Crowd shuddering and jeering in disgust while facing an implied stage in a theater.

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Medical Examiner

Beta Blockers Were a Miracle Cure for My Stage Fright

Then they took over my life.

I came down with stage fright suddenly. It was the spring of 11th grade, and I was in English class, standing in front of the room reading an essay I’d written—an opinion piece about the nature of scientific discovery—aloud. I’d had no concerns when I’d gotten up. I’d always loved performing in class plays; just weeks before, I had presented at a schoolwide assembly to a two-story crowd of peers. But this time, I stumbled over a word, my voice started to tremble, and then, for some reason, the thought crossed my mind that it might never stop. My hands shook. It felt like someone was closing their hands around my throat. By the time I sat back down, I had joined the quarter of Americans who are afraid of talking in front of crowds.

I left my hometown of Philadelphia to attend college in Montreal, but the stage fright stuck with me. I rarely spoke up in my classes. Every time I had to do a phone interview for the student paper, I felt like I was a cat trying to avoid being dunked in a bathtub. Which was a shame, because I loved writing for the paper. To cope, sometimes I’d do interviews with a glass of wine in hand, even if it was the middle of the afternoon.

The researching part of journalism, though, came naturally to me. I looked up tips and tricks on public speaking. The breathing techniques and visualization tools I found seemed too feeble a tool to even try. Then, sometime in the dead of winter, sitting in my apartment west of campus with a woefully heavy MacBook, I came across an article on beta blockers. I can’t recall what it said, exactly, just that it suggested these pills might steady my voice and hands when I was nervous. I made my case to a general practitioner: I needed them for talking in big meetings. I left with a prescription.

Beta blockers felt like magic. Never mind the panicked cat, talking in front of people was now like ice skating down the Rideau Canal. I popped one a half-hour before an interview with the paper’s editorial board and won the position of science editor. I told friends about my marvelous new trick, recommending beta blockers for nerves of all kinds—public speaking nerves, job interview nerves, social interaction nerves. Next time you are at the doctor, I Facebook messaged a friend dealing with similar issues, “pick up beta blockers!”

The feat of the beta blocker is that it slows down your heartbeat—but only just. The drug, which debuted in 1964, was created by pharmacologist James Black to treat chest pain and heart arrhythmias. The pill’s success at doing exactly that eventually helped earn him the Nobel Prize in medicine. A few years after their invention, psychiatrists started prescribing beta blockers off-label for anxiety. The same thing that makes them work for treating heart conditions helps mask the physical symptoms of panic one might feel when experiencing anxiety. While they are mostly prescribed as a blood pressure medication, general practitioners and psychiatrists will still administer them for performance jitters now and then. Today, you might pop one before giving a wedding toast, or doing an interview for a big job. Though not quite in vogue the way that, say, Xanax is, they are common in some circles, particularly among performers. According to one survey, nearly three-quarters of musicians have tried beta blockers to stave off nerves, including pop star Katy Perry, who once said that she takes a beta blocker before performances to help her cope with the singular pressure of holding down the entire stage (as she put it, “there are 500 bitches behind me.”)

Because it is 2019, today you can order beta blockers online. Hims, and Hers, a pair of websites where you can get prescriptions for everything from birth control to erectile dysfunction medication, added propranolol—the form of beta blocker commonly used for performances—to their repertoire in February. Though the Food and Drug Administration still hasn’t approved blockers as a treatment for anxiety, they’re marketed for anxiety on these websites. “Calm never felt so close,” promises a marquee on Hers’ beta blocker page; if you place an order, the blockers will arrive with a card that says “ain’t nobody got time for chamomile tea.” Kick, a startup that specializes exclusively in connecting customers to propranolol, launched its services in January, describing its one product as “prescription strength confidence.” As someone who once loved these drugs, I was curious.

When I call Justin Ip, Kick’s CEO, he tells me his company’s origin story. It all started when he fully ruptured his Achilles tendon. Such an injury typically calls for surgery to stitch the muscle back together, but after diving into the medical literature himself, he concluded he didn’t need it. “I had three surgeons tell me I was insane,” he says. But instead of going under the knife, he rested and diligently completed physical therapy exercises. His tendon repaired itself in a little over a year.

