Saturday, February 08, 2014

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?  


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.



Michelle Marie Perron said...

Thank you for your insight, Doctor Fisher. My mom passed away last year from the effects of long term smoking. My hope is that your son will stop soon.
Be well,
Michelle Marie Perron

Medical Quack said...

There's so much news click bait going on with this news story, it's not funny:)

Newspapers are looking for new revenue streams and reporters go for where they can get the ad revenue and exposure, getting more to read these articles and not the reporters fault, but if they want o keep jobs, you need the readership with titles that grab consumers by the emotional jugular to read. Almost all are doing this and why do you think Jeff Bezos bought the Washington Post...stock trading bots read news...and they want to be sure there's some decent new sources out there reporting...

I could care less what CVS sells, but I focus on what they need to do and that is fill my prescriptions and have the drug in stock...that's what I go there for so again, they could sell tubas for all I care. If they don't want people to buy tobacco, then pump up the education campaign so they walk by and say no and as stated here that doesn't work either.

The marketing here CVS got is a model of a good marketer for sure. The stories about CVS being a “bleeding heart” and being ready to give up $2 billion a year in revenue streams doing this are quite humorous too…don’t get sucked in. Sermo folks and I were chatting on this too, and we both agree on the marketing.

What do you think shareholders are going to say…”we’re just going to cut off $2 billion a year of our income”…not hardly…and of course that revenue needs to be replaced…so what are the avenues there…

Hmmmm…data selling, I have been writing for years about the big income drug stores make selling data and you have competitor Walgreens out there making over a billion a year selling your data….so there’s part of the revenue replacement streams for anyone that’s interested…link below will catch you up on how some of this works. Here's CVS will work you and your data.

In addition, yet one more way to accelerate the stock buyback program that CVS has going…tons of companies are doing this to have less stock out there which ends up being a way to raise the price of the stock…fewer shares available…and a few good press articles like this and the price and value
of the company can go up.

Plus with fewer shares out there they company has fewer shareholders to report to and can do more of what they want when they want.

Suggested reading about quantitated justifications for things that are just not true…link below…so that’s why this was a big marketing move to get you, the consumer to see the corporation as an “Angel” if you will..but in fact there was a ton of marketing and stock value stuff that goes with a PR move like this..corporations are not people, but people do work for them.

There’s a video at that link that shows the "journobot" with automated news creation…very interesting how content news farms are created too…just be aware as the news business looks for new revenue streams and how technology comes in to play.

They need the clicks from all of us to get ad exposure revenue and if the other big corporations who have tons of cash on hand wanted to make an effort here they would spend more advertising money with news agencies to keep them alive as their stocks go up and down as the trading bots read the news every day. This story by the way though seemed to have very little stock impact. Don't be suckered! Somebody asked me the other day, obviously much younger than me why drug stores sold tobacco...and my answer was the same as many things out there, it's throwback to earlier times when the world thought differently as we didn't have the knowledge we have today.

Anonymous said...

this cdc chart would seem to refute your claim that the incidence of smoking is increasing among the youth:

Anonymous said...


You're the scientist - how about posting some stats on the "huge resurgence" in smoking? Without such, I fear you are reacting to a personal painful anecdote; itself a kind of bullsh*t.

DrWes said...

Anony 11:05AM

A few links for you:

And let's not forget this:

No bullsh*t. Just reality.

Anonymous said...


Thanks for the 15,000 pages of links. I would have appreciated ONE that indicated a "huge resurgence". Most had to do with pot. One dealt with amounts spent on marketing. One dealt with hookahs! One did have an interesting point. It said price increases had the greatest impact on smoking rates. Maybe those "ridiculous taxes" make sense. It's possible I missed the paper that shows huge resurgence. I kept seeing "decrease". I'll be happy to reconsider my opinion if you provide one link that supports your position that there is a huge resurgence in CIGARETTE, pipe, cigar smoking. I'll give you e-cigarettes.

Anonymous said...

Doc, how do you explain the CDC report posted by Anon at 1:40 am?

DrWes said...

Anons 02:26 and 02:29 PM -

While cigarette smoking has declined among high school-aged kids, cigar and smokeless tobacco use is on the rise. In all groups, large cigar and loose pipe tobacco are also on the rise with loose pipe tobacco sales up over 482% from 2000-2011.

(See pp 6-9 of this most recent 2013 Lung Association report: )

Keith said...


Whatever the motivation by CVS to stop selling tobacco products, it still seems like good news to me.

One is often struck by the irony of the pharmacy chains selling products to make you healthy while selling those that make you sick. This has to be seen as a positive regardless of whether it is all marketing or not. The net effect of this press is to tell those that would consider tobacco use that it is a danger to their health and that they should avoid smoking. What's wrong with that message?

Also, 2 billion net profit or just total sales? Could be after all the taxes and cost, the profit margin is much less. Store space is limited and they will undoubtedly put something else on the shelves to sell that will take the place of tobacco, so the net loss may actually be very small.

Anonymous said...

CVS has one and only one motivation (as well it should) and that is to make money. Good for you, CVS. I can't believe how easy it is today to market - costs nothing.

I'm not one to feel the need to take away one's right to anything, really. I'll tell you smoking probably will harm you, but won't lose sleep if you smoke. It's your body and totally your decision.


Art said...

CVS is morphing to become a healthcare provider. As such, it can no longer provide tobacco products.

Anonymous said...


Your link posted on 4:39 does not work. But frankly, an increase of 400% in pipe tobacco sales does not cause any pearl clutching. The high school kids and young adults are the ones to watch. Perhaps it is an oversight, but you haven't responded regarding that CDC report posted at 1:40.

Sorry, Doc. I remain very unconvinced that there is a "huge resurgence". But I am sorry about your child. Let's hope it is only temporary.

Art said...

Why teen smoking is on the rise

Research suggests a new generation of kids and young adults believe lighting up is a choice, not an addiction

Anonymous said...

Dr. Wes, CVS made a wise move, no matter what its reasons. It's an exemplar move as every health care professional should appreciate and emulate. Great that there has been no tobacco in your house, BUT fear is not the tactic to use in encouraging ANYONE to not-smoke. The facts are clear, tobacco is the most preventable cause of death. It attacks every system in the human body. A person smokes for very personal reasons, which must be addressed if they even WISH to cease. The habit is the culprit in each case.

Anonymous said...

Where is the American Heart Association, ACC, american cancer society when is comes to the legalization of marijuana smoking in Colorado? Yes, it is still smoking whether it is tobacco or another substance. There are serious health consequences to smoking. Why isn't President Obama discouraging this deadly behavior? Thousands of young people will now be newly minted smokers in Colorado.