July 19, 2024

Health Mettler Institute

Healthy LifeStyle & Education

What Dr. Simi tells us about Mexico’s healthcare crisis

What Dr. Simi tells us about Mexico’s healthcare crisis

He sports a bushy white mustache and a bit of a gut. He dances to reggaeton in cities and towns across Mexico. He has 2 million followers on TikTok and at concerts is routinely passed into the arms of pop stars. His face even adorns a mountainside.

He is Dr. Simi, the cartoon mascot of Farmacias Similares, Mexico’s largest drugstore chain, with more than 8,500 locations across the country. His ubiquity speaks to the company’s round-the-clock marketing strategy but also something darker: the failure of the Mexican government to deliver on its promise of healthcare for all.

Medicines are often in short supply in public clinics, where it can take weeks to get an appointment with a primary care doctor.

A woman with long dark hair sits at a computer terminal. On the desk are dolls of a man in a lab coat

At Farmacias Similares’ corporate headquarters, an employee sits at her desk adorned with Dr. Simi dolls and stickers.

(Luis Antonio Rojas / For The Times)

Farmacias Similares helps fill the gap with cheap generics and $2 doctor visits. The chain says its clinics next to each location provided 136 million appointments last year.

Many pharmacies feature an employee in a Dr. Simi padded bodysuit waving to passersby and engaging in antics such as challenging the cow mascot of Mexico’s Alpura milk brand to a dance-off.

A group of people dressed as mustachioed characters in different costumes pose for a photo

Various Dr. Simis pose for a photo at an event in 2022 to celebrate the company reaching its target of 8,000 pharmacies.

(Farmacias Similares)

At the company’s headquarters in Mexico City, a mural shows Dr. Simi with a raised arm declaring: “To serve God and the people!”

Dozens of employees there answer calls to the “Simitel” hotline that provides free access to doctors, nutritionists and psychologists — and for those who press “1” to Dr. Simi himself.

Operators who have perfected the mascot’s cheerful nasal voice answer several hundred calls a day by reading a joke from a binder or simply offering a friendly ear. Alberto González, who has played Dr. Simi for nearly 17 years, cherishes callers such as 27-year-old Luis, who dialed in more than a decade ago to talk about his parents’ divorce and still phones every few weeks.

A man sits at a workstation. Behind him is a poster of a mustachioed character and the words Bienvenidos a Similandia

Alberto González, who takes on the role of Dr. Simi on the company’s hotline, waits for calls from people who want to chat with the mascot.

(Luis Antonio Rojas / For The Times)

The operators never break character.

“Hello, hello! How are you?” goes the script. “You’re talking to Dr. Simi. Who is calling me?”

::

In 1997, Mexico began requiring drugs to be labeled by their active ingredient rather than a name brand. The idea was to increase confidence in medications and open up the market to generic drugs.

The new rules were a business opportunity for Victor González Torres, whose family company had long manufactured drugs for the government health system.

That year, he founded Farmacias Similares. The name is a reference to generics, which were advertised with the slogan “The same, but cheaper.”

Promising “up to 75{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in savings,” the company launched a marketing campaign that presented the chain as coming to the rescue of poor Mexicans and pushed back against transnational pharmaceutical companies that disparaged generics.

A mural along a set of stairs depicts a man holding a note near other people

A mural depicting Victor González Torres, the founder of Farmacias Similares, at the company’s headquarters.

(Luis Antonio Rojas / For The Times)

González wanted a mascot with the right combination of goofiness and wisdom. After rejecting several ideas from an advertising company, his team found an artist who designed the winner: a simple black-and-white drawing of a doctor joyfully holding up his arms. The inspiration came from a famous movie character from the 1940s, Don Susanito Peñafiel y Somellera.

Dr. Simi first appeared in newspaper advertisements. He then took shape as an animated cartoon and a puppet on television, happily explaining why the public should trust generics.

A woman holds a blue sign outside a storefront, near a passerby

An employee holds a sign advertising a sale outside the first Farmacias Similares pharmacy in Mexico City.

(Luis Antonio Rojas / For The Times)

Before long, Dr. Simis were dancing on the sidewalks. The company created a comic called “The adventures of Dr. Simi” and a band of “Simichicas,” well-known actresses and models who traveled with the founder and promoted new products such as the “Simicondom.” “SimiInsurance” offered medical treatment for a premium.

One of the chain’s key moves was to open clinics — which are operated by a sister company — alongside its pharmacies.