The physical healing was successful. What was harder for him was the emotional fallout—having to miss out on activities, needing to sit in a plastic chair to bathe. This is what inspired Ip to start thinking about mental health care and his desire to address it “the right way,” by which he means a “more of an empowering positive way versus a ‘you’re a sick person’ kind of way.” He has resisted seeking any sort of formal mental health treatment—he’s never been to a psychiatrist or a therapist, despite having a childhood phobia of public speaking that was so bad he’d feign sickness to miss class on days when he’d have to talk in front of people. He got through that by avoidance.

Though he considers himself pretty anxiety-free these days (he’ll skydive, he says, by way of proof), he does have “an executive coach now who has a psychology kind of background.” When he was researching what he could center a mental health company around, his literature review led him to beta blockers. For all the years they have been around, discovering their utility for anxiety can still feel like being let in on a secret. Ip recalls thinking, as I did: “How come nobody knows about these drugs?” He wanted to tell everyone he knew.

Andrew Dudum, founder of Hims, feels the same way about beta blockers. Dudum grew up a concert cellist, and he’s been taking the pill for at least a decade—for concerts at Carnegie Hall, for other performances, for weddings (“the idea of screwing up somebody’s wedding … ” he told me, implying horror). He founded Hims after working at a startup called TokBox that provides software for video-based doctor’s meetings—part of the idea for his new company came from his realization that video makes customers anxious. Hims, and the sister site Hers that followed (both fall under the parent company Hims Inc.), uses online forms that are reviewed by a doctor, and an email-like conversation, rather than video.

I meet Dudum, and Hillary Coles, brand lead at Hers, at a public relations agency in New York City during a week when they had both flown in from San Francisco for press meetings. We all sat perched on gray couches with a PR minder overseeing things. Dudum and Coles struck me as beautiful in the way actors on CW dramas are beautiful: clear-skinned, thick-haired, approachable. Dudum tells me he still takes beta blockers a few times a month, including for the Hims Inc. all-hands meetings he presides over. Coles, who takes beta blockers weekly, wishes she’d had access to blockers for a string of interviews after business school, remembering the uncomfortable feeling of freezing up she used to get when she was nervous.

“It’s such an empowering medication to get to people,” says Dudum. Hims and Hers offers a plethora of similar medications, each with the potential to free you from your genetically given state—receding hairline, oily skin, hands that shake, the way mine do a little as I listen to them—and trade up for a body that can face a crowd. I ask the pair when they last popped a beta blocker. The answer was an hour before our meeting.

Back in college, after I got my prescription, I would take beta blockers before meetings, too. Then I started taking them before phone calls with sources. And before meeting a cute grad student for coffee. Before an internship interview. Before going to a new hair salon for an appointment, because why risk the embarrassment of an awkward interaction if you don’t have to? They didn’t always work: I remember popping two before a pitch slam at a journalism conference, only to remain too fearful and then also too lightheaded to leave my seat. But in general, they were a godsend.

When I went back for a refill prescription, the doctor told me that I should probably also be on a daily anxiety medication. I accepted a prescription for an SSRI, which I took for a few months before stopping because of the sexual side effects. The doctor had also told me I should probably see a therapist. I did, eventually, but that was two years later, and because I wanted to talk through issues I was having with boys and food and career ambitions and sexism. An opinion piece I wrote had garnered nasty comments from my classmates; we reconstructed from first principles why it was OK for me to express ideas. I never even told her about the beta blockers. Basic social anxiety didn’t even register as an issue, probably because, well, I had it covered! I was freelancing for national publications; I was social. As a successful upperclassman, even as I took the pills in increasingly banal situations, I started skipping them for the same student newspaper interviews for which I’d first asked for them. But just as progress isn’t linear, it can be hard to recognize that the direction you’re spiraling in is down. I didn’t even wonder what would happen when I left the country that housed my source of beta blocker prescriptions.

After graduation, I moved to Idaho for a summer gig doing PR at a nuclear energy lab. If you’ve never been to Idaho, you should know that it’s an outdoor mecca. I fell into a friend group right away; we scaled mountains every weekend. But work quickly became nearly impossible. Sitting across the desk from a scientist during an interview, having skipped a beta blocker, I asked a question about the controversial nature of his field and heard my voice waver. He knew, of course he knew, what a child and mess I was, I thought to myself, my ears suddenly blocked off from sound. Every ounce of confidence I’d ever had vanished. All I knew was that I didn’t want to let that happen again.

