Pharmacological

A couple hours ago, I set out on a little jaunt to pick up some things and get some fresh air. I learned a few things: first, that the French apparently do not produce popsicles. Second, that the United States is massively fucked up in the way we think about medicine. Like, pills and syrups with stuff in it to treat our many, many ailments.

Let me explain. My sweetheart is quite sick, you see, after an ill-fated eating adventure. Thus, we have spent the day inside, with him lying about being miserable, and me trying to be helpful and blogging (it's ok, you guys, you can comment on my Iraq post without reading the whole thing; I know it's long). I finally managed to take a shower and put on a bra and stepped outside into the cold air. We have not really been blessed with great weather on this trip; it's been alternately 50s and rainy, or 40s, windy, and rainy. But the clouds had cleared, and the sun was setting and the buildings were gleaming with reflected silver-orange at their tops, as I sauntered on down to the pharmacy.

The nice pharmacist didn't speak much English, and my French medical vocabulary is limited to "I have a tummyache", but I managed to explain to her my sweetie's problems. She reached to the shelf behind her and picked out a couple of things, all of which would have required a prescription in the United States. After paying the grand sum of 10 Euros, I strolled out to go get myself a sandwich and started thinking.

This wasn't the first time I'd been faced with a pharmacy that would give out any old thing without a prescription. In Egypt, where I grew up, it's much the same. I obtained my first pack of birth control pills, at age 17, by walking in and asking for them. But that's a developing country, right? One that probably can't afford a complicated regulatory scheme. One where there aren't sensible rules, only arcane bureaucratic rules that slap you in the face when you want to do something like, say, file a case in court.

But here I was, in France, surely one of the most modern countries in the world, where the government could certainly regulate pharmacists' ability to give drugs without a doctor's authorization, if it wanted to. They have all kinds of taxes and rules and regulatory schemes. They have a city-wide competition to determine which boulangerie will supply the prime minister's baguettes. And I could still walk into the pharmacy and demand drugs that weren't even for me without so much as a stinkeye.

In the good old United States of America, you have to have a prescription for every goddamned thing. For birth control pills, for the Nuva ring, for Plan B. For antibiotics, for pain medication that doesn't totally suck, for a cough suppressant that's not intended for children, for a pill to treat yeast infections, for an anti-fungal cream, for anything with any potency that might actually work.

I thought about this, as I flopped one foot in front of the other on Boulevard Richard Lenoir. And then I thought about what would happen if all of a sudden, there were no more prescriptions, except for really serious stuff like chemo drugs or morphine or whatever. In America. What would that be like? Ignoring the fact that that would be incredibly unlikely to happen, I imagine tat people would be flocking to pharmacies, picking up medications for all kinds of ailments we didn't have or didn't need to be treated for. Everyone and their dog would be popping klonopin and prednisone for a nightcap.

But hey. Why don't they do that here? Why do I assume that Americans are hungry to get their grubby little hands on as much medication as they can, unlike the French or the Egyptians? They are, aren't they? Why?

Oh yeah, it's called advertising. The realization hit me like a brick that the don't seem to advertise medication in countries without strict regulatory schemes. Is there a law against it? I don't remember ever seeing medication advertised growing up, and although I haven't watched much TV in France, I have looked at papers and magazines and I don't think I've seen medication advertised there either. Whereas in the US, as you all know, you can barely turn around to take a shit without running into one of a hundred "it" medications that are being heavily marketed right now.

So why are they advertising? Because the pharmaceutical companies exist to make money, and they can make a lot, because prices for brand-name prescription drugs are 35 to 55 percent lower in other industrialized countries than in the United States. Also, given the fact that you can't just walk into a pharmacy and get the drug you need, they have to advertise, so you can have the bright idea to "ask your doctor about cialis/wellbutrin/yasmin/whatever."

And when you advertise on television, in magazines, and in newspapers, day in, day out, for drug after drug, in language and images designed to help the viewer self-diagnose with a problem to be served by the medication you're hocking, people are going to want your drug. Even the ones who don't need it. So we have a nice cycle: high prices --> advertising --> high demand --> need for regulation --> expensive regulatory scheme --> high prices...

Or maybe it's just all about American paternalism. People can't be trusted to know what's wrong with them and what they need! Well, yeah, when you fuck with their minds by selling health care and medication as a product, at a profit, it warps people's desires, just like every other consumerist aspect of this culture.