The cheap clinics made healthcare more accessible to the tens of millions of street vendors, taxi drivers and others working in the country’s informal sector. It was a population excluded from public health insurance systems — in apparent breach of the Mexican Constitution, which was modified in 1983 to make healthcare a universal right.

A masked man in a white coat holds a syringe near a masked woman seated on an examination table

A doctor prepares an injection for Carmen Maldonado, a regular patient at his clinic next to a Farmacias Similares pharmacy.

(Luis Antonio Rojas / For The Times)

Like some political parties, the chain also handed out free rice and offered social assistance in poor neighborhoods.

Its populist strategy worked. By 2003, Farmacias Similares had roughly 1,000 locations and was looking abroad.

The government healthcare system expanded substantially the next year under a new program known as Seguro Popular that offered health insurance to workers in the informal economy. But that didn’t appear to stall the growth of Farmacias Similares. Catering to hourly workers who couldn’t afford to take time off to travel to public health centers, the chain placed its pharmacies on busy streets, often near bus stops, and grew rapidly by offering franchises.

By operating on a massive scale and manufacturing many of its own drugs, the company cut costs further and passed on the savings to customers.

“Victor González Torres and Farmacias Similares executed a tremendously effective strategy,” said Michael Chu, a Harvard business professor who has studied the chain.

González’s profile was growing too. Long encouraging people to call him Dr. Simi, he did not hide his desire for prestige, declaring once that he wanted to be remembered as a revolutionary like Che Guevara.

He butted heads with officials in the public health system after alleging corruption in its drug-purchasing practices and campaigned for president as a write-in candidate in the 2006 election.

“Poor people can have power in a country where there are so many,” he said in an interview at the time. “They can choose a president.”

The company has also waded through a fair share of controversy. González’s brother was the founder of Mexico’s Ecological Green Party, which in 2010 faced accusations of conflict of interest after sponsoring legislation to provide people with vouchers for medications in private pharmacies. The media dubbed it the “Simi law.”

The law failed to pass, but Farmacias Similares continue to grow amid the government’s faltering attempts to improve the public health system.

More than a quarter of the population lacked access to care in 2020, according to the government’s most recent estimate.

That same year, President Andrés Manuel López Obrador replaced Seguro Popular with a new program he promised would reduce corruption. But it has been beset by medicine shortages that experts attribute to bureaucracy and the COVID-19 pandemic. The government is currently transitioning to yet another program.

As a result, clinics next to private drugstores have been booming and are now thought to serve roughly a fifth of the population. Farmacias Similares opens nearly two new locations a day on average.

Carmen Maldonado, who owns a shop that sells artisanal honey and cheeses, recently dropped by Farmacias Similares’ first store — located in Mexico City’s Portales neighborhood — to buy cold medication and antibiotic injections, which a doctor administered at the clinic next door. A sign outside advertised birth control, oxygen and blood sugar readings, stitches and ear cleanings.

Maldonado could opt to use the public system, but the clinic is near her home and she’s been seeing this doctor for 20 years.

“He’s like the family doctor,” she said.

::

In November 2021, a 19-year-old high school student named Avril Christelle Vega Martinez was on her way to a concert in Mexico City when she stepped into a Farmacias Similares to pick up some hand sanitizer.

She had also been looking for a Dr. Simi doll, so she was happy to find the store had one left in stock. The dolls come in different guises — including boxer, mariachi and fireman — but the one she bought was the classic version: Dr. Simi in his lab coat.

Plush dolls sit on a bookcase in the shape of the letters C and S, next to a larger version of the mustachioed character

A variety of Dr. Simi dolls fill the bookshelf of an employee at Farmacias Similares’ headquarters.

(Luis Antonio Rojas / For The Times)

Vega had taken the doll out of her backpack at the concert — Norwegian electro-pop singer Aurora Aksnes — when an idea popped into her head.

“I suddenly thought of the idea of maybe giving it as a present to Aurora,” she recalled. “Dr. Simi is a symbol of Mexican culture. We grew up seeing Dr. Simis dancing everywhere.”

And so she passed the doll up through the crowd until someone flung it onto the stage. Aurora picked up Dr. Simi and hugged him to her chest.

Captured on video, the incident went viral on social media, and it wasn’t long before Dr. Simi dolls were routinely being thrown onstage at concerts of pop stars including Dua Lipa and Rosalía. Joining in on the fun, a former chief justice of Mexico’s Supreme Court “ruled” on TikTok that doing so isn’t a crime.

