apha executive director georges benjamin,md: good morning everyone. i'm the executive director at the american public health association.i want to welcome you to our forum. as you know, apha has been striving for over 140years to try to advance the health of our nation and of the people of the world. indoing so, we have had the honor of doing some interesting things around tobacco. we havehad a formal policy to approach tobacco since 1963 and actually a policy against pharmaciesselling tobacco since 1984. we have been on the forefront in many otherareas including pushing for smoke free space on airplanes, workplaces, and four while thefda regulation of tobacco. the recently appointed to sit in this is tobacco is the leading preventablecause of death. there was just so much more
we can do about it. i learned tobacco, dr.marty wasserman who has been active on tobacco in his career and i want to acknowledge hiswork, in doing that i have learned the importance of tobacco control and how to do it right.apha has also been trying to walk the walk and as they say walk the talk. since 2004,we encouraged ourselves and other groups to bring their money to cities who want to betobacco free. we’re going to break that rule this year, we're going to be in new orleans.it is our first return to new orleans since katrina. while we're there were going to pushanti-tobacco measures while where they are. we want to create that opportunity peopleunderstand the importance of tobacco control. that is why we're here today, to discuss tobaccoand have traditional and nontraditional partners
can come together to develop new approachesfor helping americans live tobacco free lives. i will talk about the number because our nextspeaker is certainly going to talk about that permits organizational perspective, then wehad have an amazing opening speaker to talk to us about this.i'm going to bring up our critical partner for this endeavor at cvs health, dr. willshrank. shrank-thank you. thank you dr. benjamin.we're really excited to have the opportunity to be here today and to welcome you all andto engage in a conversation about the role of public health interest and the privatesector collaborating and working together to make sure all americans are tobacco free.it has been an exciting time at cvs health.
interviewed mary we announce we are quittingtobacco for good in just this month, we officially became a tobacco free store. [applause].aswe considered making this decision, we reached out to public health experts and we reachedout to folks who have been spending years or generations to think about what the opportunitiesare and what the options are and we are grateful for your support, feedback and participation.it has meant a great deal to us and it has helped create a real chorus around the importanceof stores or outlets that provide health services and their appeared lack of a role in sellingcigarettes. it will come as no surprise to the folks inthe audience today that smoking continues to beam the greatest source of preventableillness and death in this country and that
approximately 480,000 deaths each year areattributable to tobacco use just in this country. we spend billions of dollars to these patients.there is been an extraordinary amount of work over the last several decades to reduce thenumber of smokers, but as we sit here today, convincing and eliminating the use of tobaccoremains our central public health concern and much more work remains to be done.we recently shared results of a study. we looked at the effect of eliminating tobaccosales in two cities where there were bans on the sale of tobacco products in all retailpharmacies, and all retailers that have pharmacies. in san francisco and boston, bands were enactedon a specific date and there would be no further sale of cigarettes and tobacco products inany outlet that had a retail pharmacy. we
conducted a study where we looked at the proportionof people who smoked in those geographic regions before and after the bands. we adjusted itsvoice states, cities for baltimore in seattle and sought trends and we found a considerablereduction in the number of smokers after the ban was put in place on the order of 5.5%to 13% reduction in smokers. if we were to extrapolate that more probably, we would betalking about saving 25-60,000 lives a year. it is this inconsistency, the inconsistencyof selling tobacco products, the single most harmful product that is out there in the worldtoday in settings where we provide health care that seem to be such a clear inconsistencyto our mission and that was what drove our decision to stop selling. we believe in thisand that we are on the right-side of history.
last night as i was on a flight, i sat downand looked at the person to my right and i had no fear he was going to light up a cigaretteand it really speaks to how quickly these things can change. we hope our actions helpto encourage and inspire others to think about what their role can be. we hope it continuesto engage public health interest as well as the private sector around how we collaborateand how we partner and work together to make this country a healthier place and one withless tobacco. >> i would like to thank dr. lushniak forjoining us today. we are honored and grateful. your particular inter-office has an extraordinaryrole in the fight against tobacco. this has been appointed with the 50th anniversary ofthe first surgeon general’s report on tobacco
and health and we are grateful to have yourparticipation and feedback. we are excited and we look forward today where we exploredifferent options and hopefully come up with something we can all do together to make suremore americans live tobacco free. thank you. [applause].dr. benjamin-thank you, will and thank you for our partners at cvs. one of the greatthings i get to do is introduce people and it's always amazing. you know people and youget their biographies and then you discover you really know them. i didn't realize ourkeynote speaker was from chicago. i am as well is two or three of my senior staff. isoften said if you want to work at apha you have to be from chicago. i'm going to bring up dr. boris lushniak who is theunited states surgeon general. the surgeon
general’s role is to articulate scienceto the public and heading the prevention council. one of the more important roles is to overseethe 6,800 uniformed officers in the united states public health service commissionedcorps. if we want to think about it for a moment we're in the process of a terribleepidemic in africa and it is often not recognized that the people that are going to be mobilizedin addition to the department of defense to fight that's terrible epidemic, many of themare members of the uniform health officers of the united states public service corps.so if you could give them their thoughts as they go to west africa to help those folksin terrible need. >> i found out our surgeon general in additionto being the deputy surgeon general has served
with distinction in the indian health service,the cdc, the fda. he got his m.d. degree from northwestern university, mp from harvard university.is both a family physician and a dermatologist and board certified in preventive medicineand dermatology. he is interesting that he walks the talk. is a long-distance bicyclist,walker and hiker. when i was in washington state i used to watch mount rainier on thosedays in which the sun came out and you could see the top of the mountain. i'm going today-- this is a gentleman who scaled to the summit of mount rainier which is about a 14,000-footmountain. i probably watched you do that but from a distance on one of the days the suncame out. this january he released the health consequences of smoking which is the reportof the surgeon general with 50 years of progress.
we have been battling this disease and tobaccoas a preventable disease for over 50 years. in his prefix he said it is my sincere hopethat 50 years from now we will need another surgeon generals report on smoking enoughbecause tobacco related disease and death will be a thing of the past. together we canmake that vision a reality. latest in general, our nation’s top doctor, dr. boris lushniak[applause]. dr. lushiak: thank you so much for that kindintroduction. those of you who have heard me speak realize i don't do podiums very well.we have warned the videographers there may be some walking around. let's start off withthree simple concepts. as i prepare for what words are going to come out of this mouthwhich right now is totally unpredictable is
i look for cues around me and i want to startwith acute that was right in front of me and in essence why we are gathered here todayis simplified by the terms put on this sign, we are here for science because part of whatwe are talking about is in fact evidence -based. it is data-driven. it is not just a feeling,any motion we say that this whole world of tobacco use and smoking and tobacco use ingeneral, i don't like it because ... this goes beyond the sense the dislike of a smell,the dislike of stained teeth. when i was a kid my brother had a staunch anti-smoker. we grew up in a householdwhere my father smoked and my sister smoked. i put that in front of you because that isa sign of how difficult this process is. the one thing i remember from my childhood wasa simple sticker he wore which said along
the lines of kissing a smoker is like lickingan ashtray. i remember as a kid that is really something. it is beyond any motion. we arehere for the science and the science is with us on this. in a 21st century world wherewe rely on evidence -based. we from all sorts of different sectors gather here today, thereis no more arguing. from that moment where we have the executives in front of congressswearing nicotine was not addictive, that moment, since then we have had more and moretruth revealed that people in fact were not following the science. they were denying thescience. we were manipulating the science so we are here for science. science for sciencesake is only numbers in a book. it is charts. it is the incredible graphics we have. theability to put in colors and give life to
its. but science without that we'll next stagewhich is science for action, and even the surgeon generals report, we put out the 50thanniversary report, and it is a great book. read it, study it, look at those incrediblegraphics. in reality at the end of this, those graphics just fade away with time. but unlesswe take that information, unless we take that science and table it and put it out thereand discuss it as we do in a form such as today, which is what are we doing about it?what is the action that needs to be taken? i keep saying one thing i have no problemdoing in bringing to the job of being the acting surgeon general is long gone are thedays where we hide behind the science because there are two ways we can be doing this. andi'm not critical of the science, i am a scientist
as well. one way of doing this is as you cansee table one we have 480,000 people ... the reality is this action now has to includeanother part of this. we have made better rents of the anti-tobacco, anti-smoking movementin this room and. who have been doing this for awhile. it's a timely gather around inthis form with apha and cvs health in the room along with the rest of us and part ofthat action includes two emotions. one emotion is passion. we introduced the concept of passionsaying, we have the science. we have the ability to change the world, and we have to be enthusiasticand filled with this sense of accomplishing something and there was no holding back becausethe other emotion i want introduce which oftentimes gets confused with passion, we need to holdwithin us until it interrupts from our souls
and that is the element of anger. the scientistwho sees all this and says i'm taking this for action, who doesn't take on the aspectsof passion or anger won't accomplish the goal because the ultimate goal is this third component,for science, for action for health. i keep using the term a bold and noble cause, itis the health of our nation. if you try to say i am here from a certain angle or federalgroup and uncovering and meeting, the reality once again is everything that goes on in thisroom today has a focus on the health of the nation.i embrace the world health organizationdefinition of health which is a complex awe-inspiring definition and that is that health is thecomplete physical, mental and social well-being and not merely the absence of disease. ifyou really want to get blown away, look at
that definition. those of you in public health,my latest recommendation is i recommend you put two things on your bulletin board support.put down the world health organization definition of health to inspire you each and every daythat that is the ultimate and that is what we're trying to achieve.the next thing i recommend you put on there and this is where we need to be reminded thatthings are achievable, i refer to the mmwr back in 1999 that listed the 10 major healthaccomplishments because in that list is that although on a daily basis, we in public healthand government and the private sector dealing with health issues may feel as if the oddsare against us. that list proves that things are accomplished. one of those 10 is recognitionof tobacco as a health hazard. that is one
of the top 10. in the year 1900 we lived ina different world. in the year 1950 we lived in a different world. by 1964, we began anew era. one that we commemorate this year in this 50th anniversary year. a commemorationthat allows us to look back in time to j anuary1964 when a report is released that has a simpleconclusion. i keep telling people i love the subtlety of these words because it is so governmentto some extent. if they want to rock the boat, they didn't realize how much the boat wouldbe rocked by the simple term. the simple sentence was cigarette smoking is a health hazard ofsufficient importance in the united states to war and appropriate remedial action. thatis the conclusion. i'm not making fun of that statement. i am awed by that statement becausein the subtlety of those words, appropriate
remedial action began a 50-year process whichhas changed the world. it has presented a different look at our social norms. it hastaken something that was so prevalent and so thought of as being just a part of societyto now 50 years later realizing that we are on the winning team in this room. we are onthe winning team and that's the product that. is the game over? is the battle won? no, itis not. we don't accept the successes we have had because we know in the midst of this westill have a lot of work to do. >> i've had two recent events in my life andi want to put it in perspective because i want to tell you how this issue is out there.last week we were in new mexico. the surgeon general travels a lot. i hate traveling. inningon an airplane and being away from home. i
realize the job now comes with that obligation.once i get on the road, my new assistant knows that i tell her to just get me home and thenagain in front of the crowd and realized i have a job to do as the surgeon general ofthe united states and one of those jobs last week was to go to elementary school. it isoutside of albuquerque and in error call to skin cancer prevention because the schoolhas done incredible things. we were there for that reason. our time period with thekids with the fifth-graders, the big kids on campus. they were so proud of the factthey were the example for the kindergartners. there was a ritual, kindergartners come tothe school and given a wide-brimmed hats they wear throughout there year. i talked the skincancer talk and afterwards what happens, we
have questions and answers. to tate have thisissue has not gone away, these are fifth-graders, i'm there to talk about skin cancer and wehad a few skin cancer questions but from the mouth of the fifth-graders, tell me againabout smoking. my mom, my dad, my grandparents smoke, what do i tell them? there are lotsof kids who still smoke. this got derailed off of topic but in fact it didn't feel likea derailment because at the fifth-grader turns to me that says you have not done enough,you were still presenting me a dilemma here it's a reminder that this is from the mouthsof these kids who were soon going to be in middle school. we know the stats with middleschool. this is where it starts. if you think there is no interest out there, i invite youto go to the fifth grade into the top.
