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Thursday 17 October 2019


Bitter pill

A startup run by men is encouraging women to take beta blockers to calm pre-date nerves. How on earth did we get here?

By Sirin Kale

The hand is racially ambiguous, with a fashionable, flesh-toned manicure. This is a woman who habitually orders Ubers and goes spinning in a boutique gym. These nails do not poke or prod the patriarchy. These nails are trimmed short.

She clutches a white pill as delicately as a rare pearl. It is 20mg of Propranolol, a beta blocker commonly prescribed for high blood pressure, but sometimes used to manage anxiety. The accompanying caption reads: “Nervous about your first date? Propranolol can help stop your shaky voice, sweating and racing heart beat.”

It is an advert for the US telemedicine startup Hers, which circulated on Facebook and Instagram earlier this year. The backlash was swift, and decisive. “You could literally kill people with this crap,” wrote one Instagram user. Another wrote: “This is absolutely disgusting… don’t market medication as if it’s Glossier” – a reference to the cult millennial makeup brand.

Hers immediately began doing damage control. “We got this one totally wrong… we agree the post was misguided and reductive, and we apologize that this slipped through the cracks,” the company wrote on its Instagram page. “We’ve permanently removed that ad and are working with our medical team to ensure that all copy is safe and accurate for the consumer moving forward.”

The Hers website promotes the use of Propranolol to calm anxiety

But despite the apology, Hers continues to retail Propranolol to US consumers at $25 for five 20mg tablets, plus a $5 processing fee. It’s an off-label use of the drug: the Federal Drug Administration in the US has not approved Propranolol as an anxiety treatment. And Hers consumers don’t have to physically visit a doctor’s surgery to be vetted for this off-label use. If they’re willing to pay a mark-up of approximately 15,000 per cent (other pharmacists retail five 20mg tablets of Propranolol for around $1.95), and fill out an online consultation with a physician, the drug is theirs: ready to be popped before a big date, as if it were a breath mint.

When a Hers advert went up above the entrance to the Myrtle Willoughby G-train in New York in November 2018, 29-year-old Chelsea Leibow was appalled. That Leibow felt that way – as a PR worker who was on the team that launched the pioneering period underwear brand Thinx – is remarkable. Leibow was effectively Hers’ ideal consumer, a feminist millennial living in a busy metropolis. “I was really charged up by it,” Leibow said. She felt strongly that advertising prescription medicine alongside the skincare treatments, vitamin gummies and hair products that Hers also retails, was deeply irresponsible.

There was another reason for Leibow’s irritation. Although you will not see him mentioned anywhere on the Hers website, the company is helmed by a man, CEO Andrew Dudum. “At the end of the day, it feels weird to me that they’re telling me what I need to do with my body and healthcare, when I know there’s a dude profiting down the line,” Leibow said.

Hers CEO Andrew Dudum

Hers was launched in 2018 as the “badass sister” brand to Hims, the direct-to-consumer telemedicine startup selling erectile dysfunction pills to millennial men. It’s a crowded marketplace: competitors Kick also sell off-label Propranolol to nervous public speakers, whilst Nurx offers direct-to-consumer birth control. And it’s a lucrative business: the global wellness industry was valued at $4.2 trillion dollars in 2017, whilst the telemedicine market has been projected to hit $130 billion by 2025. Dudum has characterised Hers as a brand that “empowers” women to access the medicines they need, without the hassle of having to interact with medical professionals. “[With Hers], they’re bypassing waiting in line at pharmacies,” Dudum told the business magazine, Fast Company. “They’re bypassing scheduling appointments and paying co-pays. They’re bypassing awkward conversations with their doctor.”

Healthcare gatekeepers exist for a reason, however, and awkward conversations sometimes need to be had. Dr Zoe Norris, who works for the NHS in the UK, said the side-effects of Propranolol include dizziness and fainting. Beta blockers before a first date involving alcohol would be a bad idea, as young women often have low blood pressure. “If you add beta blockers and alcohol to a young woman, the chances are that she’s going to feel faint and fall over at some point.”

But beyond the physical concerns, Norris finds Hers’ conflation of first-date jitters with a medically-diagnosable anxiety disorder to be alarming on a more fundamental level. “The issue for me is that you’re making something normal into a medical problem. It’s normal to feel nervous before a date, and it’s normal to acknowledge that, and we shouldn’t think that people should feel differently.”

Our consumer culture tells us anxiety is something that can be exercised, meditated or medicated away in our quest to become the most fruitful, productive individuals we can be, aided by the smooth sales pitches of Instagram and influencer culture. Poor mental health is portrayed as an inconvenience that can be smoothed over on the path to a new, optimised self; a self that exercises daily, eats mindfully and dates casually. In 2015, two academics, Carl Cederström and André Spicer, spent a year desperately seeking wellness, and wrote a book, The Wellness Syndrome, unpicking how the pursuit of health became an ideology, with its set of labour-intensive and sometimes punitive obligations – restrictive diets; punishing exercise regimes; sleep deprivation in order to eke more productive hours out of your day.

After wellness came the anxiety economy: if Hers is the New Testament challenger, the Old Testament is the book of Goop. Writing in the Observer in March, Eva Wiseman coined the term “anxiety economy” to refer to the rash of products marketed under the guise of calming us down, from weighted blankets to colouring books. “Aids for anxiety disorders in 2019 are branded like covetable scented candles – scrolling through the products, one starts to think of it as a small but universal ill like dry lips or shaving rash, and one just as easily treated,” Wiseman writes.

