Tobacco Documents Online

.- A P~arsn~~cls#s ~.~ad ~~~acco: .~. pollars befotedu~y . '' srenWG17bsb .. . .. a .... . -, . Smoking is Yhe single most impor- ant' eause df pieventable disease, lisabilityaand :deatti: :It : is 4a =lciller_ lhe 1obaaco- industry, those. who 0 Yvba~ . so -our xhildren, .ure cisring `a;ousms to - those *vho push nanjuana vr Jiash ;or :crark -or ieroiin. It.'s sime ;ve zrPated %Jsern Warcien Pournier, the. X.4 presrdent, .addressing -the Vedical Society of Nova Scotia Nov.17, 1989 ing,-promoting,-or distributing of 4sugs ,. . _ which -laclc -1herapeutic valueTor-the7paticnt." :- : -Zxt,-most pharmacies •confm- ue~o-sell nrevenactivelypromote ihe zale oI' ~cigarettes despite :at- 3empts- by -pharmacists' - leadets .andxhe CMA Yo r,nd-ahe_practice. . $n"89_ 85-1he:Canadian.haimaceu- a%ca1 ~SSOCiation t(C'PA)"launched ~i.Btand :'Up and Be 'Counted" :program 'that attempted to wean drugstores from tobacco sales in stages. It started by providing cus- .tomers -with information about -the 'health hazards - of smoking; . T he health hazards related next came the discontinuation of to smoking are now be- cigarette promotions, advertising -yond dispute, even if the -and dispiays; the final step was ,lteer magnitude of tobacco's toll ceasing to sell tobacco products of. .s not always appreciated. An esu- -any kind. 1 35 000 Canadians die -pre- The Tesult? Less than half twwrely every year from smok- participated in the first stage, and :ng-related diseases. So do the prominence the information 390 000 Americans. And then received from those that did take here is the litany of diseases part is questionable. About 15% xused by smoking: 3 in 10 cases moved on to stage two, and a )f cancer - 8 of 10 lung cancer mere 12% agreed' to go all the way. xses - plus respiratory and heart In 1987, the CPA tried again, iisease. declaring: "It is now time to take All of which lead to some an even harder line against the auestions. Why are cigarettes so leading cause of preventable death readily available? And why, in in the developed world ... phar- 3articular, are pharmacists still macists must -face the fact that 4ling them? The Code of =Ethics selling products which -hinder )f :the Ontario College.of-Pharma- Sood health is 2 serious conflict of asts, Section 1, states: "A phar- interest -which detracts 'from the aacist should hold thc health:and image of pharmacists -as profes- safety of patients -to be -of:first '- -sional health care providers" :onsideration; he should render-to -- ~ .ltlaunched a second -program :ach patient the full measure -of -r,alled -PACT'$ - Pharmacists his ability as an essential 'bealth Against-lCigarette and Tobacco Practitioner." section 2 stipulates: •-tSalos. . Accompanying 2he miass of and other A pharmacist sho.uld - uever . posters, :-press Teleases ~owin$ly coiidone fhe -dispeas- -:'aprbmotiaria]' inaterial 'awas -the ~as= surance -that discontinuing tobao- profitable Iines such -as health foods, cosmetics and gifts. An improved .public image was .also stttssed: "By memoving tobacco -products from your shelves, you ;viil enjoy renewed zeipecf -and appreciation as an .important ..health : care consultant inyoui.xommunity" .'Tlie ~ampaign iesult? A Sep- lember;1989 survey-found that of .a totaI of 6510 -pharmacies, some 800 - 12% - .no longer sell cigarettes. Most not only continue to -sell them but actively promote their sale. How can one of health care's major professions explain such activities? Dale Toni, the CPA presi- dent~ suggests that phatmacists are no different from the general -public and their awareness needs to be awakened. "It's just going to take time", he says. He declines to be drawn into the ethical.aspect of cigarette sales, but does admit that there is a conflict of interest when a health care establishment sells a product dangerous to health. Pharmacists are basically looking at "the bottom line" and. -fear change, says Toni, while the CPA is pointing to the reasons for change. He also cites the "conflict Y. within a conflict" that exists be- cause most pharmacies are owned by large corporations; only a small percentage are independent Shop- pers Drug •Mart, for instance, is Q part of the Imasco conglomerate, which also owns Imperial Tobaa w co. The CPA has approached .. some,of the major chains with.the, .~ .,r,o sales need -not miean sacrificed J Gibson iss a freefance:writer living .~rofits because sheivesemptied of n~r St. Cutharines, oRt. ~cigarettes cansbe used for new and -suggestion" iliey ":go toliaCco free, - - . 'iJ but has -received no response. [The CMA past president, Dr. John O'Brien, -had a well-publi- cized scrap with~ Shoppers Drug . CaNMEDaSSOCJ 1990'.Ja2(6) 621