This is how I found myself rationing my blockers, breaking them in half, until I had none. After they ran out, I’d sit in my cubicle trembling in the hours before I knew I’d have to go somewhere, talk to someone, ask a scientist a few questions about winning a big award. I wondered what I would even begin to say to my supervisor about my nerves. My body felt alien to me. “I find myself dreading doing my job,” I wrote in an email to my old therapist that I never sent, confessing to the beta blockers, but describing the problem not as straightforward anxiety but as the “physiological obstacle” that I had come to see it as. My problem certainly seemed outside my head—I was having trouble figuring out how to speak and also breathe. But when I returned to Philadelphia in the fall, I went to see a psychiatrist.

In the decade or so after beta blockers came onto the market, it seemed like they might prove to be as genuinely helpful to panic and anxiety disorders as they were for heart conditions, perhaps even becoming a daily medication. But “that theory hasn’t worked out very well,” said Stefan Hofmann, who directs the Psychotherapy and Emotion Research Laboratory at Boston University. (He told Stat News in 2017 that Kick’s then-plan to offer blockers to anyone who asked was akin to “resurrecting a dead body.”) While beta blockers can address physical symptoms, they don’t tackle the underlying thoughts—which, for those of us with stage fright, are often telling us that our physical symptoms are far more exaggerated and noticeable than they really are.

A 2016 review of the literature found that there’s no evidence to support beta blockers’ use for people with anxiety disorders. Instead, doctors favor drugs that can be taken daily, like SSRIs, alongside cognitive behavioral therapy, in which a patient learns to cope with anxiety-provoking situations. These can be used in tandem with other tools, like fast-acting drugs including Xanax or Klonopin, which can be taken to head off acute instances of panic. These tools are each highly imperfect: SSRIs can dull sex; cognitive behavioral therapy can prove overwhelming, time-consuming, and pricey; benzos can be addictive. All of them simply fail to work for many people. Which is perhaps why, in some cases and depending on a person’s particular needs, beta blockers really can be a useful tool, at least for a short period of time and combined with other things. But it’s still an off-label use: They’ve never been evaluated by the FDA for the safety of taking them sporadically for performances.

Experts, and the fine print at Kick and Hims Inc., emphasize that beta blockers should only be prescribed for specific instances of performance anxiety. According to multiple experts I spoke to, beta blockers are not typically a first line of defense or routine option. Even the 30 pills that I received from my busy physician were probably overkill and would have been even if they were for someone with stage jitters alone. A Harvard psychiatrist I spoke to for this story told me that he couldn’t even find anyone in his Rolodex who he knew prescribed beta blockers regularly. After 27 years of working in medicine, Gary LeRoy, a family physician in Ohio and the president-elect of the American Academy of Family Physicians, can count the number of times he’s prescribed beta blockers to a patient “on one hand and have some fingers leftover.” He recalls one instance, in which he gave them to man who was going to present while on a business trip: “I asked him specifically, ‘When are you having your speech, how long are you going to be in Atlanta?’ ” LeRoy recalls. He prescribed the patient five pills: “He did not get refills, he did not get a whole bunch extra for next time. We had a long discussion about how he can do this without medication. He got past it.” The ability to deploy this kind of judgment, to advise beta blockers to get someone over the initial hump of fear “is the difference between a skilled clinician and a butcher,” says Hofmann. (Kick does have an app in the works to help users face their fears head-on through challenges called “kicks,” but it is not out yet.)

“Let’s say the beta blockers worked—what do you do the next time you have a performance or audition?” asks Noa Kageyama, a performance psychologist on faculty at Juilliard who trained as a violinist in the ’80s and ’90s. He doesn’t recall hearing about beta blockers until around the time he was working on his dissertation in the 2000s. He maintains that most musicians don’t need them. He cautions that if performers use beta blockers to alleviate their shaky hands during a small recital, they may not have the psychological tools to tackle the opening night of an orchestra performance down the line. “The stakes never get lower, they always get higher,” says Kageyama.

That is why blockers can all too easily become a crutch that ends up preventing progress and making things worse, especially for folks with underlying anxiety. They can be what Hofmann calls a “safety behavior,” a sort of security blanket that appears to help someone face their fears but actually serves to enable them in avoidance. While the chemicals in the drugs themselves weren’t addictive, they became something that I clung to, a medicine that helped maintain my real problem. My fear wasn’t even of public speaking, per se: It was a fear of people seeing me get nervous. I told you that my stage fright came suddenly, but it was a symptom of something much darker that was taking hold of my mind, a feeling that’s common in young women—the feeling that maybe my ideas weren’t really worth reading in front of a class, that maybe if I raised my hand, my question would be dumb, that the ladies at the hair salon would think I had weird hair. Beta blockers let me keep thinking that as long as I appeared the right way, polished and steady, I’d be OK. They were part of the lie.

