November 7, 2008 — The City of San Francisco has taken a strong position on tobacco sales in pharmacies within its city limits. An ordinance which went into effect October 1, 2008, requires pharmacies to remove tobacco products and signage from their stores. This policy change has little influence on privately owned pharmacies within the city, as more than 75 percent were not selling tobacco products before the ordinance went into effect.
Large corporate pharmacies like Walgreens and Rite Aid, are impacted the most by this policy change. The tobacco industry has a longstanding relationship with executives in both organizations, utilizing their positive public image to promote a pro-tobacco viewpoint. In trading public trust and negatively affecting their customer’s health in return for tobacco profits, have pharmacies who sell tobacco products failed in their responsibility to the health of their customers?
Pharmacist Code of Ethics: Tobacco an Unhealthy Endorsement
Pharmacies have built a positive image upon being a trustworthy source of health information with an emphasis on the public good. The local pharmacy is a place to pick up aids for your physical ailments, medications prescribed by your doctor or simple over the counter medicines to help kick the winter flu. The American Pharmaceutical Association’s code of ethics states that “A Pharmacist should hold the health and safety of patients to be of first consideration…[and] should not engage in any activity that will bring discredit to the profession.”
It is no surprise the association, since 1971, has recommended tobacco products should not be sold in pharmacies. Organizations such as the Massachusetts Tobacco Free Pharmacy and Prescription for Change have launched information campaigns to increase public awareness of the pharmacy/tobacco conflict of interest.
Pharmacies have long been synonymous with an image of healthy living, and corporate pharmacy codes of conduct support that position. The Walgreens Creed states “We believe in the goods we merchandise, in ourselves and in our ability to render satisfaction. We believe that honest goods can be sold to honest people by honest methods.”
Rite Aid echos this position in their code of ethics, stating “It is essential to the Corporation to provide safe products and services that fulfill Rite Aid’s responsibilities to the public, maintain a competitive position in the marketplace, and retain the confidence of our customers.”
But these same corporate pharmacies have worked with the tobacco industry to promote a pro-tobacco viewpoint. Have drug store executives, seeing an opportunity to utilize their image to influence public opinion, placed profits ahead of the public good by selling tobacco products?
Drug Store & Tobacco Industry Connection
There is a long-standing history in the partnership between the tobacco industry and large drug store chains. With the release of the groundbreaking Surgeon General’s report “Smoking and Health” in 1964, the tobacco industry was faced with the need to continually cast doubt about the accuracies of these reports or risk a significant drop in tobacco sales.
Seeing a potential business opportunity in the midst of a building controversy, Walgreens executive David Carlson contacted the Tobacco Institute and expressed an interest of utilizing his company’s position of being an established health center to “gain and maintain the understanding and support of the public” in regards to tobacco health information. The Tobacco Institute expressed interest in utilizing Walgreens to “[assist] the tobacco industry in getting the true word put about.” Walgreens seized the opportunity, not only selling tobacco products to customers, but even introducing its own private label brand, Manchester, a product of its partnership with RJ Reynolds to increase Walgreen’s cut of tobacco profits.
Rite Aid also saw an opportunity to capitalize on their brand image, which included selling their own private label of cigarettes. Called “Rite Aid Quality Seal” cigarettes, the box wore the Rite Aid brand label on the packaging, a symbol that is associated with their position as a health information resource. The impact of tobacco sales on Rite Aid’s bottom line was large enough that Rite Aid even participated in lobbying efforts to restrict the passage of legislation that could potentially impact their volume of tobacco sales. In a letter to Lorillard Tobacco, Rite Aid Senior Vice President Howard Diener requested lobbying support to defeat proposed legislation changing the legal smoking age from 16 to 18 in Maryland–and placing the burden on the retailer to make sure purchasers met the age requirements. The concern about the legislation was solely tied to the impact on tobacco sale profits for Rite Aid.
Tobacco Disappearing From Pharmacies
There is a changing attitude toward the sale of tobacco products in pharmacies. Studies in San Francisco and Los Angeles have shown that the majority (76-89 percent) of privately owned pharmacies do not sell tobacco products while 93 percent of corporate-owned pharmacies continue to sell tobacco products (UCSF School of Pharmacy position paper). The same UCSF position paper was the basis for the City of San Francisco city ordinance banning the sale of tobacco products within pharmacies which went into effect on October 1, 2008.
Pharmacists have long supported promoting the health and safety of their customers. Removing tobacco products from sale in pharmacies is a positive step to promote the health of their customers. San Francisco’s city ordinance has set a governing precedent to help pharmacists do that.