Entry 20: We Should Ban Cigarette Sales in Pharmacies Because They’re Dangerous

November 19, 2008

Pending legal action from tobacco companies, San Francisco is attempting to ban the sale of cigarettes in pharmacies. Boston is also considering a similar ban, and large pharmacy companies seem to be thinking about getting their day in court as well. Since we’re talking politics, the doublespeak and outright bullshit surrounding this story really provided me with countless opportunities to write entries. For instance, the head of some San Francisco health department both asked where you can find the right to sell tobacco in the Bill of Rights (non sequitur) and claimed that it is an honor to be sued by Phillip Morris because that implies he must be saving lives (ad hominem). However, I’ll be restricting myself to the statement in the title of this entry.

This topic seems like an apt time to bring up Pell & Teller’s show Bullshit!, because they did a rather controversial episode on secondhand smoke. This is a great show, both because it’s freaking hilarious and because it promotes skepticism. However, Penn & Teller often put their political ideology (hardcore libertarianism) ahead of their science and their skepticism. This was almost certainly the case in their secondhand smoke episode, though they have since admitted that they were “very likely” wrong in concluding that secondhand smoke isn’t dangerous. Ideologies influence people, of course, but it is unfortunate that it often so significantly taints one of the few skeptical shows on television.

My own ideologies pulled me in a variety of directions when I first heard about this topic. I personally think smoking is a dangerous and disgusting habit, so part of me liked San Francisco’s plan. However, hippies drive me nuts, so part of me opposed the citizens of SF imposing their hippy will on the populace. Finally, the small government conservative in me fretted that now even the damn left was trying to legislate morality.

The Truth About Pharmacies

But, being a good skeptic, I strived (strove?) to look past my various biases and examine the claim being made. After doing so, I realized that the statement is bunk because it relies on an unstated false premise: the idea that pharmacies don’t sell dangerous items. I’m not referring to the prescriptions in the back; of course medications can have serious side-effects and can be abused. I’m talking about the stuff you can find just walking up and down the aisles, and even then I’m not referring to over-the-counter drugs.

What I am referring to is the Complementary and Alternative Medicine (CAM) aisle found in every pharmacy, where you can find a jaw-dropping variety of dietary and herbal supplements. As discussed in Entry 03, the supplements industry is more-or-less completely unregulated. Though the manufacturers are technically ultimately responsible for the safety of their products, they do not have to demonstrate the safety (or efficacy) of their products prior to their placement on store shelves. The manufacturers don’t even have to register with the Food and Drug Administration (FDA).

Thus, there is precisely zero regulatory oversight of these products. You have no guarantee that the advertised product is safe to consume, much less effective at whatever it’s claiming to do. It took me five minutes of googling to find a website that would mail me Vitamin A megadose pills, each of which contains a literally toxic level of the compound (25000 IU). Every single one of those pills contains a dangerous overdose of a bioactive compound; the term megadose is a marketing euphemism. This all assumes that the product even has the advertised dosage; there is no independent verification or accountability of the dosages contained within dietary supplements. Hopefully, in this case, they’ll lowball ya!

Even if you avoid demonstrably dangerous products, you have no guarantee that purportedly harmless products don’t contain dangerous contaminants. For example, ayurvedic medicines are notorious for containing high levels of heavy metals, including lead, mercury, and arsenic. A Pubmed search of “ayurvedic metal” brings up a whopping ten articles published since mid-2005 discussing the problem of heavy metal contamination in these products. (The NCCAM estimates that roughly three-quarters of a million people in America have used ayurvedic medicine.) This is admittedly the most egregious example of contamination I know of, but it nicely demonstrates the potential danger of CAM products. These are entirely unregulated products based on pure pseudoscience. And your local pharmacy is full of them.

Pharmacies sell many dangerous products every single day. Their supplement aisles have products definitely containing toxic levels of bioactive compounds and possibly untold levels of toxic contaminants. That’s to say nothing of the real danger that occurs when people take completely inert or ineffective supplements in lieu of seeking real medical treatment. Even a completely benign product like a homeopathic remedy can kill, if a sick person chooses CAM over science- and evidence-based medicine.

Consistency Is Key

Why am I tearing into alternative medicine in an article about banning cigarettes from pharmacies? Because the idea that pharmacies don’t sell dangerous products is patently false. If you want to ban dangerous products from pharmacies, you have a much bigger problem than lawsuits from tobacco companies. Pharmacies are chock-full of dangerous products, and people unknowingly buy them every single day.

If a city wants to ban a dangerous product from pharmacies, that is certainly its prerogative. However, that city will have to do a much better job of explaining its rationale for the law than just yelling because it’s dangerous! Pharmacies sell a variety of dangerous compounds, and singling out cigarettes for banning is terribly inconsistent.
Heck, at least everybody knows cigarettes are dangerous.

One last thing I’d like to mention is a great website I recently heard about. It’s called What’s The Harm, and is a wonderful response when some woo-pushers rhetorically asks you what the harm in believing their particular pseudoscience is. The person behind What’s The Harm has gathered thousands of stories about people who have been harmed by pseudoscience. As of this writing, he has tracked over 3200 deaths, 300 thousand injuries, and 2.8 billion dollars in economic damages. I would recommend perusing the extensive and growing section on herbal remedies, which are readily available in any pharmacy.

Before you try to play the skeptic’s skeptic, I am fully aware that What’s The Harm is “just” a bunch of anecdotes. The plural of anecdote is not data, so the website in and of itself does not constitute proof of anything. Some misguided pro-CAM person could just as easily compile a list of people who died while receiving chemotherapy. The key point here is that the topics covered on What’s The Harm are known to be pseudoscience, for a variety of other reasons. This site exists to document examples to counter claims that these things quote-unquote “aren’t hurting anyone.” People hear herbal remedy and they imagine various Native peoples communicating with nature and eating a panacea that their wise men have know of since time immemorial. Well, when you hear herbal remedy, you should think of the fifty dead people whose tragic stories are documented on What’s The Harm as of this writing.

Posted at 7:57 pm by cheglabratjoe