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A tale of two Pharmacies


A tale of two Pharmacies

I have spent some time in the US now due to medical reasons.  During my stay, I had the dubious opportunity to frequent many pharmacies; I can honestly say the American experience in this subject is quite different than the Brazilian one.  Would you like to know which of the two countries have better pharmacies?  I bet you do huh?  Then follow me in this contest, although a bit less exciting than the World Cup, there is a lesson to be learned here.

I started thinking about the subject while still in Sao Paulo, when I had to purchase contact lenses, but could not find them available anywhere.  In my second attempt, already a bit frustrated, I asked the pharmacy clerk whether another nearby pharmacy may have them (I remembered buying them recently).  And what could possibly be the answer?  Pharmacies are now prohibited to sell contact lenses and eyeglasses, interesting.  I then headed to an optical store.  I can imagine that possessing good eyesight may be extremely dangerous to the individual and society as a whole, and because of this reason the authorities decided to make it a difficult process to obtain it.  Now, every poor elderly citizen with presbyopia must set up an appointment with an ophthalmologist and present a prescription in order to buy a pair of glasses. Consumers could already do this before, consult a doctor and obtain a prescription.  However, those who thought that this process took too much time and money and that the benefit of eyeglasses which were a bit more precise was not worth the time could purchase them directly.  Not anymore.

Contact lenses are just a small step in the list of growing restrictions of what pharmacies are allowed to sell.  I remember a story on the Jornal Nacional (National News) a few years ago about products whose sales would be prohibited (I no longer remember the exact products), where they asked a buyer in a pharmacy whether he approved of this law or not.  Yes, of course, he approved of it.  Ironically, there were several products which were already prohibited by law in this conscious consumer's basket.  So, you all see how polls and votes in the ballot box faithfully reflect the real preferences of the population.The result is that nowadays, our pharmacies only sell medication, cosmetics and a few bathroom items.  Soon, someone will realize that a shampoo is very different from any other drug; they will think that it is "irrational" to offer both items in the same store and will want the law to separate what the well being of the consumers put together.

There must exist many good motives to ban pharmacies from selling products in general, causing the citizens lose precious time going to several different stores.  Is there a good motive?  Take a look at the justification provided by the president of ANVISA (Brazil's equivalent to the FDA), Dirceu Raposo de Mello (WARNING:  The logic of those that work for the Ministry of Health can be hazardous to your mental health):  "A pharmacy is a different type of establishment; one cannot vulgarize this environment with products that have no relation to its objective".  Is there a need for criticism?

Let's think of something more pleasant than the ANVISA, which isn't difficult to do.  Let's go to the US!  There, pharmacies sell everything from medicine, electronics, domestic items, toys, books, food and more, much more.  I looked around a bit and there they were:  eyeglasses of up to 3.5 diopters for 15 Dollars, freely displayed (yes, the health of Americans has not yet reached the level of the Brazilians', even though important advances are being made in this field).  While I waited for my medicine to be ready for pick up (more on this below), I purchased some sweets.  I have no doubt in my mind:  Pharmacies that are vulgarized are much better.

The other side of the pill

Maybe you are thinking somewhere along these lines:  "liberal scum sold to Yankee Capitalism!"  If this is the case, calm down.  In the contest for the best pharmacy there is still one subject with which we may salvage our Brazilian honor.  Notice that up to this point I have spoken about everything, except drugs.

The American pharmacy enjoys many liberties except when the subject is in relation to drugs; then it becomes the dream of every bureaucrat.  Pay attention:  In order to purchase any prescription drug, one must provide a prescription (which is nominal, numbered and it has a special paper with several marks so that they cannot be falsified) to the pharmacist, identification, a phone number and personal address; then the pharmacist inputs all this information into the computer, makes a few phone calls and then places the exact prescribed amount of the medicine in a container.

On the first time, the clerk told me that it would be ready in 20 minutes.  I was perplexed: 20 minutes?  In Brazil the sale is instantaneous (except for those that are deemed "controlled substances" -- in the US it is like this for almost all medication):  The clerk looks at your paper and then checks you out.  A new law which prevents the consumer from obtaining the medicine himself messes up the process a bit, but the service is still fast.  Well, as aforesaid, I used my 20 minutes to buy ice cream, Coca-Cola and other medications for the soul.  I was not even aware that I lucked out that day; typically it takes one hour to "prepare" that particular medicine.  I asked a pharmacist that I met around here and he told me that the wait is due to the checking of the prescription and the negotiation with the insurers.  Is this a market failure?  More so a failure of Government:  the American insurance market ranks amongst those most regulated in the world,  and the insurers are obligated to give a lot of medicine away for free without raising dues; naturally they fight tooth and nail to not give one cent above that which was required by law.  The result is an accumulation of requests which turn into one immense queue.  This particular pharmacist laments that he no longer has time to help any client, talking and removing doubts about any symptoms.  His time is entirely taken up by bureaucratic tasks.

If the Brazilian system is already unnecessarily complicated, the American one is a joke told in bad taste.  I told my clerk here in the US about how drug sales work in Brazil.  "Yes, it used to be that way here.  There were too many fake prescriptions though."  I did not have the presence of mind to answer back with a "So what?".  In Brazil there are many fake prescriptions.  So what?  If prescriptions were not mandatory, you can bet that the number of fake ones would drop precipitously.  And they would fulfill their legitimate function:  inform the patient and the clerk at the pharmacy about which drug and dosage was prescribed by the doctor; not serve as a form of control over who can or cannot ingest a certain substance.

But, you will tell me, what about the dangers of taking the wrong medicine and dying?  Is it worth to raise the prices (in time and money) of all that relates to our health because some people are reckless enough to take dangerous drugs without knowing whether they serve for what is ailing them or not?  Ironically, many of those that defend health regulation admit that they themselves routinely do not comply with the law, for example asking for the pharmacist (or even their mother) to refer them to certain drugs, which is illegal (maybe this will partially change; notice the fear doctors have in losing their market protection).

Similar to the FDA, the institution in the American Government that decides which substances are to be sold and those that are to be controlled, the ANVISA is benign and liberal.  The FDA, for example, already wants to limit the amount of salt found in all food.  Many large corporations have already conformed to this requirement voluntarily.  To them, this is a positive: usually, any new regulation can be easily put into place within a large corporation (for whom the extra cost is minute) than with a smaller company, for whom the new cost may compromise its very existence.  Do not then complain about monopolies and cartels.

I have prolonged this enough, time to announce the winner.  Who wins in the contest of pharmacies; Brazil or the US?  And the winner is.the market.  The US and Brazil have their own respective pros and cons; but in both country's pharmacies the pros ought to be the liberty of the people to free voluntary exchanges in order to better their lives, and the cons are the actions of the governments that decide to better the situation.

Translated by David Klein

Sobre o autor

Joel Fonseca

Economista e filósofo. Colunista da Folha e Exame Hoje. Integrante do MyNews. Youtuber em formação.

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