We recently read an article on the changing role of placebo in modern medicine, and it inspired us to return to the question of Chica’s impact in a placebo-controlled environment. In this letter, we address the science, history, and emotion that inform the Chica formula.
Elise: Dear Sugar Pill,
As we wrap up our second “trial” conducted to test a new Chica formula, I am haunted by the same question that has been asked of us many times since we began sharing these herbs with the world.
Have you done a placebo test?
The answer: no.
Why? The first reason being that I felt too shady around not giving someone the herbs they expected. The folks who have connected (aka self-selected) with us for the trials have all been struggling with their periods in one way or another. I know these herbs have a potential to help, and I can’t bring myself to send them a plain piece of chocolate. Chica changed our periods in a way no chocolate bar ever has, and we care about sharing this healing.
I can’t help but wonder, why do people care so much about double-triple-blind-bending-over-backwards placebo tests? We started Chica after being exposed to the hundred of years that Traditional Chinese Medicine has successfully used these herbs, including witnessing your dad use this formula with great success in his own practice. We created the trials not because we doubted the efficacy of the formula, but because we wanted to experiment with our herb-to-chocolate ratio, and gauge flavor and user-experience. So, when someone looks at two young women starting their business with grant funding while still in college, and asks if they have tested for placebo, I see them as questioning our legitimacy rather than that of the herbs. And to these people, I truthfully just want to give a big, “thank you, next.”
Now, before we get too far, I want to note that I am not suggesting that we ever try to use the placebo effect in our favor. That is, we will never sell Chica Chocolate that does not contain our herbal formula. Our chosen concentration has been determined by our consulting acupuncturist because it is a universally effective dose for most people, not because it provides just the right amount of herbal flavor.
This annoyance by the placebo question cues why we recently exchanged the NYT Magazine article, “What if the Placebo Effect Isn’t a Trick?” over a text message series that included its fair share of all-caps and exclamation points. We were excited to finally see some positive recognition of the presence of a placebo, rather than placebo being something that must be eliminated.
The first line to catch my eye in this article, “You can…tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention,” brings about the question of how warmth and close attention apply in the context of periods. There is a long running history in the medical field, that is still pervasive today, of ignoring women’s pain. Women are often expected to deal with higher pain levels because of the belief that women can endure extreme discomfort, re: childbirth. (This belief especially puts women of color at risk. While I do not have the time to go into that here, I always feel the need to note that point, as it is a distinct sign of white privilege in the medical field). What does this mean for periods? Menstruators who visit their doctor complaining of monthly pain are encouraged to get over it, or even told that they are simply imagining or exaggerating the pain. Many people with endometriosis, PCOS, and fibroids have to wait years to receive a diagnosis. In the case of fibroids, relief can be difficult to achieve without the removal of the fibroids themselves, and a diagnosis is essential for this to occur.
We cannot change the attitude of doctors, at least not yet. However, I see us as working to fill the empathy gap. We are building love, care, and attention into the Chica brand because we believe in its power as an essential part of helping our customers feel better during their periods. We’ve been carrying every part of this journey with love–it’s the only reason we’ve made it this far. Even as we craft each truffle with intention and care, we are planning other ways to remind our Chicas that we love them, every single day of the month. Can’t wait to drown in this love pool with you!
Cassidy: Dear Bedside Manner,
People care about placebo testing because it’s science. Let me be completely clear: I am not complaining about this. I want and need science to be in charge of my medicine. However, I also understand that science is a constantly evolving field, one that is informed by the economic, historical, and political conditions that it must exist within. In the words of science journalist Christie Aschwanden, science is not a bulletproof engine of discovery, but rather “a process of becoming less wrong over time.” In short, science itself knows that it is dynamic and imperfect. This characteristic is what allows for and encourages improvement, and medical science deserves the same attention.
Placebo is the perfect example. As reported in the NYT Magazine article, we are now discovering that the effect is not the absence of molecule-based medical science, but rather evidence of molecule-based medical science at work. I’m still processing how this could revolutionize modern medicine. Not only does this finding suggest that medicine’s moral & emotional dimension is far more important than previously thought, but also that a phenomenon science defined specifically to exclude and provide a locus of control actually has genetic significance and can skew results.
