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CVS Wants To Provide Care, Not Cigarettes

Doctors don't sell us cigarettes. We would not trust our doctors if they did. The doctor-patient relationship is built on trust. We want to be sure that our doctors' motives are pure and that they focus on improving our health, not increasing their salaries.

Increasingly, big retail drug stores like RiteAid, CVS and Walgreens, which have long sold tobacco products, are getting into the health care provider business. They, like Wal-Mart, all have a growing retail health care clinic business in which doctors, nurses and/or pharmacists provide medical advice and deliver basic medical care. We have become accustomed to this striking incongruity between selling toxic tobacco in one aisle and providing medical treatment in the next. However, we should be uncomfortable.

This month, CVS announced that it would stop selling tobacco products by October. CVS is making a big bet that its customers will place more trust in a wellness company that does not also promote and profit from tobacco and ill health. CVS is backing its bet with a lot of money. It estimates that the tobacco ban will cost the company $2 billion per year in lost profits across its 7,600 stores.

Yet over the last 30 years, as sales of tobacco products have declined, medical expenditures have risen. CVS may be effectively positioning itself to capture more of this bigger medical care market in the long run.

Through the Affordable Care Act, many more people will be seeking care at retail clinics, and CVS wants their business. With Obamacare, more people will be covered by health insurance and will in turn seek medical treatment. Many of these people do not have a primary care doctor now, but would find retail clinics such as the MinuteClinic of the CVS model attractive. Such clinics offer easy access, longer hours and convenience that may appeal to the newly insured.

CVS has indicated that it wants to grow its 800-clinic MinuteClinic business. In effect, CVS wants to become our primary care provider — our trusted provider. Eliminating the sale of tobacco could strengthen our trust and increase the demand for the medical services CVS delivers relative to its tobacco-selling rivals.

Not only is CVS interested in expanding its clinical services, it also is expanding in the pharmacy sector. In 2007, CVS bought Caremark, a company focused on managing pharmacy benefits for employers and insurers — encouraging generic prescribing and improving drug adherence.

Both these businesses — primary care clinics and pharmacy benefits — rely on trust. We want to know that our health care companies have our best interests at heart, not their profits. If CVS didn't evolve and stop selling tobacco, prospective patients, insurers and employers who work with CVS might worry about the company's trustworthiness and quality.

CVS's decision to stop selling tobacco raises a number of important questions. Will CVS's rivals follow suit and stop selling tobacco? Where do we draw the line regarding what other potentially harmful products like candy and soda should be sold at companies like CVS? Can we rely on companies like CVS to be our trusted primary care physicians?

But there is a more fundamental question. Should Medicaid and Medicare keep paying for care offered by companies that simultaneously undermine health by selling cigarettes?

In the past, state Medicaid programs have sued tobacco companies and won millions. In the 1998 "Master Settlement Case," state governments sought legal damages from tobacco companies to compensate them for the funds spent treating tobacco-related diseases of Medicaid patients. If we hold tobacco companies responsible for poor health, can we continue paying billions to drugstores for medications to improve our health while also allowing these companies to profit by selling products that so clearly make us sick?

In an era where health care costs are a leading problem in our country, we can't pay companies that both sell a product that causes cancer and profit from selling a product to treat cancer.

Jody Sindelar is a professor at the Yale School of Public Health.

Copyright © 2014, The Baltimore Sun
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