The fact that beta blockers work by lowering your blood pressure makes them a particularly terrible security blanket. While they are pretty safe for people who need them for help with their hearts, almost all experts not involved with companies selling them emphasized that they are a medication, and like all medications, come with risks. Marijn Kroes, a neuroscientist at Radboud University in the Netherlands who researches how beta blockers might possibly be useful in PTSD treatment, tells me that he has to ensure participants don’t have subtle heart abnormalities, the kind that they may not feel, but would show up on an EKG. “We’re obligated to be incredibly careful,” he says. Taking them “can be really dangerous.” Going off them abruptly—say, if you took them for a string of presentations, then stopped—is dangerous, too, because blood pressure can spike in response, argues LeRoy.

The fine print of the warning pamphlet that comes with Hers beta blockers acknowledges this: “in some cases, heart attack may occur.” The Hers website also lists a slew of side effects, tucked behind a link above the “try now” button, including tiredness, decreased sex drive, and vomiting. (Kick has a similar page and sends customers a pamphlet outlining how to use them.) While it is overwhelmingly likely that any one person who takes them will be fine (save, perhaps, for some temporary discomfort), Kroes and doctors argue that even this small risk isn’t worth it for folks who are suffering only from the normal human condition of, say, feeling antsy during a string of high-stakes jobs interviews, a key target market for Kick and Hims Inc.

This is probably why, when I announced to the psychiatrist in Philadelphia that I wished I simply could take beta blockers all the time, she reacted with a seriousness that I found overbearing, even though I’d already accepted that the drugs were a problem. But not only could they lower blood pressure enough to cause me to pass out, she explained, repeated use can lessen the effects as your body adjusted. So, instead, she gave me a prescription for an SSRI (a different one than before) and a referral to a cognitive behavioral program, where I’d begin the process of exposure therapy. I felt lucky to live near the University of Pennsylvania, where I could work with a therapist-in-training for a bargain $40 per session. I cried on the phone when I made the appointment.

With the therapist, I began a laborious process of getting my brain to learn that it was OK to be scared. Together, my therapist and I wandered the streets of University City; I would ask people for directions to places I knew well—a Starbucks, a bathroom, Chestnut Street—in the shakiest voice I could muster. I practiced reading aloud to a small roomful of doctors, and eventually I gave a practice presentation on the fly. Phone calls got easier. I began taking improv classes. I got a fact-checking job, then a reporting job, and then another. I flushed my beta blockers (don’t, think of the fish). Later, when a general practitioner gave me another prescription for occasional use (at my request), I realized they were still too much for me, still fed that little voice telling me I’d better take one just in case. Anxiety is like a sports injury: Even after the initial recovery, a tendon that was once torn can still require some physical therapy. My brain is the same—I still come back to the tools that I learned at Penn. They’re like dynamic stretches and resistance bands that I’ll always keep carefully stored in case I need them.

While all this was happening to me, health care laws were expanding rapidly in response to telemedicine. As of 2017, it is now legal to see a doctor over video anywhere in America. The exact rules vary by state and can be vague: Some only require that the doctor and the patient somehow establish a relationship. They’re still evolving. In May, the Florida state Legislature passed a bill that will allow doctors with licenses in other states to treat patients there, remotely.

These changes have left plenty of room for Hims Inc. and Kick to argue that the interactive forms they use on their websites are enough to constitute a doctor’s visit, enough to issue a prescription. (The companies do not currently operate in all 50 states: Hims Inc., for example, is in 25.) In general, I think online medicine is a great development and I use it in my own life: I see a therapist weekly over video and have advocated buying birth control online. Deployed smartly, online care stands to increase access in ways that will change lives for the incredible good. But we need to make choices, right now, about which kinds and for what ailments.

What Hims Inc. and Kick are doing is a form of asynchronous care, meaning that the patient is not interacting with a doctor in real time; the two are interacting on a delay. Whether asynchronous care is sufficient varies greatly by how it’s being employed. While reproductive health researchers and OB-GYNs agree that a form reviewed by a doctor is more than enough to safely dole out birth control, the independent researchers at the forefront of therapy conducted over text messages say it’s still unclear if this form of treatment will work as well as speaking face to face.

