Doctors are tough critics — as well they should be. The news that CVS Caremark pharmacies will no longer sell tobacco brought about quite a bit of rapid online dialogue. Even President Obama chimed-in with praise, a response that some in the business world say is worth billions for CVS. Having a good reputation, particularly when you’re in the business of delivering health care and lending health advice, seems essential. In my mind we should praise and celebrate what today brings — leadership for making it harder to get addicted to tobacco products we know seriously harm health.

But not all doctors may think a move to ban the sale of tobacco in a health care environment is enough. Dr. Sunny Chan, a family doctor in Canada, asked the tough question about our health care providers (HCP) working environment:

@SeattleMamaDoc @kevinmd @matthewherper Seriously why are pharmacies, where HCPs work, selling tobacco in the first place? Makes no sense

— Sunny Chan (@waisunchan) February 5, 2014

Meanwhile, Texas pediatrician Bryan Vartabedian wrote a blog post asking CVS to take a bigger step  by banning sales of unhealthy sugar-sweetened beverages (that we know are associated with obesity) and junk food. He wrote,

You can’t make money peddling savory snacks while at once setting the pace for a healthy lifestyle.  And condemning one vice works for the press release, but not as a brand offering health solutions.

When focusing singularly on CVS’ decision to stop selling tobacco products, it’s easy to say the choice is a phenomenal one. Not promoting (or profiting) from the sale of carcinogens is always in the best interest of our communities and our long-term health. I return to what Centers For Disease Control’s Director, Dr Thomas Friedman, recently wrote in JAMA, “Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people.”

As a pediatrician I’m thrilled another company is going to bat for public health. I hope the halo effect works and preserves CVS business, despite the reported $2B expected loss in sales. Their success will propel big box retailers, pharmacies, grocery stores, and online marketplaces to easily follow suit in strategically deterring cigarette smoking. Obviously I’m not a policy researcher nor an expert on tobacco prevention and so I like the optimism that Matthew Herper reported on Forbes with Cancer Society President John Seffrin’s response,  “Over time, we think lives will be saved by this.” The skeptic in me also knows that taking cigarettes out of arms’ reach is only one part of the solution to preventing teen and adult addiction to nicotine and tobacco products. But a step in the right direction, for certain.

It must be noted that this business move by CVS brings up the complex new health care environment we all face. When we merge retailers and health care delivery we may mix motivations. CVS also owns Minute Clinic, the largest retail clinic in the United States.

@DrMommyCalls @SeattleMamaDoc For sure. The point was that there’s clear tension when you sell stuff and deliver health care.

— Bryan Vartabedian (@Doctor_V) February 5, 2014

My opinion: we have to keep this in perspective. Today’s decision by CVS is very positive news and we must commend  for their decision. Consider this tweet:

@SeattleMamaDoc this is good for public health. Credit where due.

— Tom Lyons (@thlyons) February 5, 2014

We must also acknowledge that other companies have long-before halted the sale of tobacco. I did a quick personal search just now at stores I frequent myself. Amazon doesn’t sell tobacco products (or e-cigs) and neither does Target. In fact Target ceased tobacco sales way back in 1996 although the decision wasn’t reported for health reasons, rather they discontinued tobacco sales secondary to costs of keeping cigarettes out of the hands of teens. Regardless, as retailers increase health protections they need to scream from the rooftops as to why. In my mind, that’s part of health care delivery — education and advocacy. I want to hear from these stores who help us make better decisions.

What parents need to know

• How we get information, scientific evidence, products, and medications to support our families’ lives and preserve our health is rapidly changing. Thank goodness for you CVS, and all the others before you, for implementing business decisions to leave our nation a healthier one. As parents we can choose to shop, when possible, in stores that protect our children better. This new decision may compel other retailers to detail how and why they don’t sell products that may harm us. We’re ready and waiting for your voice.
• Teens still use cigarettes and still get addicted. Just under 1/2 of teens have tried a cigarette. Lifelong habits form while our children are children. The far majority of regular adult smokers started smoking as children! Because a teen brain is still developing it is more vulnerable to addiction.
• Talk to your children about avoiding the use of ever-present e-cigarettes that contain nicotine. These devices remain unregulated. CDC data published recently finds that rate middle and high-school student experimentation with e-cigs have doubled in the just one year. I consider e-cigs the gateway to the gateway drug.
• Recently, the FDA just launched a new anti-smoking campaign. More good things to come for our children!

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.