Things about France that surprised me: the importance of la Pharmacie

I’ve previously mentioned that one of my least favourite places is the pharmacy, any pharmacy. This is largely because of the queues. It’s not the volume of customers but rather the amount of time taken to deal with each one and their myriad of purchases, going through the pros and cons of all the products on offer. Yes, the advice of the pharmacist is keenly sought, never more so than over the last few months, by the hypochondriac-prone French.

The pharmacy is a cornerstone of France’s (quite rightly) revered healthcare system, not to mention the beauty industry. You’ll find at least one in every small town and even in some relatively small villages. On the French Riviera, we seem (to me) to have one every 100 metres! In fact, there are around 21,000 pharmacies across the whole country. In some places, pharmacies are the only places where you can go to for medical advice if there’s no doctor’s surgery nearby and, many French will talk to their pharmacist before visiting their GP.

Laws currently regulate where you can buy medication and medical equipment, and most of these can only be prepared and sold by a pharmacist. Pharmacists are also authorised to prepare medicines for specific conditions or for other medical establishments such as hospitals. But this exclusivity is under threat.

The reverence with which the pharmacist’s advice is held carries over from medical to beauty products. While I’m waiting in one of those interminable queues I might get to overhear a conversation between customer and pharmacist with the latter’s weighted opinions on, say, the correct moisturiser. It’s rare to see anyone question the authority of the pharmacist or even their lieutenants: no-nonsense, white, lab-coated salesladies. They’ll analyse skin problems and lead you to anything from mink oil face cream to Homéoplasmine, a waxy balm traditionally used to soothe nursing mothers’ chafed nipples, a great remedy for chapped lips, to Embryolisse Lait Creme Concentré, the well-priced and truly wonderful face cream with the disconcerting name. A number of these products have achieved cult status in the skincare industry and are now available globally.

Elaborate pharmacy window displays change according to the seasons. At exam time, their windows will be full of ads for, and boxes of, things that I’ve truly only seen in France: memory pills, anti-snoring tablets and, of course, pills and supplemental regimes for le fatigue. This year these have been replaced by anything and everything to help ward off COVID-19. Prevention and protection have been the key themes.

After exams, comes the summer holidays and everyone wants to have beach-ready bodies. So the pharmacy will showcase slimming remedies, anti-cellulite pills, pre-bronzing capsules, gel for “heavy legs”  – the last one is something I’ve only ever seen in France. What are heavy legs? All the French women I know have enviably slim, svelte legs.

Come autumn, pharmacy windows are full of fascinating fungi charts. Autumn is wild mushroom season bringing in cèpes, girolles, chanterelles and the sinister sounding trompettes de la mort (trumpets of death) – all of which are edible. This is one of the more important functions of the French pharmacist. They are all required to study mushroom taxonomy as part of their training and provide the service of examining your basket of foraged fungi and oint out any that are not edible.

Alas, as with many other icons of French culture, such as cafés and bistros, the pharmacy as it exists today is under threat. Firstly from parapharmacies, often within supermarkets, which can discount heavily, and online – an ever- growing channel. The current government has floated the idea of deregulating pharmacies, which pharmacists worry will allow supermarkets to also begin selling over-the-counter drugs and which will also potentially allow corporations to buy up the typically owner-run pharmacies. The highly personalised service would be just one casualty of that model, they say. To protest, they upheld another French tradition: they went on strike!

Things about France that surprised me: French hypochondria

Now, what do I mean by this? The French exhibit abnormal, chronic anxiety about their health. I suppose that’s one of the reasons my beloved feels so at home here. Am I just making base accusations? Let’s look at the evidence.

Any time you sniffle in France your friends and neighbours (all amateur diagnosticians), will quickly recommend any number of doctors to visit or pills and potions to take. Youngsters can tell you if their mal à la tête (headache) is stress-related or whether your angina is a petite angine or a grande angine. Or whether you have one of the ailments that I’ve only ever heard of in France. My favourite is the ever rampant crise de foie – digestive troubles most often caused by a too rich meal.

Far be it from me to suggest that France is a nation of hypochondriacs, but let’s just say their comprehensive healthcare system – for which I’m suitably grateful – hovers at the top of the WHO’s best healthcare lists  and makes it rather easy to be one.

The French visit the doctor more than in any other country. And there is a cultural consensus that the doctor isn’t treating you well unless you come away with a prescription. Or two. Or three.

Next stop: la Pharmacie

The French fixation with all that is scientifically au courant has ensured that le pharmacien is embedded in the Gallic esprit as omnipotent. Since the days of Molière, Voltaire and Flaubert, the self-important pharmacist has been celebrated and lampooned (as have their patients) as they dispense pseudo-scientific potions to a nation of hypochondriacs.