focus a few days later down in north carolina,the heart of tobacco country. giving a talk on tobacco. talk about being empowered inthinking our lives have changed, first of all admitted to north carolina and i returnedfrom north carolina safe and sound. in the midst of that talking with the north carolinapublic health association was an important endeavor because their you see people in thefront lines in the historically pro- tobacco state who are making headway. on stage, oneof the lobbyists talking about her role in her organizations world in terms of tryingto get the state legislature to look at the tobacco tax, and issue a north carolina. ithink it is $0.48 a pack in the national averages $1.53. here they are trying to do that knowingtaxes play a key role in terms of people getting
off tobacco. on stage a person who admitsthey are not a public health person, they are not even a health person. he is the managerof multiunit housing. he is a realtor and yet that organization has gone 100% tobaccofree in their units and part of it was it makes business sense. yes, the repercussionsare plays a role in the health of the nation, etc.. but ultimately, he said that's whatthe public wants, even in north carolina. looking at the decision-making of cvs health,you come in totally altruistic into this and i know that is that mission and passion forpublic health but at the end of the day your people running the numbers say when to takea hit but ultimately we are changing. we are changing a philosophy that ultimately it iswhat the public wants. i think that's what
the discussion here needs to be is at theend of all this, we can't be in a position of saying this is not attainable. look atthe list of the 10 achievements in the 20th century. look at the concept of what we cando, what we already have done, but in the midst of this we have so much more that needsto get done. so where do we start? we start with a multiunit housing unit outside of wilmington,north carolina. we start with the department of defense that is beginning to say i'm startingto get this. the fact that most of their medical units are now tobacco free, we're still not100%. the public health command has gone tobacco free, this is in an environment where we thinkof the social norm being that's what a soldier does. we start infiltrating to have peoplestart scratching their heads and have them
run those business models. part of what dodis interested in, a national security objective which is they want healthy people coming in.i am always amazed with the dod they don't allow smoking during basic training. theybring them in saying we're going to mold you into the soldiers of the future, no smoking.. do you realize how incredible that is? once that's done, it's back to being normal andit's okay. there is a disconnect, but one i feel is going to be connected.the healthy base initiative is part of the dod perspectives. how can they look at theirgroup they are in charge of, not only the people in uniform but their family members.part of it is the cost associated, when you run the numbers of how much healthcare isexpended for smoking-related diseases is another
way. i don't care what the reason is, at theend we have the science, we need to take action and we are doing it for the health of individuals.partnerships, housing and urban development, epa, we have multiple partnerships that existthat even from the u.s. government perspective, the ability for us to look at the housingunits operated by hud and saying how many are going smoke-free? the ability to infiltratecollege campuses realizing part of the tobacco free college campus initiative is that goingfrom 700 colleges to 1400 that are going tobacco free. that is how we start this. you lookat a small service, thank you for the kind regards to the u.s. public health servicecommissioned corps, this yourself ridding the 125th anniversary of being a uniformedservice in this united states. part of my
team is sitting at hubert humphrey rewritenow putting together the teams that will soon go back to liberia to assist and that a publichealth crisis. this is also a service that proudly on january 1st shortly before thecommemoration of the 50th anniversary and before the release of the 50th anniversaryreport under the signature of then surgeon general regina benjamin who had signed thispolicy a year earlier to go into effect on january 1st implemented by me, the fact webecame the first service to go tobacco free and easy directory while in uniform. you wouldthink the public service health service commissioner would've done this years ago, we didn't. wesave it to the 50th anniversary. what a great place to be where we see pictures of officersaround us. the reserve officers association,
and a credible historic building and activism,we now are inspiring the other services you want to talk about health? do you want totalk about example and patriotism recs let's tie this together. i submit we can waive manydifferent flags under the aspect of tobacco free america and one of those flakes is thepatriotic flag. i strongly believe we need to treat health as a national natural resource.preventable diseases need to be targeted that if it is preventable, then we blew it. evenone person getting lung cancer from tobacco, one person developing diabetes, one gettingcolorectal cancer, any of those maladies we now a no strike every single organ systemof the body, that is how bad it is from one cancer in 64 to 13 cancers begin adding otherthings. if we can prevent one individual from
getting those diseases, that is a positivefor the economy of the nation. that is a positive for the morale of the nation. that is a positivefor the productivity of the nation. that is a positive for the happiness of the nation.let's start talking about a national natural resource and let's blended whatever flag youwant to waste. if you want to waive the public health association flag and continue yourexcellent work, do so. if you want to wear the cvs health lapel pin, you were part ofthe team. if you want to wave the american flag and say this is good for our nation,join us. for to long i think we have disregarded health as a key component to our nation. forto long we have treated it as a secondary phenomenon, as an individual decision points.go back to the who definition, that these
things are attainable. are we going to getrid of all sickness and disease and injuries, no. we are never going to get there. but canthey make a dent in terms of the principles? yes. when it comes to tobacco use as alreadystated, number one, this is it, 480,000 people a year die prematurely from cigarette smoke.from tobacco related diseases. 18% of our population smokes, it is down from 43%, thenumbers look good. that is 5.6 million kids currently alive who die prematurely. the inroadsare being made. if we can show up in north carolina and inspire the public of workersthey are, i would love to say when i go out there to inspire them with a checkbook, hereis more funding for tobacco cessation. the reality is we are in high economic times.the inspiration has to be one of saying we
are 50 years into this, it remains a boldand noble cause, and we can do this. we can make a difference. as already stated, 50 yearsfrom now, we have a surgeon generals report that has this great cover. the surgeon generalat the time will come out and make speeches and it will all be at historical vignetteabout how bizarre our culture was that we allowed for this. certainly the 75th anniversaryreport, my expectation is that we have zeros in there in certain groups that are sayingwe have gone tobacco free. it is doable. at the end of all this, what are we trying todo today? we're going to discussions and panels. at the end of today we go out and we startwith we started remembering the fifth-graders at the elementary school and their inquisitiveness,there concern. we remember we are talking
about science, but that is not enough becausethat science needs to be put into an action phase to do something about it and ultimatelythat attainable goal of the health of our nation. let's have a great day. let's walkaway invigorated. let's walk away reset on our past and our mission, and let's walk awaybeing friends in realizing all the way of multiple interest groups we represent in thisroom with a common bond that is in fact we the commissioned corps take on years ago asour motto but it's not just exclusive to wes because what we are doing in this room iswhere following the mission and that mission is to protect, promote and advance the healthand safety of our nation. that is how big today is. thank you for your attention. [applause].i never use notes but i decided to use this
because i thought it looked intellectual.[laughter]. ronada henry: my name is ronada henry andi work for a funded addiction technology transfer center. given the world health organizationdefinition of health, mental is in there and what we know we have a desperate populationof those with mental illness and substance use disorders that still smoke at a rate ofabout 40%. our efforts to continue to reduce smoking in this country are really dependenton reaching that population and reducing smoking in that population in a major way. one ofthe things i would like to see happen is i know there is been a lot of focus, i knowyou work closely with the smoking cessation leadership at the university of san franciscowith dr. schroeder, but we need to do more
because that group still smokes and with theprescription drug abuse epidemic, one in five individuals in this country had a behavioralhealth condition diagnosable without impacting that population, we won't drive it down..lushniak: i agree. we're we are at that base happy century did this where the strategynow is if we really are tobacco free, whatever numbers you want to use, certainly we lookat you as being our savior and we can influence that. we’re not giving up on any of thehigh risk groups. the reality is i'm in uniform service, i'm not a person who goes out andshoots guns. i spent a quarter of the century in uniform knowing i am non- service but iwill put out the analogy of war. would go toward a battle and we have strategies inthat battle. hopefully the pays we're switching
it to is opposed to saying we are in owl outwar, we have to change the phrase to saying what are the high risk groups? what are theinfluential groups? we have the data. cdc has the data and do have the data. the concertedeffort to need to get into is that, where are my problem areas akin to a battlefront?had why not send battalions against that, but how do i infiltrate? how di o make thiswork effectively with the least number of resources? that's what it's about. right nowwe know where our problem areas are. in the world of mental illness and substance abusewe have a problem area. we know tobacco cessation works but they may have to be changed in thatworld i now have a person suffering with other maladies and the question is the processingdifferent and is the ability for me to influence
different? i have to know what's going towork and that population. last week i was on capitol hill testifyingon prevention of suicide. the mental health crisis is tied into so many different aspectsof preventable public health issues in this country.speaker: will we talk about the next generation of tobacco users in targeting children whoare susceptible to advertising in images especially in the media. we know that influence is greateven though it may be unpaid advertisement they are viewing that we aren't they are inmovies and they see it after they like smoking, that can change the behavior in turn theminto smokers. what are your thoughts about having warnings so children can see thesebefore they view a movie?