But asynchronous psychiatry does hold promise as a supplement to traditional care: A study published last year evaluated patients who did an in-person, recorded interview with a trained practitioner at a primary care clinic. That recording was then sent to a psychiatrist, who could use it to make a recommendation to the patient’s own primary care physician for various forms of mental health treatment. The exercise proved successful, and it makes me imagine a world in which my first beta blocker prescription was considered not just by my primary care physician, but a psychiatrist who watched a video of our visit, and stepped in with more care sooner. As Ip and Dudum do, the authors of that study note that asynchronous psychiatry can cut down on the time and cost it often takes for patients to see specialists (another side benefit is that it could also provide the specialist with a heap of data). Unlike Kick, the experiment wasn’t just checking if everyone should take beta blockers.

I wanted to know how the asynchronous care used by Kick and Hims Inc. would handle a request for beta blockers from a person with the problems I had experienced. I wrote that I often had trouble just saying my name when introducing myself to a group of peers, in a form that I knew would later be looked at by a psychiatrist. A doctor from the Hers platform corresponded with me over the course of a few back-and-forths. His messages (which he sent at 1:50 a.m.) included an accurate word of caution that the meds weren’t meant to treat general anxiety and should be used sparingly. He requested that I go get my blood pressure tested, which I did for free at a Walgreens pharmacy. One of the messages addressed me as “Mr. Palus.” He also gave me a link to a Hers blog post with information on performance anxiety and asked me to confirm that I’d read it. After I did all of that, he prescribed me the meds.

The results for Kick were a little more heartening: “We recommend that you make an in-person appointment with your existing primary care physician to discuss possible next steps with them,” an email said, though it didn’t explain any specifics. (Ip says Kick doesn’t provide reasons for why a patient is turned down “in order to avoid having patients redo their visits immediately after finding out why they were rejected.”) I saw no way to ask follow-up questions except by replying to the general orders email address the note had come from (I did not do this). As I’d had to prepay under the assumption that I would be buying meds, a refund appeared on my Visa statement shortly thereafter.

I feel mixed about these results. After speaking to so many doctors and researchers, I am fully convinced that beta blockers should not be prescribed following anything other than a face-to-face discussion (which is possible over video). After going through the process of trying to order them online myself, I feel worried about how easy it was to get them from Hers, and how easy it would be to lie on those forms. I feel worried that I wouldn’t have even thought of it as lying in college—that was a time when I didn’t know the whole truth myself. But both Hims Inc. and Kick, whose prescribing protocols Ip notes have been reviewed by over a dozen doctors, are at least restricting the medication they proffer with one hand, trying to screen for folks who could actually benefit from it. The ads may be trying to sell beta blockers as a no-brainer anxiety fix for everyone, but the fine print says all the right things.

Even though some elements of telemedicine have been well-studied—the use of video for psychiatry and therapy, for example—Kick and Hims Inc. represent an entirely new experiment in digitizing health care interactions. It’s hard to tell if people seeking help are receiving enough counseling and feedback, given that everything is done via questionnaire and, essentially, emails, with limited external follow-up. (When I ask questions in the Hers platform chat window, it takes up to a week to get replies, which, after the initial back-and-forth to get a prescription, come from a different doctor each time. When I ask to speak to a doctor on the phone, I get a reply from “patient support” saying that all interactions must take place in the chat window. In response to my questions on the speed and the different doctors, Hims Inc. said interactions are “guided by highest priority for patient care” and noted that “it is not uncommon to be directed to different providers within the same medical group.”)

Kick and Hims Inc. “are putting all the risks, including medical risks, onto consumers,” says John Torous, a psychiatrist at Harvard and the leader of the American Psychiatric Association’s working group on apps. When I ask the Hims founder about the risks involved in beta blockers, he points out that the liability of prescribed meds falls on the doctors doing the prescribing. (The doctors are not full-time employees, and according to other reporting, in fact work for different companies that cater to the sites.)