Mart over this issue last year. He accused the chain of hypocrisy - Ed.] In June 1989, the Ontario Colkge of Pharmacists also adopt ed a policy against tobacco sales in drugstotts. Like Toni, Jim Dunsdon, deputy registrar of the college; declines to eommit him sdf on the ethical aspect of such sales. He- says the college has no power to enforce its policy be- causee tobacco is not legally de- fined as a.drug and its sale has not been defined as unprofessional conduct. Dunsdon takes exception to action suggested by Physicians for a Smoke-Free Canada - that doctors direct patients to pharm- acies that do not sell tobacco. He says it suggests there is a connec- tion between selling tobacco and professional competence: Howev- er, he admits that the- college has no alternative tactics in place to promote its policy. "Pharmacists are in a- market economy'.", he says. Although the profit margin on tobacco is not high, it is seen as a "traffic buildec" - it attracts customers who. may buy some- thing else when getting their ciga- rettes. David Sweanor, legal counsel for the Non-Smokers' Rights As -: sociation, maintains that it is both unethical and unprofessional for pharmacists. to sell tobacco, "the: only legal consumer•, productL which kills when used exactly as. intended". Pharmacies, - he says, give tobacco an air of legitiatacy, especially among young peopltt- How caa something: sold by a, health facility be that bad? Sweanor asserts that there is more. to the profit aspect than meets- the eye. Pharmacists; he claims, receive cash payments for the amount of shelf space devoted to cigarettes and for countertop displays. Thus, Sweanor argues that drugstores• are putting.profits ahead of ethical integrity. He would like to see pharmacists' governing bodies declare the sale of tobacco unprofessional con- duct. sible decision" not to se3l_ tobaoco: F Indeed; he: sees ir as. being: im the• interest of his: patients_ In: lus+ vtew, the saleC of tobacco ia; a; drugstore- indicatess a. laclc of pro-. fessional judgement He, too, would likc to • see:- pharmacists' governing, bodies take: a stronger line. Tha CMA has, made its posi tion clear. It wants to• see pharma: cists get out of the tol?aoca busi • ness- and it is. worldng with the CPA to achieve this. However, Doug Geelde, the CMA's director of communications and govern- ment relations, points to "thc re- ality - cigarettes are a significant -financial factor" in drugstore op- erations:: - He says - the average pharmacy can turn the product _around,-from delivery to sale, in .10 days, but does not. have to pay Dr. James Walker, an Ottawa'..•-for it for-30 days. This means it is dermatologist active in Physicians for a Smoke-Free Canada - he was one of the first Canadian physicians to have a request print ed on his prescription pads asldng patients to take their prescriptions to drugstores that don't sell tobac- co - regards the sale of tobacco by pharmacists as "totally inap- propriate". He sees no ethical problem in directing patients to those who "have made the respon- 0 W equivalent to an inteitsi free loan. As- for the ethics of directing pa- tients to pharmacies that don't sell tobacco, he sees no problem: "Damage to health far outweighs any such considerations." Toni says his associatiozr has chosen the route of "gentle, per sistent and consistent pressure". It will be interesting to see how much effect this will have, and how soona 1 octors must exercise more says. Dr. Ronald Ailsby, who• rep- the SMA's Representative caution. and common resents the Saskatchewan Medical- bly, pointing to: one case in.whic*i sense when asked to pro- Associatioa (SMA) on the provin- a seat belt was not being, wora •-vide.medicai- exemptions that free • cial safety couacil, •says there -.4 • because. of a 6-year-oid• hip:fr~ :. ' _` ' ` th ptintsfrm w g sea: n t her rhyme nor reason to the : ture. belts, a Saskatchewan physician largc number of exemptions being Ailsby- acknowledged that Patrfek Sullivan is CMAJ news and fea- tures editor. 622 C? N MED ASSOC 1 1990 t a2 (G). granted by many of his. less-than- temporary exemptions• may be ; cautious colleagues. warranted in. "rare•' cases; but "It is: becoming. fairly ridicu- said frivolous ones must be lous", he told a recent meeting of stopped: "Some doctors give them