CVS Stops Selling Cigarettes: How OBs and FPs Can Follow Suit

CVS Caremark announced today that it will stop selling cigarettes at its pharmacies.

"Ending the sale of cigarettes and tobacco products at CVS/pharmacy is the right thing for us to do for our customers and our company to help people on their path to better health," said Larry J. Merlo, President and CEO, CVS Caremark. "Put simply, the sale of tobacco products is inconsistent with our purpose."

What if the offices of physicians (obstetricians, perinatologists, and family practitioners) who serve pregnant women would announce something similar? Obviously, physician offices don't promote tobacco products.  But, many do promote a product with known risks to the health of the baby and the mother.  

What if they said "Ending the distribution of formula company marketing material, including free formula at our office is the right thing for us to do for our patients to help them on their path to better health, and on the path for better health for their babies. Simply put, the distribution of formula company marketing materials is inconsistent with our purpose."?

Merlo, with CVS Caremark, continues:  "As the delivery of health care evolves with an emphasis on better health outcomes, reducing chronic disease and controlling costs, CVS Caremark is playing an expanded role in providing care through our pharmacists and nurse practitioners. The significant action we're taking today by removing tobacco products from our retail shelves further distinguishes us in how we are serving our patients, clients and health care providers and better positions us for continued growth in the evolving health care marketplace."

Could perinatal physicians say "As the delivery of health care evolves with an emphasis on better health outcome, reducing chronic disease and controlling costs, our office is playing an expanded role in providing care through our staff and associate professionals.  The significant action we're taking today by removing formula company marketing materials from our closets, waiting rooms, patient rooms, and office decor further distinguishes how we are serving out patients."?

The CVS Caremark press release goes on to state " Smoking is the leading cause of premature disease and death in the United States with more than 480,000 deaths annually. While the prevalence of cigarette smoking has decreased from approximately 42 percent of adults in 1965 to 18 percent today, the rate of reduction in smoking prevalence has stalled in the past decade. More interventions, such as reducing the availability of cigarettes, are needed."

Formula feeding causes approximately (only) 900 infant deaths per year in the US.  However, its effect on the health of US citizens over the lifespan is much greater.  It has been shown  that weaker immune systems, propensity to diabetes, asthma, G.I illness, certain cancers, and so on are caused by formula feeding.  Women who do not choose to breastfeed are more likely to suffer from breast, ovarian, and uterine cancer . . . all potentially lethal.  All illnesses resulting from not feeding babies breast milk cause an enormous financial strain on the health care system to the tune of billions of dollars per year.  The pressure that a sick baby or child puts on families is felt more readily than that which comes from cigarette smoking.  Tobacco related illness typically take years to develop.

Perhaps, most significant of all, is the effect of formula on the developing brain of the child.  While formula fed babies are not at risk of becoming the village idiot, studies show an lower IQ by an average of 8 points.  This means the child will not reach its full potential.  Of course people will say, "I was formula fed and I'm just fine".  But, wouldn't we all like our IQ to be 8 or so points higher?  The potential for solving issues or improving life for society is lessened with the loss of brain power multiplied over and over.  Effects on the lives of each child and on society in general can be significant, both socially and financially.

CVS Caremark has made a statement by their action. In essence, they are saying "We are here to promote optimal health care.  One thing we can do is to stop 'endorsing' a product, which is known to be detrimental on the health of our customers, by promoting it or making it available."

CVS Caremark customers already know the serious health risks associated with tobacco use.  There has been campaign after campaign over the years by governmental and organization sources to educate against those dangers.  Yes, smoking does have benefits.  It calms the addicted smoker.  It gives kids a sense of maturity and self confidence when they do something "adult", like smoking.  It provides for taxes for the government.  It provides profits so tobacco companies can contribute to campaigns of politicians who will protect and support their industry.  These reasons, however, do not excuse a health care business in promoting the product by simply having it available.

Physicians and hospitals also have a responsibility for health promotion.  Yes, formula has it benefits.  If a mother truly can not breastfeed (rare) and if breast milk is not available to give to that baby, formula will keep it alive. (Note:  most cases of "can't breastfeed" are due to mismanagement of labor, birth, and/or early days of breastfeeding).  Of course, some women will choose to formula feed for a variety of reasons.  Their informed choice should be respected.  But many women choose to formula feed just because their mother formula feed all of her children.  They don't really know the pros and cons of their choices.

