CVS Caremark pharmacies to halt tobacco sales | Hacker News Reader

CVS Caremark pharmacies to halt tobacco sales

bbc.co.uk

23 pointskenshiro_o69 comments

One interesting thing I picked up from Damian McBride's political memoir was that the most progressive (in the taxation sense) change that they could make to the VAT would be to lower the taxes on cigarettes and alcohol.

Here in the UK the only shops that sell cigarettes are supermarkets and independent newsagents, and neither is allowed to have them on display - they're on shelves behind the counter with shutters or curtains in front. Some bars have vending machines for them, but even that's becoming quite uncommon. I imagine within a decade supermarkets will have stopped selling them altogether so the few remaining smokers will have to hunt out little backstreet shops that still stock them.

To learn that cigarettes are sold in pharmacies in the USA is frankly incredible.

In the US, Pharmacies are basically just convenience stores with an actual pharmacy/prescription pill-dispensary in the back. Not sure what they are like in the UK, are they more formal?

In the UK, pharmacies sell pharmaceuticals, healthcare, beauty and toiletry products.

I was really surprised when I last visited the US to find a pharmacy with a deli counter, electronics aisles and a fridge full of frosty beers. It really was just a slick, well-stocked convenience store.

We have a store called SuperDrug which is similar, but no tobacco or alcohol. We also have Boots which tend to be bigger than SuperDrug, and again no cigs or booze.

Both of those are similar to I guess Walgreens and CVS, from my limited experience of California.

CVS/Caremark is trying to be a real healthcare company (Caremark is a massive prescription drug benefit management subsidiary).

But, in some places in the US, CVS the store is more like a general store or even a corner grocery. Some CVS stores do not sell prescription drugs at all.

Vending machines were outlawed a couple of years ago:

http://www.bbc.co.uk/news/uk-15132529

Pharmacies aren't really a kind of store in the US, they are a department that might be found in a supermarket, big-box general retailer, etc. Even "drug stores" like those operated by CVS are basically a convenience store plus the health and beauty departments of a big general retailer plus a pharmacy. Retail pharmacy is a store feature to generate traffic to sell general consumer products, not the central feature of the store.

I buy holiday supplies (Christmas tree lights), birthday cards and chocolates for my wife at CVS. They are always open and usually have a good selection of items. They are never really too crowded either. I'm in the US.

Good move for CVS. A rational clear case can be made that a pharmacy should not be selling products whose primary use is subversion of our health. The notion is in fact rather bazaar. It perforce sends a bad message when a store operating under the aegis of a state license to sell medicine sells something as bad for you as cigarettes.

While I applaud the stand they are taking against this killer product, it does seem a bit hypocritical that they will continue to sell junk food and liquor.

I agree, they should do a full rebrand and only sell organic kale and granola.

Or not take it to any extreme and just remove the most unhealthy products? Possibly replacing them with something on the healthy side of "neutral", without going into "only organic" craze either.

What are the "most unhealthy" products, exactly? Where do you set the bar?

Well that's the problem, isn't it?

The bar never stops moving.

Today, it's cigarettes. Tomorrow, it's e-cigarettes. Then it's sugary sodas. Then cookies.

Eventually, the store sells tofu and free-range cotton balls.

Not just that it never stops moving, but that it's arbitrary. What I consider unacceptably unhealthy is entirely different from what you may consider unacceptably unhealthy. My original point was that if we're going to eliminate all the unhealthy things, we might as well just keep going until we're all buying nothing but raw vegetables.

You don't have to choose a bar, choose the worst thing first and see if you think it's something you're ok selling. Repeat until content.

Contrary to popular belief, granola is not really that healthy.

Heh, I know, but it made the sarcasm a bit more clear.

This could mean that they're moving the cigarettes from the pharmacy proper, to the regular retail area--with a healthy amount of spin.

I'm pretty sure they've always been behind the checkout counter. Most (all?) stores that sell smokes keep them somewhat guarded to prevent people (particularly minors) from stealing them.

Cigarettes aren't in the pharmacy area of my local CVSes, they're at the front of the store behind the regular cashier.

The only thing in the pharmacy proper are controlled (mostly prescription, but their are a few non-prescription pharmacy-counter-only) drugs.

My first question was how CVS-Caremark, a publicly traded company would be allowed to do this, considering it would hurt their bottom line. I didn't think ethics were a reasonable excuse for knowingly hampering profits, unless they felt there was some long-term benefit to their business of not selling cigarettes. Fiduciary duty trumps morals.

Does it have anything to do with the fact that CVS-Caremark is one of the largest PBMs in the US (second only to ExpressScripts, actually)?

There's more at play here than just a moral action.

Public companies do not have a "fiduciary duty" to put profits ahead of morals. Whatever made you think that was the case?

Executives are beholden to the board who is beholden to the shareholders. If the shareholders don't want this, they can force change at any level.

  Whatever made you think that was the case?

Probably because public companies frequently use this as an excuse for their immoral business practices. Examples? Basically any health insurance company in the US.

There are a couple of benefits to doing this:

1) They look better

2) They get extra shelf space back

3) They don't have to secure all those high-dollar cigarettes or worry about their theft

4) As smoking declines, they'll probably eventually have to do this anyway, so why not get some positive spin out of it?

