Tobacco: Is the Endgame Drawing Close?

Sept. 3, 2014 marked a milestone in the evolution of the tobacco epidemic: The CVS pharmacy chain — the second largest drugstore in the U.S., with over 7,000 locations across the country — stopped selling tobacco products.

This measure will not only have significant effects in reducing tobacco consumption in the country, but it also implies a paradigm shift that may have a global impact.

In a sense, attitudes toward smoking in the U.S. have come full circle in the last 100 years. At the beginning of the last century, tobacco use was undesirable, but slowly, thanks to tobacco companies’ promotional efforts, it began to be socially accepted. It was encouraged by advertising campaigns such as the one from Camel, which presented itself as the preferred brand of doctors, or by actions such as giving cigarettes to soldiers, who then returned from war as smokers.

During the ‘50s, when the relationship between tobacco and cancer started to become evident, people began to become aware of the harm associated with its use. However, this process has been slow in the U.S. and other developed countries, and is still in its early stages in some developing countries. The reason remains the same: the persistent action of an industry aiming to maintain its profits.

In response to this veritable “epidemic” of tobacco, the World Health Organization sponsored the development of the Framework Convention on Tobacco Control, which came into force internationally in 2005. Over 170 countries around the world are now parties to the convention, which recommends actions such as protecting the public from exposure to secondhand tobacco smoke, providing tobacco cessation treatments, warning about the risks of tobacco, outright bans on advertising, promotion and sponsorship of tobacco, and raising taxes on these products.

Countries that have implemented these recommendations in a comprehensive manner have achieved significant reductions in tobacco consumption and diseases related to its use. These measures have also helped to change the perception of smoking as socially acceptable conduct.

It will be hard to explain to future generations that a product that kills around 6 million people every year has been so widely accepted for so long. Even more so when it not only sickens and kills those who consume it, but also those who do not smoke but are exposed to secondhand smoke.

That is why the decision made by CVS to stop selling tobacco in an environment associated with health care such as a drugstore is auspicious. It is evidence of a shift in the social norm and creates the expectation of thinking about a future “endgame” for the tobacco epidemic.