Bryson's America: 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 pounds 16.99. Available at all major bookshops or by mail order on 01624 675137