An Iron Curtain Has Descended Upon Psychopharmacology | Hacker News Reader

An Iron Curtain Has Descended Upon Psychopharmacology

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171 pointsyummyfajitas115 comments

It's important to look at the FDA's job in terms of diminishing returns, or maybe as a classification problem. You have some number of drugs coming in, some of which are helpful and some of which are harmful. But you don't have any perfect means of figuring out whether a drug is good or bad. If you start from no screening it's very easy to stop a lot of bad drugs without stopping many good drugs, but as you apply tighter and tighter criteria the ration of good drugs you accidentally stop for each bad drug you stop gets higher and higher.[1]

In practice, of course, some of the rejected drugs aren't explicitly rejected by the FDA but rather rejected by the system because they are never put through the FDA screening in the first place, but the principle is the same.

One would ideally want to set the difficulty of getting through FDA testing to maximize some quantity, such as the average effect of an approved drug on people's Quality Adjusted Life Years. But it's clear that this is not actually what happens. When the FDA rejects a drug people never hear about the lives that were not saved by it, but if even a single person is killed by a drug that was let through FDA screening. Every study on the matter that I've seen says that the FDA is actually way too restrictive in how it regulates drugs. And I should mention that this is in contrast to other countries such as most of Europe or Canada or Japan which have much saner drug regulation regimes.

I should also say that this is only a criticism of the FDA in it's role as a drug regulator. It seems to do a pretty good job as a food regulator. I suppose the number of voters involved in food production dwarfs those involved in drug production.

[1] You get more type 1 errors for each type 2 error. http://en.wikipedia.org/wiki/Type_I_and_type_II_errors

You have to keep in mind the history of the FDA. When kids were being born around the world with flippers instead of arms and legs because of thalidomide, that wasn't happening in the US because of the FDA. Incidents like that breed cautiousness.

The pendulum swings back and forth. A decade ago, the FDA got hammered for being too cautious. Then Vioxx happened and they got hammered for being to lenient. I think the FDA does a dam good job to be honest. Mistakes are made, but I'd give them an A- overall.

The other thing to keep in mind is that the US has pretty lenient "supplement" regulations. As long as you can prove it's safe and don't make efficacy claims you can't backup the FDA will often leave you alone. I'm often amazed at what the FDA allows regular citizens to buy.

I'll admit that on average the FDA has gotten better over the last few decades. They are genuinely better than when they caused 10,000 excess deaths a year for a decade due to their refusal to permit beta blockers during the period they were in use in other countries. But you can't say "Both Type 1 and Type 2 errors are occuring, so they must be balanced."

I think the point stands that the FDA get almost no credit when it rejects drugs that could have harmed Americans and get fully blamed when any drug causes excess deaths in the US.

That's the big problem.

In addition, the public has little appetite for conversations that start with "We balance risk so only a handful of Americans die..." The public has zero tolerance for any mistakes the FDA makes, which I think is unfair, but that's the world the FDA lives in.

Thalidomide was very effective in treating morning sickness, it "just" wasn't safe. Why does the danger of thalidomide justify giving the FDA extensive powers to regulate the effectiveness of treatments?

> Why does the danger of thalidomide justify giving the FDA extensive powers to regulate the effectiveness of treatments?

... because it wasn't safe for use by pregnant women? Am I not understanding part of what you're saying?

I wouldn't consider that to be truly "effective" when the side-effects are quite serious. And by the nature of the medication, all pregnant women taking the drug are necessarily at risk of these side effects.

The big debate is whether the FDA should approve a drug as being "safe and effective", or whether it should just declare a drug "safe" and then leave it to doctors to decide what they use. The later is what most of the world uses and what reformers want the FDA to adopt. Moving to the later would not have done anything to prevent the Thalidomide tragedy.

Most first-world countries have a form of socialized healthcare. Before any new drug is admitted to market in that kind of system you need to have proof that it offers an improvement to what is already available - you can't ask the taxpayer to pay premium prices for something that offers no improvement over what's already available.

Treatments that are safe but not effective can be dangerous as well, if they replace or prevent access to other more effective treatments. There is a pretty vast information imbalance between doctors and patients, and patients may not always have the time or knowledge to investigate the effectiveness of a treatment. The FDA does this research for the patients, and approves what claims can be made by doctors about a given treatment's effectiveness.