The publicity was good news for Farmacias Similares. Dolls were selling so fast that the company boosted monthly production to 40,000 from 12,000. When one was left at a memorial for Queen Elizabeth II in Edinburgh last year, Mexican media outlets thought it newsworthy enough to cover.

The company carefully guards Dr. Simi’s image. The more than 1,000 staffers who wear Dr. Simi bodysuits are forbidden to speak to the public while in costume in order to preserve the character’s identity. One benefit of the job: lessons in dancing salsa, cumbia and the Simi pasito.

A communications team works a night shift to produce seven television shows a week, bringing in specialists to discuss anxiety and stress, as well as staffers from different areas to explain their jobs. Employees keep a close eye on social media, tracking down for an interview members of the public who have helped Dr. Simi go viral.

The company also promotes its brand through what Victor González Herrera, the son of the founder, called “conscious capitalism” — funding natural disaster relief, tree planting and food assistance for the hungry.

In December, the company raffled 25 cars to customers to mark its 25th anniversary. Before the winners collected their new car keys, pharmacy employees launched into the corporate anthem:

We have the courage
Dr. Simi has the heart
What we offer
We do with love

With pharmacies in all of Mexico’s 32 states and more than 400 in Chile, the company aims to reach its target of 10,000 pharmacies in the next five years and ultimately become the largest chain in the world.

“Simi has simply become necessary,” said Victor González Herrera, who recently took over as head of an umbrella group that includes the pharmacies and the clinics.

Health experts have warned that while the pharmacy clinics can treat immediate illness, they are not ideal for chronic conditions.

“Can it be a business that does good? Without a doubt,” said Dr. Andrés Castañeda, who coordinates health issues for Nosotrxs, a Mexican organization that promotes citizen participation in public policies. “But the health system can’t leave things 100{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in the hands of clinics adjacent to pharmacies.”

One problem is that the care may not be consistent, because the doctors tend to come and go.

But Cori Hayden, an anthropologist at UC Berkeley who recently published a book on Farmacias Similares called “The Spectacular Generic,” said that many people have resigned themselves to “something is better than nothing” when the state fails to provide healthcare.

“It’s a force. It’s wild,” she said of the chain. “It’s totally wild.”

But its true power remains something of a mystery, because Farmacias Similares keeps its sales figures private.

“It’s a gray area,” said Jorge Perichart, director of the National Assn. of Sales Executives of the Pharmaceutical Industry. “We don’t know what we’re competing against.”

::

Four people look out of an upstairs opening in their home, which painted in blue with black stripes

A family peers out from a home in the “Simi Neighborhood.”

(Luis Antonio Rojas / For The Times)

About 30 miles north of the center of Mexico City, in a mountainside community in the municipality of Ecatepec, the homes have bare concrete floors and tin roofs. Access to running water is a luxury.

For Farmacias Similares, the Lomas de San Carlos neighborhood was not just a symbol of neglect: It was a canvas.

Last year, the company sent in representatives offering residents food assistance and free house painting. Then painters got to work on 305 houses.

The result was an advertisement for Farmacias Similares visible from the nearby highway.

White houses make up a man’s bushy mustache, pink houses his tongue, and black-striped houses the three wiry hairs on each side of his head.

It was, of course, Dr. Simi.

A view of homes in a neighborhood painted to depict the likeness of a cartoon character with a white mustache

Hundreds of houses in the municipality of Ecatepec have been painted to form a mega-mural of Dr. Simi.

(Luis Antonio Rojas / For The Times)

The company — which also remodeled the community center, built a vegetable garden and opened two new pharmacies nearby — dubbed Lomas de San Carlos “Simi Neighborhood.” Reporters rushed to cover the story.

“No one has ever paid this much attention to us,” said Hortencia Olivares Ramos, whose home was painted blue — the background of the mural.

At the mountain’s peak, Eva Ojeda López lives with her husband and four children in a house painted to match the hairs on Dr. Simi’s balding head.

The stay-at-home mother buys her hypertension pills at Farmacias Similares when the public pharmacies run out and frequents the company’s clinics for basic ailments such as colds.

Ojeda swore that the arugula from the new community garden lowered her cholesterol levels. One of her daughters read the book that Farmacias Similares gifted the family: the founder’s autobiography, “My Life Is a Struggle.”

Another daughter Johana, 18, joked about how some of her neighbors lived by Simi’s tongue or his eyes.

“We consider ourselves a part of Dr. Simi,” she said.