lushniak: we have learned so much more aboutthose influencers, specifically on youth it was the academy awards or something my heartsank when i saw the actors using e-cigarettes. one of the things we're looking at and ithas been a proposal from sectors in california which is you look at the influences, and thisis documented. this incident a feeling i have. because you show a cigarette on the screenthat someone is going to think about initiation of smoking, this is science. we know thatinfluences kids. the reality is we're looking at mechanisms. one of the things we wouldlike to have a more vibrant discussion is the rating system of movies for example. rightnow, if you shall illicit drug use in a movie, somebody smoking marijuana, it automaticallybecomes an r rating. the reality is with ken
with cigarettes in the same world. it's maybenot the perfect answer but the answer where i think we need to be going in this worldof this next 25 years of activism which is let's look at what is out there and what works.certainly be the influencers out there, be they in the world of sports or the hollywoodscene or the tv scene, we know they played incredible roles in terms of influencing theyoung and that needs to be a concerted effort. lori adams: we’re helping pregnant womenquit smoking and stay quit and we've helped over 5000 pregnant women squids and have healthybabies born runtime. our program uses an incentive -based process where a mom will get free diapersfor a year if she stays quit. that's not a traditional partnership we have often seenour public health entity go. would often say
they are not incentivizing as much. it couldhelp more, so i'd like to hear your thoughts on an incentive -based project.lushniak: there is no one answer. it falls into the realm of public health, implementationof public health activities in general. there is never one answer. we simplify things. theconcept of the stick and carrot and what works. if i called the stick a regulatory approach,if i call a stick taxation of cigarettes approach, that in essence is these things work. certainlybe numeral the fda has taken on with the tobacco control act, that is going to be stick likeendeavors. in the midst of all this, the incentives built in, we know premiums can be lower. weknow certain industries are warding or rewarding people who take on healthy lifestyles, thatis part of the puzzle. it's a very innovative
program you have in an area that once againwe know we are behind on. some of the statistics we have seen recently in terms of the percentageof pregnant women who still smoke, it is 43% in west virginia, along those lines. 30%?can you imagine we still have a full one third, in some of them are getting some sense ofprenatal care, but somewhere we are broken. somewhere is a healthcare provider that basicallysays you are a smoker, you shouldn't smoke. next. that's not good enough anymore. i seedr. benjamin is getting nervous on time. speaker: i congratulate you. i’m the onethat said go cvs because i think it is splendid that you have changed your business modelto one of health promotion rather than give the customer they want. my colleague fromarc, as we came down from rockville on the
metro we were talking about cvs because everyweek i stopped at cvs at 5:30 in the morning and i talked to a clerk who works there allthe time. it was wonderful wonderful wall of tobacco products was gone and replacedby tobacco cessation aids. my friend who is an immigrant who has been in this countryfor seven years, five years after he got here he became an american citizen. he never votedbut in this country he has voted in every single election.[indiscernible] told me hishours are being cut back because cvs revenues are down because of tobacco sales. we weretalking about ways cvs could replace that revenue stream by becoming more active inhealth promotion and getting customers and clients who carry a cvs card and perhaps preparesome kind of model that would encourage people
to become more physically active. maybe itis a separate aid program. benjamin: so one question might be for thesurgeon general to talk a little bit about the private sector in health promotion activities.lushniak: the sense is this is a multisector approach and the approaches it is all perhapssurrounding a business model but the business model is one that needs to be encouraged andone that can work. at the end of the day no business wants to make a decision that ultimatelydecreases revenues. every decision has to have a bottom dollar that says it's eithergoing to decrease and we will regain it or send sense of stability or get the publicrelations aspect that allows people to come in. let's be honest. it is not strictly amedical health decision. we look at cvs health
as being an example of a group, a group wewant to continue to have interactions with, if nothing else to show as an example muchlike the commissioned corps -- the senses i want the cvs help out there saying this is doable the flag we wave is different.at the end of the day let's bring in that patriotic player. at the end of the day thecommon bond is he may have these cvs blake and i may have the health service or surgeongeneral slight but let's get patriotic. health has a major impact on our issue. that is thereality. benjamin: ladies and gentlemen, our nationstop doctor, dr. boris lushniak. while i'm doing that i will introduce our moderator,lyndon haviland -- who was well known in the field of global health. she will -- completedadvanced bidder should training at the harvard
business school. she has over 20 years ofexperience in domestic and international public health and has led numerous public healthcampaigns, initiatives and organizations. she has been an advisory of global leadersand agency heads and a range of activities. -- in disease prevention she's been a member ofthe executive board of the public health association and a friend of public health. with that,i will turn it over to -- who will introduce our panel.haviland: thank you. it's an honor to be here and it's an honor to join with such a distinguishedpanel in talking about how together we can create the healthiest nation ever. the peoplei am about to introduce to you all have an essential role to play and i think one ofthe questions that the surgeon general left
us with his he asked us to think if we needinspiration to look at the top 10 accomplishments of public health in the last century. thequestion i would lay in front of each of our panelists is how can we make the eradicationof tobacco use in america the number one accomplishment in the first part of this new century? thatwould be one key question. i think it was lovely to have the surgeon general remindus of the essential role that apha plays in pulling together advocates, business, foundationsand being at the center of cross sectoral work in public help in promoting the healthof the nation. with that, i will introduce our panelists and tell you a little bit abouthow we're going to do this. each panelist will speak briefly. we are getting peoplewho are watching us on a live webcast and
they are tweeting and i would encourage anyoneon social media to please tweet at hashtag #aphatobacco and you can tweet your questionsand we will get those questions from susan polan, our director in the back.first to my right is shari davidson. i'd like to say everyone comes to tobacco with a story.her story is a story of family health and tobacco. she has any central role, she isthe vice president of the national business group on health. a question for shari wouldbe how do businesses think about tobacco, both among the people they work with and thepeople they sell to? her job is devoted exclusively to representing large employers on nationalhealth policy issues. i think shari will have an interesting perspective. next to shareis tom menighan. he has the joy of working
at the other end of the mall working for theamerican pharmacists association. one of the questions we have always and tobacco controlto ask ourselves that cvs is thankfully answered for us is why on earth do pharmacists workin a place where they sell tobacco? thank you cvs for helping us, there is no placefor pharmacists to be selling tobacco. it will be excited to hear about the role, thepharmacist role in the next century of tobacco control. finally, a man who needs no introductionin tobacco control is my friend and colleague matt myers. matt has been involved with tobaccocontrol i think since the earth cooled. there is no bit of tobacco control he hasn't cuthis hands on, his passion behind in his strategic thinking so i was a very warm welcome to myfriend and colleague matt myers. at the end
we went to want to have all of you join usin this conversation. with that, i think i'm going to ask matt to kick us off.myers: thanks very much. it's a real pleasure to be here. dr. lushniak did hit the corefacts. as much progress as we have made, tobacco is probably this nations greatest public healthvictory. children alive today will die from tobacco in 3000 kids today will light i dofor the first time. 700 kids today will become confirmed addicted smokers. the good newsis there is no issue where we have demonstrated scientifically that we know how to make thefundamental change that's necessary. the bad news is that we have a demonstrated the politicalwill, the ability to bring together all sectors of our society to finish the job. dr. lushniaksaid his goal is to come together 50 years
from now and talk about tobacco as history.we can't wait 50 years. we can't wait 15 years. when we have a solution and no how to do itand don't do it, then we have to look at ourselves and ask the core question, why? the bad newsis as well that the disparities today are huge. who smokes is largely a function ofsocioeconomic class and education. it's the high risk populations as we heard, both themid-to-late ill, lgbt, native americans. it is geographic. where you live today will havea direct relationship on your risk of dying of lung cancer, heart disease, diabetes, unnecessarily.and it's not just which state you live in today. as recent data has shown, virginiafor example, fairfax county has among the lowest smoking rates and the highest lifeexpectancy in the united states. go down the
road to petersburg, virginia and you haveamong the highest smoking rates and the lowest life expectancy. what it says is we have toolsthat we haven't applied them and we have to ask ourselves how are we going to do that's?for me, it is a critical question. if we know raising taxes is the quickest most effectiveway to reduce tobacco use, we e-mail it generates needed revenue for government programs, weknow what affects every one of those populations, why aren't we doing it? if we know going smoke-freeproduces an immediate reduction in cardiovascular disease, it changes the social norm for ourchildren. how is that we can tolerate any community that does that? if we know fromthe report that dr. lushniak released this year that 50 years after the first reportof the surgeon general, cigarettes today are