This is particularly interesting to me because placebo holds a reputation similar to that of Traditional Chinese Medicine in the West; i.e. as a “‘fake medicine’ doled out by the unscrupulous to the credulous” (NYT Mag). (I will point out that I’m somewhat skeptical about the conclusions made in this article with respect to placebo and acupuncture, given that they assumed acupuncture’s effect based on a study that didn’t include any actual acupuncture). Chinese medicines, especially facets like acupuncture, were heavily romanticized and misreported/misinterpreted as miracle cures by Western reporters in the late 20th century–and this continues to undermine its credibility in the medical field. For example, the five phases theory is often compared to the Ancient Greek and Roman system of humorism that preceded the germ theory of disease. However, for those still leveraging the critique that Traditional Chinese Medicine doesn’t hold up under rigorous scientific investigation, I refer you to the man that standardized the practice: Chairman Mao Zedong. TCM as we understand it today is actually quite empirical and analytical–even if it uses different language to describe certain phenomena–because it underwent rigorous scientific reduction under the communist regime.
In a nod to the despotic tradition of redefining national ideology through destroying cultural heritage, Mao could have indulged his skepticism and erased the ancient and heterogenous traditions of Chinese medicine. However, he was perceptive enough to evaluate the disparity of Western physicians and the widespread reliance of the “broad masses of the people” on Chinese medicine to treat illness (Taylor, 2005), so he instead undertook the integration and exportation of Traditional Chinese Medicine as a central part of his national project.
I think Chinese medicine’s contemporary relevance is worthy of discussion in itself, because such endurance is fairly rare in the medical field. Do you know what was not only popular in the US, but aggressively endorsed by physicians, approved by the FDA, and sold by Bayer Pharmaceuticals (the very same conglomerate that currently sells you the majority of your birth control, from the Pill to almost every IUD on the market) less than a century ago? Heroin, for the common cold. Kids all over the country were addicted to their cough medicine and somehow nobody thought this was an issue. And that’s one of the tamest skeletons in the closet of medical history. (Another of my favorites is the jar of farts, which was prescribed by 17th century doctors as treatment for exposure to the bubonic plague).
In sum, we are relying on the validation of history when it comes to our formula, at least in part. But that’s just the cherry on top. We have confidence in the science behind our herbs, and that is not because we conducted “trials” with our prospective customers. If we expected conclusive results from those trial periods, that would be astoundingly bad science–the brand of double-blind, placebo-controlled meta-analysis that such a conclusion requires is virtually impossible to distribute for a couple of broke college students bootstrapping their business. Instead, we rely on existing (placebo-controlled) scholarship, the expertise of our consulting Chinese medical professional, and a biochemical and molecular understanding of how our herbs work in the body.
That being said, I share your frustration with those who may question the credibility of our science as a vehicle for disguising their un/conscious bias towards women & youth in business. For reference, consider the case of Ridhi Tariyal, an engineer at Harvard that in 2016 was trying to develop a way for women to monitor their fertility at home. She understood that a significant resource–menstrual blood–was being overlooked in this sphere, considering the volumes of blood required for diagnostic tests. In her words, “We have an opportunity every single month to collect blood from women, without needles.” This would be a huge advancement in menstrual health, especially for those who suffer from endometriosis–which often goes unidentified for considerable amounts of time because the only option currently available for diagnosis is laparoscopic surgery. Tariyal’s innovation in home-diagnostics would help bridge the empathy gap that, as you mentioned, is particularly present when doctors are addressing menstrual health. However, when pitching her 3D printed prototype of a tampon machine to investors, she was only met with skepticism. They either wanted to re-engineer the product for men or simply didn’t believe there was a market for it. “Someone told us that the product would only help women, and women are only half the population–so what was the point?” Ms. Tariyal said. Sound familiar?
If you doubt our business acumen, at least be honest about it (we are always learning and receptive to constructive feedback). In the meantime, we’ll keep making our Chica recipe with equal parts science and love.