Formula can NEVER allow the mother or baby to enjoy OPTIMAL health.  The components needed by the body for establishing incredibly complex systems necessary for life long optimal health are just not in formula.  They are found only in human milk.  Dr. Ruth Lawrence, an expert in human lactation states that formula provides basic nutrients and helps to stave off starvation, but predisposes to obesity.

The act of breastfeeding also affects the mother's systems and provide some protection against cancer, heart disease, osteoporosis, and other illnesses.

So, what can physician offices and hospitals do?

First, adhere to the guidelines from governmental and professional organizations on ways to promote, support, and protect breastfeeding.  These in include the Centers for Disease control, the World Health Organization, the Office of the Surgeon General, the American Academy of Pediatricians (who, sadly have violated their 2012 policy statement), the Academy of Breastfeeding Medicine, and others.

1.  Do not dispense formula company education materials as a resource for the mother to learn about breastfeeding. By doing so you are sending a message: " Formula is the standard.  Formula is an equal choice for infant feeding.  Breastfeeding may be a little better, but formula provides everything your baby needs.  We are recommending it by having promotional material all around the office, and by giving you these materials, including free formula gift bags."

2.  Remove any marketing materials from view.  Evaluate office decor.  Does it suggest support of bottle feeding or breastfeeding as the standard?  

3. Ask each patient what she has heard about breast feeding and about formula.  Do NOT just ask "Are you planning to breastfeed or bottle feed?"  Talk with her about the risks of formula for her baby and of not breastfeeding for herself.  Encourage her to breastfeed! There are studies that show the patients respond to physician's advice, including the advice to breastfeed.  Encourage her to read a good book on breastfeeding.  Refer her to a class.   However, assure her that she is the one who knows her situation and that you will respect and support her informed feeding decision.

4.  Tell the mother that colostrum is a special medicine that a mother makes specifically for HER baby.  It sets up the immune and other systems in the baby's gut.  Let her know that her baby will be able to handle formula better if she breastfeeds for two weeks, until the colostrum is no longer in her milk.  Let her know she can talk with the lactation consultant at the hospital to learn how to wean comfortably when the mother is ready to start formula.

5. If her decision is not to breastfeed, tell her how she can save money by not using the most expensive formulas.  Let her know that the 'new and improved, brain developing" (and more expensive) formulas have not been able to establish that their product does what it says it will do.  Let her know the ingredients for brain growth in these formulas are not the same as what a mother makes for her baby. 

6.  Tell her that if pasteurized breast milk is available, it is preferable to formula, but if not, formula is better than plain milk from a cow, goat, or a plant.

7.  Work with a lactation consultant.  Have one on staff to assist with questions, education, or consults.

8.  Because of the significance of breastfeeding, become more educated in this important area of health care.  A great website to start with belongs to the Academy of Breastfeeding Medicine -- www.bfmed.org

9. . Adjust medical practice, if necessary, so that it is based on evidence.  In addition to www.bfmed,org, a great website to check out is www.EvidenceBasedBirth.com .  Support more natural approaches to labor.  Avoid interventions, when possible, which might affect breastfeeding.  
It is only in the human medical system that birth is considered complete once the baby has been delivered.  In the animal world, birth is not complete until the newborn has nursed.  Encourage birth practices like skin to skin contact immediately after both vaginal and c-section deliveries.  Postpone routine procedures until baby has latched and breastfed.  C-section moms and babies can often begin breastfeeding before the surgery is completed.  This is now becoming a "best practice".

10.  Encourage the hospitals where you deliver babies to stop giving out formula company gift bags.  Studies, overall, confirm that this results is more women giving up breastfeeding sooner than planned.


Removing formula company marketing materials from OB offices won't make the news like removing tobacco products from CVS Caremark.  But it will serve to improve health outcomes for more patients.  If all physicians did this, and all hospitals were more "Baby Friendly" and "Mother Friendly", the positive impact on the health of the nation could be even more significant.