Ketamine is well known to have great anti-depressant effects, but since it's long out of patent, no one has the incentive to spend $1B to get the FDA approval for it.
So J&J invented the chiral twin molecule (the mirrored version), got it approved, and it's now sold as Spravato.
To me this is 100% a regulation bug rather than some misfeature of capitalism or corporate greed.
The bug is that we don't incentivize funding expensive studies to discover unpatentable (i.e. cheap) treatments.
The minimum "patch" would be that the governments of the major drug markets decide that effort and discovery of applications count as a basis for patents. Then a drug maker could fund their studies based on which drug candidate is the most promising, not which is the most promising but also novel and thus patentable.
Much better, would be to have the governments presiding over the major drug markets get together and create a proportional fund to cover studies for the public's benefit. The economics of that would be similar to private companies, but at least the profits would go towards further research.
That's actually not how it works.
When a drug is FDA approved for a certain use, doctors are free to prescribe it for anything the think it's useful for. This is called "off label" use, and is ~20% of prescriptions in the US. This "loophole" cures a lot of people!
And there are some clinics who do use regular Ketamine for depression. The main problem for them is that insurance will not cover this usage.
> The bug is that we don't incentivize funding expensive studies to discover unpatentable (i.e. cheap) treatments.
This I agree with. Though I'd expect some philanthropic billionaire to get to that long before any governments would.
Also, while some see the trip as the point of this, I woke up at knife point due to psychosis caused by that. Yet it also really does basically cure depression, if not accompanying anxiety, and it is known to cause new psychosis.
So I hope this works out and can be used on people who really need to avoid the psychosis caused by ketamine.
So that number was probably 10x off. That doesn't change the conclusion though.
I learned all this from Scott Alexander. All details here: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...