What One Cardiologist Thinks About the CVS Caremark Decision to Ban Cigarette Sales

By now the world has heard the remarkable news: that CVS Caremark will no longer be selling its tobacco products in any of its stores.  Locked and loaded with the news, the American Heart Association, American College of Cardiologists, local public health experts, Phillip Morris, and even the former-smoking President of the United States was quick to applaud the news by publishing press releases. 

But when press releases and major announcements of a single company's business decision floods the airwaves, newsfeeds, and radio spots, my bullsh*t antenna goes up. 

This is not to say that CVS Caremark's announcement wasn't nice to hear.  It was.  But making me feel better isn't going to stop people from smoking.   Is pulling the supply of cigarettes from one pharmacy/convenience store chain really going to affect the incidence of smoking in America?  Is it really going to "send a message" to other convenience stores and states who make billions of dollars from the sale of cigarettes each year?  Can we really sit and applaud this action while more and more states (like Illinois) seem to feel that smoking marijuana is just fine for our health?  

Please. 

After all, despite the public's widespread knowledge of the dangers of smoking, being ridiculously taxed, stored behind counters, and withheld from minors for years, tobacco smoking is seeing a huge resurgence in both the young and old in America.

But politicians and public health experts, reeling from this reality, are desperately in need of some good news to spin.  They need to show the world how their self-righteous drum beats of preventing disease by restricting the supply of cigarettes at one business will make a difference to people's consumption behavior. 

It seems these same people have forgotten Prohibition.

To understand smoking in America, you have to meet smokers where they are - specifically their social circumstance.  People are growing up in a time of unprecedented pessimism in America.  They can't get jobs.  They are incredibly anxious, fractionated, and uncertain about their futures.  They are desperate to belong, to gain their own identity, to feel imporant, and to belong to a set of peers.  If smoking helps them achieve their own set of personal, social, or professional needs, no feel-good corporate policy announcement is going to change their minds about using cigarettes.

Supply-side public policy edicts will never affect psychology.

How do I know this?  Because I see people who smoke despite knowing these risks every day.  I know this because I am one of the most argent anti-smoking promoters to my kids.  As a cardiologist and father, how else could I be?  Throughout my entire career and my kids' entire lives, they've heard about the dangers of smoking, the addictive potential of nicotine, the poisons in the smoke, and the horrible cases I saw of lung, oral, and bladder cancer in my training.  My wife and I have never allowed cigarettes to be smoked in our house and have we have never smoked.

But despite all of our harping and example-setting, I recently learned that one of my young-adult kids has started smoking.  He felt so conflicted about this decision that he knew he was making, he recently met with my wife and me over dinner to explain.  His reasons were specific to him and him alone.   He just didn't want to lie to us about his decision and I know for certain that this decision wasn't because he didn't know the dangers of smoking or what it could do to him.  Were we happy about this? Of course not.  But the decision is his and I know that if he wants something, he's going to get it, even if CVS Caremark doesn't carry cigarettes any longer.  Hopefully, as his life circumstances change, he'll quit.

This is why we need to get over ourselves about the CVS Caremark business decision to stop selling cigarettes - there are just too many other confounding variables and mixed messages out there that are bringing people to smoke.  Sure the CVS Caremark announcement was good news but good news and one pharmacy chain's decision to not sell tobacco products won't really affect the booming incidence of smoking in America.  CVS Caremark's announcement has already come and gone.  Smoking, however, is still here.

To me, when we start focusing on why people are smoking despite the known well-known dangers of this habit we'll be much closer to gaining a real foothold on this public health problem.

Anything else is just spin.

-Wes