As readers may recall, while I was in France this fall I gleaned a number of lessons about such issues as hospital billing and France’s superior system of banning drugstore chains. Here is one more.

Toward the end of our stay, my wife and I both got bad coughs (happily, not COVID). We went to our wonderful local pharmacist in search of something like Mucinex or Robitussin, which are not great but better than nothing.

"We have something much better," said he. And he did. It’s called ambroxol. It works on an entirely different chemical principle, to thin sputum, facilitate productive coughing, and also operates as a pain reliever and gentle decongestant with no rebound effect.

We experienced it as a kind of miracle drug for coughs and colds. A box cost eight euros.

Ambroxol is available nearly everywhere in the world as a generic. It has been in wide use since 1979.

But not in the U.S.

A comprehensive review published by the National Institutes of Health judges ambroxol to be safe and effective. But as far as I can determine, no U.S. drugmaker has ever applied for FDA approval to sell it, which requires extensive testing and clinical trials, as if the drug were brand-new; the FDA does not take the word of, say, the European Medicines Agency.

As a drug manufacturer, you couldn’t make much money marketing and selling ambroxol as a generic, especially given the costs of getting it approved.

This leads me to suggest two reforms. First, we need a public agency to manufacture generics.

The promise of generics has been blunted because the big dogs at PhRMA, who want exorbitant profits and restricted competition, have been buying up generic drugmakers. (That should also be illegal.)

The FDA could also issue waivers to allow sale of generics that have been approved by reputable drug agencies abroad and have been in wide use for a long time with no problems.

In the meantime, it’s possible to go online and order ambroxol from Europe. This is decidedly a second-best.

When you track down all the anomalies and inefficiencies in the American health system, they all lead back to one thing—too much corporate power.