Visitors smell scented candles at the pop-up Museum of Feelings in New York

But 20 milligrams of Propranolol is not a weighted blanket or scented candle – overpriced but ultimately benign. It is a medication, with real-life side effects. How did we get to the point where a male-run, venture-capital-backed telemedicine startup thought that encouraging women to sedate themselves before dates could be marketed as empowering?

You cannot understand how the Hers beta blocker ad came to be without understanding how fourth-wave feminism was co-opted by consumerism. When the movement emerged in 2013, with social-media-led activism and high-profile campaigns railing against rape culture, press sexism, and violence against women, it was initially characterised by a spirit of intersectionality, that crossed gender, race and class lines. Writers such as Rebecca Solnit and Laura Bates sharply described their experiences of living in the world as women, popularising terms like “manspreading” and “everyday sexism”, to make visible the contours of the invisible world women navigate daily.

Over time, the movement coalesced around the mantra of personal empowerment: a single, shining diamond under a crush of coal. “A kind of neoliberal feminism emerged, one that recognises the gendered wage gap and sexual harassment as signs of continued inequality, but proffers solutions that are individualised and that completely disavow the profoundly unequal socio-economic forces that shape our lives,” explained Dr Catherine Rottenberg, who researches neoliberal and popular feminism at the University of Nottingham.

Women leant in, to use the term popularised by Facebook COO Sheryl Sandberg, and Hers reflects this model of personal-growth-oriented, individual empowerment feminism. You see it across their marketing copy, which is feminist buzzword bingo, and in their pared-back, low-fi aesthetic, which emulates that of beauty brands such as Glossier. “Performance anxiety can stand in the way of you manifesting your badassery,” reads one caption alongside a photograph of a smiling Asian woman, Propranolol placed on the middle of her tongue.

The message is clear: you can medicate your way to a fitter, happier self. It’s self-care via big-pharma, and about as empowering as a manicure. “Instead of being a radical movement outside society that critiques it, feminism been co-opted into the very system that it was designed to critique,” summarises Dr Fiona Vera-Gray, an expert in sexual violence at the University of Durham. “That’s a really clever way to take the power and revolution out of a social movement and sell it back as an identity.”

Lucy Moon

British YouTuber and social-media influencer Lucy Moon was first approached by Hers in early June, when they asked if she’d take part in their celebrations for Selfie Day. “They asked if I could send a photo of myself encouraging my audience to ‘own the way they look and feel’”, Moon said. “They described Hers as ‘a company that empowers women to take control of their well-being’.” Moon had heard about Hers’ advertising of Propranolol, and declined. “I don’t love taking on campaigns that involve a performed authenticity to promote a product.” Having taking beta blockers herself to manage her anxiety, Moon knows them to be powerful medication. “Describing potentially life-altering meds as ‘wellness’ doesn’t sit right with me.”

The company’s suggestion that you use beta blockers to project confidence on a first date is also an example of what Rosalind Gill and Shani Orgad have termed “confidence culture”. “The problem with these adverts,” Rottenberg explains, “is that exhorting women to be empowered and confident is an individualised address, thus making disempowerment an individual problem, while leaving untouched the social and economic conditions that lead to women’s oppression and disempowerment to begin with.” When you view female anxiety as a personal struggle to be overcome – rather than the consequence of a society that makes women feel anxious – individual solutions, like beta blockers, could appear to be the answer.

But the Hers advert also overlooks the fundamental reality that existing as a woman in the world is frightening. Eighteen-year-old Eleanor Hebden, a student from Norwich, doesn’t feel fearless: not when she’s running, nor when she’s out with her friends. “I do feel afraid, for myself and my friends,” Hebden said. “There shouldn’t be that need for fear, even if it is a defence mechanism. When I’m out running, it helps me run faster – but should I even be feeling that fear in the first place?” Hebden came across Hers earlier this year, and found the concept alarming. “Why should women have to take medication to make a date go better?”

By connecting prescription medication with dating culture, Hers also sends out a message to women that the emotions they feel when meeting a man should not be trusted. “Women may have really valid anxieties around meeting a man they haven’t met before,” said Vera-Gray. One in five women are sexual assault survivors.

Even if you haven’t experienced sexual violence, dating is stressful – and not always safe. In the UK, recorded sexual offences involving online dating sites and apps nearly doubled in the period from 2015 to 2018, according to data obtained by the BBC. The UK’s National Crime Agency has warned of a new type of serial perpetrator who uses dating apps to identify and target potential victims. Hers is, in this context, capitalising on legitimate female anxieties around dating – or as Vera-Gray said: “seizing on that to market to women a product that at a basic level is telling them that what they’re feeling is wrong, and they need to fix it.”

Vera-Gray is the author of The Right Amount of Panic, a book that analyses the everyday safety work that women do while navigating public spaces: taking the well-lit road home, calculating which stranger seems least threatening in the crush of a crowded tube train. “Women are meant to find the right amount of panic, the magic amount, and only if we find that amount can we ever be blameless,” she wrote. “If we panic too much, we’re paranoid and crazy, and if we don’t panic enough, it’s our fault. So we’re screwed.” She regards the Hers beta blocker ad as an illustration of the mixed messages contemporary dating culture sends women, who are expected to be relaxed about the prospect of meeting a total stranger from the internet, but also manage the situation to keep themselves safe. We contacted Hers for comment, but we did not get a response.

Over time, Leibow’s rage has given way to ennui. The Hers ad is still above her metro stop, but it doesn’t enrage her as much as it used to. More irritating are the Hers ads she’s constantly served via social media, which seem to follow her around. In March, Leibow snapped, and posted an angry message under a Hers Instagram post. “How is it legal for you to advertise a prescription drug without mentioning any side effects in the ad?” Leibow wrote. They didn’t respond.

Photographs Getty Images