In much of the discussion about smoking and health, the emphasis has been on action by government or society — higher excise taxes, stronger regulation, more public education campaigns. The recent surgeon general's report, marking the 50th anniversary of the landmark 1964 document that warned of the dangers of smoking, is chock-full of good suggestions on tobacco control, pointing out that regulation, litigation, higher prices and campaigns in the mass media have all deterred people from smoking. In the past 50 years, the smoking rate in the United States has declined by more than half, from 42.7 percent in 1965 to 18 percent in 2012.
But there has always been a question about what to do next to curb tobacco use. That question received a refreshingly honest answer Thursday that came not from government but from business. The pharmacy chain and retailer CVS Caremark said it would phase out tobacco sales at its more than 7,600 stores by Oct. 1, a decision that will cause it to forgo an estimated $2 billion in revenue. The company said, “The sale of tobacco products is inconsistent with our purpose — helping people on their path to better health.”
Certainly, this is smart for CVS. The chain and others like it have been expanding in-store clinics and other health-care offerings, such as immunizations and treatment for minor medical conditions. Dr. Troyen Brennan, chief medical officer for CVS, said the question of tobacco in the stores has come up as the chain seeks closer ties with hospital groups and doctor practices. “One of the first questions they ask us is, 'Well, if you're going to be part of the health-care system, how can you continue to sell tobacco products?' ” he said. “There's really no good answer to that at all.”
How true, and how honest to say so. The evidence is incontrovertible that smoking leads to premature death and disease. “More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history,” the surgeon general reported. And, he said, “The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risks of smoking cigarettes.”
The CVS decision may not have a huge immediate impact on tobacco use. Drugstores sell only about 4 percent of the tobacco in the United States, while gas stations sell nearly half. For CVS, the revenue loss will be less than 2 percent of its annual total. But symbolically, CVS has taken a big step.
The effort to curb smoking began with small text-only pack warnings and moved on to indoor smoking bans, restrictions on advertising and promotion, media campaigns and tax increases. Now, a major retail chain is standing up to be counted — declaring “CVS quits for good” — and that is a bright spot in a long, unfinished struggle to end habits that are proven to kill.