10/13/2004. Oh-so-French pharmacies

Stand on any Parisian streetcorner, and you're just a few steps away from a pharmacy. Stand in front of any Parisian pharmacy, and you can probably see another one less than a block away. They're easy to spot, because they all sport regulation lit-up signs: a green and blue cross, often flashing. If the green cross is lit, the pharmacy is open. Look closely in the background of the photo above, and you'll see a second sign about a block behind the one in the foreground.



Why so many pharmacies? According to the World Health Organization, France has the best healthcare system in the world. Its comprehensive socialized healthcare means that more people visit the doctor in France (per capita) than in any other country. And those doctors write prescriptions.

If you want a shock treatment that will give you a new perspective on the French versus American healthcare systems, get one of your American prescriptions filled in a French pharmacy. A medication that costs--say--$75 in the U.S. will usually not cost more than 10 euros in France. That's because the government controls pharmaceutical prices (and lo and behold, the big pharmas are apparently still able to make a profit). And, if you were French, you would get reimbursed for those 10 euros by the Assurance Maladie, France's national health insurance system.

Walk in the door of a French pharmacy, and take a leisurely look around. You will probably be approached by a pharmacist asking if you need help. As is often announced on the plate-glass window of any pharmacy, conseils pharmaciens--pharmaceutical advice--is available. Not only available, but an essential part of the French pharmacy experience. The pharmacist who spends 15 minutes with an elderly customer, patiently explaining and reassuring, over and over if necessary, is doing exactly what is expected of the French pharmacist. In the larger perspective, this sort of personalized and detailed service is a major thread in the fabric of French social life.



You'll likely be glad for the offer of help, even if you're just looking for a bottle of shampoo. The French believe for every human need or quotidien problem there's a special product. (Il existe un produit... is the prelude to many a piece of advice.) And because of their innate love for complication and specificity, every imaginable permutation of a given problem requires a unique product.

So, say you're looking for a shampoo for dry hair. Well, is your hair dry with oily roots? Is it dry, and you shampoo frequently? Perhaps your hair is dry, and you have dandruff. Or, your hair is dry and color-treated. Worst of all, might your hair be dry...and falling out? Whatever the problem, not to worry, because in any given brand of shampoos, rest assured there is a product adapted to just your problem.



The array of health and beauty products is staggering in its complexity. And--because the French can almost never resist tinkering with a product--the array is always changing. In addition to all these off-the-shelf products customized to every imaginable human plaint, most French pharmacies will "prepare" products for you (see the word preparation on the pharmacy window above?) That is, the pharmacist will concoct a formulation tailored to your needs.



Another thing that is striking to the American eye is the prevalence of plant-based health and beauty products in French pharmacies. Many stock not only plant-derived beauty products and health tonics, but will fill herbal prescriptions from stocks of dried plant material, tinctures, and essential oils. These pharmacies will identify themselves as herboristories.

Homeopathic remedies are wholeheartedly embraced by the French, to the point that pharmacists often recommend them and the national health system even reimburses some of them. Now, for instance, as flu season looms, a popular homeopathic product called "Ocillococcinum" is advertised among the ever-changing array of promotional posters in French pharmacy windows.

\With so many pharmacies, competition for customers is fierce. Profit margins on prescription medications are extremely thin, which is another reason why the pharmacist never hesitates to come out from behind her counter to help you choose a shampoo or face cream. That's where she makes her money. And it must be said that the beauty products offered in French pharmacies are awfully good. I remember my amazement to find the Phyto brand of shampoos--which I had only been able to buy in a very expensive salon in the States--were standard fare in every French pharmacy.

Last week, I had a very sore throat--so bad that when I swallowed while asleep, the pain would wake me up. I had been dutifully using the collutoire (throat spray with a special long-necked nozzle for directly targeting your sore tonsils) in the medicine cabinet. But the brand we had on hand seemed not as strong, horrible-tasting, or effective as another one I remembered using--without being able to recall its name. The stuff we had on hand wasn't helping me at all.

I walked into a local pharmacy and stood in line for the attentions of one the panel of pharmacists busy dispensing personalized advice. I have learned to wait patiently, in typical French style. (It's not for nothing that the French language has a special verb for this ubiquitous French activity: patienter.) I have also picked up the corollary French behavior: taking maximum advantage of my long-awaited turn. Why not? Everyone else did...

I explained my problem to the pharmacist, adding that I was looking for a very strong throat spray. She waved her hand at the shelves of different collutoires behind her, but then, fixing my eyes with an especially frank gaze, she gave me her best advice. "But for the pain of sore throat, by far the most effective product we have is Pholcones. C'est un suppositoire, she added brightly.

"A suppository...for a sore throat?" I quavered. I have lived in France long enough to know that the French believe passionately that medications that are in either effervescent or suppository form are more effective than a simple, easy-to-swallow pill or capsule. (Warning: If you buy something as innocuous as aspirin in a French pharmacy, be sure to specify that you want une comprimé où une gellule. Otherwise, you'll almost surely get home to find you have purchased an effervescent product which will have to be dissolved into a ghastly-tasting solution and drunk.) But I never thought to encounter a suppository for a sorethroat. Why not a lozenge, maybe even an effervescent lozenge? But a suppository?

"Mais oui, Madame," the pharmacist replied. C'est beaucoup plus efficace. (It's much more efficacious--code word meaning that the medication will be absorbed more quickly from the mucosa of the nether regions. And, she pointed out reasonably, I had already said that the throat spray I'd used hadn't worked.

"But...don't you have a different, stronger throat spray?" The canny pharmacist could tell my resistance was faltering before the force of her Pure Reason. "Les Pholcones, alors?", she asked, setting a box of the dread "cones" firmly on the counter.

Unwilling to belabor the point any longer, especially with an eye to the people waiting behind me, who were probably amused by the spectacle of la petite américaine resisting what every French citizen knows is the best way to take a medication, I gave a small, defeated nod.

I was only a few moments out of the pharmacy when I started chuckling to myself about the absurdity of a suppository for a sore throat. Only in France!, I thought. Wait until I tell Denis... The French predilection for effervescence and suppositories forms the substance of one of our continual cultural mock-battles.

In the last installment of this war, Denis had--tongue in cheek--brought home a pharmacy bag bearing an advertisement for a medication. In the illustration, bubbles were rising from a medicine package. Blazoned below it were the words "Merci, l'effervescence!" (Thank you, Effervescence!")

So it was with relish that I related my story that evening. "I went to the pharmacy today to get something stronger for my throat, and guess what they gave me?" To my delight, even he didn't guess. And so I was able to triumphantly deliver the dénouement of my story. I positively crowed: "Une suppositoire!!! Pour un mal de gorge, t'imagines?" Can you imagine, a suppository for a sore throat??? "Only in France," I felt compelled to add, could you experience such absurdity. Feeling full of myself, I added that you could make a fortune in France by inventing an effervescent suppository. Denis just looked at me. He didn't even crack a smile at my brilliant joke.

What I neglected to tell Denis was that when, miserably unable to sleep in the middle of the night, I caved in to the call of the Pholcones. It helped me through the ignominy of the moment to be half asleep. And--don't tell Denis, but the d...d thing worked.

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