I recently spent a few days in America and felt it appropriate to report back. First, I can confirm that you can buy a dozen Dunkin’ Donuts for less money than eight mushrooms or even three courgettes, which are not called courgettes in America but rather ‘zucchini’, which I think is Apache for ‘strange food without icing or jam’.
Second, many of the shops have full-time customer greeters who stand at the door saying: ‘Hello, how are you today?’ This is a real job and people do it with an enthusiasm that would appear drug-crazed in the UK. Despite their apparent sincerity, they do not expect you to answer: ‘I’m quite well thank you, how are you?’ even if you stand beside them and politely wait for their reply.
Finally, the television makes Celebrity Big Brother look like high art. There is a programme where a short, chubby rock star with a bandana and a butler auditions stupid, skinny women to be his wife. I’m almost certain this was not satire, although the butler did look a bit like William Hague.
And then there were the adverts, advertising everything from hairpieces (no, I didn’t) to a $10 pizza the size of Taiwan with no vegetables whatsoever. And if you buy two, you get a free cheesecake - no, I don’t think they are taking obesity seriously either.
They also advertise medication for everything from depression to rheumatoid arthritis. These start with a happy recipient saying what a fantastic job the tablets have done and then a voiceover lists the benefits before closing with the list of side-effects. So essentially the audience is being told to try the said drug but be aware that some people have lost the use of both hands, begun to lactate randomly and died.
It is clear that many Americans go along to their doctor and ask for the drug they saw on TV. The doctor may advise it is not the best course of treatment but either way, at the heart of this process is patient choice as designed by the drug companies.
The audience is being told to try the said drug but be aware that some people have lost the use of both hands, begun to lactate randomly and died
Could that happen here? On the one hand, our drive to sell stuff is not quite as pressing as America’s. We don’t even have customer greeters. On the other hand, policymakers are attached to the idea of patient choice - and we know pharmaceutical companies have a lot of power over prescribing choices and NHS spending, don’t we?
It could be argued that the more open marketing of new medicines direct to the patient is a progressive and transparent way of developinginformed health care. Maybe I am just too English in my lack of appreciation of the directness of American drug companies.
However, the key issue is the motive. This transparency is not about empowerment or choice. It is about profit. And when profit becomes a motivator in the provision of health care, then the care changes shape.
It becomes something else: a commodity, an opportunity, something that progresses because it makes money. Some people call that realism. I wonder if it isn’t just a little sad.