You can't attribute thalidomide being blocked in the US to "the FDA". Frances Oldham Kelsey was practically solely responsible for stalling the drug until sufficient evidence of birth defects emerged to reject it. She was under intense pressure from within the FDA to approve it. In addition, the US benefited from being the last major market to receive the drug - if it had been developed in the US, the US would have almost certainly been hit just as badly as Europe.

The scandal did lead to FDA drug testing reforms, but that was after the fact.

(Also, there were US victims of thalidomide birth defects. There were human clinical trials and the American distributor aggressively distributed "free samples" to employees.)

I guess we'll have to disagree as to what constitutes "the FDA". Frances Kelsey was a physician working for the FDA, so although there were internal disagreements on whether or not to approve, the point is, "the FDA" didn't approve it.

My argument is that that situation bred a lot of cautiousness at the FDA after the fact.

"The FDA" would be taken to mean some quality of the organization - a regulation, a standard process. It was not. It was a single stubborn person, working off little more than a gut feeling, and going against standard practices of the organization.

To say the least, the problems with the FDA are pretty well documented: http://www.nap.edu/catalog.php?record_id=11750#toc

> And I should mention that this is in contrast to other countries such as most of Europe or Canada or Japan which have much saner drug regulation regimes.

Except for example, Canada tends to just accept whatever the FDA accepts.

Imagine that there were no FDA Iron Curtain and doctors prescribed afobazole because "the paper was good" (or more likely because the money was good). Then people taking this drug got hospitalized left and right (or - shudder - found dead) because of side effects.

FDA could not do anything to protect her dear US citizens. She couldn't sue the manufacturer or ask them to do further research or impose black box warning or pull the drug out of the market because it was simply beyond their jurisdiction. Doing any of that would constitute a version of the Iron Curtain.

So FDA is doing the right thing to prevent this from even happening by requiring the manufacturer to have everything in place before the drug sees the market.

Furthermore, a randomized controlled trial is no synonym of "drug is good to use". Do they work on US populations? How big is the sample size? Is the methodology sound? What is the side effect profile? Is there any long-term data (like 1 year after using the drug)? These are answered for FDA-approved drugs, but not necessarily for non-approved ones, especially if you are not a healthcare professional that speak Russian (even then, they have teams of professionals looking at drug applications, are you sure you're not overlooking anything?).

The primary issue here is extremely well understood drugs for which the patent opportunity has expired. The only problem is profit incentive, not any serious question marks about safety or efficacy. There are European drugs in wide use for decades with reams of great research that nobody is ever going to bother pushing through approval in America because ultimately no profit would be made.

But the argument still stands, right? Who will be responsible if the "extremely well-understood drugs" have some problems in the US? They don't care about US population because it is such a small market for them. Let's say we lower teh barrier of entry by waiving these "extremely well-understood drugs" from proper research in US. There are instances of drugs that exhibit different side effect profile due to genetics in different population, and this sometimes tip off the risk-to-benefit balance, how do you account for that?

The more barrier you place for drug approval, the safer it will be. It is a classical risk-versus-benefit trade-off. If there is an option that may be slightly more effective than current practice but has unknown (or perceived less certain) side effect profile, healthcare industry mindset prefers the status quo.

"First, do no harm." http://en.wikipedia.org/wiki/Primum_non_nocere

I would be on the same page as you if the FDA and the American medical establishment had a great track record of protecting Americans from harm. As it is there's massive over-prescription of dangerous chemicals doing serious harm. Remember Vioxx? Remember estrogen hormone replacement therapy? There's currently massive, dangerous over-prescription of statins, amphetamines for kids, female hormones, and SSRIs.

Consequently I take a bit of a more libertarian perspective on pharmaceuticals. You can't really trust the government or most doctors anyway. So people might as well be more free to find helpful chemicals.

Over-prescription is the problem of the prescribers' and their incentives, not FDA. FDA opens the tap, prescribers put the water in the cup and give to patients. Patients do not access the water directly. Your concern is better directed to American Medical Association (AMA).

