For decades, doctors have written off-label prescriptions for the heart drug propranolol to help anxious musicians, poker players, and tech executives calm their racing hearts and still their trembling hands before a big performance. Now, a San Francisco startup called Kick is planning to bring the beta blocker to a mass market — a plan that’s giving some psychiatrists and psychologists anxiety of a different kind.
The plan is to jump on the wave of telemedicine - where patients interact with physicians via telephone or video chat -and would entail passing a screening and engaging with a doctor before the prescription could be written.
As for the medication itself, Kick has reformulated the traditional pill into a minty lozenge, like an Altoid, that dissolves in your mouth, releasing 10 milligrams of the cardiac drug. The company wants to make it available in different colors and flavors, like watermelon.
Not all physicians are on board with the idea:
Even physicians who sometimes prescribe propranolol for performance anxiety were critical of Kick’s pitch. Dr. Franklin Schneier, a psychiatrist who co-directs Columbia’s clinic for anxiety disorders, warned that Kick’s plan to repackage propranolol like Altoids “trivializes both the condition of social anxiety and the treatment of propranolol.”
Or as Stanford psychiatrist Dr. Anna Lembke put it: “To suggest that propranonol is entirely benign and equal to an Altoid, I think, is a really dangerous notion.”
'Resurrecting a dead body'
Many psychiatrists embraced beta blockers for social anxiety and performance anxiety in the 1970s. But they’ve since fallen out of favor and are not considered a first-line treatment, in part because they aren’t as effective for people whose anxiety doesn’t manifest in mainly physiological ways.
“Bringing up propranolol is resurrecting a dead body,” said Hofmann, the Boston University psychologist.
In spite of naysayers, Justin Ip (Kick founder and CEO), is plugging ahead and now in talks with manufacturers.
“The way I think we’re going to message this is: Fear gets in the way of living your best self and achieving what you want to achieve and reaching your full potential, especially around the things that you value the most,” Ip said. “So what if there was a cure for that that involved an app and potentially a prescription drug?”