The thought first struck what Vinayak Jha, M.D., assistant professor of Medicine, calls his “ridiculous nerve.”
Then, it struck his curiosity nerve, which struck his action nerve. Suddenly, Jha — a pulmonary disease specialist and amateur community organizer — was personally committed to a cause that, just minutes earlier, he didn’t know existed.
“When I learned that the sale of tobacco had been banned in pharmacies in San Francisco and Boston, I wondered what the status was in D.C.,” he recalls of his internet stumble in March 2010. “It didn’t take long to figure out that there is no status in D.C. In fact, hardly anyone had even heard of the issue. And so I decided that this was a cause worth fighting for.”
TobaccoFreeRx, Jha’s resulting campaign, seeks to eliminate the sale of tobacco in Washington, D.C. pharmacies (including stores that contain pharmacies) through a combination of grass-roots advocacy, endorsements from professional and governmental organizations, and tactics of “embarrassment and expose,” he admits.
“What characterizes a place that calls itself a pharmacy is having a health care provider who is licensed by the Department of Health, whose sworn goal — and personal philosophy — is to keep people healthy,” Jha reasons. “Unlike a convenience store or gas station, these places are operating a health care enterprise, so they shouldn’t sell the same products that are going to cause the diseases for which you need the medications.”
According the Center for Disease Control and Prevention, tobacco use is the number one cause of preventable death in the United States, killing 443,000 people each year. It is the direct cause of 80 to 90 percent of lung cancer cases, and is linked to the exacerbation of other serious illnesses like stroke and heart disease. It is a drug whose effects Jha tries to counteract every day. Sometimes, he is successful. Sometimes, it is too late.
“Every day is a motivating factor to address cigarettes and tobacco usage — not just once people acquire a disease, not just while they are using the products and want to quit, but even before that,” says Jha. “Even before they ever get a chance to become addicted.”
Since the launch of the TobaccoFreeRx website, Jha has emerged as an accessible resource for other activists across the country. A county health department in Oregon, for example, enlisted his expertise to help them pass an ordinance prohibiting tobacco sales in pharmacies. An anonymous pharmacist too requested help writing a tobacco-free policy for a pharmacy chain. In both instances, Jha happily obliged.
Locally, Jha has sought and earned endorsements from Alan Wasserman, M.D., Eugene Meyer Professor of Medicine and the chair of the Department of Medicine at GW; and Robin Gross, MD, past president of the Metro DC Thoracic Society, which is a chapter of the American Thoracic Society. He has presented his case to the D.C. Board of Pharmacy, and initiated discussions with the D.C. Department of Health and the deans of the Howard University School of Pharmacy.
In the future, Jha plans to design a survey about physicians’ views on the issue, and to petition the city council for legislation as a member the D.C. Tobacco Coalition, an organization that consists of representatives from different the American Heart Association, the American Cancer Society, community groups, and others.
But legislation, he says, is not the only — nor even the preferable — route to success. “If you ask for legislation, people say, ‘Where is it going to end?’ But if you go short of that — if you challenge health care establishments to defend their simultaneous sale of tobacco and flu vaccines; if you ask pharmacists if they feel bad that part of their salary comes from sale of cigarettes, you might find that they are ready to join in this effort,” he thinks. “Pharmacies could actually be taken a little more seriously as health care establishments if they weren’t selling the number one cause of preventable death.”
Ultimately, Jha dreams of hosting a traveling exhibit created by his collaborator, Alan Blum, M.D., director of the Center for the Study of Tobacco and Society in Alabama. The display, called “Your Drug Store and Cancer Center,” is a mock pharmacy adorned with authentic advertisements, correspondence, documents, and other tobacco industry artifacts. By pitting these materials against a backdrop of health, the installation highlights the irony of chain drugstores’ existence as both public health partners and tobacco product enablers.
In a phrase, Jha hopes to strike other peoples’ ridiculous nerves. “I think that in ten or twenty years from now, we'll be looking back and saying, ‘boy, isn't it ridiculous that pharmacies were still selling cigarettes in 2010?’” Jha predicts. “I hope this is just a moment in time.”
