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At this stage of the American empire, we have exported just about all the culture we are going to export. The apple pie is available globally. Cities around the globe have hosted and endured Major League Baseball games. There is a new jazz festival in Moldova, and experts have not reached a consensus as to whether Moldova is a fictional country. The tank is nearly empty. But there is one strictly American art form left in the world, and we are keeping it just for ourselves, which works out pretty well because nobody else wants it.

The last piece of real American culture is the television pharmaceutical advertisement. Big Pharma spends about $6 billion a year on direct-to-consumer broadcast ads, and the U.S. is one of two countries on earth that allow it without limits. (The other is New Zealand, also potentially not a real place.) Drug ads are not only ours, they are us, and it is time we appreciated them.

Pharmaceutical commercials are easy to tune out in the way only truly ubiquitous things can be, but we urge you to pay attention. Look at the tropes with fresh eyes. It is always a sunny spring day on a Hallmark Main Street or in a green and high-fenced backyard. There is always a chance for our average American protagonists to be at their best for a child’s birthday party or a flower-arranging class or a hike with diverse and cheerful friends.

There is also an obstacle — plaque psoriasis, migraine, irritable bowels — and to overcome it, they must reach for a breakthrough medication whose effects, side effects, and contraindications we well hear about while our protagonists dance, embrace, or kayak.

These medications nearly always have three-syllable names: Wegovy. Humira. Jardiance. Often these names sound like they’d be fun to steal and drop into conversations: This cake is moist and ubrelvy. Should I color my grays, or do they make me look dupixent? I hope you abilify your math test, and I can’t wait to hear the resulti.

The music is inobtrusive — Imagine _Friendly_ Dragons — and interchangeable: A composer friend of ours wrote a jingle for a decongestant, a ditty that sounded like it was sung by a choir of chill and approachable angels. When we asked what had inspired him, he said, “I originally wrote it for Valtrex.”

Pharmaceutical commercials present sickness and healing as matters of individual consumer choice. “Ask your doctor whether Mespuqa is right for you,” they suggest, inviting us into a world in which we have a regular doctor at all, much less one who has time to answer a question. They allow us to imagine an interaction with a medical professional that is longer than twenty seconds, at a pace less frenzied than a “Call Her Daddy” episode played at 1.5x speed, somewhere other than a strip-mall urgent care next to an Ono Hawaiian BBQ. They exist in a world where we have a degree of agency over our health-care decisions, and in this way they have improved upon the genre of magical realism.

At the end, a voice-over encourages us to take vague positive action: show off your clear skin, do more with osteoarthritis, say “I can” to clearer vision. What do these medications cost, and will insurance cover them? That’s none of your business. Relax. Do yes. Be smile.

Anxiety, high cholesterol, persistent gastro-drama: The ailments these ads address are often symptoms of twenty-first-century American life. Our diets and expenses are making us sick and depressed. Our pharmaceutical industry offers us cures at a price, and if they cause side effects, maybe an additional cure will help, at an additional price. And on and on. Too bad “ouroboros” has four syllables, because it would make an awesome drug name.

Pharmaceutical ads hold a mirror up to our ailing, flailing, retailing country at this moment in history the way Byzantine art reflected the gaudy, gold-leaf vibes of Rome before the Fall. They deserve a wing in the museums of the future, if concepts like “museums” and “the future” turn out to be durable. If nothing else, I want future generations to know that for all its faults, twenty-first-century America produced a voice-over artist who said, “The most common side effect is diarrhea” with pizzazz.

The sick and searching America of the TV drug ad is who we are now, so we might as well face it. If you experience difficulty facing it, ask your immigration attorney if Moldova is right for you.

– Esquire, March 2025