I'm willing to guess they've run the number and know this isn't going to be a huge hit to their business.

As has been repeated many times here, there is no legal "fiduciary duty" that requires profit maximization in lieu of every other business goal. They don't need a reason any better than good PR.

>Fiduciary duty trumps morals.

That's an anti-corporate fallacy.

It's not really anti-corporate when the same logic is used in defense of corporate actions. It's just incorrect.

If the article on the same topic in the WSJ is accurate, this decision was portrayed as a strategic move by CVS to move further toward becoming a healthcare provider rather than simply a drugstore. CVS already has nurse practitioners providing basic care in clinics in some of their stores, and apparently CVS tries to have their pharmacists counsel people on some health concerns. It was reported that, in trying to deepen their relationship with the medical community and some medical organizations, that CVS's continued sale of cigarettes was a point of distrust among the medical community. CVS wants to prove that it is earnest in trying to become a healthcare provider.

There is a large shortage of primary care physicians in the US that is only expected to get worse (which continues to result in the utilization of physician assistants and nurse practitioners for primary care). Furthermore, slipping cigarette sales in recent years (and renewed campaigns to curb smoking in the US) make this look like a long-term tactical bet by CVS.

lifehacker.com to continue interspersing Gawker and Jezebel story links amongst treatises on focus and productivity.

Huh?

probably because they are making enough money selling e-cigs to make up for it.

CVS has always refused to sell e-cigs, as I understand it. They certainly don't right now.

edit: just found this:

>CVS does not sell electronic cigarettes, the highly popular but debated devices that deliver nicotine without tobacco and emit a rapidly vanishing vapor instead of smoke. It said it was waiting for guidance on the devices from the Food and Drug Administration, which has expressed interest in regulating e-cigarettes.

source: http://www.nytimes.com/2014/02/06/business/cvs-plans-to-end-...

Cool, I just assumed they sold e-cigs - thanks for the correction.

In this day and age, I am continually astounded that people smoke and take up smoking.

Let me guess. West Coast USA?

Nope. St. Louis

I'm not. Smoking a little (e.g. 1 cigarette a day) is inexpensive, has very little harmful effects to your health but allows you to enjoy the cultural experience of that particular drug.

For some reason people these days think that it's pretty much okay to drink a lot of alcohol which is very expensive and very unhealthy, but if someone smokes here and there it's "crazy", "stupid" and "very expensive".

Nicotine itself has plenty of beneficial effects: http://www.gwern.net/Nicotine

(I accidentally downvoted you. Sorry.)

Buying cigarettes means giving money to tobacco companies. I firmly believe these are an example of corporations bein evil - which I understand is a controversial opinion on HN.

The tactics (spread fear and misunderstanding; discredit your oponents) have been taken up by other campaign groups (eg, anti climate change groups) often using the same scientists for hire.

"Vaping" avoids most of the social stigma of smoking and if you buy carefully you avoid giving money to tobacco companies.

I think there's still a pretty significant stigma against smoking an e-cig in public, but I guess YMMV.

I agree. I like the fact that some people are careful about where and when they "vape" - not in feont of children, not around people eating etc etc.

> Vaping

Nicotine on its own is vasoconstrictive. The compounds in tobacco smoke altogether are dialative. Tobacco smoke has MOAB agonists and aromatase inhibitors. Tobacco smoke lowers serotonin sensitivity while I don't think pure nicotine does this.

Vaping is really not a substitute for tobacco smoke as it is missing a bunch of chemicals.

You sound like a 1950's Doctor paid by the tobacco industry.

Are you serious or did I miss a <satire> tag ?

One can get nicotine through e-cigs, patches, or gum. There's no need to inhale a bunch of things that are bad for you.

Even if tobacco was perfectly healthy, it has other issues. It ruins your sense of taste, making foods bland. Many people dislike the smell. And smoking just one cigarette a day requires near-superhuman willpower. It would likely become an expensive habit.

>One can get nicotine through e-cigs, patches, or gum. There's no need to inhale a bunch of things that are bad for you.

Yes. I didn't argue for nicotine consumption through smoking.

>It ruins your sense of taste, making foods bland.

I don't think smoking one cigarette a day does this. Do you have a source for that claim?

>Many people dislike the smell. And smoking just one cigarette a day requires near-superhuman willpower. It would likely become an expensive habit.

I agree that smoking pack a day is pretty expensive and unhealthy. So if someone smokes a cigarette a day and doesn't start smoking more than that, then that person is smoking a cigarette per day. Some who smoke one cigarette per day will start smoke more, some will not.

Actually, light smoking is almost as harmful as heavier smoking. Going from zero to one cigarettes is much worse than going from one to two.

Do you have a source for that?

http://tobaccocontrol.bmj.com/content/14/5/315.full

http://www.health.harvard.edu/newsletters/Harvard_Mens_Healt...

You can find more with a simple search on Google. I used, "light smoking, dangerous".

1-4 cigarettes does not equal 1 cigarette per day.

