On October 1, 2008, San Francisco becomes the first city in the United States to ban the sale of cigarettes and other tobacco products in pharmacies.
"A pharmacy should be a place you go to get better, not a place you go to get cancer," a spokesman for San Francisco mayor Gavin Newsom, who sponsored the ordinance, said. The citywide ban is modeled on similar legislation that bans pharmacy sales of tobacco products in most Canadian provinces.
According to city officials, the ban will affect about 70 pharmacies, including Walgreens, Rite-Aid, and the handful of independent pharmacies that are still selling tobacco. Most independents in the city have already stopped selling tobacco products on their own.
Walgreens, which has the largest number of pharmacies in San Francisco, said the ban amounts to commercial discrimination against retail pharmacy outlets. Spokesman Michael Polzin did not argue with the public health intent of the ordinance, but the company objects to its commercial impact.
"The ordinance lacks basic fairness," Polzin told Drug Topics. "It unfairly penalizes certain classes of retailers while unfairly advantaging others."
Polzin said Walgreens is considering its options, including legal action to block the ban.
Tobacco sales typically represent low single digits in terms of retail sales, Polzin said.
"We're not just impacted by tobacco sales," he stated. "We are also impacted by the loss of all the other purchases the smoker makes while in the store. You have to look at all of the store as part of the transaction that we would be losing."
The citywide ban was actively supported by the California Medical Association, the American Cancer Society, and other health-oriented groups. A study by Yale University researchers found that 82 percent of pharmacists and 72 percent of adults surveyed supported a ban on the sale of tobacco products at pharmacies.
Mary Anne Koda-Kimble, dean of the University of California San Francisco School of Pharmacy, said, "There is no place in a setting that promotes health to sell a product that unquestionably causes death and disease."
Other faculty members testified in support of the ban and wrote opinion articles for local media outlets. But pharmacy associations were largely silent.
Conflicting interests on the part of independents, chains, grocery stores, and other members sidelined the California Pharmacists Association, said an association official who asked not to be named.
The National Community Pharmacists Association also stayed out of the discussion. An official said the group may take a position against pharmacy sales of tobacco products at its annual convention in October.
The American Pharmacists Association (APhA) has had policy against tobacco sales in pharmacies since 1971, chief of staff Mitchel Rothholz said. APhA's anti-tobacco policy was reaffirmed in 2005. He added that the association expects its state affiliates to support organization policies at the state and local level.
"Our policy would apply to any pharmacy, including groceries and mass marketers," Rothholz said. "Why target just drug stores? If the intent is to restrict the sale and use of tobacco, the city should be looking at all retail settings, not just drug stores."
That is just what San Francisco hopes to do, Department of Health director Mitch Katz, MD, said.
Katz noted that the city is targeting pharmacies first because selling tobacco in a healthcare setting is an obvious conflict of interest. Pharmacies present themselves as businesses that promote health and wellness, he said, while supermarkets and other retailers sell a variety of products, including both medicines and cigarettes.
If the pharmacy ban is effective, Katz said, the city could pursuer a wider retail ban on tobacco sales in the future.
Supervisors who favored the ban predicted that it would ignite a wave of similar actions in cities and countries across the nation. Public health and elected officials in Marin County, just north of San Francisco, are planning to introduce a similar ordinance this fall.
"It's all part of our continuing look at tobacco and access to the population," Larry Meredith, director of the Marin County Department of Health and Human Services, said. "We don't believe stores promoting health, such as pharmacies, should be selling something that is harmful."
Pharmacy tobacco sales bans have already failed this year in Illinois, New Hampshire, New York, Rhode Island, and Tennessee.