Tineye tracks this image back to 2017 and Pimsleur is old school in every way (including factoids) so the info behind it could easily be a last minute drunken assignment from 50 years ago.

We’re a lot more globalized and everyone has been exposed to the America “character” through mass media since then. My advice to American tourists is to stop comparing everything to “back home” and to realise you are constantly breaking taboos but your hosts are too polite to tell you. And to remember this when the similarily offend you.

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Too much Novacaine etc can make the skin go all mushy which makes it more difficult to tattoo and heal, which increases the chances of it looking crap. Instead, people with money and aversion to pain get put under general euthanasia while a team of artists all tattoo at the same time. The only real downside is that general anaesthesia is always dangerous so it’s probably too big a risk just to avoid a few hours of pain and discomfort