Tobacco Takes Hits from Comedian, Supermarket Chain

Antismoking advocates have much to celebrate. Recently, a regional supermarket chain ceased tobacco sales, a new study affirmed the effectiveness of a smoking-cessation drug, and tobacco manufacturers were the targets of a popular comedian’s wrath.

On the February 15, 2015, episode of HBO’s “Last Week Tonight,” host John Oliver devoted an entire segment to delivering sharp criticisms of tobacco manufacturers, particularly Philip Morris International (PMI).

Oliver began by discussing the positive effects of increasing regulations on tobacco marketing, citing a 2014 Surgeon General’s report published by the US Department of Health and Human Services, which stated that adult smoking rates in the United States have dropped from about 43% in 1965 to approximately 18% in 2014.

Turning his focus overseas, Oliver described a 2012 Australia law requiring tobacco companies to sell cigarettes in plain packages with warning labels and graphic images of disease-ridden smokers. Supported by data from the Australian Department of Health, Oliver suggested that this measure led to record lows in Australian tobacco consumption.

In response to this legislation, Oliver explained, British American Tobacco Australia and Japan Tobacco International sued the Australian government, though the High Court of Australia ultimately ruled against the tobacco manufacturers. He stated that, following this ruling, Philip Morris Asia threatened to take the Australian government to international court, claiming that the removal of its brands from cigarette packaging could cause the value of its trademark and intellectual property to drop. Oliver also rebuked PMI for threatening similar lawsuits against the governments of Uruguay and Togo, both of which also attempted to pass more stringent tobacco packaging laws.

Oliver ended the segment by proposing a humorous compromise that he claimed would satisfy both governments’ attempts to warn their citizens of the dangers of smoking and the tobacco manufacturers’ desire to market their brands: a new mascot he named “Jeff the Diseased Lung in a Cowboy Hat.”

In a response published online in the Los Angeles Times the next day, PMI defended itself against the TV segment, claiming that the show is “known for getting a laugh through exaggeration and presenting partial views in the name of humor” and accusing Oliver of mischaracterizing the company.

Practice Points

Patients with a smoking addiction may turn to their pharmacists for suggestions on how to quit. In an exclusive interview with Pharmacy Times, Bill Blatt, MPH, director of tobacco programs for the ALA, offered the following counseling recommendations:

• Pharmacists should ask patients whether or not they smoke, and if so, emphasize the importance of quitting. While many health care providers worry that this will potentially annoy patients, they will ultimately appreciate the advice.
• Patients who are looking to quit smoking can call a hotline available in each state (1-800-QUIT-NOW), which can provide support and direct patients to additional local resources.
• There are 7 smoking cessation medications available in the United States, including 5 OTC nicotine replacement products (patches, gum, inhalers, nasal sprays, and lozenges) and 2 prescription drugs: Pfizer’s Chantix and GlaxoSmithKline’s bupropion (Zyban).
• Patients may respond to each type of medication differently, so a treatment that works well for one patient may not be as effective in another.
• Pharmacists should always ensure that there are no interactions between currently prescribed medication and either smoking cessation drugs or the tobacco product.

“Pharmacists can make a big difference in the number of people smoking,” Blatt told Pharmacy Times. “It’s important for them to encourage patients to make a quitting decision.”

Nevertheless, many antismoking advocates praised Oliver’s attack. Paul Billings, senior vice president of advocacy and education for the American Lung Association (ALA), found the segment effective in raising awareness of tobacco manufacturers’ actions.

“Any attention that can be brought to bear on the tobacco industry is very helpful to our goal to reduce death and disease from tobacco use,” Billings told Pharmacy Times in an exclusive interview. “Entertainers like John Oliver speak to a segment of audience who might be harder to reach.”

Billings added that while he was not surprised by PMI’s response, he felt that it reinforced Oliver’s message.

The “Last Week Tonight” segment is not the tobacco industry’s only recent wound. On February 18, 2015, family-owned supermarket operator Raley’s Co. announced that it will stop selling tobacco products at its 128 Raley’s Bel Air Markets and Nob Hill Food stores in Northern California and Nevada by the end of this month.

“Raley’s decision to remove tobacco products is our next big step in ongoing efforts to provide healthier options and to raise awareness about health and wellness,” the company said in a statement. “This decision was not based on any governmental pressure or reward. It was based on Raley’s commitment to the health and happiness of our customers. We care about our customers and the communities we serve.”

With this announcement, Raley’s will follow CVS Pharmacy, the first major pharmacy chain to stop selling tobacco products in September 2014.

A final piece of good news for antismoking advocates emerged from a study published in the February 17, 2015, edition of JAMA, which indicated that varenicline (Chantix), a nicotine addiction medication, might help reduce smoking prior to quitting.

Among patients who were unwilling or unable to quit smoking within a month, yet willing to reduce the amount they smoked over the following 3 months with the ultimate goal of quitting, researchers found that Chantix was more effective at reducing smoking habits at 24 weeks compared with placebo.

“The US Public Health Service and other guidelines recommend smokers set a quit date in the near future and quit abruptly. However, many smokers may be unwilling to commit to a quit date at a clinic visit,” the study authors wrote. “Because most clinicians are likely to see smokers at times when a quit date in the next month is not planned, the current study indicates that prescription of varenicline with a recommendation to reduce the number of cigarettes smoked per day with the eventual goal of quitting could be a useful therapeutic option for this population of smokers.”

Adverse events associated with the use of varenicline include nausea, insomnia, and upper respiratory tract infection. The rates of serious adverse events did not greatly differ between the placebo and varenicline groups.

Tobacco use is the leading preventable cause of death in the United States, according to the US Centers for Disease Control and Prevention (CDC). The CDC estimates that cigarette smoking and second-hand smoke are responsible for approximately 480,000 deaths in the United States each year, or about 1 of every 5 deaths.

Krystle Vermes contributed to this report.