If you think you can find helpful chemicals on your own, you are either very confident to use your own body as a guinea pig or suffering from http://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect .

The FDA specifically on-label approved ritalin for kids, hormone replacement therapy, and statins for people with high cholesterol but no signs of heart disease. Your faith in regulation is misplaced. If you take FDA approval and a doctor's recommendation as proof a prescription is safe you are misguided. (The AMA is a lobbying organization to which about 15% of doctors belong and is irrelevant here.)

There is no reliable government organization out there stopping harmful medical treatments. I just want to acknowledge that as fact rather than pretend otherwise and deny people choices.

> The FDA specifically on-label approved ... statins for people with high cholesterol but no signs of heart disease.

You say this as if it were bad, but the net effect is to save lives (at a cost of money and increased diagnoses of diabetes). Statins are an example of the FDA and the industry actually doing the job they are supposed to do.

I may not be as well-informed as you, but I don't see a problem on those on-label uses you mentioned.

If you want to evaluate the safety of a prescription, I hope you have the right degree for that. Things can look safe on one paper and not safe on another. Or your condition may warrant a risk of greater side effect with the upside of better efficacy. It's true that doctors and FDA can make mistakes, but they are the best people you have.

Uh oh... Didn't know that your AMA is such a place. Do you have a association that represents all prescribers? Prescribing habits should be looked over by them.

You're right that the solution shouldn't be automatic US approval for any drug used in Russia. It's reasonable to have standards for drug testing and require that any drug used in the US is tested to those standards.

The problem isn't (only) that US drug standards are strict. The problem is that the financial burden of testing a new drug, which is significant, lies solely on the manufacturer, who can only recoup those costs by selling patented drugs at high prices. This means that the incentives don't line up for drugs not covered by US patents: because there's no profit in selling them, no manufacturer can justify funding the clinical trials to get them approved. This despite the fact that society would, as a whole, benefit from having those studies done.

One obvious solution would be a government program whose mission is to identify promising treatments for which private incentives don't line up, and shepherd them through the approval process by funding clinical trials and so on. You could also imagine a free-market variant, in which the government just auctions off US patent rights for foreign drugs; the auction winner gets exclusive rights to sell the drug in the US for some limited period of time in exchange for agreeing to fund FDA approval.

> One obvious solution would be a government program whose mission is to identify promising treatments for which private incentives don't line up, and shepherd them through the approval process by funding clinical trials and so on

You already have this. It's called Orphan Drugs in the US. http://en.wikipedia.org/wiki/Orphan_drug

> a free-market variant, in which the government just auctions off US patent rights for foreign drugs

This will probably work. But once the barrier is too low, a lot of "useless" drugs will show up (i.e. providing more choices to prescribers but in reality does not really give much benefit) - and you need to fund those too using the taxpayers' money.

Cool, I wasn't familiar with the Orphan Drug program. From the Wiki page it looks like it's focused on development of new drugs for rare diseases, for which the market is inherently small and thus impossible to do large clinical trials, etc. That's similar to but not quite the same as the problem here, where a drug already exists and the market is potentially quite large, but the lack of patent protection prevents any one company from funding its approval. Do you know if the Orphan Drug Act specifically designates some government body with the mandate and funding to study and approve pre-existing foreign drugs? If not, maybe that could be a useful extension.

I see, it is indeed quite different. I'm not sure what the Orphan Drug Act specifically says though.

Actually if the market is potentially quite large, big pharmas should already be researching it. The problematic ones are those that are in-between orphan drug and market-quite-large drug. The society probably needs less of these drugs (there should be alternatives at the other ends), but if it's still needed, maybe expanding the scope of the Orphan Drug Act can be a good solution.

You can get a patent for 'novel' treatments for existing drugs which should in theory fix this issue.

Overthinking it. The Russian regulations presumably are adequate to protect her own citizens; its not necessary for US sufferers to sue in Russia to correct manufacturing problems there.

Its hubris, American regulatory groups sticking their fingers in the affairs of other countries. And its beyond their charter to try to regulate what Americans do; they're supposed to regulate what American manufacturers do, not private citizens?

The original article says the curtain has descended on Psychopharmacology, which seems an important distinction vs Pharmacology used in the submission here.

