke (ETS), Tobacco Smoke and Smokeless Tobacco finally

were all listed in the Department of Health and Human Services, Ninth Report on Carcinogens

(2000), as agents “Known to be a human carcinogen.”14 Pharmacists know the risks associated

with heart disease, use of oral contraceptives, asthma, COPD, emphysema, premature birth and

smoking. Pharmacists also dispense the medications to patients with advanced lung disease and

sometimes cancer.

It seems that even though the news is out about cigarettes, Big Tobacco still would not

back down without a fight. As the pharmaceutical companies geared up to offer pharmacists the

tools to assist patients to help quit smoking, the tobacco industry once again asserted their

influence on to the pharmacy community to keep as many smokers on board as possible. The

plan this time was not to control the definition of “what” was a drug, to orchestrate the portrayal

of doctors with “healthier” cigarettes, nor the “science” behind of the origins of lung cancer but

they would now influence how pharmacy would market cessation products.

Merrell Dow Pharmaceuticals was the originator of Nicorette gum. In 1980, Nicorette

gum was launched in the US market as a product encouraging smokers to quit. Merrell Dow had

prepared and started anti-smoking literature, The Smoking Cessation Newsletter for physicians to

provide information and encouragement to advise their patients to quit smoking. Dow also had

financially supported Policy Analysis Incorporated Study that concluded that smokers incurred

an average of an additional $59,000 in lifetime healthcare expenses16 as compared to non-

smoking employees and was encouraging the plant workers of the Dow to quit smoking with the

company’s new and innovative product.

However, Merrell Dow Pharmaceuticals is a subsidiary of Dow Chemical, and cigarette

giant Phillip Morris held a large contract with Dow Chemical for the manufacture and purchase

of the humectants added to cigarettes to keep the tobacco moistened. The targeting of smokers

with an urgency to quit smoking resulted in Philip Morris pulling their very lucrative $8 million

yearly contract with Dow Chemical.17 Philip Morris rationalized that they would not continue to

spend millions of dollars with a company that in turn was taking the profits of those millions in

sales to launch a negative campaign against Philip Morris’s product.

Merrell Dow Pharmaceuticals backed down its campaign to target smokers, The Smoking

Cessation Newsletter was discontinued after its first and only eight page edition and the

product’s toned-down, but catchy slogan became and has remained basically the same

throughout the years, “You can do it. Nicorette can help.” The current slogan fell into the

guidelines pushed by Philip Morris and other tobacco companies to avoid emotional pleas to stop

smoking, statement of any health problems, or any statistics on morbidity or mortality regarding

continued smoking. Any new literature or advertisements would strictly appeal on the basis of:

If you want to quit, we have a product.

The pharmaceutical industry came under pressure again in December 1991 when Swiss

held company CIBA-Geigy released the transdermal nicotine smoking cessation product, the

Habitrol patch. Habitrol’s release included an educational ‘smokebusters’ campaign that

included a ‘help line,’ at ‘1-800-YES-U-CAN,’ for smokers trying to quit. CIBA-Geigy made

pharmaceutical products in one division and its Ag Chemicals division produced pesticides and

fungicides used by Big Tobacco. Philip Morris voiced their displeasure over CIBA-Geigy’s anti-

smoking marketing tactic by going through the Ag Division.

Ag Chemicals met with the CIBA-Geigy pharmaceuticals division to compromise and to

set up some intra-corporate ground rules that would meet Philip Morris’s approval. After that

meeting, it was soon announced that the ‘Smokebusters’ campaign would be ending on February

1, 1992 and would not be repeated. 16 The pharmaceutical division voiced that they had never

intended to engage in an anti-smoking theme and that in the future the pharmaceutical division

would work closely with the agricultural sciences division in regards to activity with the patch.

A third pharmaceutical company fell into the gray area of ethical debate. Procordia AB

was another Swiss owned company that held controlling interests in many diverse companies.

One of its subsidiaries was Pinkerton Tobacco Company, whose main product was loose

chewing tobacco. Two other companies also held by Procordia AB were Kabi Pharmacia and

Pharmacia Leo. Pharmacia Leo was the originator company that had developed the technology

for Nicorette gum that was first marketed by Merrell Dow in the US. Kabi Pharmacia, in 1993,

had developed and released the technology for the nicotine inhaler, also used for smoking

cessation.

