CVS Caremark announced Wednesday that it will remove cigarettes and all tobacco products from its 7,600 pharmacies nationwide by October 1 costing the retailer an estimated $1.5 billion in annual revenue.

The move addresses what public health officials and pharmacists have long seen as a hypocritical practice patients picking up medications to treat disease, not to mention smoking cessation products, can also add a pack of cigarettes to their purchase. In recent years, the disconnect has become even more glaring, as retail pharmacies have increasingly shifted their role in the health care community, investing in delivering medical services such as immunizations and other basic care through retail clinics, and targeting more wellness oriented goals. Such health care delivery, says Dr. Steven Schroeder, professor of medicine at the Smoking Cessation Leadership Center at the University of California San Francisco, is in clear conflict with the commercial interests of pharmacy chains in selling tobacco products. I think the pressure has been building over the last five years as pharmacies have gotten more into the care dispensing business. Schroeder co wrote an essay appearing the latest issue of the Journal of the American Medical Association with CVS Caremark s chief medical officer, Dr. Troyen Brennan.

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The American Medical Association (AMA) supported the decision, noting that reducing access to tobacco products is one part of a multi pronged approach to lowering smoking rates in the U.S. In 2009, the Association urged pharmacies to stop selling tobacco products, a position echoed by the American Heart Association, the American Cancer Society, the American Lung Association, and the American Pharmacists Association.

President Obama issued a statement Wednesday morning praising the step, as well. “As one of the largest retailers and pharmacies in America, CVS Caremark sets a powerful example, and today s decision will help advance my Administration s efforts to reduce tobacco related deaths, cancer, and heart disease, as well as bring down health care costs,” Obama said.

Other aspects of the anti smoking effort include taxes on tobacco products and increased education and awareness about the dangers of smoking, a strategy that began 50 years ago with the first Surgeon General Report on Tobacco, which linked smoking to lung disease, including cancer. Tobacco and smoking causes nearly 500,000 deaths each year in the U.S., and costs $132 billion in medical expenses, according to the latest Surgeon General Report.

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Public health officials hope CVS s decision will prompt other pharmacy chains to do the same, and build on the regulatory and cultural momentum that is marginalizing smoking. Wider bans on lighting up in public, hotels, planes, and office buildings has helped to drop smoking rates from 42% of U.S. adults in 1965 to 18% currently. Still, 42 million Americans light up, and by making cigarettes scarcer, it s possible more smokers may consider kicking the habit. If someone comes into CVS to buy a pack of cigarettes, and CVS isn t selling them, they might think that it s time to quit, says Schroeder.

Health canada tracks e-cigarettes

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As electronic cigarettes straddle the line between legal and illegal, Health Canada is trying to find out exactly how many of these devices are being sold.

Ottawa is about to spend up to $230,000 to study how many electronic cigarettes have been sold over the past two years as well as current monthly totals.

Electronic cigarettes are surging in popularity but exist in a legal grey zone. They can be sold if they release vapour but not nicotine. They also cannot be advertised as a healthy alternative to cigarettes.

But the devices can be sold with vapour cartridges that are easily swapped out for nicotine, and demand is booming.

I ve had (customers say) everything from you ve saved my lungs to you ve saved my marriage, said Phil Ralph, employee of the downtown Ottawa retailer e Steam.

The company is two years old but has expanded to 14 locations in Ontario. Buyers can purchase an electronic cigarette kit, starting around $80 and ranging up to hundreds of dollars.

Each device comes with a vapour cartridge. Vials of up to 24 milligrams of nicotine can be bought separately.

Ralph is himself a 12 year smoker who tried and failed several times to quit, but is now onto e cigarettes.

I haven t had a cigarette in over three months. The switch was seamless, he said.

But anti smoking groups have called for tighter restrictions on e cigarettes. The Canadian Lung Association called them gimmicky, unproven methods and urged smokers to use other methods.

The government has mostly followed suit.

To date there is not sufficient evidence that the potential benefits of e cigarettes in helping Canadians to quit smoking outweigh the potential risks, says a statement from Health Canada.

Without scientific evidence, Health Canada continues to advise Canadians against the use of these products.

Ottawa is now paying an outside company to sort out how many smoking cessation aids are being sold.

AC Nielsen of St. Laurent, Que., has been pegged for a $133,000 contract to study retail sales of electronic cigarettes and non pharmaceutical nicotine replacement therapy products.

Health Canada wants to know how many have been sold in the past two years, plus ongoing monthly reports. The contract runs through all of fiscal 2014 2015, but can be renewed for a second year for $100,000.

The office of Health Minister Rona Ambrose isn t saying if the research could be used to craft new legislation.

I don t have any further info for you at this point, said spokesman Michael Bolkenius.

Bolkenius said Health Canada is currently sending out letters to e cigarette vendors to bring them into compliance with the laws.

He said e cigarette manufacturers would need to make the scientific case that the benefits of their products outweigh the harms. He said no companies have so far applied to have their products authorized.