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> What if racemic ketamine performs better than esketamine? We'll never know because they won't test that.

It's quite likely some public institutions (e.g., universities, public research labs, etc.) or other countries (e.g., in India, China) will test exactly that. It's also in their interest to pubblish the results. So we'll get to know the differences between racemic ketamine, esketamine and arketamine.

The question is if different variants will also be approved, which is much more expensive.

Racemic ketamine is also dirt cheap, while esketamine might be absurdly expensive after being patented.

Do you have a source for that? You can get a patent on a new use for something that already exists if the new use is a non-obvious advance over the prior art.