Saturday, September 5, 2009

You can't buy Tylenol at Kroger here!

Kroger Doesn't Exist Here . . .

Kroger doesn't exist here, of course, but there are supermarkets, huge box stores like WalMart, 7-11 type stores, modern gas station stores on the highways and the like. What do they have in common?

You can't buy any over-the-counter medicines in any of them - that is, not even an aspirin, Tylenol, Advil, and maybe no Band-Aids or Bactine (I have to check).

To buy any of those things, in addition to all prescription medicines, you have to go to a FARMACIA, all well-marked by the requisite standardized lighted green crosses, spaced every so many blocks (a minimum of 250 meters apart) in every city and town as established by law; and depending on the population density (
2,800 - 4,000 inhabitants per pharmacy, approximately). FARMACIAS are open after hours, all night, and on Sunday only when it is their turn to be 'de guardia' or on duty, also as established by law.

There is no chance in Spain of the convergence of Walgreens, CVS, Rite-Aid and a Kroger Pharmacy at the same intersection as happened near my house in the USA. (The Rite-Aid eventually folded.) There are no franchised chains, nor is there freedom to open a new pharmacy if you want to. On the contrary, the number of pharmacy licenses is strictly limited by the (national) Ministry of Health (though some community and regional exceptions are allowed) and only a licensed pharmacist can own a pharmacy, many of which are passed down from generation to generation, keeping the lucrative resource all in the family.*

A key word here is control. Pharmacies are tightly controlled. Medicines are tightly controlled. [Only now, after being a regular in Spain off and on for 3 decades, do I see on TV a few ads for over-the-counter medicines like Immodium. Neither Boniva, Zoloft, Crestor nor any other prescription med is allowed to advertise.]

Pharmacy customers are also tightly controlled, a fact which infuriated me the first 15 years I came to Spain. Now I am used to the drill.

Here's how it goes: you go into the pharmacy, which has one or two pharmacists and perhaps an assistant at the counter. Around you on display are Nivea face creams, Roc anti-cellulite lotion, toothbrushes and maybe mouthwash. But that's about it.

You can't browse diarrhea remedies or foot fungus creams or types of vitamin C. You can't browse anything. When it's your turn at the counter (there is always a line), you describe your pain or lesion, your chief complaint and the frequency of urination, as applicable, in earshot of anybody yearning closer to see what ails the foreigner and if she can get the vocab right.

Next, the pharmacist goes to the back and pulls out some unguent in a tube, or a box of blister-packed pills, either of which might or might not require a doctor's prescription (she will sell you either). She tells you the price (on the label as established by law). You pay and leave the doctor-druggist to attend the next patient-customer.

If you have the nerve, the balls, and a little knowledge of what ails you and the indicated medications for a cure, you ask her if there are alternative medicines or alternative strengths. Then she might bring out one or two other options, or she might not (there is a line, remember). In no case will she ever bring out the 23 cold remedies on the shelf at Walgreens even if she does have them, which she probably does. So.

What are the core issues here? I'm still working through that. Certainly consumer freedom of choice and free easy access to information are involved.

There also seems to be a cultural disconnect between the Spanish mindset and the USA mindset (mine, at least) in these regards. To wit: my 31-year-old niece and her older sister are both pharmacists. We had the freedom-to-browse-analgesics discussion one year recently, but we never did intellectually intersect. I was huffy and snidely sure that I have the God-given inalienable right to browse through Tylenol, Excedrin, Advil, Aspirin and their various permutations and generic equivalents. They were just as sure, and incredulous to hear the contrary, that everybody (including me) is too ignorant and uneducated about drugs to make wise and safe decisions for self-medication.

Everybody, that is, except for pharmacists!! HA!!

*In 2006 the European Union called the Spanish restrictions counterproductive to the provision of an adequate supply of medications to the public. The Spanish professional associations of pharmacies responded that, per capita, Spain has as many, or more, pharmacies than other European countries and that the price of medications is lower in Spain than in most countries.

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