I really don't care. If you want to believe that you're not hurting yourself by smoking a cigarette a day, that's your prerogative. Ask any doctor and they'll tell you different though.

Even one cigarette a day is harmful to your health.

I think aside the physical dependence one may have from prolonged smoking, quite a few people see it as a cultural thing that's part of their lifestyle.

Maybe if we could better predict mortality rates due to smoking, and convey this in ads, people would realize how bad it is. Until they are faced with their mortality in a more brutal way, they will not change attitudes towards smoking. Changing bad habits is very hard. See how difficult it is for obese people to lose significant weight, and not relapse into obesity.

I don't think people care about dying from smoking.

I think if we could accurately tell people about the effects of smoking at dofferent levels that might make a difference.

Smoking is apparently one of the leading cause of erectile dysfunction. Perhaps it's a sneaky trick to ise that, but if true it could help persuade some men to avoid smoking.

It reminds me of a Soviet political poster I saw about alcohol. It had the male symbol but the arrow was drooping. Funny and quick.

male ♂

My parents both smoked. I graduated high school in 1975. I never took it up, in part because I was nerdishly unaffected by peer pressure from the cool kids, in part because it just never interested me, in part because I knew that it would kill me.

There were lots of PSAs in that era about the dangers of smoking, so I think it was also partly a rebellion on my part, against "those stupid adults."

I've been very up front and unrelenting with my kid about smoking and other hazards. I think I've been successful so far. It helps that not that many kids smoke, so I think there's less peer pressure.

I think it'll take another generation or two before it's all but unseen.

I too am amazed that anyone takes up smoking. I see younger coworkers in their twenties out taking a smoke break, and I can't believe how such smart and gifted people can be so idiotic.

Not that I have it all together, I just don't smoke. Lots of other things I could improve on.

Its how many professionals that smoke, let alone smoke at work that forever astounds me. Especially when these same people will belittle others over quirks or other actions they deem stupid.

Got to love it when my friend goes on about how unsafe my motorcycling is while she is taking a drag.

My favorite bit about smoking, people will go into the gas station and buy a pack of smokes and a lottery ticket ignoring the near certain outcomes.

My favorite thing about smokers is when it gets cold outside and I get to watch as they squirm making the decision as to whether its worth freezing just to have a smoke.

I never understood why people take it up either but I had a friend a long time ago that tried a couple of cigarettes on a night out (the usual, out for a drink, people were smoking so he tried it - it was a long time ago when smoking was 'normal'). Anyway, months later he started lighting up and I asked him what he was doing ? He said he just couldn't stop; I was incredulous and said but you just had a few draws on a night out how does that work? He was adamant that the addiction was immediate and there was nothing he could do to stop.

Some people just seem to be wired differently and even a small exposure is all it takes. I think other addictions to [illegal] drugs are the same - smoking has a little less stigma since it is legal (but's it's certainly not socially acceptable like it used to be 'in the old-en days' when I was younger).

Try it sometime--you might like it.

I did try it when I was a young kid, around 10 or so, and many people smoked. I tried it cause it supposedly made you cool. And, yes, I never inhaled the first time cause I coughed too much.

When I was in my teens, I went with some friends out and about and they all smoked. They told me I had to take small breaths to get used to inhaling the smoke. I tried it and felt the overwhelming fogginess it brought to my lungs. I was an athlete and immediately sensed how it was clogging things up. My lungs were trying to tell me something!

That was many decades ago and I have not picked up a cigarette since and never will.

I had a girlfriend who smoked. When we broke up, she said that the one thing she was grateful to me for was getting her to quit smoking. She said, "Everything smells better and tastes better and I don't run out of breath all the time."

I was great in bed, too.

Tobacco does have some well documented medicinal qualities, believe it or not. There's no shortage of things at CVS that can harm through abuse.

That's clearly not how it's being used in this case.

Nicotine has a lot of really great qualities, but anyone trying to justify smoking or chewing tobacco for its medical benefits is in denial.

There are a lot of people who have found that one or two cigarettes a day keeps depression at bay. There are biochemical reasons to believe them. Who are you to tell them they should have to get a prescription SSRI?

That would be the nicotine stimulating the release of glutamine and dopamine. The value there is in the nicotine, not in the tobacco. You can get nicotine separately from tobacco trivially.

The false choice of cigarettes or SSRIs is silly.

It's not just nicotine. Tobacco smoke has compounds like beta-globulines that lower serotonin and estrogen. There are also arguments that low doses of carbon monoxide can have therapeutic affects.

...but reduced serotonin levels are linked to depression. The entire point of SSRIs is to keep your serotonin levels higher and thus improve synaptic signalling. Wouldn't reducing your serotonin production be bad?

Edit: Here's a link to a cross-sectional study showing a cause-effect relationship between smoking and depression. http://bjp.rcpsych.org/content/197/5/413.full

That's a point of debate, actually. SSRIs in the long term appear to actually work by reducing serotonin in the brain tissues.

Serotonin is really more of a torpor hormone that depresses the whole body than a "happy" neurotransmitter. It's associated with hibernation, for example. The "turkey causes sleepiness" meme is about tryptophan in the meat boosting serotonin levels.

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