Yes, when I read the title I was expecting the article to talk about Alexander Shulgin.

The analogies with room temperature superconductors and antigravity suggest that bromantane is some kind of super drug. But the only thing the author bases this on is the summary of a study in russian that the author can't even read.

Believe it or not there is a respectable number of scientists, physicists no less, who make a living doing nothing but bringing 80 year old Soviet Science to the west.

Every so often they get the front pages of nature for essentially finding anti-gravity: http://www.nature.com/news/2008/012345/full/news.2008.1185.h...

Or you find actually build computer architectures and languages which American theoretical computer scientists rediscovered 30 years later as the most efficient possible: https://en.wikipedia.org/wiki/Setun

I have great appreciation for russian technology, but aren't those exaggeration ?

If setun , the ternary computer was so efficient - how is ithat today we use binary machines(and that in general the russians didn't have a moore's law ) ?

The industrial spies in the West send back information that binary was used exclusively and the Soviet bureaucracy, like usual, decided that the West knows best and shut down that area of research.

One thing people in the West don't understand is that the Soviet Union after Stalin believed it was a second rate power and acted like one. In many ways the Politburo was a US cheerleader, they only challenged the US tactically while strategically accepting most of the propaganda more uncritically than US dissidents.

One of the many disadvantages of a closed state...

> But the only thing the author bases this on is the summary of a study in russian that the author can't even read.

Not true. He said that "they seem to have pretty good evidential support", and that russian study was used only as an example. Also while comparison tu room temperature superconductivity might be a hyperbole, apparently drug having "both stimulant and anti-anxiety properties" that "millions of Russians have been using for decades and are by and large still alive" is something really big in the field of medicine.

The possible evidence is in those other journal articles, but they are in russian as well, which the author admittedly can't read. So I'm wondering how he arrived at his conclusion when all the possibly hard evidence is in a language he doesn't understand?

The author works in a hospital, does psychiatry for a living and is known around the Internet for reading tons of research papers, so I'm personally willing to give him benefit of doubt here, but in essence you're right, he didn't provide much support references for that medicine, regardless of whether he has or has not read any.

The author is talking about a market category in which successful drugs are worth billions. If these Russian drugs are so effective, why isn't some pharma firm in the US driving them through testing? The answer can't be "because the FDA is capricious and rejects drugs at the last minute", because that problem applies to all drug research, and we obviously have a lot of drug research.

The answer may be one of:

* US pharma is developing a me-too / copycat drug that has very similar molecular structure

* US pharma has tried and it failed before public announcement (oh there are so many of them)

* US pharma negotiated contract and found that the Russians are non-negotiable :)

But we have patents, as well. If a major US drug company invents a new superdrug, and spend decades and billions of dollars to get it approved, they can at least be sure that if it gets approved they will get the royalties from its sale.

But if a company spends decades and billions of dollars fighting for the approval of a drug they do not hold the patent on, they are by no means guaranteed making even a single penny of that investment back, even in the best case scenario where it succeeds in getting through the FDA.s

Hyperbole. Marketing is how the rest of us sell things. Giant drug company would have many advantages there. They are likely to sell boatloads of product regardless of patents. The patent is a greedy attempt to dominate the market legally in addition to commercially by creating a monopoly.

It's not how many they sell that matters, but how much money they make on them and how that compares to the cost of getting a drug through the FDA approval process.

To say that drug patents are nothing but greed is way off base. The cost of R&D together with the work needed for FDA approval is typically astronomical – the only way you're recouping that is with a monopoly and a high price.

If that was true, why do major pharmaceutical companies spend way more money on advertising than on R&D?

(Trivially searchable, for example here: http://adage.com/article/special-report-pg-at-175/procter-ga...)

The drug industry is very different from other industries because of generics. The FDA has an approval pathway that allows you to say "my drug is identical to that other drug". Also, many states have legislation that requires pharmacists to fill Rx with generics. Marketing won't do a whole lot to help that.

If the same thing happened to the tech industry, it would work like this... you create an awesome new gadget and a competitor creates a copy. The gov't certifies this copy as "exactly the same". When you go to purchase the fancy gadget at the store, the clerk automatically gives you the cheaper copy without even asking.

