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In the U.S. alone, more than 1,300 people die every day from regular doses of cigarettes, according to the U.S. Surgeon General’s Report on Smoking, released last month. More than 20 million Americans have died because of smoking since the first surgeon general’s report was issued 50 years ago. The report adds that 10 times more “U.S. citizens have died prematurely from cigarette smoking” than those killed during all U.S. wars in history.
Secondhand smoke is the third leading preventable cause of death in the United States, after smoking itself and alcohol. Two and a half million nonsmokers — merely trying to breathe — have died because of heart disease or lung cancer from secondhand smoke in the past half-century. Secondhand smoke increases the risk of stroke alone by 20 to 30 percent, according to the surgeon general’s report. It also hurts infants and children — compromising their lungs and causing sudden infant death syndrome (SIDS).
Despite these alarming statistics — and unlike Hoffman’s death, which led to discussions about heroin addiction — the cigarette-smoking epidemic generally receives scant media attention.
And the attention the media do offer is misleading. I am tired, for instance, of the media calling smoking a “habit.” Picking your nose is a habit. For most people, smoking is a serious addiction — the first possible chemical dependency, and one most likely to end in death. Smoking is responsible for 1 in 5 U.S. deaths annually — killing more than HIV, illegal drugs, alcohol, cars and firearms combined.
By referring to it as a “habit,” the media support smoking as an acceptable social norm. I teach business management ethics and organizational leadership at a Catholic university in Minnesota. Our social norms — including business policies — reflect the moral tributaries that have flowed to us from generations past. Many of these social norms are hard to notice even as they contaminate our living social environments and disrupt the health of our communities. Tobacco economics is one such toxic norm.
The problem is not the individuals addicted to smoking per se — it is, rather, the larger economics of addiction. Tobacco addiction has become so acceptable, so much our norm, that 5 million deaths each year to global citizens are a matter of tobacco sales’ perverse cost-benefit calculus. This is because we continue to enable multinational corporations and political leaders to drive huge profits, to the tune of megabillions annually, by perpetuating addiction.
Pharmacists are among the most trusted health professionals. As an aspect of our health care system, this lends credence to chain drugstores, which often use and leverage pharmacists’ licenses to legally dispense prescribed drugs.
Among pharmacies, the chains — Walgreens, Rite Aid, CVS — serve as the main outlets for the addiction machinery. Under waves of chain drugstore expansions, most locally held, privately owned pharmacies have ditched tobacco as their stores’ numbers continue to diminish.
As a result of chain expansions, instead of overseeing all business operations, as they used to when they ran their own stores, many pharmacists now work as corporate staff with little store authority or relative economic power.
For many years, drugstores got both their tobacco and candy from the same distributors. Through the 1990s, many products on store shelves came from brands variously connected to multinational tobacco companies. For example, Marlboro maker Philip Morris owned Kraft Foods, Post Cereals and Miller Brewing. Camel maker R.J. Reynolds was owned by RJR Nabisco, whose flagship products were cookies and crackers. In addition to providing economic incentives, the supply-chain monopoly put pressures on chain stores not only to sell but also to promote tobacco.
It took years of concerted efforts to force chains such as Walgreens, CVS and Rite Aid even to stop displaying their tobacco products directly next to their toy sections. Until 10 years ago, in many chain drugstores you could pick up and bring heart or lung medications to the checkout counter in a Marlboro-emblazoned shopping basket. Tobacco distributors even had compensation policies for drugstore “losses” when people, typically children, shoplifted cigarettes.
Between 1997 and 2001, litigations in almost all U.S. states forced tobacco companies to release millions of internal records and correspondence about how they targeted children and communities. These disclosures included letters between tobacco companies and chain drugstore executives.
Over the years, besides promoting a public health catastrophe, the tobacco economy has continually squeezed money from communities, states and nations while increasing the corporate percentage of profits from the sales chain. Even tobacco farmers suffer in this arrangement, continuing to get smaller portions of tobacco profits. Tobacco farmworkers worldwide have often had far worse consequences: Picking the toxic plant can cause a condition known as “green tobacco sickness.”
The overarching problem in the addiction crisis is our enabling social environment — systems that allow and foster a uniquely human-made epidemic to serve deadly business plans.
Despite these damning facts, the media and American politicians continue to dance lightly around stigmatizing tobacco use. From 1996 to 2003, I worked with interfaith leaders on tobacco prevention campaigns, one of which I helped set up in Minnesota. Our research found that a majority of faith leaders were afraid of offending members who smoke cigarettes.
Many faith leaders have yet to overcome institutional perceptions that would moralize tobacco addiction and other chemical dependencies. While public health professionals and faith leaders rarely blame those who smoke, tobacco addiction is far from the glamorous notion of free choice that cigarette ads depict. That is a ploy to lure the next crop of youth for an addiction machinery that seduces thousands of kids each day to start smoking.
This is another reason that health and faith leaders alike focus on the predatory nature of tobacco economics on communities. A California-based pastor and activist, Bishop S.C. Carthen, calls Big Tobacco’s business practices a chemical version of the plantation economy. Dr. Raymond Gangarosa, who formulated the economic theory behind almost every state’s tobacco lawsuits in the ’90s, described it as an illness: “We’ve got an immune system not attuned … Failing to see this as cancer means it thrives while the body wastes away.”
Social environment is key
Tobacco companies have long behaved as a predatory industry. Any association with it is to a degree corruptive, corrosive and unhealthy — especially in health care settings, a seeming no-brainer. Some cities, such as San Francisco and Boston, have banned tobacco sales in pharmacies. That is the real news behind this impending divorce for a decades-long marriage between tobacco companies and CVS. A business is stepping away from an economic machinery’s enticement, an enmeshment with dark social incentives that are seen as a norm, even in places we go for our medicine.
The overarching problem in the addiction crisis is our enabling social environment— systems that allow and foster a uniquely human-made epidemic to serve deadly business plans that continue to hemorrhage lives and economies alike.
It is easy to notice the tragic death of an inspiring celebrity. But, as illegal drugs attract drama and concern, the nearly half a million people who die each year and millions more who suffer from cigarette addiction are treated as free-willing aficionados. For pharmacies positioned as part of our health care system, to profit from both promoting and treating the same deadly addiction is two-faced, counterproductive and socially harmful. It shows little principle or mission integrity.
As CVS’s CEO Larry Merlo concluded at long last, “Cigarettes have no place in a setting where health care is being delivered.” We need to get our social waters clean of predatory business models and the all-too-real carnage of cigarette addiction. Otherwise, society collectively will continue to grow economic tumors.
Rick Bernardo is a Minneapolis-based communications and development consultant, and adjunct professor at Saint Mary’s University of Minnesota. He is the former director of California Medical Association’s Health Partnership Project, including its Pharmacy Partnership.
The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera America's editorial policy.