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Each issue will include an editorial on a topic that is important for the profession of pharmacy, as well as a review of a new drug that includes a comparison of the new drug with previously marketed drugs that are most similar in activity, and a New Drug Comparison Rating (NDCR) for the new drug. Read on for this month's issue.

March 2017 Issue [Download PDF format]
EDITORIAL:

MANY WALMART CUSTOMERS WILL STOP SMOKING TODAY!
Their Funerals Will be Held Sometime in the Next Three or Four Days

I am not creative enough to have developed the title for this editorial. It is adapted from an observation made by the late Dr. C. Everett Koop, former Surgeon General of the United States who was a strong advocate for tobacco cessation initiatives. His observation began, "A thousand people…," whereas I substituted, "Many Walmart customers…"

On several previous occasions over a number of years, I have written to the CEOs of the largest retail organizations that have pharmacies (i.e., CVS, Rite Aid, Walgreens, Walmart) to urge that they discontinue the sale of tobacco products. To CVS' credit, it has taken that action on its own initiative (and not as a result of anything that I or others have recommended). On one occasion I did receive a response from a former CEO of Walgreens, but I have never been able to elicit a response from any CEO at Rite Aid or Walmart to whom I sent letters. I wish to acknowledge that these CEOs are very busy people who do not have any obligation or responsibility to respond to me or other individuals who attempt to communicate with them. However, their silence and failure to take action with respect to such an important public health issue are evidence of their hypocrisy in attempting to communicate in other messages that they have an interest in the health of their customers.

Last summer I learned of Walmart's actions to eliminate potentially toxic chemicals in certain products (e.g., household products) they sell. I was encouraged to hear this as I felt this initiative might signal a concern about other toxic products they sell. Accordingly, I sent the following letter to Mr. Doug McMillon, the President and CEO of Walmart. I have also provided below the subsequent exchange of email messages with other Walmart officials whose names I have not identified as they do not have the authority to take the action that I urged.


My letter of August 3, 2016

Mr. Doug McMillon
President and CEO
Wal-Mart Stores, Inc.

Dear Mr. McMillon:

I am aware of the strong position that Walmart has taken to eliminate or significantly reduce potentially toxic chemicals in certain products. It is my understanding that in 2013 Walmart asked its suppliers of these products to remove eight toxic chemicals from these products, and that this initiative and related requests from others have resulted in the removal of 95% of the "high-profile" chemicals about which there is concern. I commend you and Walmart for taking this very important action to protect the health of your customers and the public. It is an impressive accomplishment.

It is puzzling, however, that Walmart still sells tobacco products. Smoking cigarettes and other tobacco products is a causative factor in the deaths of more than 440,000 Americans each year. As the world's largest retailer, it is not unreasonable to think that Walmart stores sell more tobacco products than anyone else. The number of deaths and serious illnesses attributable to tobacco products far exceeds the number of potential problems that might be caused by the chemicals that you have asked your suppliers to remove from their products that you sell.

I urge you to be a leader among retail organizations and discontinue the sale of tobacco products in your stores. This would be an extremely important action and example in protecting and promoting the health of the public, as well as the interest in the health of your customers that you wish to convey by having pharmacies and other health services in your stores. In addition to Walmart, Target stores have requested that suppliers remove toxic chemicals from their products. It is noteworthy that Target discontinued the sale of tobacco products many years ago.

Walmart has an excellent opportunity to demonstrate its concern for the health of its customers and to provide a very important example by discontinuing the sale of tobacco products. I have recommended this action to several of your predecessors in the highest executive office at Walmart. Now, however, an additional question exists. How can Walmart reconcile its request of and pressure on its suppliers to remove certain chemicals from their products, if it is not willing to stop selling products that are far more dangerous? Thank you for your consideration of this request. I look forward to hearing from you.

Sincerely,
Daniel A. Hussar


Response of August 12, 2016 from Walmart Executive Communications

Dear Dr. Hussar,

Thank you for your letter. We appreciate your positive feedback on our move to significantly reduce toxic chemicals in many of the products we carry.

With more than 140 million people shopping our stores each week, we serve a diverse customer base with a variety of wants and needs. Our merchandising decisions are based on our customers' preferences, and we strive to offer a broad assortment to meet a range of demands. While we understand the sensitivity surrounding tobacco products, our role is to provide our customers with access to the choices they are looking for – and also to ensure that we are doing so safely, legally and responsibly.

It's important to note that our commitment to offering choices includes stocking a number of over-the-counter smoking cessation products, such as nicotine patches, gum and lozenges, as well as nicotine inhalers and nasal sprays by prescription. For our associates and their families, we also offer a free program called Quit Tobacco, which includes telephone counseling, online coaching, tools for support, and nicotine replacement therapy.

At Walmart, we are always evaluating our product assortment. We will continue to be purposeful about serving our customers and associates and operating as a responsible retailer.

Thank you for writing to us.