Perhaps most problematically, though, the sites themselves only make money from the exchange if the doctor ends up prescribing something, presenting a worrisome conflict of interest. That’s not how most medical interactions work. “Their interest is to sell you this stuff for a long-term use,” notes Kroes. When asked about the potential conflict of interest, Ip defended how his company works: “We only make money when a prescription results from an interaction because we feel this is in the best interest of our patients, especially the ones who would be better served in-person. Some of our competitors charge for visits even if patients are rejected for a prescription, and we don’t believe that’s fair.” Hims Inc. stated that it does not think this is representative of its business model and emphasized that it also sells products that are available over the counter. It also noted that doctors are paid for their time regardless (which is also the case with Kick), stating that “under no circumstances does a physician receive any compensation based upon the number of prescriptions they write.”

On Kick, I am given two options at the end of the questionnaire: $59 for a shipment of 24 propranolol tablets, or $79 for a shipment of 48 (“most popular”). Both include the cost of the visit. Hers is pricier and also more cautious—it meters out pills five at a time ($30). (At a regular pharmacy, beta blockers are about $15 for 30, though a full video psychiatrist visit costs $200 out of pocket.) With Hers, I find, if you don’t want to keep getting five pills a month, and your doctor has set you up with automatic refills (mine gave me five), you have to reach out to them to cancel. I forget to do this after my first shipment and end up with multiple envelopes of beta blockers, each pill in its own attractive square wrapper.

I was curious to talk to Ip about how he sees his business, given that it seemed like Kick is marketing beta blockers to the average go-getter while maintaining appropriately conservative prescribing practices. I wanted to know how that worked, financially, but in our back-and-forth to set up the call, he said something funny: “They’re not appropriate for everyone (as you found out going through our flow).”

When we get on the phone, he tells me about the backstory of Kick, his childhood anxiety, his desire to start a mental health company. I have not mentioned my experience with beta blockers, or my attempt to get them through Kick. But when I ask him how Kick’s doctors screen patients, he says: “I think in your case, your visit got looked at by a doctor, and their clinical judgement was it might be better to go see someone in person.”

I feel myself shaking on a call for the first time in a while. “It’s kind of an eerie feeling to have one of these newfangled doctor’s visits online and then to be on the phone talking to you about the results,” I say. When I get off the phone, I do a gut check with a few other sources. Should Ip have been able to see my file?

Eric Stieglitz, a technology lawyer to whom I describe what happened, responds with shock. “What he did is a horrendously bad idea … I’m having trouble thinking of why he would be allowed to do that.” According to both Stieglitz and another lawyer I spoke to, it seemed like it could be a violation of HIPAA, the privacy rules that protect patient information (though being lawyers, very careful, and not having the full details of the case, neither could say for sure). Both agreed it was, at minimum, baffling why the founder of this company would be talking to me about a specific patient’s health file, even if he had good reason to think it was my own. I’d expected a doctor to read it, not the CEO of the company. While he could be justified looking at patient files for other reasons—say, quality control—neither I nor the lawyers could reason how getting an email from me triggered a need for him to look at my file, then talk to me about it.

I followed up with Ip to ask if it was normal for him to look at patients’ files, including my own. He said that he understood that I might feel concerned if that had happened, but clarified that he had not looked at my file. At least, he didn’t look directly at it. Instead, he explained, “I had seen your visit come through on our completed appointment list (which only contains names, state, and profession), and had then noticed that a billing refund was to be processed for you, so came to the conclusion that your request was rejected and you were referred to an in-person doctor.”

This feels emblematic of everything else about Kick: a health care company that doesn’t quite function like a health care company, perhaps simply because it isn’t quite a health care company. It’s like how Kick advertises its prescriptions as “FDA approved,” which, yes, is true of beta blockers for some uses, but not performance anxiety . “This company gives me the heebie-jeebies,” Kroes told me.

Anxiety is a difficult thing to treat. That’s not only because the world of mental health care is confusing and difficult to navigate. It’s also because patients that have it tend to also have a hard time reaching for or believing they need help. That the internet is increasing the ease with which we can see doctors is, in many ways, a wonderful thing. So is the fact that the law is evolving to accommodate new versions of what it means to see a doctor. But these are tools and permissions that need to be wielded with care, in a way that integrates with existing health care knowledge and best practices. That people who know how to wrangle VC money have a desire to address anxiety could be a godsend, too.

I think about my 19-year-old self a lot. She wasn’t too scared to ask for help—the problem was more that she didn’t realize what kind of help she needed. She was capable, and thoughtful, and she would have felt so relieved to find these websites. I don’t know for certain what would have made her seek more serious treatment sooner, but I do know that such easy access to these drugs, packaged so appealingly, would have kept her feeling alone longer.