not only not safer but they more than doubleyour risk of lung cancer, how would we allow any industry in the world, once it learnsits product is a killer to double its killing right? today for the first time the fda hasthe power and the authority to ensure tobacco companies can't make their products more addictive,can't make them more toxic and can make them more appealing. . if we as citizens don'tdemand the fda used that authority then there is something wrong and it is our mistake,not their mistake. lastly, we have failed to properly and enthusiastically embrace theprivate sector. the key to what cvs has done it is has shown that corporate leadershipcontains the public dialogue, the impact of cvs's courageous decision is not just thatcvs will go smoke-free, but that we are asking
fundamental questions about what the privatesector can do that we have simply not asked. i think there is a critical question all ofus as citizens had to answer, and i think cvs has helped us define it, we need to definewhat a responsible retailer is in our society. i put to you that is all of our responsibilityto say that no responsible retailer in our society doesn't sell tobacco products whetherthey are a pharmacy, a convenience store, a gas station or box store. what will changethe public dialogue? is how we act with our feet and our dollar and our organization.i think we as a society should say that a retailer that doesn't sell tobacco that putsthe health of its community before his short-term profits, we need to make sure every retailergets that message and we need to do it with
more than rhetoric. we need to do it withwe as individuals and organizations interact with the private sector. we need to rewardthose who do the right things are doing the right thing is good business as well as goodpolicy. that's the way our society works. when you ask what are our priorities? amongthose needs to be to ensure the private sector that steps forward is embraced not only withour rhetoric but with our actions and our day-to-day actions and i think that's incrediblyimportant and what we need to do. we need to embrace the private sector in a way thatwe haven't. we need to ensure it is not just cvs that is sending a message to the entirenation that says if you care about your kids you can't sell tobacco products. even morethan bad, and i congratulate cvs for doing
this as well is it is one thing to make abusiness decision, it's another thing to recognize every private sector in this country operatesin a community and you won't have healthy workers. you won't have productive workersif you don't become engaged in the public policy actions in your community to engagein that. we have seen that cvs. they have shown real leadership and respect as well,to speak out in favor of the proper policies that will ensure not just their customersbut every child in the communities in which they work are protected, that they go to schoolsthat promote proper education, that the living communities for kids are not exposed to secondhandsmoke from cigarettes or e-cigarettes and any form of those. we need a community toembrace those organizations that step out
and do that.>> i don't think it is an overstatement to say that with the reduction in smoking rateswe have seen it just the last 15 years, smoking rates from teenagers have gone from 36% tounder 16% that it is wrong to say that if we finish this decade and still have smokingrates among our kids in double digits, we have failed, they haven't failed. we willonly succeed with the kind of public private partnership that cvs is demonstrated thatwe're capable of doing. if we embrace business and ensure business understands it is in thereeconomic interest as well as their goodhearted interest that we can get to that goal. thelast thing i want to say is dr. lushniak talked about passion and anger. i would say we needmeet at two things and that is discipline
and focus. we need to use the proven scientificallydemonstrated strategies to ensure they are applied and the science they demonstrate isjustified in this case. we can't look back and say we know how to solve this problemthat we simply didn't get off of our receipts and demand the proper action. there is anenergy for this and it's in every single state. it doesn't matter whether it is a conservativestate or a liberal state, a northern state or a southern state. the public supports tobaccocontrol and political figures will take the actions necessary when we in our communitiesunite with the private sector and adopt those policies. there is a cvs store right nearthe high school near my home. in the morning you see the kids pour in there and in theafternoon you see the kids pour there. three
months ago they sought background of cigarettesevery single day when they walked in there. we know much of cigarette sales among theyouth is spontaneous buying. reinforced by the view because they see cigarettes everywhere.when cvs removed the cigarettes from its store, it changed the daily stimuli that 1000 kidsgot every single day. suddenness cigarettes were no longer the norm and your community.suddenly there was no longer the temptation. the adults in the community hoop smoking warm-upno longer tempted every time they walk to the store because the jews were the opposite.the impact of withdrawing the visibility of cigarettes as well as the assess ability onour community and kids and people making a good-faith effort to change their life isenormous. we not only need to think companies
like cvs we need to ensure every other retailerstarting with the pharmacists and moving down. convenience stores are the heart and soulof our community. you can't be the heart and soul of our community and not care about thekids of our community. when you sell cigarettes you are not the heart of soul of my communityand were not going to support you and need to make sure we do everything we can to communicateto mothers, fathers, grandmothers, if you care about the kids you will reward thoseretailers who care about the kids and you will say clearly to the local conveniencestore and the local gas station you can't tell us you are part of her community unlessyou take actions that demonstrate you care about our community.haviland: so matt’s left is a challenge
which is how do we promote this idea of responsibleretailing and what are we going to do, and what is the role of pharmacists? not all pharmacistsare lucky enough to work for cvs so there are many pharmacists spread across the countryscratching their heads saying how can i be an activist for change?menighan: thank you and thanks for apha for organizing this event and including pharmacistson your team.. 50 years ago, i believe surgeon general identified smoking for the healthrisk it is. for more than four decades the american pharmacists association founded in1952 has applauded and recognize the science and the pharmacies who have never sold ormade the decision to stop selling tobacco products. indeed, our organization has extensiveanti-smoking policies. recently, efforts by
our current surgeon general, and cvs everyinvigorated action agenda with the public and i can tell you from my conversations thatcvs pharmacists love it. they are so proud of their country. as the conversation grows,i'd like to offer america's pharmacists and underutilized resource located in problemareas in the fight to stop smoking. increasingly well-trained pharmacists engage in the provisionof smoking cessation programs. these programs effectively influence smoking cessation bypatients with not just medication or nicotine replacement therapy but also coaching on behaviormodification and other support. increasingly, schools of pharmacy are training student pharmaciststhe skills to help smokers quit. patients may pay out-of-pocket but a growing numberof employers cover these services provided
by pharmacists. there are currently five statemedicaid programs that support programs for beneficiaries to receive services from premisesincluding alabama, alaska, indiana, delaware and nebraska. two dates, ask us to pharmacistsservices not provided under medicare unless provided while the smoker is in their positionsoffice. despite this limited coverage, an increasing number of pharmacists are trainedand engaged in smoking cessation. one great passion example is apha member dr. beth martin.in her managed care practice in the early 1990s, she her colleagues assessed the impactof nicotine replacement therapy. in the process they learned the key to success was a combinationof therapeutic and behavioral approaches. simply, they found assisting patients throughoutthere quick journey using cessation aids and
tailored counseling to help them manage triggerswas the most effective approach. later when dr. martin joined the university of wisconsinthe state tobacco control board gave the school funding to support committed to pharmacistsin a pilot program to train on the pharmacology of nicotine and addiction as well as whattherapies to use for specific critters. these pharmacists got used to talking with patientsabout an rt and other agents as well as behavioral modifications and changes. smokers who expressedinterest in quitting were enrolled. initially the programs targeted adolescents in the teamlearned for this group money was not the sole motivator. peer group engagement was an effectivetechnique to keep these folks engaged. often meeting at the pharmacy after hours to supportone another in the process.
>> another effort involved a large healthsystem and employer group in madison were the employers hr department new 80% of theirworkforce smoked. the healthcare team used peer support to help with meds and monitoringdosing dealing with potential side effects and coaching patients individually and ingroups. behavioral aspects such as per identification and mindfulness are emphasized. smokers spentthem to people known for weeks in preparation for the quick date. by that time they gainedkeen awareness of triggers and have the confidence and motivation to quit. triggers such as stress,arguments or meals or favorite chair or typical reasons for smokers. one smokers realize theydon't be tobacco the game is on and the quitting begins. team support remains important inthe workplace through peers, even when the
pharmacist coaches are not around. and thereis an active alumni group known as -- that meets once a month to serve as a service brightspots for those in the process of putting. other incentives including simpler supportof time and cope the adjustments are also key. what about results? in large part becauseof programs i just described began with folks who have identified a desire to quit, successrates or in the 40 -- 44% range after six months and this has been sustained in variousprograms since 2001. unfortunately, for the non- employer-based programs when fundingruns out the program simply can't continue. pharmacists to provide services have beendrinking behavior change behaviors and principles and they know it is critical to identify folksready to quit before enrolling them. knowing
that quitters often takes several attemptsto put, these programs are offered on an unlimited basis for six months to allow enrollees tocontinue if they aren't successful in their first attempt. quitters learn more each timethey try and the tobacco cessation services are there when they are ready to try again.haviland: thank you. tom is talking about a really essential role, and i think for manyin tobacco control we do believe -- that they've been ready, willing and able but we haven'thad a grateful for them so we are excited to hear there are some great innovations outthere. people are stepping up. now we turn to shari and shari has an interesting takeon this especially if we start with matt's question of what is responsible retailingand how do we get there?