Sincerely,
Xxxxxxxxx Xxxxxx
Walmart Executive Communications


My response of August 27, 2016

Dear Ms. Xxxxxx:

Thank you for your response to my letter to Mr. McMillon. The reason that I sent the letter to Mr. McMillon is that I feel that, as the President and CEO, he is the only individual at Walmart who has the authority to make the decision to discontinue the sale of tobacco products in your stores. However, I am left wondering whether my letter has been brought to his personal attention. Accordingly, I wish to request the opportunity to meet personally with you and Mr. McMillon. I consider this matter to be so important that I am willing to travel to your corporate headquarters in Bentonville at my expense for this purpose.

In your message you note that "…our role is to provide our customers access to the choices they are looking for and also to ensure that we are doing so safely, legally and responsibly." I must strongly disagree with the use of the word "safely" to describe any aspect of the sale and use of tobacco products. Your use of the word "legally" raises a question as to whether Walmart considers it appropriate to sell any product that is legally available. For example, several states have legalized marijuana for recreational use. Should it be anticipated that Walmart will sell marijuana for recreational use in these states because many of your customers will want access to it?

You also comment that you serve a diverse customer base and that more than 140 million people shop in your stores each week. I am very impressed by that statistic but the corollary is that Walmart is selling products with known health risks to a huge number of these people. With this number of shoppers, Walmart must be selling more tobacco products than any other retailer and, therefore, contributing to serious health problems for more individuals than anyone else.

With more than 140 million shoppers each week, Walmart is also in a better position than anyone else to provide a very positive example to the public. An exceptional opportunity exists for Walmart to address America's most important public health challenge by announcing that it is discontinuing the sale of tobacco products. I might suggest the date of the Great American Smokeout, November 17, 2016, as an ideal time for this announcement. This announcement might also be accompanied by an expanded program in which Walmart pharmacists participate in smoking cessation initiatives, and the increased participation of Walmart and your employees in community initiatives to encourage people to not start smoking and to encourage current smokers to quit.

If Walmart was a retail organization that did not have pharmacies, I would not be contacting you regarding the sale of tobacco products. However, by having pharmacies you want your customers to think that you have a commitment to improve and protect their health. By selling tobacco products you communicate a contradictory message.

I look forward to your response and the opportunity to meet with you and Mr. McMillon.

Sincerely,
Daniel A. Hussar


Response of September 1, 2016 from Walmart

Dear Dr. Hussar,

Thank you for your response.

As I am sure you can imagine, Mr. McMillon receives a high volume of requests for meetings. Because of schedule constraints, he is unable to accept all of them. I can, however, connect you with Xxxx Xxxxxx, Director of Global Public Policy, who would be happy to discuss this issue with you. I am copying Xxxx here.

Thank you again for reaching out.

Sincerely,
Xxxxxxxxx Xxxxxx


My response of September 1, 2016

Dear Ms. Xxxxxx:

I understand and respect the heavy demands on Mr. McMillon's schedule. I am very disappointed, however, that he is too busy to meet to discuss Walmart's sale of products that cause/worsen health risks for thousands of shoppers and employees, particularly when Walmart has pressured its suppliers to remove chemicals from certain products that are of lesser risk to fewer people than are tobacco products.

I would be pleased to speak with Mr. Xxxxxx. In his position of Director of Global Public Policy, would I be correct in thinking that he has the authority to make a decision for Walmart to discontinue the sale of tobacco products?

Sincerely,
Daniel A. Hussar


Response of September 2, 2016 from Walmart

Dear Dr. Hussar,

I certainly understand your viewpoint. No one individual, even in a leadership position, is in a position to make this type of decision. I do think Mr. Xxxxxx is a great place to start the conversation, as he is deeply familiar with this issue and the policies associated with it.

Xxxx

(Following this message, I had a cordial and lengthy telephone discussion with the Director of Global Health Policy on September 7, 2016, in which he noted that the subject of the sales of tobacco products is sometimes considered in meetings of the Walmart executives.)


My follow up of September 7, 2016 to the telephone discussion

Hi, Xxxx:

Thanks for your time and our discussion this afternoon. The thought occurs to me that, when you and your colleagues meet to discuss this topic, if there would be an opportunity for me to personally present my recommendations in part of the discussion, I would be pleased to do so.

Dan


Response of September 7, 2016 from Walmart

Pleasure speaking to you. You will be at the top of the list if such an opportunity arises.

Xxxx Xxxxxx


My letter of December 9, 2016

Hi, Xxxx–

It has been more than three months since we last communicated and I wish to follow up on our discussion. I called yesterday and left a message on your office phone. I have the following questions:
  1. Since the time we spoke in early September, has the Walmart executive group considered the matter of the sale of tobacco products? If not, is this topic on the agenda for the next scheduled meeting of this group? I wish to request the opportunity to make comments regarding this matter at the meeting at which it will be discussed.
  2. With regard to the eight toxic chemicals that Walmart asked its suppliers to remove from their products, how many deaths is Walmart aware of that have been attributed to the use of these products?
  3. How many cartons of cigarettes were sold by Walmart stores in the United States in 2015 and 2016?
I appreciate your courtesy in speaking with me in September, and I look forward to hearing from you. However, I am concerned that the matter of the sale of tobacco products is not considered important enough for me to be permitted to communicate with Mr. McMillon, and I am becoming increasingly pessimistic that he and the executive group will give serious attention to the recommendation that I have made. If you feel that I am wasting your time and my time in attempting to communicate with the Walmart executive group, please let me know so that I may pursue another course of action.

