IT IS GREAT CVS is ending cigarette sales by October, and I know exactly what other dangerous products should go behind the counter when the wall of cancer sticks comes down: Coke, Pepsi, Gatorade, Red Bull, and all other sugary beverages. I say this because I take CVS’s new public health pronouncements seriously.
In announcing the tobacco ban, CVS chief medical officer Troyen Brennan said the drugstore industry is positioning itself to offer more clinical services for chronic diseases. He wrote Wednesday in the Journal of the American Medical Association that it is a “paradox” to sell cigarettes as pharmacies work with primary care clinicians to treat hypertension, diabetes, and other conditions “exacerbated by smoking.”
If CVS truly cares about all the sources of diabetes and other preventable diseases, soda should be the next target. Two days before Brennan’s op-ed, the Centers for Disease Control and Prevention released the most dramatic findings yet linking high sugar consumption to heart disease. The WHO and the American Heart Association recommend that less than 10 percent of a person’s daily calories should come from the added sugars found in processed foods, snacks, and beverages. But 71 percent of Americans exceed that figure.
The study, published in JAMA Internal Medicine, found that people whose added sugars comprise between 10 to 25 percent of their calories were at 30 percent higher risk of dying from heart disease. People whose sugar consumption was 25 percent or higher were nearly three times more likely to suffer fatal cardiovascular disease. The average American consumes 15 percent of their calories from added sugars, based on a 2,000-calorie diet.
“The average American eats 22 teaspoons of sugar a day,” lead author Quanhe Yang said over the telephone. “If you put 22 teaspoons in front of someone, they probably would be shocked.”
By far, sugar-sweetened beverages are the biggest culprit, comprising 37 percent of American adult added sugar intake. Next at 14 percent were grain-based cookies, cakes, and crackers. Laura Schmidt, a professor at the University of California San Francisco medical school, who wrote an accompanying editorial to Yang’s study, told me over the telephone that she hopes that concern over sugar-sweetened beverages is reaching a tipping point.
“It’s not fun to talk about grandma’s chocolate cookies and the analogy to smoking is more complex to make,” Schmidt said. “But one 20-ounce Mountain Dew is the national average for added sugar by itself. We’re finding out that obesity leads to so many diseases we’re losing count. Sugar is not a poison, but the dose can be a poison.”
It means CVS has much more work to do. Besides soda behind the counter, candy, chips, and other trash food should be removed from the front of the store to prevent impulse buys. Products with added sugars surpassing 10 percent of calorie intake should have big warning signs that they can contribute to heart disease.
Deborah Cohen, a RAND health researcher, said CVS deserves praise for turning its back on tobacco. But too many other products still on the shelf may give people a higher risk of diabetes and coronary artery disease than second-hand smoke for cancer, she said. The grocery section of the CVS weekly circular is dominated by soda and candy. “The food industry is just shoving food in to us,” Cohen said, “And we don’t have any quantification of the harm.”
The question now is how long the drugstore industry will turn a blind eye to the harms of sugar. If it is as long as it ignored the carnage of cigarettes, the answer is not good. The American Pharmacists Association recommended in 1971 that cigarettes should not be sold at pharmacies. Association CEO John Gans told The New York Times in 1994, “It is not right to sell a nicotine patch at one counter and then a pack of cigarettes at another.”
We cannot wait that long for drugstores to stop selling Coke as if it is a harmless product.