davidson: thanks again for inviting me tocome. i represent the national business group on health where i handle our institute onhealthcare costs and solutions which includes a committee on evidence -based that the designwhich has large employers, strategic partners as well as public and private researchersand agencies. we spend a lot of time looking science and try to large employers determinehow to cover them. what i wanted to talk about today is i joined the business group figureand have a go at my dream job having come from a large employer and that all the largeemployer side for most of my career because the business group had long supported errornearly 400 large employer members which represents 55 million employees, dependents and retireeson tobacco cessation. we have supported employers
inputting a programs, comprehensive programslike financial support, cessation aids, counseling and medication and creative toolkits for ourmembers to learn how to do that. in the last year, we have created the facts on e -cigarettes.we have done a survey on large employers on how they are handling the e-cigarette situation.we created a forum for discussions. last week we had to use a group that talked about whatto do with smoking huts other facilities and repurpose them to meditation rooms or thingsof that nature. we also highlighted including cvs large employers doing really excitingthings in the space of tobacco cessation. our view is all employers should support theseactions. most of our members, the large employers which include about two thirds of the fortune100, 95% -- 93% of our members mentioned they
offer smoking cessation programs which isup from 66% in 2009. i work with the hr department and the benefit department of these largeemployers, not necessarily the folks at the side to sell or not sell tobacco. they lookat themselves as a community of employees. large employers in fact were some of the earliestto ban smoking on their properties and in company vehicles including treating e-cigaretteslike any other tobacco product. in our survey 95% in exactly the same. in 2015, this isa recent survey we just released, more than half of companies will ban tobacco on theoutside of their facility on their campus and outside the building so you have to gooff-campus. 7% plan to ban hiring smokers where that is legal. 58% of companies expectto use some sort of incentive. most are three
times more likely to use an incentive ratherthan a penalty. they do both for. in fact, the median incentive for tobacco cessationparticipation is about $280 per year per employee. the surcharges are higher, about $520 a year.those do work for the smokers. 11% of employers make a contribution into a health savingsaccount for people that are not smokers. again, large employers taking the lead in being innovativein this practice. if other peers, if medicare and medicaid in all the exchange plans didthings similarly, we could really bend the trend on this issue. i wanted to talk abouta personal experience from the employer side. i came from a relatively small large employer,about 5000, when i joined, we had just formed this organization from a bunch of small companiesand we identified 22% of our employees for
smokers. we implemented a consumer directedhealth plan and encourage people to take it tobacco cessation and a weight managementprogram and do other healthy behaviors and we incentivized them with $100 to join and$100 to complete a tobacco cessation program. would look at the date of the next year, 3%of our population have participated in that program and we really didn't have much ofthe way of successful people quitting. . the next year we decided to pay a surcharge. iparticipated in a national business group on health, i was a member of the businessgroup is a large employer. i sat in on a webinar they did on tobacco cessation programs andhow to implement a successful one. how to change the culture of your organization andremodeled our program like other successful
employers had done before us. we put in asurcharge. i went to every one of our locations including winston-salem, north carolina indenton, texas and state college, pennsylvania and told them 18 months from now we're goingto be tobacco free on our sites where they were still smoking at the reception on dancein winston-salem at the time. i told every employee we do not want to collect a singlesurcharge that we are putting this program in place because we want you to pay attention.and next year we had 70% participation in that tobacco the tobacco cessation programincluding air union facility in topeka, kansas. that worked. most people did not get the surcharge.they went to -- we just wanted them to try. based on that webinar in the research andthe science, we put an incentive that said
if you stay quit for six months we will rewardyou with money in your paycheck and 12 months another $200 because the statistics showedan employer can have that kind of impact. over the years i spent at that large employerwe went from 22% down to under 15% so we were moving the needle. it is large employers likethe members of the business group that are having that impact. in particular the largeemployers would consider best performers, the most innovative organizations in the country.i defined them as companies that have a trend that is lower than national average for thelast four years. those employers have seen about a 1.6% healthcare cost increase overeach of the last four years versus about a 5.2% in the nation. those employers are doingall the things you mentioned, free medication,
incentives and disincentives and so one. theyare also doing things on the broader health perspective. wellness initiatives offeringtelemedicine, particularly in rural areas. they are peaking value -based payments thathold providers accountable for outcomes for better health. pricing transparency toolsthat are helping make people better consumers. they are looking at specialty pharmacy costmanagement and offering a very comprehensive wellness program with physical activity aswell as help and food nutrition and so one.we hope other employers take the lead of thesebest performers and others in the public health space and public and private can do that aswell. haviland: i love your examples from topeka,kansas and showing you’re going out to where
the action is in demonstrating you can movethe needle. one of the things you said that made matt take a deep breath was some employersare thinking about not hiring smokers. from your perspective and from the perspectiveof we are trying to put the healthiest nation, trying to incentivize and support people knowingsmoking is an addiction and they need a wide range of support, what do you say to yourcolleagues? davidson: it’s a very small minority ofemployers that are taking that tact. and from what i understand many of them are hospitalsthat take the position that we are health company like cvs and many of say that we willhelp you quit, we will work with the community, we will work with the programs that are inplace, offer those in the local community
to help improve the group. those are the storiesthat i’ve heard, a one-off here and there but mostly it is for the common good.haviland: matt, you and i both know that the numbers of youth smoking have been on a steadydecline downward yet the emergence and or explosion of e-cigarettes is troubling. atthe very least. what do think it is going to take to really deliver on a promise ofyoung people not initiating tobacco use. myers: the reason for concern about e cigarettes,people have never witnessed the marlboro cowboy or the virginia slums women or the associationof tobacco products with a host of these events. and the irresponsible marketing of e cigarettes.whether these have potential to be helpful. threatens to jeopardize that because a criticalfactor on why we have been successful in reducing
tobacco use in our children is to disassociatefrom all the glamour, from all of the attributes that a teenager aspires to. that has takendecades of work to do and it is critical for us succeeding in creating a true tobacco freegeneration. it is one of the reasons why the cvs action is so important. when you pullyoung people you discover that they have an inaccurate perception of how many of theirpeers small. that is because they are still bombarded tobacco products and tobacco marketingwhen they go into so many retail outlets. the elimination of tobacco from those retailoutlets is a critical component of us communicating to our young people that not only is smokingnot the social norm, but that's a very tiny fraction of your peers are really doing itand there is nothing glamorous about it. there
is nothing about it that makes you sexier,more independent, more virulent and better to perform athletic and other activities.and so the concern is that as we explore what role e-cigarettes may or may not play in oursociety is that the irresponsible marketing of those significantly undermines all of thoseefforts. we really are at a place where it is not absurd to be talking about the factthat we can create the next smoke free generation. if we can eliminate the visibility of tobaccoproducts from the daily existence of our young people, the stores they go into, if we continueto have society treat tobacco as the number one preventable health hazard that it is,these societal change we have seen is -- makes it very easy to concede but to do that, weneeds other stores to follow the lead of cvs.
for that to happen. we won't do it otherwise.we need the states and communities that have not gone smoke-free to take that extra step.we need to ensure that businesses take the steps that we just heard about. if a youngperson in high school sees that i'm not going to be able to smoke in the business, on thefloor of the business or anywhere near the business, then my smoking is going to be somethingthat will make it harder for me to succeed going forward. all of those cues, a lot canmake it a really -- can make it realistic for us to talk about taking the 15.7% of teenagerswho smoke today and turning that into a tiny fraction and not within our lifetime but withinthe next five to seven years. we need to treat it with urgency with all the tools to do it.if every retailer did what cvs did, if we
could get the movie industry not to face governmentregulation, but socially responsible action in eliminating smoking, if we could get governmentofficials to recognize raising the tax on tobacco products is not only good for therevenue but it is good for society, it is very easy to conceive of a situation wherewe come together not 50 years from now but 2020 and see smoking rates well below thosenumbers. new york city smoking rate among public high school seniors are 8.5%. thathappen because the government of new york city simply followed the tried and true evidence-based mechanism that existed there. raised the tax, go smoke-free, eliminate smokingin outdoor places where young people are found, and fund tobacco prevention programs thatwe know help people quit. and they have demonstrated
that there is no city, no state that can justifyhaving smoking rates among their kids. any higher than that -- because if you can doit in new york city, you can truly do it everywhere. it is not a national nanny to protect ournation's children. menighan: i would emphasize one additionalpoint on your comments and that is the targeted marketing of e-cigarettes with flavors likecherry and bubblegum are clearly pointed at our kids. and it is just unconscionable thatthat is allowed. haviland: i think everyone had a question,join us here in the empty chair and i think we will -- we will not be joined. i do haveone question for tom, in terms of pharmacy. matt is the only one who has said what weknow to be true which is that at this point,
in america, socioeconomic status is a predictorof smoking. and yet when someone goes into the pharmacy, the pharmacist knows everythingbecause the pharmacist knows all the different drugs you may be taking, all the differentconditions and all the current conditions so tell us a little bit about how pharmacistare getting ready to be an active part of the smoking cessation -- a more active heardof smoking cessation in the country. menighan: my boss today is a guy named mattgoes to her house in iowa and met is a pharmacist whose pharmacy has never sold cigarettes andhe is actively engaged in his smoking cessation efforts. do we have enough pharmacies engagedin that? know we don't. we have a long way to go but we've -- as i said earlier we havereinvigorated the dialogue. our organization
past policies in 2010 that basically saidthat schools of pharmacy should not place interns and residents and pharmacy studentsin pharmacies that sell cigarettes. that's a policy that was a bold statement. and itmade it very difficult for pharmacy schools that were challenged to find sites to traintheir folks and so we are on a path to that. but we're not there yet. but in 2010 i rememberthe dialogue because right after our annual meeting where the house of delegates met inpastor these policies which were updates to earlier policies, i went to another meetingwhere i met with a lot of the senior chain execs for multinational chains. and we havethis dialogue in 2010 where i was basically saying i can't tell you how to run your business.that is not what our organization does but
i can tell you that the pharmacist of americado not like selling cigarettes. they don't like them in their stores, and they want themout. and i was a conversation and as i said, i had with all the senior executives and oneof those guys was larry merlo from cvs. and so just prior to the announcement by cvs heand i had a conversation the evening before and he recalled the conversation. and so ithink -- it struck a chord with me that these policies that we passed aren't just wordson a page. it make a difference. these things don't happen overnight. but i am just thrilledas i said to larry that night, i am thrilled with the stage that has been set, and admirallushniak, i am thrilled with -- to celebrate the 50th anniversary to really re- stimulatethis dialogue. we are on the right path.