Thank you.
Dan


Response of December 12, 2016 from Walmart

Mr. Hussar,

Sorry I missed your call. I was out of the office speaking at a conference. Thank you for following up with me for an update on this issue. As I discussed on the call, it is our position that as a general retailer our customers expect us to offer a wide variety of products for all who shop in our stores. We pride ourselves on being a one stop shop for the whole, not just a few. That is why we offer tobacco cessation products and assist associates who wish to stop using tobacco while also responsibly selling tobacco to adult customers who desire those products. At the current time, Walmart will continue making these offerings where allowed by law.

Again, thank you for reaching out to us and as such, felt as though you should know where the decision stands. If this decision should change in the future, I will be sure to let you know.

Xxxx Xxxxxx


My response of December 12, 2016

Hi, Xxxx–

Following our cordial telephone discussion in September, I was slightly optimistic that Walmart might seriously consider discontinuing the sale of tobacco products. Therefore, your message is very disappointing. You identify Walmart as "a general retailer." However, by having pharmacies in your stores, you want your customers to think you are interested in protecting and improving their health. The sale of tobacco products is a strong contradiction to that message. Since you choose to continue the sale of tobacco products, my recommendation is that you no longer have pharmacies in your stores.

I would make the following observations with respect to my communication with you and Xxxxxxxxx Xxxxxx:
  1. Mr. McMillon is too busy for you to permit me to directly communicate with him, and you and Xxxxxxxxx Xxxxxx do not consider my concerns and recommendation important enough to bring to his attention.
  2. Because you did not respond to my question regarding the number of deaths of which Walmart is aware that have resulted from the use of the eight toxic chemicals that have been a source for concern, I am concluding that you are not aware of any such deaths.
  3. You did not respond to my request to identify the number of cartons of cigarettes sold by Walmart stores in the U.S. in 2015 and 2016. I realize that the number must be astounding and, if Walmart is not willing to share this information, I believe that I can obtain it from other sources.
Please let me know if you consider any of these observations to be inaccurate. As I will now be pursuing this matter in other ways, I wish to be sure that I have not misinterpreted any of our communication.

Dan Hussar

P.S. I almost overlooked the slogan included in your "signature" information below: "Walmart – Save money. Live better." For "truth in advertising," I suggest the addition of a footnote such as, "Exception for Walmart tobacco purchasers: Save money. Die faster."


My message of January 3, 2017 to Mr. McMillon

Following the above exercise in futility, I attempted to "guess" at a possible email address that would directly reach Mr. McMillon. I sent the following message to multiple possible email addresses. Most bounced back as "undeliverable," but one was not returned.

Dear Mr. McMillon:

On August 3, 2016, I sent a letter (copy attached) to your attention in which I urged that Walmart discontinue the sale of tobacco products. Most of the subsequent communication between individuals at Walmart and myself is provided in the email messages below. I have been denied the opportunity to personally bring this matter to your attention and hope that this message might reach you.

I think that it would be clear that I intend to persist with this request. I repeat my offer to travel at my expense to your office in Arkansas for the purpose of meeting with you regarding this matter.

Sincerely,
Daniel A. Hussar


There has been no response.

Conclusions

My experience in this situation and from previous efforts to communicate with the CEOs of large retail organizations with pharmacies about discontinuing the sale of tobacco products have resulted in the following conclusions:
  1. Courteous requests for discussion and action will be ignored and are not successful.
  2. The sale of tobacco products is motivated by just one factor – MONEY. The explanations of service and convenience for customers are weak excuses.
  3. The executives of these companies are not concerned about the health of their customers.
  4. In recognition of the fatal consequences of smoking, the executives responsible for the continued sale of tobacco products should be identified as merchants of death. Identification as blatant hypocrites is also warranted for the Walmart executives who force their suppliers to remove allegedly toxic chemicals from certain products while Walmart continues to sell tobacco products.

Recommendations

  1. Advocates for the discontinuation of sales of tobacco products in stores that include pharmacies should not shop at Walmart and should urge others to not shop at Walmart.
  2. The number of cartons of cigarettes sold in Walmart stores in the U.S. in 2015 and 2016 should be determined.
  3. The number of deaths in the U.S. from smoking-related causes that correspond to the Walmart percentage of total tobacco sales should be estimated and publicized (e.g., in the media, billboards).
  4. State Boards of Pharmacy should discontinue issuing and renewing Pharmacy licenses to pharmacies in facilities that sell tobacco products.
Daniel A. Hussar

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