WHY AMERICANS HAVE A LOVE AFFAIR WITH DRUGS

Do you know what I really miss now that I live in America? I miss coming in
from the pub about midnight in a blurry frame of mind and watching Open
University on TV. Honestly.

If I were to come in about midnight now all I would find on the TV is a
series of nubile actresses disporting in the altogether, plus the Weather
Channel, which is diverting in its way, I grant you, but it doesn't begin to
compare with the hypnotic fascination of Open University after six pints of
beer. I'm quite serious about this.

I'm not at all sure why, but I always found it strangely compelling to turn
on the TV late at night and find a guy who looked as if he had bought all
the clothes he would ever need during one shopping trip to C&A in 1977 (so
that he would be free to spend the rest of his waking hours around
oscilloscopes), saying in an oddly characterless voice, "And so we can see,
adding two fixed-end solutions gives us another fixed-end solution."

Most of the time I had no idea what he was talking about - that was a big
part of what made it so compelling somehow - but very occasionally (well,
once) the topic was something I could actually follow and enjoy. I'm
thinking of an unexpectedly diverting documentary I chanced upon three or
four years ago comparing the marketing of proprietary healthcare products in
Britain and the United States.

The gist of the programme was that the same product had to he sold in
entirely different ways in the two markets. An advertisement in Britain for
a cold relief capsule, for instance, would promise no more than that it
might make you feel a bit better. You would still have a red nose and be in
your dressing gown, but you would be smiling again, if wanly.

A commercial for the same product in America would guarantee total,
instantaneous relief. An American who took this miracle compound would not
only throw off his dressing gown and get back to work at once, he would feel
better than he had for years and finish the day having the time of his life
at a bowling alley. The drift of all this was that the British don't expect
over-the-counter drugs to change their lives, whereas Americans will settle
for nothing less. The passing of the years has not, I assure you, dulled the
nation's touching faith in the notion.

You have only to watch any television channel for 10 minutes, flip through a
magazine or stroll along the groaning shelves of any drugstore to realise
that Americans expect to feel more or less perfect all the time. Even our
shampoo, I notice, promises to "change the way you feel".

It is an odd thing about Americans. They expend huge efforts exhorting
themselves to "Say No to Drugs", then go to the drugstore and buy them by
the armloads. Americans spend almost $75bn a year on medicines of all types,
and pharmaceutical products are marketed with a vehemence and forthrightness
that takes a little getting used to.

In one commercial running on television at the moment, a pleasant-looking,
middle-aged lady turns to the camera and says in a candid tone: "You know,
when I get diarrhoea I like a little comfort." (To which I always say: "Why
wait for diarrhoea?")

In another, a man at a bowling alley (men are pretty generally at bowling
alleys in these things) grimaces after a poor shot and mutters to his
partner, "It's these haemorrhoids again." And here's the thing. The buddy
has some haemorrhoid cream in his pocket! Not in his gym bag, you
understand, not in the glovebox of his car, but in his shirt pocket, where
he can whip it out at a moment's notice and call the gang round.
Extraordinary.

But the really amazing change in the last 20 years is that now even
prescription drugs are advertised. I have before me a popular magazine
called Health that is chock-full of ads with bold headlines saying things
like, "Why take two tablets when you can take one? Prempro is the only
prescription tablet that combines Premarin and a progestin in one tablet",
or, "Introducing Allegra, the new prescription seasonal allergy medicine
that lets you get out there".

Another more rakishly asks, "Have you ever treated a vaginal yeast infection
in the middle of nowhere?" (Not knowingly!) A fourth goes to the economic
heart of the matter: "The doctor told me I'd probably be taking blood
pressure pills for the rest of my life. The good news is how much I might
save since he switched me to Adalat CC (nifedipine) from Procardia XL
(nifedipine)."

The idea is that you read the advert, then badger your doctor (or
"healthcare professional") to prescribe it for you. It seems a curious
concept to me, the idea of magazine readers deciding what medications are
best for them, but then Americans appear to know a great deal about drugs.
Nearly all the adverts assume an impressively high level of biochemical
familiarity. The vaginal yeast ad confidently assures the reader that
Diflucan is "comparable to seven days of Monistat 7, Gyne-Lotrimin, or
Mycelex-7", while the ad for Prempro promises that it is "as effective as
taking Premarin and a progestin separately".

When you realise that these are meaningful statements for thousands and
thousands of Americans, the idea of your bowling buddy carrying a tube of
haemorrhoid unguent in his shirt pocket perhaps doesn't seem quite so
ridiculous.

I don't know whether this national obsession with health is actually worth
it. What I do know is that there is a much more agreeable way to achieve
perfect inner harmony. Drink six pints of beer and watch Open University for
90 minutes before retiring. It has never failed for me.

Extracted from 'Notes from a Big Country', published by Doubleday at
UKP16.99. Available at all major bookshops or by mail order on (UK)01624
675137