Again, not something marketing can help a whole lot with.

Funny, my pharmacist has never done this. My doc prescribes, and she asks me if a Generic would do? Usually she advises against it.

It all depends on your state's laws. Some go as far as requiring the pharmacist to dispense the generic unless the doctor writes "DAW" (dispense as written) on the Rx. Others just have to ask if the generic is OK.

Most of those laws are on the books because gov't funded health insurance (Medicare, Medicaid) don't like to pay brand name prices when generics are available.

Successful drugs, or successful drugs that are eligible for patent protection? I imagine[1] it would be much harder to turn a profit on the massive upfront costs if you immediately had to compete with the existing manufacturers at generic-scale prices.

It seems like it might be useful (assuming it isn't already) to separate the rights concerning drug discovery and those demonstrating efficacy/safety to allow costs to be recovered.

Then again, it needs to be weighed against the inevitable rent-seeking that pharma has a name for.

[1] but don't have any evidence handy to back it up, so ICBW.

This is one of my favourite blogs I read. There are many interesting and thought-provoking things there, and the author's style of reasoning makes me regain faith that there is still some level of sanity to be found on this planet.

> It doesn’t count if some foreign scientists already did a bunch of studies. It doesn’t count if millions of Russians have been using the drug for decades and are by and large still alive.

Um, no, it doesn't. What's the FDA going to do if they have additional questions or want additional studies done?

The FDA doesn't approve these drugs for the exact same reason the author doesn't prescribe them.

Lament the situation, sure, but pointing fingers at the FDA seems dumb.

The author doesn't prescribe them because they don't want to get sued.

The fda doesn't allow them because they are (argues the author) run by big pharma.

> The fda doesn't allow them because they are (argues the author) run by big pharma.

The author argues that "big pharma" doesn't seek the FDA approval because there's no way to recoup the expense.

To quote,

"Absent an extremely strong patent on the drug there’s no reason a drug company would want to go forward with all of this. I don’t know what the legalities of buying Russian drug rights from Russian companies are, but I expect they’re complicated and that pharmaceutical companies have made a reasoned decision not to bother."

Note the reasoned decision part. The author's actual point is summarized in the N-2th paragraph:

Everyone follows their own incentives perfectly, and as a result the system as a whole does something insane. Classic multipolar trap..

This is most likely an extremely unpopular opinion here, but mandatory FDA approval is another one of those government regulations that I think the world would probably be better without.

If I'm desperate for medicine and am willing to take a risk by taking a non government-tested drug, then shouldn't that be my right? Also, it's not even entirely clear whether on the whole, the FDA saves more lives than it harms. Sure, it's prevented many bad drugs from going to market, but the astronomical costs (both time/money/energy) associated with getting drugs approved by the FDA 1) slows down good pharma companies and 2) discourages many people from starting good pharma businesses at all.

A free market solution to this would be to have FDA and/or commercial enterprises vet the drugs with open, transparent standards, and the pharma companies can choose at will whether or not they want to be certified by these companies (and list whatever certifications they received on their products). The consumers can then choose at will whether they want to buy products with only these certification(s), or they can take a gamble and buy completely uncertified products.

Entrusting a government agency to retain totalitarian, opaque control over what drugs can make it to the market is just a bad idea.

Not long ago, the free market solution was snake oil. Literally.

And it should be my right to buy snake oil, just as it is my right to pay hundreds of thousands of dollars for Scientology courses.

You can buy snake oil. The limitation is you can't market it as curing cancer and doctor's can't prescribe it. Which is a vary important distinction.

Herbal infusions, Homeopity, and a host of other 'options' still, but if you call yourself a doctor and not just a 'faith healer' they effectively don't which is a good thing.

> It is considered novel having both stimulant and anti-anxiety properties.

That would be handy. I did take an American anti-anxiety drug for a short while during a painful divorce, but I went from someone who gets hours of work done on the bus to work every day to someone who just stares out the window. Sure, I was happy and not worried and not desperate, but I wasn't getting half the amount of work done either.