Pharmacies throughout France look as important as they are. Many are elegant old shops with polished wood counters and glass shelves lined with antique vessels holding arcane formulas. Some even have chandeliers. The Pharmacie de la Bourdonnais (above), near the Eiffel Tower, for example, is a 19th century establishment that has been deemed an historic monument.

I’ve never seen or been into an empty pharmacy in France and there’s generally at least one every 500 metres. They’re full of people, largely the elderly, lining up to present their ailments and receive the benefit of the pharmacist’s wisdom, or pick up their one, two or three prescription. It is generally accepted that France is one of the most highly “prescribed” countries. When everything from prescriptions to seawater spa therapies is covered, it’s easy to understand why. Indeed the pharmacy and the pharmacist’s importance in French society cannot be exaggerated. And it goes beyond the nature of the healthcare system.

French pharmacies are different from American drugstores or UK chemists. French pharmacies are single minded places, so you won’t find cigarettes, greeting cards, soft drinks, magazines, sandwiches or any thing else associated with one-stop, convenience. The key relationship between the customer and pharmacist, who is usually also the owner, is trust, as opposed to convenience or price. The pharmacist is heavily invested in advising customers on the appropriate over-the-counter medicine and/or the most appropriate toothpaste.

French Pharmaceutical Market

Given what I’ve just said, you won’t be surprised to learn that France is among the biggest consumers of pharmaceutical products in the world. It has the world’s highest consumption of medicines per capita. With a population of 65 million (of which 11 million are over 65 years), France vies with Germany as the largest European market for medical care.

According to INSEE, the French statistical office and the French Ministry of Industry, the French pharmaceutical sector generates an annual turnover of €36 billion and is ranked third in the world for the wide-ranging drugs prescribed by doctors.

The French have long been known for their high prescription drug use rate. Further statistics from France’s National Drug Safety Agency show that 32% of the French population had used anti-depressant drugs, either on a regular or occasional basis. The French pharmaceutical sector is the biggest in Europe and the third largest in the world, with the giant French Sanofi Pasteur group being one of the biggest drugs company in the world.

However, I can’t deny that the health care system here is excellent. Once you have obtained a carte vitale, you are refunded the cost of doctors’ appointments, medication and treatments.

Pill poppers

To France’s envious European neighbours, the pace of day-to-day French living may seem attractively pedestrian. In theory, workers enjoy a maximum 35-hour working week, and their quality of life is further enhanced by generous holidays and a healthy respect for sacrosanct long lunches and weekends.

Yet beneath their apparently relaxed exterior, the French have been outed as Europe’s leading hypochondriacs, consuming a record number of prescription drugs – including vast quantities of tranquillizers, sleeping pills and anti-depressants.

So worried are the French about their health that on average they buy more than 48 boxes of medicines per annum from French chemists, a total of 2.6 billion pills and potions, according to newly released government figures – more medicine per head than any other country in Europe. I can concur with this finding as my beloved has what appears to be a small sub-branch of the local pharmacy in his bathroom cabinet. I, on the other hand, have no pills or potions in mine.

French officials were shocked at the year-on-year rise in the annual drugs bill, despite a campaign to cut consumption. Among the drugs most often prescribed by doctors were over-the-counter painkillers, sleeping tablets, tranquillisers and anti-depressants. The number of hospital prescriptions also rose.

One Parisian doctor said the French health system encouraged hypochondria:

I get a lot of people coming to me because they think they might be getting a cold. They are not happy unless they go away with a prescription for something. If I don’t give them what they want, they will only go to another doctor and another until they get one.

Has the French approach to illness and the body brought about a health system that panders to le malade imaginaire, or has the efficiency and popularity of the system itself bred a whole nation of hypochondriacs? Either way, it’s something that should be given urgent attention particularly as here on the Cote d’Azur we’ve just had our first instance of someone infected with the Coronavirus confirmed.

So far I’ve not seen evidence of mass hysteria, though there have been calls to close the border with Italy. The Nice Carnival and Menton Lemon Festival were abruptly terminated, though that was largely due to the danger posed by high winds. Our local pharmacy is handing out useful leaflets with plenty of advice on preventing infection and still has some disposable masks in stock. To allay fears, the Mayor of Nice has even set up a helpline:-

Saturday Postscript: Events involving gatherings of more than 5,000 people have been cancelled. This includes the Nice Foire, MIPIM – the property expo in Cannes and quite probably the bike race Paris-Nice.