Pharmacists hope opportunity to advance profession won’t go up in smoke

Pharmacists, especially those who practice at neighborhood pharmacies, are on the brink of an extraordinary opportunity.

It is an opportunity that promises to bring about a shift in how health care is delivered while also addressing challenges related to patient safety, quality of health outcomes and health care costs.

And it is an opportunity to tackle one of the biggest health problems in the U.S.

A December 2011 report to the U.S. Surgeon General provides a compelling discussion that recognizes and advances the role pharmacists play in delivering patient care services. The report calls for recognition of pharmacists as health-care providers, which would remove barriers to compensating pharmacists for clinical services they provide. Beyond payment for products they dispense, pharmacists would be compensated for activities that promote your health and prevent adverse drug events, such as working with your doctor to reduce the number of medications you take to reduce the chance of drug interactions or overdoses.

This couldn't come at a better time. Every year, poor reactions to medications send about 4.5 million patients to a doctor or a hospital emergency room. About 400,000 people are subsequently hospitalized. Of major concern for the 100,000 who are over 65 is that about two thirds of hospitalizations are due to unintended overdose—medication errors. Improved medication management has the potential to reduce hospitalizations and billions of dollars in this age group alone.

In light of this remarkable opportunity to improve health outcomes, my colleagues and I are speaking out about an elephant in the room that has long loomed large and cast a shadow on the pharmacy profession. It's an issue that esteemed colleague Daniel Hussar, Ph.D., professor of pharmacy at University of the Sciences, has long supported and written about recently: the selling of tobacco products in many community pharmacies. According to the Centers for Disease Control and Prevention (CDC), tobacco is the leading preventable cause of death in the US—more than 433,000 deaths annually—more than all deaths from human immunodeficiency virus, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.

Most independent pharmacies do not sell tobacco products, but many chain pharmacies do. On visits to CVS, Walgreens and Rite Aid this week it was easy to find displays of tobacco products right by the cash register where they could be seen by everyone, normalizing their use and letting children and young adults think smoking is acceptable. This places pharmacist employees in a compromised environment. At one end of the pharmacy, cigarettes that destroy health are being sold. At the other end, prescriptions are being dispensed to promote health and, sometimes, to treat the devastating health consequences of smoking.

Pharmacies that promote and sell tobacco products still portray themselves as an important part of our health care system, but they also appear to be dead serious about maximizing tobacco sales. You would be horrified to find a cigarette vending machine in a physician's waiting room, but probably are not so horrified that cigarettes are promoted and sold in many of our chain pharmacies.

Some cities, including San Francisco and Boston, have enacted laws prohibiting tobacco sales at pharmacies. Massachusetts is even considering a sales ban in pharmacies throughout the state. There have been some legal challenges from Safeway Supermarkets, and Walgreens and Philip Morris, which felt they would be at a competitive disadvantage.  However, the City of San Francisco prevailed. I'd love to see Philadelphia take similar action and hope the new City Council and Mayor Nutter will take notice.

There are also pharmacists and others working within organizations that have taken on a mission to stop the sale of tobacco products in pharmacies. One of them conducts ongoing picketing at CVS stores in Washington. At least two major chains — Target Stores and Wegmans Supermarkets — no longer sell cigarettes out of concern for their customers. Kudos to them both.

If ever there has been an optimal time to promote a professional image of pharmacists as providers who improve health outcomes, it is now. But they can't do that while also selling cigarettes that kill people. We need to eliminate any barriers to the provision of new ways to provide pharmacy care and address the multibillion dollar problem of adverse drug events. Here's hoping that tobacco sales in pharmacies won't remain as one of those barriers.

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