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Comment by dawhizkid | Hacker News Reader

Johnson & Johnson patented and got Esketamine FDA-approved specifically for the treatment of depression, which is literally just the active part of Ketamine, which is otherwise a very cheap generic drug but not approved for the treatment of depression. And with the patent raised prices at least 300x over what Ketamine costs.

And we wonder why drug prices are so high.

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Take an already active drug, repackage it, patent it, and market it, and nobody knows how much you're charging because thats the insurance companies problem

They ran a bunch of clinical trials on it.

Maybe the gov't should fund trials for the use of generic ketamine to treat depression, and then come to the conclusion that generic ketamine can be used to treat depression (as they've concluded with esketamine) and then any medical profession could prescribe ketamine (in a controlled setting) at 1/300th the price.

The drug was already discovered and in use on humans. Universities everywhere could’ve run clinical trials on it. There’s not much here that’s novel or new, but they get to charge a good used car a month because they ran some trials? Sorry.

No studies on long term use for people with depression . Trials are expensive . esketamine by j&j was done for people that don't have money for clinic which are out of pocket but money enough for insurance

Esketamine is just an enantiomer. Both enantiomers are similarly active, and to me it's not 100% clear to me why Esketamine was the enantiomer chosen.

There is no rhyme or reason other than the fact that one or the other could be patented by a private co unlike Ketamine. I assume trying to patent both would've doubled their costs, so why bother, especially if it's highly probable both do the same thing.

Esketamine doesn’t have the same activity as racemic or Arketamine (S- hits some of the dopamine receptors harder and doesn’t bind with the sigma ones iirc). Patients seem to find esketamine more pleasant because of this and it’s eliminated faster than R- so patients can (probably) get back to normal faster.

(Edit: had my right from left mixed up. It’s been a while)

So maybe it makes you a little less groggy but at 300x the price? Don't think anyone can say that justifies the price multiple.

Now r-ket can be developed as a patentable improvement over the state of the art :)

Some studies suggested that the enantiomer they chose was slightly better at driving the effect people thought was causing the anti-depressive effect.

Unfortunately, newer studies suggest that 1) that effect isn't responsible for the anti-depressive effect and 2) the enantiomer they chose doesn't seem to be as good as normal ketamine.

Too soon to say, but early signs suggest this may have all been a fantastically expensive mistake. :(

They started the trials before the NIH study that proved that nmda receptor only played a small role it it's effects and that R-ket and it's metabolite was more important .

They were already too deep it

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