haviland: we have time for a few questions.take a microphone. wait for a second and if you will keep your remarks to a question nota long comment. that would be awesome. speaker: thank you i am jim curry with thecommissioned officers association of the us public health service. one of the things thatmatt talked about and others have talked about is the d glamorization of smoking and thatis terrific on smoking rates, that is not done that is the washington post. i have seenstory after story with wonderful photos and cigar smoking and hookah bars. within thelast three weeks, washington post a couple on these blind dates and at the end of itit showed them, lighting up their cigars. posted in the washington post. in the sportssection recently, for the washington nationals
who put a plug of tobacco in his mouth tobring good luck. how can we get some entity like the washington post, they're doing everythingbut not serving the community. what will it take to get their attention on something likethis? myers: that is a dangerous question and iam happy to roam into it. [ laughter ] in the washington post response to the community.when we are silent about these issues. when they don't speak up. supporters select thesensitivity that we have engaged in those behaviors. this is not an attack on the washingtonpost, almost need to be doing is communicating to the washington post that their behaviorunintentional as it is. the kind of impact they you are talking about censoring them,they don't read that further story. they should
eliminate that. that won't happen to readthe washington post, civilly, and carefully. and you've also hit another anyway. we havean opportunity second to speak up as an opportunity about the uses of -- smokeless tobacco inbaseball. you actually communicate the washington nationals in the major league players thatit is time to -- out of the part. no justification for our time we will speak up and take thaton the critical been made so -- to what the proposed. a deadline for eliminating the useof smokeless tobacco and we as a community should be supporting every baseball team andthe owners in doing so. there is no reason. let alone talking about doing that. we'llquit. both of that. we need to be providing them the support. we need to make sure therewere of the cessation and cvs new program
for doing that. will we have seen a decline,use of smokeless. remained dead study. as long as they see their heroes on the playingfield doing it. speaker: simon mcnabb from hhs and cdc. i'mhappy to hear this talk, hitting all the right areas and promoting cessation. how we do thatthree community approach. in the interest of trying to make cessation services as easyas it is to find a cigarette or tobacco product and cvs has made it easier to find cessationhelp. i was encouraged with the numbers that say that companies that are embracing healthare seeing their healthcare costs rise at a lower rate than others. i've encounteredin my experience some skepticism on helping smokers quit because the return on investmenton that is so far downstream in this day and
age where people move jobs and such, thatit's not a priority. we've got them running were eating better. i know there are otherreasons to do a return on investment but i wanted to know is have any of you, i willstart with shari encountered that same skepticism that we may help them quit smoking but wewill not see any benefit, five, 10, 20 years down the line. is that something you haveexperienced and if you have how do we overcome it?davidson: that's an excellent question. employers do vary by industry. there are differencesin what different organizations offer. but in many cases, employers realize they arewatering their own garden. i work for an old line manufacturer where people stay foreverand so they were a real community. helping
each other, weight loss or damage whateverproblem you have. taking walks together, creating fitness teams, creating the fitness challenge.everyone is walking around with a pedometer. employers are using the data. if they lookand say it's a real problem for a 77% of my employees are obese and 22% smoke, they aregoing to after that first. for example smokers, smokers cost us twice what non-smokers did.it's immediate, when you stop smoking you don't need to go off campus, get a cigaretteand your brakes are much shorter. also am placing the families. and free nicotine replacementpackages and on-site assistance for spouses and children. many of them on our plans now.does vary by industry. somewhere the margins are so tight and they have a lot of part-timeyoung employees, but those might not be the
places where you're going to get 93%. butemployers offer many reasons a healthier more productive workforce impacting their claims,improving absenteeism and present he is of even maintaining or improving morale, employeesknow we care about them, we get out there and say with a passion and with an anger thatwe want you to get healthier and we are going to help you. it matters to them. they feelbetter trust. and the competition to provide a competitive been and -- benefit practice.they're employers that have a richard in a fit package the mothers. i think it does vary,but they are all good reasons to do this. and you are often watering your own gardenalmost immediately. speakers: our members are very concerned aboute-cigarettes, and i definitely understand
that having any type of meaningful researchwill take quite a bit of time because the products are very new. but i am curious whatis in the pipeline right now in terms of research. what is taking place in terms of researchon e-cigarettes, the impact of secondhand vapor, and also whether or not e-cigarettesmight be effective in any way in terms of promoting cessation? i don't know if you allcan answer but we're very curious about these things.myers: it's a challenging question. because without meaningful government regulation,we have seen a proliferation of science on all sides of the issue, none of which standsup to rigorous scientific scrutiny or standards. we talk about e-cigarettes as if it is a singleproduct. and many studies it is treated as
a single product and yet there are hundredsof different variations each of which change everyday. would you allow research on a drugto tell you whether or not it is safe or effective? if you didn't know what the substances andyet most of the study -- studies done in poland that category. so the quickest answer i wouldgive to you is it is up to all of us to push the fda as quickly and as rapidly as possible.to both assert it's jurisdiction with e-cigarettes and get a hold on the science. the type ofscience that is being done is the kind of science that we can rely upon in making decisionsso that we have some sort of vehicle to rein in the kind of marketing that we are seeing,the use of flavors, the industry claims suddenly that cherry vanilla is critical for someonesmoking. for someone quitting smoking. and
has the same sense of credibility as whenthe ceo stood up and said the products are not addictive. but the reason for giving fdajurisdiction is so we would have an objective independent scientific -- scientifically -baseddecision. we need to hold fda accountable. they cannot take years to do this becausethere is way too much at stake in how it gets resolved. we're not going to have meaningfulanswers into we have some kind of government regulation that controls the kind of studies,the kind of products and how they are marketed. menighan: you could take another approachand look simply at the substance, and nicotine is a poison. we know it is a poison. thereis no ambiguity about that. what are we doing allowing our kids to buy poisons? what arewe doing property dr. lushniak mentioned we
have the science but nicotine we know it isa poison but i've got a feeling that we all in this room know that this is a bad ideaand i don't think waiting for the science to decide whether e-cigarettes should be soldin pharmacies or not just doesn't make sense to me. i don't think we need to wait.myers: there are a whole host of things we need to do. every state and locality, notonly should ban the sale of e-cigarettes to young people but to apply the full force ofthe rules to ensure that they are just old which means applying the full rules that applyto tobacco products. nobody should oppose -- be exposed to that. that doesn't make anysense. we don't use our humans as guinea pigs in other fields and that is basically whatwe are being asked to do here and that will
also prevent e-cigarettes becoming the newsocial norm. within our communities. we can ensure the local stores would have the authoritywith regard to local forms of advertising take steps so that they are not glamorizedin those communities. there are a number of steps that we as community leaders can ensurethat our local communities take even while we're waiting for answers to some of thosebigger questions. we don't have to be sitting on the sideline during this period of time.and lastly we need to be speaking out. about that. so that the extent to which there arethese flavors out there, the extent to which movie stars are now serving as spokespeoplefor these sorts of things, the extent to which we see it on social media becomes a nationaldebate, national dialogue. the senate commerce
committee headed hearing on this issue thatreceived attention. we need to ensure that that dialogue goes on in our communities.davidson: also on commercials for the first time this past week and watching footballthere were at least a half a dozen like the first few hours but our members were askingthose same questions. what do we do about e-cigarettes so at the end of last year weput out a just the facts and answer just those questions, that it's not proven, it is a poison,and other countries have banned it, and encouraged them to treat them like any other tobaccoproducts to include them in their definition of not being a smoker. and most have embracedthat. this is one of our most downloaded documents. employers are asking a question and then thatwas one of the reasons we had a webinar and
had 250 employer sit on that call to findout what others are doing. it is really important to share those facts.dr. will shrank: consistent with what all of the panelists said, without a compellingstory, to suggest that e-cigarettes somehow help people to quit, and with a very clearevidence that nicotine is a poison, it is a no-brainer for us. we don't sell e-cigarettes.we have no plans to sell e-cigarettes. but our approach was more of a scientific one.we want to wait for the evidence, we want to see some shred of compelling science thatsuggests that there is something beneficial or useful that comes from these products.that isn't something we feel like we have seen to date.speaker: i'm a pediatrician with the c. everett
coop institute at dartmouth. and i certainlyknow channeling dr. coop, he would want me to say thank you for the courage and passionand commitment that cvs has brought to this conversation and this movement. i think allthe surgeons general would indeed applaud your effort. my question has to do with tobaccolabeling. the cigarette package labeling. and where that stands given the controversyabout what has happened with it. and more specifically, we had the pleasure of surgeongeneral lushniak here and the latest labeling eliminates the words surgeon general's warning.from the cigarette package. and i'm curious about the status of the new labels, how isit that it was felt that with the issues of the science that we know about how peoplecan make a difference in the lives of young
people, how it is that the word surgeon generalis no longer part of the new label? havliand: i will ask matt to handle the answerto this question. you have asked a highly politicized question that is both an issueof advocacy science and policy. matt? myer: let me answer the easier one first whichis the status. the legislation giving fda jurisdiction over tobacco products also mandatedthat fda propose a rule requiring that warning labels covering the top 50% of the front andback of the cigarette package including graphic pictures fda did that. and did it on time.and the dc courts declared that the pictures were so inflammatory that they somehow violatedthe first amendment rights of the tobacco companies. we can debate the merits of that.that put the onus back on fda. to go back
