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Big Tobacco and Drugstore Chains: A Long, Cozy Relationship.

On December 8, 1971, the Walgreens pharmacy chain received a letter from a registered nurse in the Chicago area. Her brother-in-law, a smoker, was about to have his cancerous larynx removed, and she admonished the company for selling tobacco and not warning customers of its effects. “By the time you receive this my brotherin-law will have lost his ability to ever speak again,” she wrote. “Ghastly, isn't it?”1 For guidance in shaping a response, Walgreens reached out to the public relations department of Lorillard Tobacco Company, which passed the sensitive job along to the Tobacco Institute, the industry-funded think tank. The institute drafted a proposed letter that thanked the nurse for writing “in your time of sorrow,” reassured her that “the overwhelming number of smokers” do not get laryngeal cancer, noted that cigarettes were a legal product that the chain would continue to sell, expressed hope that the federal government’s research efforts would uncover what caused cancer and how to cure it, and extended “sympathy and best wishes for good health to your brother-in-law.”2 This episode, culled from an online archive of more than 14 million tobacco industry documents, offers a glimpse into the long and very cozy relationship between cigarette makers and the retailers responsible for a key public health function: selling prescription medications. Cigarettes and other tobacco products, in fact, have been such a staple at chain drugstores that last year, when CVS announced that it planned to stop selling all such products at its 7600 outlets, the news grabbed the attention of the media and shook up the drugstore business. The edict, which drew praise from public health officials, took effect last September. And the company wasted no time pivoting away from its smoky past: The day cigarettes vanished from store shelves, the chain rechristened itself CVS Health. It has since expanded its network of walk-in medical clinics and is ramping up its pharmacy benefits management business, hoping to recover some of the projected $2 billion in lost annual sales to tobacco customers. Most recently, the company announced in July that it was leaving the US Chamber of Commerce because of the business group’s role in fighting antitobacco laws in other countries. Until the CVS decision, all the leading chain drugstores had not only sold cigarettes and related goods but, for decades, collaborated closely with tobacco companies to boost point-of-purchase sales, test market new products, shape public attitudes toward smoking, and thwart regulatory efforts, according to our review of hundreds of memos, letters, reports, and other items from the Legacy Tobacco Documents Library (https: //industrydocuments.library.ucsf.edu/tobacco/). The archive, obtained largely through litigation, is housed online at the University of California, San Francisco. Public health advocates, including professional pharmacists associations, have long opposed tobacco in drugstores as antithetical to the outlets’ governmentsanctioned function as sellers of pharmaceuticals. Many independent pharmacies have never carried tobacco or stopped doing so years ago. The practice is banned in San Francisco and some other US cities as well as throughout most of Canada and Europe. Now that pharmacies also sell a proliferating number of smoking-cessation products, they face even greater charges of hypocrisy and conflict of interest. Tobacco executives have long understood the tension between a pharmacy’s roles as cigarette seller and purveyor of health care products and services and recognized that sometimes a soft-sell approach was required. According to a 1990 Philip Morris report, a drugstore “perceives the cigarette category as one that conflicts with its health care image...[and] is reluctant to accept any visibility other than the most low profile version.” Therefore, the report declared, “scenic Marlboro advertising is preferred to a bold 'red roof' and/or lit signage.”3 Despite such public relations challenges, tobacco companies coveted pharmacy customers because a significant majority were women—a perceived growth market for smoking. In a 1990 memo, an RJ Reynolds executive wrote “I've become quite interested in chain drugstores because: 1. They have volume potential (traffic). 2. They have a heavy female skew—all ages!”4 That same year, a Philip Morris executive wrote in a memo that “Rite Aid has requested Virginia Slims Shopping Baskets, personalized with the Rite Aid logo, for placement in all 2,365 stores.” This was apparently a marketing coup for the female-targeted brand; the executive noted that the Virginia Slims baskets were “the first PM [Philip Morris] permanent POS [point-of-sales] item ever accepted by the country’s largest drug chain.”5 To cement their relationships with pharmacies, tobacco executives were willing to extend themselves. According to a 1993 Philip Morris memo, CVS had requested that the company research and provide information about Walgreens’ “philosophy and views regarding the cigarette category,” “current merchandising methods along with pictures,” and “promotion and pricing strategies.”6 The memo went on to assert that CVS also “expressed a need to know” how competitors “measure gross profit margin percentages and what components are factored into determining their margins.” The memo tasked specific employees to ferret out this and other “need-to-know” data about Walgreens and other CVS rivals.6 VIEWPOINT