CVS, tobacco, and knee jerk reflexes

Now we come to a post in which Orac unloads a bit about one of his pet peeves. It is a post that will likely piss a few people off on “his” side. If it does, so be it. He does this now because yesterday something happened that irritated the crap out of me because it put on display one of the less appealing characteristics of the skeptical movement, a tendency to obsessively focus on what it views as important at the expense of losing touch with the big picture. It is a story about knee jerk responses to which we all (myself included) fall prey.

Yesterday it was widely reported in the media, arguably the biggest story of the day other than the havoc snowstorms were causing across huge swaths of the country, that the second largest pharmacy chain in the United States, CVS Caremark, is going to stop selling tobacco products in its 7,600 stores:

CVS Caremark Corp said on Wednesday that it would stop selling tobacco products at its 7,600 stores by October, becoming the first U.S. drugstore chain to take cigarettes off the shelf.

Public health experts called the decision by the No. 2 U.S. drugstore chain a precedent-setting step that could pressure other stores to follow suit.

CVS, whose Caremark unit is a major pharmacy benefits manager for corporations and the government Medicare program, believes the decision will strengthen its position as a healthcare provider.

“I think it will put pressure on other retailers who want to be in healthcare,” said CVS Caremark Chief Medical Officer Dr. Troyen Brennan.

Make no mistake about it, this is a rare instance of a corporation doing the right thing. I’m under no illusion that CVS expects that this decision will in the long run help its bottom line, there is no doubt that in the short term the company will lose a lot of money. News reports that I saw last night estimated that CVS will be giving up $2 billion a year in sales, $1.5 billion in direct tobacco product sales and around $500 million spent by smokers on other products because they happen to be in the store to purchase their nicotine fix. While it’s true that in the US the days of the old-fashioned pharmacy are long over and these days many pharmacies seem more like convenience stores with a pharmacy attached than a pharmacy (heck, there was a rather amusing parody commercial for CVS as the place to go to get Valentine’s Day gifts on the most recent episode of Saturday Night Live), pharmacies are still health care businesses. Given the massive toll on public health that smoking takes and the number of preventable deaths caused by the use of tobacco products, the move by CVS is huge and is to be praised. At least, that’s what I think, and I posted as much on my Facebook page, along with a link to the story above, saying that as a pharmacy chain CVS is in the healthcare business and shouldn’t be selling something as harmful to health as tobacco.

What do you think was the first comment after that?

Yes, it was a link to this, the part of the CVS website that covers homeopathic remedies. Everywhere I went (at least in the usual skeptical hangouts, which is where I tend to be in the blogosphere and Twitterverse), that’s all I saw, almost always the first reaction to the CVS story was to say something along the lines of, “Well, yeah, that’s great, but what about homeopathy?” It’s a misguided and, frankly, annoying reaction.

At that point, I got annoyed and pointed out that it irritates the crap out of me that the first reaction of skeptics to this news is not to praise CVS for making a bold move that will hurt its bottom line in the name of living up to at least one of its responsibilities as a health care provider, but rather to criticize it for still selling homeopathy. As I pointed out, there’s time for that later. As a physician, I see getting rid of tobacco products as a much bigger deal. In terms of the toll on health, compared to the horrific effects of tobacco products, the effect of CVS selling homeopathic products is, well, homeopathic. Most homeopathic products are harmless; the manufacturers, knowingly or unknowingly, scam the purchaser by selling something that does nothing. Tobacco products, on the other hand, are addictive and actively contribute to death through their ability to increase the risk of heart disease, various cancers, chronic lung disease, and other conditions. Even accounting for the occasional homeopathic product that has something harmful in it, there’s no comparison. Tobacco wins, hands down by a landslide, in the contest for which product causes more harm.

One of my Facebook friends put it perfectly; so I’m going to shamelessly steal his analogy. What we as skeptics are doing is to praise the company, but then immediately add a “but…” which is likely to be counterproductive. Consider this example. Your friend has just successfully quit smoking (example intentional) and tells you he’s reached his one year mark off of cigarettes. In response, you say, “That’s great! Good work. Now, about your weight…” In the same way, skeptics are saying things like, “Great job, CVS. Excellent decision. Now, about that homeopathy…” Do you think the company is likely to react favorably to this? More likely, the reaction would be to think, “No matter what we do, it’s never enough with you people, is it?”