and develop a new set of pictures that wereboth compliant with the statute and i could pass constitutional muster. fda hasn't doneit yet. it is one of those issues that has now set for way too long and it's actuallya frustration. the us currently has among the weakest least visible warnings of anycountry in the entire globe. and yet fda has the statutory mandate to do the right thingon that. there is no noncontroversial way to answer your question about the surgeongeneral. the labeling. i can tell you just what i know, which is not the full picturewhich is there a number of studies that were done the test it out effectiveness of differentlabels. and the labels that were in the legislation that don't include the name of the surgeongeneral were the result of a number of polls
and studies that were done that said the labelactually was more effective as congress drafted it. one can debate that back-and-forth andi understand map that that was as i understand it the rationale for other countries thathave considered similar issues that don't have the surgeon general but other prominentpeople. have found that the studies reached -- the studies their reach the same conclusion,the specific definitive statement as a matter of fact had a greater effect than if it camefrom an individual even a credible individual. in this case. and unfortunately the unitedstates today while we all treat the surgeon general as and incredibly prominent incrediblycredible individual when you look at the population we are trying to reach it doesn't have thesame effect with it. so again, i understand
the controversy with it but that was the rationalebehind the decision-making. fda currently is cast -- it is initial rounds of labelsare set by statute and need to be imposed. thereafter fda is given the authority to testout different labels. for a period -- pure effectiveness so that labeling be done asscientifically as everything else. and where that would shake out. would depend on thedata. speaker: i am from baltimore city health departmentand health equity is really at the heart of what we do, and my question is how can wetailor some of these strategies to work specifically with and economically disadvantaged communitiesbecause we know those are the folks who are having me highest rates of tobacco use.menighan: one thing i might observe is that
there are pharmacies in every community, certainlyin the underserved areas that serve often as a health center for that area. there theplace that people go to get questions answered on health needs. and our -- are a naturalplace for folks who are interested in quitting to ask those questions, they see that nicotinereplacement therapy products in the pharmacies as well as the cigarettes unfortunately inmany cases. so they are a natural place to begin the discussion. but without support,for the smoking cessation programs, what those patients get if they're motivated enough tobuy and and rt product is a 32nd finger wagging that says good luck with this or work hardat it and off they go. they don't get the coaching, they don't get the behavioral modificationtechniques. they don't get the dialogue an
ongoing connection that we have found is soessential to help people stay abstinent. part of the answer is put us in, we are ready toplay. shrank: one other thing i would add is -- astom was getting at, our pharmacy in particular has really built sophisticated programs totry to help patients quit. and we are in patients neighborhoods. we are easy to access. we -- froma city or state standpoint, making sure that there aren't financial barriers to those servicescould be one alternative to try to make sure that that -- that they are not denied theservices that could be essential to try to make sure that they get the care that theyneed. but i feel like there is actually a host of things coming together right now toaddress these disparities. a lot of the financial
incentives that are in place around taxesare disproportionately challenge those that are vulnerable. and maybe that's a thing.it is helping him to quit. and when you start thinking about all the different pieces comingtogether and the fact that there is in the neighborhood, in each -- just about everyneighborhood, a place to get help, if we can make sure that the funding system works, ithink we are building an infrastructure that could be really helpful.speaker: two quick questions. one is given what appears to be the very the of publicitythat came out of cvs announcement, have we seen others follow? if not, why? or are wewaiting to see the next great corporations step up and do that? doesn't seem to be hittingthe press. my second question was there is
a brief reference to medicaid. at the affordablecare act created dramatic expansions and coverage. related to tobacco. particularly for the populationswhere talked about today. low income disparate populations. not every state has expandedmedicaid but pregnant women on medicare, some of the incentives you're talking about forenhanced as well by the affordable care act. what does that mean mrb why are we seeinga dramatic call to action as a result of those expansions?menighan: one of the challenges for our community that is pharmacist is -- i mentioned thisearlier, we are eager to be part of team -based care which is a big component of the affordablecare act. to that end, eager to partner with our colleagues in family practice and primarycare and the like. one of the challenges is
that we as pharmacists are not consideredproviders for medicare. because we're not providers, we are not eligible to provideservices. unless as i mentioned we are in a physician's office providing incident tothe physician. we have no interest in pulling those services out of physician offices. butthere is an unmet need out there that will take some policy change to get greater adoptionin the communities. haviland: i want to challenge you to answerthe first part of the question which is cvs did something that by anybody standards wasa game-changer and highly admirable. is their backroom conversation that you are hearingabout others following your lead? and if not how can we answer ask all for voting withour feet to reward cvs for your decision and
helping to build a groundswell of pressurethat all retailers be responsible retailers. we all collectively have a role to play, weare not ceos but we purchase things everyday. what can you tell us about how we might helpmove the needle towards all retailers being responsible?shrank: i certainly could not guess what folks are speaking about in a boardroom or in theceos office at other retail pharmacies. publicly, the response has not been that they are planningto stop selling cigarettes. we have had wonderful press, that wasn't the motivation for this.the motivation was we thought it was the right thing to do but we are grateful for that goodpress and we are grateful that people seem to appreciate the fact that what we are doingis valuable and meaningful and progressive,
and in all of our best interest. i think whatyou are getting at is exactly right. if the more folks choose with their feet, if youwatch these -- what is happening in the nfl or these other settings, and it is money thattalks. if we start seeing an overwhelming group of patients that are coming that aremigrating to us because they like or policy and the like the way we run our business thatmakes us happy and we will provide better care to them. mike take something for thatfor competitors to change. that said, i would bet and i think tom you got at it, that ifyou ask the pharmacist if they want to be selling cigarettes, the overwhelmingly theanswers no. there are challenges and moving large for-profit companies in ways that immediatelyhave financial implications to shareholders.
so it's -- we understand it’s not an easydecision but we hope that this is -- this has started some momentum around others doingthe same thing. myers: i think there are some concrete thingswe can do. shrank: good.haviland: give us our to do list. myers: let’s be concrete. we have heardabout two cities that a ban the sale of tobacco products in pharmacies. that to should be200. and so all those who work at the state and local level should ought to be going inand talking to city council people mayors and saying if these people won't do it ontheir own, then let's do it for them. second, we all belong to organizations. with largemembership. it ought to be our organizational
policy to support those businesses that supportpublic health and we've got to be very visible about that. third, we are all citizens. andwe do talk. if there were 30 letters in the washington post saying we all should treatbusinesses that don't sell tobacco as the only responsible retailers, that word wouldget out. so that we are not silent voices. we can impact -- we can return to the media,we could meet with editorial boards to say that one business here is a shining example.not only should they be rewarded but frankly we should call out of -- our other businessesto join with them as well. so that we have a concrete set of voices. and we all belongto i think -- many of us belong to parent organizations. so that this is an issue thatparent organizations ought to take on. parents
and grandparents who care about their childrenshould treat this as an issue that is directly relevant to their own children. and we shouldmake it easy for members to find tobacco free retailers. we have a project where we intendto do that and there well -- hoping others will join with us. i think there's a numberof concrete things. we are not passive players in this. we can drive this agenda just aswe have driven other agendas. in the past. and it will -- normally these things startslow, cvs has given us a running start on it. but i would think that with all of theorganizations that represented in this room, that if we do what we are capable of doing,every business will say this is something we have to do. as we move forward, and itwill quickly become the social norm. the first
airline that went smoke-free was attackedand challenged and lost business initially. in today's inconceivable that there was evera world, we hear the same thing about restaurants. inconceivable. candidly one apha goes to neworleans this fall, there will be legislation before the new orleans city council. laterthis year for new orleans to take the final step to go 100% smoke-free and tobacco freein its bars and casinos. we should make sure that every one of our organizations back thoseto new orleans makes sure that the bar owners and others know that we are not coming backunless they take that step. and we should make sure the city council knows it and thenall of our organizations speak up in new orleans. no reason that new orleans shouldn't followsuit with all of the other cities in the country.
and we can do that. if new orleans does it,it will flow through the rest of the south. marty wasserman: i’m dr. benjamin's olderbrother not from chicago. picking up on what you were saying and talking about concrete,i am thinking back 20 years when we started smoke-free maryland and it started at a panellike this. what i heard this group today 100 plus strong, no small thing, the washingtonpost, maybe we could go run the panel and just some comments from the audience thatconcrete steps that we could take instead -- and set a timeline. what can we do, jeffbezos and amazon not going to stop amazon from selling it's products but what can wedo the members of the string to take some action as a result of this discussion thismorning and get the washington post to do
a little bit better than they are doing withreducing using washington redskins on the sports page. that's a challenge.havliand: i got the challenge marty so thank you very much.polan: i'm taking the microphone and responding to some of the questions from twitter andas you can guess one of the biggest issues has been e-cigarettes. for the record someof you have been personally attacked on twitter and some of you have been very well supportedbut the issue really is -- i think the dichotomy that has come up has been is there any valuein e-cigarettes as a step down from tobacco and are we misleading kids by telling themthat e-cigarettes have no value versus what do we know about e-cigarettes as being a stepdown when it comes to using tobacco?