The problem with Procordia AB having a controlling interest in these companies came

into play when Pinkerton Tobacco introduced a chewing gum product called Masterpiece

Tobacs. Masterpiece Tobacs was marketed in 1987 for a short time, but failed to gain FDA

approval so it is no longer available. But, for the user’s chewing pleasure, the gum came in two

flavors, either peppermint or cinnamon. The product used the same technology developed and

employed by its sister division’s product, Nicorette. Masterpiece Tobacs was not geared to be

used as a smoking cessation product. Its use was aimed at smokers for those times when

smoking was not appropriate or was prohibited. Ethical issues arose when concerns were voiced

about Procordia AB collaborating and sharing its technology between pharmaceutical and

tobacco divisions to benefit financially through starting a nicotine addiction via tobacco products

and then standing by to also provide a Nicotine Replacement Therapy to combat it. 16

Novartis later took over CIBA-Geigy Pharmaceuticals and no longer maintained

ownership of the agricultural sciences division and Nicorette is now marketed by

GlaxoSmithKline. Both companies claim to have no ties that lend themselves to the political

pressures of the tobacco industry and have focused business only on healthcare. Even with

claims of severed ties, ad campaigns that trend softly around anti-tobacco sentiment still exist

and pharmaceutical companies have been careful not to join any political lobbying to raise

tobacco taxes or anti-smoking bills.

Some have viewed this relationship between the drug and tobacco firms to be strangely

peaceful, in what at first glance would seem to be natural enemies. But as activists have been

able to uncover, there have been financial pressures exerted against the medicine, pharmacy and

pharmaceutical companies throughout history. Anti-smoking activists have been quick to call in

to question the integrity of pharmaceutical companies that have bowed to this pressure. Stating

that the two industries have a well developed relationship of exploitation, where everyone is

making profits from the patients that cycle through competing forms of nicotine, by smoking,

trying to quit for a month or so, and then returning to their tobacco product.

The concern over the peacefulness of this relationship becomes increasingly more evident

and includes the community pharmacy setting when in a 2003 California study that showed, 61%

of pharmacies sold cigarettes, (a significant decrease compared to 89% of pharmacies selling

cigarettes in 1976). 84% of the pharmacies selling cigarettes also displayed cigarette advertising.

But what is also seen is that non-prescription nicotine replacement products were stocked by

78% of pharmacies, and in 55% of pharmacies selling cigarettes, the nicotine replacement

products were stocked immediately adjacent to the cigarettes at the front counter.18

"Millions of people who were desperately trying to break the most deadly of all drug

addictions apparently were thwarted by the very industry which first addicted them, and as a

result, millions are dead or disabled," says John Banzhaf of Action on Smoking and Health, an

anti-smoking legal activist, "Drug companies might soon join tobacco companies as defendants

in lawsuits brought on behalf of the dead or dying."19

What is Wrong with this Picture?

The current question is: why is the pharmacy one of the few healthcare settings still in

existence that continues to promote tobacco sales? How is it that we have allowed pharmacists

to serve a patient’s vital healthcare needs at the back counter just to have patients walk up to a

lengthy display of cigarettes for sale at the front counter? How soon before the community

pharmacy or individual pharmacist becomes liable, too?

An industry study has shown that while 48.4% of a traditional chain drug store is built

around prescriptions only about 2.8% is realized from tobacco.20 Many independent pharmacies

have moved away from including tobacco in their inventories and have replaced the cartons of

cigarettes with expanded photo departments. The motivation behind that move is to increase the

customer foot traffic into a department aside from the main draw, the pharmacy. By

emphasizing the photo department, they hope to see the customer come to purchase film, drop

off the film for developing and then make a third trip to pick up the photos.

This move away from tobacco is also seen as a trend to protect pharmacists from liability.

Nicotine is a drug and cigarettes are a device used to deliver that drug, bringing cigarettes pretty

much under the regulations of a pharmacist’s dispensing license. With what is known to be fact

regarding cigarettes, pharmacists are doing themselves a grave disservice to the image of the

profession if they agree to handle cigarette sales for their patients. Many pharmacists employed

by some of the national chains have at least taken the stand of refusing to handle tobacco items

and refer those sales to the general merchandising counter at the front of the store. But simply

having a hands-off approach is not good enough for some anti-smoking groups that have been

steadily launching attacks against pharmacies. The Pharmacy Partnership ran an ad, which read,

"To help a persistent cough go to aisle 8. To get a persistent cough go to aisle 14."21

If pharmacy is going to move forward from its battle scarred history of involvement with

Big Tobacco then changes need to occur. The sales, advertisements and displays of cigarettes

need to disappear from pharmacies and away from the involvement of dispensing pharmacists.

The rest of the medical professions have recouped their embarrassments and are united against

tobacco and its use. Pharmacy and pharmacists need to do the same if we are to be recognized

by the public and other healthcare professionals for the position that we have been striving for:

clinical excellence in health, medication and drug management.

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