We see this self-righteous scolding tendency on full display in a post on Skepchick by Heina Dadabhoy that declares the whole decision to be a “smokescreen” and a “publicity stunt,” based on what she “knows as a former CVS employee.” One of her arguments is that CVS sells quack remedies. (Yes, yes, we know. So does every other pharmacy chain.) The others are mostly non sequiturs, such as the assertion that CVS participates in food desert situations based on her personal experience. She also then brings up what she sees as exploitative labor practices and this:

The numbers don’t lie. CEO pay is rising while worker pay and benefits are falling. What used to be jobs by which teenagers could earn extra cash (retail, fast food, and so on) now constitute many adults’ main source of income. Remember my coworkers who worked multiple jobs? There are very few full-time positions available in retail; most retail positions these days are “part-time” (read: 35-hour-a-week) jobs designed to ensure that people aren’t eligible for benefits. As a result, people with dependents are forced to work two or three jobs in order to make ends meet. This means juggling transportation as well as multiple schedules and uniforms, ensuring more difficulties for people whose lives are already difficult.

I get it. Food deserts are bad. If you want to see a whole city that is, except for a couple of small areas, a food desert, come to Detroit, my hometown. It’s so bad here that it was a huge deal when Whole Foods opened a store in Midtown last summer, and to my knowledge there still aren’t any stores from major chains within the city limits. However, all of this, as unfortunate as it is, has nothing to do with whether or not the decision to drop tobacco products was a rare responsible decision by a large corporation. Who knows? It might be the harbinger of things to come in the industry, putting pressure on other pharmacy chains to stop selling cigarettes as well, although it might take time. Walgreen’s response to the decision by CVS, if I’m to judge by the disingenuous corporatespeak Walgreens issued about its sale of cigarettes and other tobacco products in its stores.

Yes, I know that the argument is that CVS doesn’t care about the health of its workers. No, no one’s claiming that CVS is a paragon of corporate virtue. Yes, CVS stores in states that allow it even still sell booze. Of course, although booze can cause serious health problems in those who become dependent on it, it can also be enjoyed responsibly in moderation. At “low doses,” wine, for instance, can even be healthy. In contrast, smoking cigarettes is never healthy or even neutral. The same argument applies to the other favorite argument, enshrined in the Skepchick post, namely that the convenience store part of CVS still sells snacks, candy, pop (I’m from Michigan), and other foods and drinks that aren’t particularly healthy. These things can be enjoyed in moderation in a manner consistent with health. Not so, cigarettes.

Finally, one reader characterized my argument as being that skeptics should avert our eyes and be silent on issues that we’ve been fighting for years. Nothing could be further from the truth. My point was that when a company does something that is good for public health (or at least makes a strong statement consistent with public health), potentially at significant expense to its bottom line, even if that expense is likely to be short term and the company expects long term benefit, our first response as skeptics shouldn’t be to immediately attack the company for not doing something else that we think it should be doing. Accept the good action for what it is, acknowledge that it’s good, and resist the impulse to instantly yoke it to criticism of bad things the company is still doing. Save those complaints for another time, long enough to decouple the deserved praise for the good action from the pressure for more action on the first comment.

Don’t be that scold in the example above congratulating someone for quitting smoking but then telling him in the same breath it’s time to lose weight. (Oh, and what about his horrible wardrobe and hair that desperately need a makeover?) To do so is counterproductive and makes us look like zealots who are so wedded to our causes that we can’t see the big picture. None of this is to say that we shouldn’t resume the pressure on pharmacies to stop selling homeopathic remedies next to real medicine, but keep this in mind. Even if CVS were to stop selling homeopathic remedies tomorrow, the impact on public health (and the company’s bottom line) would be minuscule compared to that of ceasing to sell cigarettes and tobacco products. That’s not to say that getting homeopathic remedies out of pharmacies isn’t important, but its importance is dwarfed by the horrific toll on public health due to tobacco products.