Early Monday morning, an untold number of Britons, unwilling to wait a day for the British broadcast, made their first foray into the morass of American television, using VPN connections and other creative workarounds to tune in for Oprah’s highly anticipated interview with Harry and Meghan, the Duke and Duchess of Sussex.

The two-hour interview, which aired on CBS, included bombshell allegations of racism and an emotional recounting of Meghan’s struggle with suicidal thoughts. But to many viewers in Britain, it contained another shocking revelation: U.S. television broadcasts are punctuated by a continual barrage of pharmaceutical ads that would be illegal almost anywhere else.

“I’ve never seen so many commercials in any program, ever,” BBC broadcaster Caroline Feraday observed.

Between Oprah’s questions, viewers sat through a soft-focus montage that showed women swimming the backstroke, smiling at salads and hugging their children — along with a warning that common side effects of the breast cancer drug Kisqali include nausea and vomiting. A man jogged on a beach and splashed in aquamarine waves as a narrator intoned the benefits of Skyrizi, a treatment for “moderate to severe plaque psoriasis.” A commercial for Jardiance, which is used to treat Type 2 diabetes, warned that the drug should not be taken with grapefruit.

There were even ads for pet medicines, featuring sprightly dogs bounding around with Frisbees: “Ask your veterinarian about Simparica.”

Most of the ads could never have aired in England. Like other European countries, the United Kingdom bans pharmaceutical companies from advertising directly to consumers on the grounds that doctors should be making independent decisions about what drugs to prescribe — rather than fielding requests from patients eager to try something they have seen advertised on television.

Some British viewers responded to the string of advertisements with shock and disbelief — both at the sheer volume of the ads and the lengthy lists of potential symptoms and alarming side effects that they invariably contained.

“Watching the pharmaceutical ads in between the interview was crazy!” tweeted one British viewer. “I’m convinced I have multiple health issues now.”

Another asked, “How are the side effects of the medicine in American ads more lethal than the thing they’re treating???”

Los Angeles-based writer Ayesha A. Siddiqi collected numerous other baffled reactions in a Twitter thread that went viral early Monday morning. In Britain, “people seeking healthcare are considered patients not customers,” she added in an explanatory note to U.S. readers.

While American audiences are used to commercials urging them to ask their doctor about new prescriptions for high blood pressure or arthritis, that idea seems bizarre overseas: One viewer who tuned into the Oprah interview was left with the question: Why “would you be the one to tell a DOCTOR what medicine to give you?????”

In fact, public health researchers have found that the United States and New Zealand are the only two developed nations that allow pharmaceuticals to be advertised directly to consumers. The industry argues that the practice, which costs billions each year, can encourage people to seek out help for conditions that would otherwise go untreated. That in turn can lead to earlier diagnosis and intervention.

It’s also a highly lucrative strategy for the drug companies: Researchers at Dartmouth College found pharmaceutical companies nearly doubled the amount they spend on marketing between 1997 to 2016, and sales of prescription drugs came close to tripling during that same period.

But critics argue that advertising campaigns have been known to hype new pharmaceuticals that later turn out to have dangerous side effects. Meanwhile, doctors end up wasting crucial time trying to persuade patients they don’t actually need the drugs they saw advertised on television.

The World Health Organization has warned that the net result “is higher cost for the consumer or tax payer,” who ends up paying for all those ads when refilling a prescription. (According to the Wall Street Journal, a 30-second slot during the Harry and Meghan interview went for about $325,000.)

That concept, too, is hard for Britons to wrap their heads around: Thanks to the socialized National Health Service and government oversight, most prescriptions in the U.K. can be obtained for around $12.

“If these medicine ads are what it’s like to not have an NHS I never want to experience that,” one British viewer wrote.

This report has been updated