Perhaps I was a bit hasty recently, when I compared CVS to a vertically integrated hydra of world domination. Last week, on vacation to Italy, I had reason to feel nostalgic for the US model of self-service, as poor packing meant several visits to farmacias for basic over-the-counter products.

In Italy, as in France and Spain, but not in England, there is no aisle four at the drug store; there are no gym locks, lawn chairs, plush toys or chocolates for sale. Farmacias come in two types: wood-paneled apothecaries with coffered ceilings and medieval insignia on the walls, and sleekly modern, shiny white emporia with automatic doors and end-of-aisle displays featuring the smooth buttocks of naked women.

Valerie Block is the author of the novels Don't Make A Scene (Ballantine, 2007),...read more

Either way, anything you want, including toothpaste, is hidden, and you must ask for it. Almost always, behind the raised counter is a 48-year-old professional bureaucrat in a white coat with coarse hennaed hair who wears glasses on a chain and stares down at you and finds your character wanting.

In spite of the fact that she is giving off vibrations of bitterness, impatience and disdain, you cannot get to the toothpaste without her help. No matter that you walk in carrying a bottle of water and a map, she will give you a can of shaving cream the size of a municipal pylon.

No, you say, you need a travel-sized can. Well, there's nothing like that here, she says, implying that is bad taste of you to ask. What about a different brand? It's the same size with other brands, she insists. It's either a chunk of iron for 19,50 Euro, or you're out of luck. You say no thank you, and she jerks her head once, as if she expected it all along.

When one has a health issue of a more intimate nature, there is no private area to communicate symptoms to this official. I once underwent a humiliating ordeal in a pharmacie on the Isle St. Louis in Paris. This shop no doubt played a critical role in a 14th century war, heightening the sense of moral superiority its naturally condescending French employees feel towards gauche Americans with the audacity to walk in asking for medicine.

Augmenting my rusty French with sign language, I spoke quietly to the pharmacist, a white-coated 48-year-old with coarse hennaed hair and glasses on a chain. She announced loudly, amid mixed company, that I had a case of champignons, mushrooms. She made it sound simultaneously like something I'd inherited from my filthy forebears, and something that I'd caused myself, due to unsanitary practices. She pulled out a large white box with glass phials to treat this condition.

I don't have mushrooms, I told her with all the dignity I could summon, aware of at least six other people enjoying this conversation.

Yes, you do, she insisted.

Perhaps champignons was French for yeast infection. Are there other brands of this medicine, I asked, mentioning a drug that I knew by its American brand name.

The despot shook her head firmly. She had never heard of such a medicine and there were no other brands of this medicine. She told me that if I didn't believe her, I could go to the ob-gyn clinic in the 5th Arondissement. She was so autocratic and arrogant, that I did just that, without an appointment, which is possible in a land of socialized medicine.

After a wait in a crowded room of pregnant women and their sophisticated yet feral children (so young, and already speaking French!), I was directed into a cubicle that had two doors, and told to take off all my clothes and wait there until the doctor was ready for me. I changed into the gown, but there was no place for my clothes, as the cubicle was smaller than most fitting rooms.

Sitting on the bench on top of my clothes made it feel smaller, so I stood. I waited a good 20 minutes -- plenty of time to ponder the state of my body, and all the things that were going wrong with it that, though not life threatening, were a constant source of irritation while traveling. Burning and itching in a private area was one issue. Burning and itching that was probably athlete's foot was another.

There was also foot pain from stumbling into my luggage a few days earlier, and back pain that was clearly the result of limping all over Paris ignoring the foot pain. If I'd been at home, I could have made quick work of all of this at CVS. Ah, the day when Monistat went over the counter I was proud to be an American!

Of course I'd have to wait a good 20 minutes on line to buy everything. European pharmacies are nothing if not efficient: you enter, and you're promptly insulted and expelled. It is clearly different with the Europeans themselves, who have the language skills, and of course the savoir-faire, to deal with these petty tyrants.

There was a sharp knock on the door. When I opened it, my clothes fell to the floor. I tried to stabilize them on the bench, but they fell again, so I carried my garments with me into the doctor's office in a messy pile. I sat in front of a man at a desk in a navy silk shirt and pressed khaki pants who had clearly just come back from a two-hour lunch with three courses and wine and regarded my clothing maneuvers as clownishness.

With equal embarrassment over the state of my French and the state of my vagina, I explained my situation. When I told him that I also had itching on my foot, he said, "Well of course it's connected!" as if I were a slow and irritating child.

He directed me to an examination area. Apparently, while I'd been standing in the cubicle my period had arrived; the male gynecologist was clearly disgusted. Why hadn't I mentioned it? I hadn't mentioned it because I wasn't aware of it!

With a snort, and without further examination, he hastily wrote a prescription to treat something, perhaps mushrooms, and I made sure to go to a different store to fill it, although I had to limp five blocks out of the way to do so. This gave me plenty of time to fume about the experience. Why go into gynecology if menstrual blood disgusts you? Why keep basic toiletries behind the counter, guarded by bullies?

But all of that mortification was in the past. This trip, as we entered each farmacia, prepared to be fleeced by the exchange rate (two toothbrushes: $19), my husband was determined to speak Italian and I was determined not to be condescended to when asking for choices. While giving people more access to doctors, the European system offers less access to medicaments. I'll keep this in mind next time I wait on line for 20 minutes at CVS for the privilege of picking the tube of toothpaste off the shelf myself. ...read more blogs