Daily Archives: April 22, 2009

Ordinance prohibits tobacco sales and leaves tobacco advertising completed unregulated

Philip Morris cannot avoid the fact that the ordinance prohibits tobacco sales and leaves tobacco advertising completed unregulated. Of course, had San Francisco chosen to restrict tobacco advertising, it would have been constitutionally permitted to do so, provided any such restrictions satisfied intermediate scrutiny.  But where, as here, San Francisco chose to send its message about tobacco by regulating conduct – and not speech – the First Amendment is not implicated at all.

Tobacco products sales in pharmacies in particular

The public health research also establishes the need for a ban on tobacco products sales in pharmacies in particular. Such a ban serves as an important means of shaping social norms and reducing the ubiquity of smoking and cigarettes, toward the ultimate goal of eliminating tobacco use.
First, “selling tobacco products sends misleading messages that conflict with a pharmacy’s purpose of promoting health.” Tobacco Education and Research Oversight Committee for California, Toward A Tobacco-Free California 2009-2011. Because research has demonstrated the centrality of social norms in tobacco use prevention, public health advocates have understandably been vigilant in their efforts to combat factors that contribute to positive perceptions about smoking. Pharmacies affirmatively hold themselves out as stores where customers can receive trustworthy healthcare advice.  Indeed, the public perceives community pharmacists as among the most trusted health care professionals. The sale of tobacco products in pharmacies contributes to the intolerable danger that non-smokers, particularly impressionable youth, will perceive smoking to be somehow compatible with a healthy lifestyle.
Second, tobacco control groups have long advocated for increased restrictions on the accessibility of tobacco products. See Tobacco Education and Research Oversight Committee for California, Toward A Tobacco-Free California 2006-2008 at 3. Empirical research connects lower densities of retail outlets with lower consumption, particularly among youth.  Eliminating tobacco products from pharmacies is squarely in line with other restrictions on tobacco products sales, such as the ban on sales to minors, and the ban on public college campuses throughout California.
Third, pharmacy customers – who may be patronizing the store for the express purpose of seeking healthcare advice or purchasing healthcare products to aid in their efforts to quit – are especially vulnerable. A survey of San Francisco pharmacies in 2003 revealed that 55.2% of the pharmacies that sold both tobacco cessation products and tobacco products, sold the items “immediately adjacent” to each other.  The sale of tobacco products in pharmacies undermines the efforts of those seeking to quit.
Fourth, and related to all of the above reasons, tobacco products sales in pharmacies directly contradicts the Code of Ethics for Pharmacists. The Code considers “the patient-pharmacist relationship as a covenant,” pursuant to which the “pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.” Code of Ethics for Pharmacists, §I. Further, the Code requires pharmacists to avoid “behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients.” Id. at §IV. The sale of a product that will contribute to the death of at least half of its users simply does not contribute to patient welfare. And the profit off of the sale of such products creates an inherent and unacceptable financial conflict of interest for pharmacists.
4. It is thus far from surprising that pharmacists have long been opposed to the sale of tobacco products in pharmacies.
In 1970, the American Pharmaceutical Association (“APhA”) stated, “Mass display of cigarettes is in direct contradiction to the role of the pharmacy as a public health facility.”  The next year, the APhA House of Delegates recommended that tobacco products not be sold in pharmacies. See id. In 1973 and 1977, the California Pharmacists Association recommended that pharmacists discourage the sale of tobacco products in the pharmacies in which they practice “in the interest of raising the standards for public health and social welfare in the community.” Id. A study published in 2006 found that 81.7% of licensed pharmacists are opposed to the sale of tobacco products in pharmacies and only 1.6% of licensed pharmacists favored such sales.

Tobacco products should not be sold in pharmacies

The prevailing consensus in the public health community is that tobacco products should not be sold in pharmacies. Empirical research establishes the need for a comprehensive, multi-prong approach to tobacco control, including measures that change social and cultural norms about tobacco use, limit tobacco accessibility, and restrict smoking. Governments at all levels have responded with measures, some incremental, some more sweeping, in each of these areas. San Francisco’s ban on tobacco sales in pharmacies is simply the latest governmental tobacco control measure aimed at promoting public health.
1. Empirical research has repeatedly confirmed the common sense view that negative social perceptions, as well as reduced access to and visibility of smoking and cigarettes may lower the rate at which current non-smokers experiment with and ultimately become addicted to smoking.
Social norms about smoking influence smoking rates, particularly among those not yet addicted.

Cigarettes - the only legal product

Cigarettes are the only legal product that, when used as intended, will contribute to the death of at least one half of all users.1 For this reason, public health organizations have sought for decades to reduce and ultimately eliminate cigarette consumption. San Francisco’s ordinance banning the sale of tobacco products in pharmacies is a modest, yet pioneering, measure that responds to the longstanding calls by the public health community for a ban of tobacco products sales in stores ostensibly committed to the health and well-being of their customers.
We submit this brief amici curiae to show the evidence-based public health reasons for a ban of tobacco product sales in pharmacies. Extensive research demonstrates that social perception and the ubiquity of tobacco products exert a strong influence on whether non-smokers will experiment with and become addicted to cigarettes. As a result, public health advocates have long sought to change social and cultural attitudes toward tobacco and to restrict its availability.

Snuff is not to be sniffed

Banned by the World Health Organisation since 1992, the use of snuff is fast becoming a smoking gun at European level, writes ISABEL CONWAY .

Health inspectors checking smoking ban request police escorts

Kanawha-Charleston health officials want city police or sheriff’s deputies to accompany health inspectors on smoking inspections to keep potential conflicts with bar owners or patrons from raging out of control.

Cancer risk of nicotine gum and lozenges higher than thought

Nicotine chewing gum, lozenges and inhalers designed to help people to give up smoking may have the potential to cause cancer, research has suggested.

Altria Cigarette Shipments May Drop Most Since 2003

Altria Group Inc., the first U.S. tobacco company to report first-quarter results this year, may post the biggest drop in cigarette shipments in six years after a new tax reduced orders.

Spain To Place Gruesome Images On Cigarette Packets -Minister

Spain said Tuesday it plans to force tobacco companies to put gruesome images on cigarette packets to warn smokers of the health risks, a measure already introduced in some European countries.