haviland: tom take the first crack. he representsthe apha. menighan: thank you and it is a fair question.as teenagers look for answers, our organization adopted a policy last year that said the evidenceis still out, we don't know and while we don't know, we're going to be very cautious aboutacceptance or any other positive look at e-cigarettes. we are a wait-and-see approach but meanwhile,encouraging folks to be very vigilant and careful about it. it's a poison. there isno way to say that it is a good egg necessarily. it may be better than smoked tobacco but wedon't even know that. so we're being cautious about it.haviland: your group has a fact sheet, just the facts about e-cigarettes and you had awebinar over 200 people. tuned in to have
a conversation. what are you hearing askedand how are you responding properly? davidson: it is a really good question. lastweek on a call we had one member, it was a health system that had banned cigarette onits campus, but hadn't banned e-cigarettes. because they understood it was less toxicor they had taken that position with their employees that it would be better to avoidthe secondhand smoke. so they have that policy in place and now they were trying to figureout what to do. with moving people away from that as well. they had taken a position andnow wanted to make that change. how do you go about communicating that and so the othermembers on the phone shared their best practices about going ahead 18 months or a year to saythis policy is going to change, and making
sure that they had moved in that direction.so we are supporting each other with success stories. somebody else said we have a smokinghot, everybody at 10:10 in the morning goes on smokes. it is a bad message to send howdo we fix that? again, how to make sure that you are a good partner, a good neighbor becausethen once you have banned smoking on your facility, people go to the next placed andthere is smoke in there. it was all about sharing with each other the best practicesand the stories, and how other people have succeeded making those changes. the e-cigarettes,most again are treating them the same. some are not. about 20% are silent on it. in theirpolicy. they haven't gotten to updating it or change it. so they're looking at at makingthose changes going forward. it's about finding
be best practices and tapping into those.haviland: matt, the question was are e-cigarettes a pathway to cessation from the tobacco freekids point of view what would you say? myers: the science is still out. and thatis the critical question. the comments that susan talked about focus on young people.when we are talking about young people we are talking about -- not talk about five-year,10 year, 50 near addicted smoker. the message for young people does need to be clear whichmeans there is no safe use of nicotine. as a young person you shouldn't be starting anynicotine -based product. you're not in the position of the 30 -year-old addicted smokerwho we are trying to find a cessation solution for. with regard to that. the issue is isa less addictive and less harmful than smoking
a pack of marlboro? for a 14 -year-old and15 -year-old that is not really the rate discussion to be having? the right discussion to be havingis nicotine is particularly harmful foreign adolescents in an adolescent brain and weshould be using all of our efforts with that population to discourage the use of any tobaccoor nicotine -based product. with regard to it. it is a careful messaging that i thinkhas to be there. the second issue that relates to that is there's a lot of debate, is ita gateway to eliminating smoking or a gateway to starting smoking? when we're talking rockets,and almost doesn't matter. if it is a gateway to using nicotine, that is something we shouldbe doing everything we can to stop. and then the last gateway question is we do have scienceto show if it leads to dual use. someone just
reduces the number of cigarettes they smokebut doesn't quit and goes on to a long of dual use and recent data shows that dual useis a very significant percentage of the population. that does not produce a -- that you don'thave to wait for the jury on if it is being used to sustain smoking while they are usingthis as well, then we as a society have not gained a public health benefit. the only publichealth benefit will come if it shows it helps people get off cigarettes altogether. withregard to that. that when the jury is still out.menighan: there is an important point to be made. without judging young smokers and folkswho are already smoking, we can't wag our fingers at them and say you shouldn't be smokingin the first place, we have to say what can
we do to help? while the evidence is stillout on e-cigarettes, it is not so out of nicotine replacement therapies of other types. nicotinegum, patches, etc. work for young people just as well as they do for adults. i think thereare answers -- that aren't offering the same perhaps deleterious effects of e-cigarettes.haviland: obviously cvs has a very specific point of view, you are not selling. job anythingelse you want to say to our questionnaires on twitter e-cigarettes propertyshrank: i think our policy is clear, that we don't see -- we haven't seen compellingevidence that suggest that e-cigarettes are a clear treatment for people who are tryingto stop smoking combustible cigarettes. and in the absence of that their piece of clinicaldata, we can see -- we would not see a path
towards using.haviland: i will give each of the panelists to minutes. rapidfire, two minutes each. yourlast word on how will we deliver on a promise of a tobacco free generation? i will startwith shari. davidson: i looked at our statistics and theemployers in our survey population have 13% tobacco use. and so less than the nationalaverage, but still double digits. and i think that -- i mentioned 93% of large employersoffer these programs but more can do it. work could save the culture of health that wouldhelp them and support them. using all the techniques we just discussed. we have to figureout the right way to make sure that the employees when they are ready to quit, when we findthose folks that are moving along that spectrum,
are ready to quit, that they remember thatthose techniques are there. so keeping it in front of them is really important. andsupporting all of the initiatives that we just discussed like retailers that aren'tselling. i think it's a combination of more of what we are doing, and using all of thosebest practices following the companies that have made a really good impact. and just movingforward with keeping those cultures of health in their organization with all of the newtechnologies that are available, and making sure that it is all tobacco products as well.haviland: tom, what is the role of pharmacists in creating this culture of health?menighan: and solving any problem or addressing any issue it is always first what and how.we know the what. we know we need to stop
smokers and stop smoking. there's good scienceon how to help quitters quit. let's employ it. pharmacists are capable providers in andoften incapable system we are eager to help the public with smoking cessation programs.these services need coverage and partnership with government, employers, insurance plans,health systems and physician groups to afford quitters access in medicare and team -basedcare to improve public health. many pathways to quit lines as every state and the cdc hostthem. these quit lines need more professionals engaged at the other end to help smokers quitand pharmacists are ready to serve. techniques identified by hhs such as ask advise assessassist and arrange are recommended by hhs on study by [ indiscernible ] and shown toincrease chances of success. study support
increased involvement by pharmacists and smokingcessation and we know that face-to-face is the best approach. it even brief counselingcan be effective for some. they hhs guidelines for treating tobacco use and dependence provideturnkey guideline recommendations you and emphasize practical counseling social supportand effective medication use. most experts agree that a common nation of face-to-facecoaching and medication significantly improves success and the public health payoff is recognizedover 50 years ago. put us in coach, pharmacists are ready to play.haviland: and the last word we will give to matt myers. matt, the role of advocates, advocateshave helped us dream a dream of a united states were no child begins tobacco use whereversmoker has access to the cessation support
services and products they need. tell us whatadvocates will help us to dream and do the next century.myers: first i want to say, i'm incredibly encouraged. with all the progress we havemade, both shari and will’s presentation demonstrate for the first time that we arelooking seriously at how the private dr. and we can all work together. we only really succeedif we do that. we have the tools, we need to speak up. what we have lacked is the politicalwell going forward. as dr. lushniak said, are key is translating the science we haveinto the action we know we can and we have demonstrated models of success around thecountry. what a think is exciting about today is that it is clear that leaders in the privatesector have stepped forward and they can send
a different kind of message to a differentaudience, impacting a very broad range of people. it is exactly the kind of complementswe have needed. we has advocates and -- we as citizens need to do is that those privatesector members who step forward become winners in every sense. and so if you want to knowthe new thing that we can do, that we haven't been doing, we can make sure that every privatesector member that shari represents who does the right thing is rewarded everyday in everyway. and we can make sure that absolutely the thing that happens is that one companywho has stepped forward and literally stepped out on a limb is a winner. in at the end ofthe day because the best way to ensure that the other businesses follow, is if cvs isunquestionably perceive to have taken not
only the right step from a public health standpoint,that the smartest business step everybody could have. we want to come back in two yearsand have every pharmacy saying why did we do it worst. why did it take so long to doit? that will only happen as we as citizens take the action to absolutely guarantee thatthat is deemed to be the social norm from a business standpoint, from an ethical standpoint,and every other standpoint in our community. it has to be the norm and it's really up tous to make sure that happens. haviland: thank you. please join me in thankingthis distinguished panel. and i think we will hear from will. thank you.shrank: i wonder if anyone else here is as inspired and excited about the prospects hereas i am. i suspect you are. hearing this panel
speak and the -- perceive the sense of alignmenthere, alignment between health professionals, the pharmacist, between the public, betweenadvocates, the public sector in general, the private sector large businesses, it just seemslike there is -- there is really a path here for us to collaborate, first to put our headstogether, for us to build a momentum together. and reducing -- eliminating cigarette in pharmaciesis one piece, but helping to get to a tobacco free society is our goal. and this reallyfelt like we are starting to lay out some steps that begin to make sense. so i am reallygrateful to have had the opportunity to listen and participate. one critical step that iwanted to focus on briefly that we have taken at cvs is we realize it is not enough justto stop selling cigarettes. that there are
still a lot of people who smoke, not sevenout of every 10 people who do smoke want to quit. and we want to be a place that is inthe neighborhood of these smokers, where they can come to us and get help. we want themto see us as their neighborhood partner. we're leveraging about 7700 retail stores, 900 minuteclinics, pharmacy benefits management company that insures about 65 million americans. weare leveraging all of our resources. as aggressively as we can to try to identify patients thatneed help and to tailor appropriate programs for them. our program has four critical components.assessment of readiness, education around smokers tools and information they need toquit, medication sport, nicotine replacement, other smoking cessation meds to help curbthe desire and as tom was getting at, the
critical role of motivation. of coaching andof the relationship around smoking cessation. as you noted, the evidence is really clearthat that can double the smoking cessation rate. when a personal touch is part of theinteraction. we also know that it takes on average seventimes for people who are trying to quit to actually quit and we want to make sure thateveryone keeps on quitting. since we announced our plan it's been really interesting. there'sbeen a lot of discussion around people's personal stories. their personal stories about someonein their family to quit or that didn't quit or something, some personal experience thatthey have had with someone who smokes. that's really made this a very personal campaign.and folks have responded in ways that bring
them back to various sally and relationshipsin their lives. i will just -- i would like to if you will indulge me for a moment i willtell you one of mine. when i first started a medical school, early in my medical schoolcareer i met a patient on the oncology service and she had a lung resection and she was receivingchemotherapy when i met her. and we have a conversation about her illness. and she spokeat length about how ashamed she was. she really felt as though she was responsible for herillness. and i was very hard for her to talk about it. and that really stuck with me, howashamed she felt. and then later that evening, i went and did my rounding on the six patientsthat i was following at the time and i left the hospital that night. i walked up the frontdoor and i saw the very same patient standing
in front of the hospital. she had a bag ofchemotherapy hanging, she was receiving her chemotherapy and she was smoking a cigarette.and we looked at each other, and we didn't say a word. and it just really emphasize thefact that this is a hard problem to kick. this is something we all need to put our headsaround together. i want to thank everybody who joined us here today. i think this isbeen a really productive and useful meaning. and i hope we can keep this momentum going.i think matt was trying to get to a very discreet set of action activities and others were aroundhow we speak directly to the washington post. but i do think it's really -- it would begreat if we could walk away from this meeting with a clear sense of how all of us who workin different settings and potentially come
from different backgrounds but all have ashared and profound interest in this result, how we keep this momentum going and continueto work together. one sincere thank you to our speakers whoreally made an extraordinary effort -- you are wonderful communicators. thank you. thankyou to our surgeon general i believe who has left. he has more important things to do.but i think his words and particularly his comments around how we all have to be friendsin this, that we are all on the same team, and we have to see at the same way i thoughtwas really sally and then of course a thank you to dr. benjamin, to the apha for bringingus altogether. and for all you do to help keep all americans healthy. thank you verymuch. [ applause ]
benjamin: as always i get the cleanup. i guessi have my to-do list. a letter to the new orleans city council. when we go there forthe annual meeting in november. done. a letter to the washington post. maybe we can get thatout before i leave tomorrow. a thank you to -- obviously to cvs and two well and judyand marissa our colleagues here from cvs who have been helping us work on this problemeach and everyday. thank you to our friends at the local park group and to my staff. isee karlene and susan and daniel. i see mighty back there and others. let's give them a greatround of applause for their work putting this session together. [ applause ] and our panelsand speakers if you could give them a round of applause. [ applause ] and so in closing,i just want to say that we've got 400 plus
thousand people who die each and every yearfrom the number one preventable cause of death and we have a lot of work to do. we've donea lot here over the last 50 years. but as the new legacy foundation ad says, let’sfinish the job. thank you very much. [ applause ]