I've had a similar experience with anti-anxiety medications. While they (benzos in particular) do alleviate the 'synergistic cycle of worry/negative thought' I associate with anxiety, that isn't necessarily beneficial in the long-term. At times I feel like low levels of anxiety are almost behaviorally indistinguishable from 'initiative to do un-preferred stuff I should be doing'. If anxiety is triggered by (or a barrier to) not accomplishing things you should, or feel you should, taking such medications could be counter-productive.

But a medication that disrupts the anxious cycles of thought while at the same time stimulating the motivation/energy to complete tasks... well, that sounds almost like magic to me, especially if it doesn't involve the retrograde amnesia associated with benzos like alprazolam, lorazepam, etc.

A lot of these Russia-specific drugs are scams. The papers glorifying their magical properties have no scientific basis, but rather published for bribes. There are serious papers in Russian medical journals describing healing properties of holy water. There are very popular anti-flu drugs like Arbidol that actually do nothing. This is the country where pseudoscience reigns supreme.

Isn't this the normal case of drugs having different names in different countries? I thought this is why the drugs also have a secondary, chemical, name that describes the actual molecules. Even the most popular drugs have different names - Tylenol isn't named like that in Europe or Russia, AFAIK.

The problem lies in the so called social contract each society wants to endorse. Either people face drugs as social goods (social economical model) or as goods (liberal model).

If drugs are social goods then, in theory you put the well being of the masses above anything else.

If drugs are just goods to be marketed, then there's no need to bother. Either the financial aspect is lucrative (e.g. reasoned) or you can't have legal access to the drug.

ps. The fact that the US has the worst and most expensive health system in the world of course, says something about healthcare.

I think the problem here is that the predictive value of the "pretty good evidential" support and success in a future (acceptable to the FDA) clinical trial isn't as high as you might think.

Admittedly it's for a different indication, but the Medivation experience with dimebon, which is a drug used in Russia as an antihistamine for decades, which had "pretty good evidential support" that the drug might work for Alzheimer's disease is, unfortunately, more likely to be par for the course.

I'm not sure about US law, but there should be a provision like importing a non-licensed drug for a named patient, with declaration from the doctor and pharmacist saying that they bear full responsibility in case anything goes bad. Using this the doctor can import any kind of drug as they wish - but of course they must be responsible for it as there is no more "screening" from FDA.

Singapore has this provision because the market is too small for lots of drugs to come in.

>Singapore has this provision because the market is too small for lots of drugs to come in.

Interesting how do doctors end up bearing "full responsibility"? It seems like something has to work differently in civil court or current culture most be different enough that the doctor is not run out of business after a few patients die after importing and taking responsibility for a drug.

Singapore is not really as litigious a society as US, I don't think there is ever a case where the patient sues the doctor because s/he uses an exemption (non-registered) drug. In some cases the patient probably doesn't even know that the drug is not registered.

Importing a drug under exemption is "serious business" and is usually only done by the most senior doctors (or by approval from a committee of senior doctors). They must exhaust all registered options first before moving to exemption drugs, and the pharmacists play a role in ensuring that (another incentive to do that is the paperwork can be rather significant).

Because you need a pharmacist to do this, it usually happens only in larger establishments like hospitals, where pharmacists are readily available and cooperative.

That kind of already exists. US resident are allowed to import up to 90 days worth of a prescription drug. For drugs that aren't prescription-only, the FDA doesn't really care unless they feel the drugs are unsafe.

Most of the drugs mentioned in the article can be purchased by people in the US through the internet.

The analogies in this article are stretched to the point of nonusefulness and the sarcasm makes it difficult to parse what the author is saying.

I'm more worried about the fact that more and more drugs are reclassified as prescription only. Right now, I can only get green tea or alcohol without a prescription for anxiety - not exactly the best choices.

No Adderall, Xanax or Provigil for me either - the only things I can get right now are Tofranil from a friend (which is technically illegal) and racetams from eBay.

Why can't you see a doctor about your anxiety?

Why should he have to?

It was a question, not a suggestion or an argument.

However, if I was suffering anxiety, or any other disorder, to the point where I wanted to take medication, I would see a doctor. I would not trust myself to diagnose myself, let alone prescribe a course of treatment.

The question has some pretty strong assumptions, and OP should not have to justify why he doesn't wish to spend resources to be analyzed by a government agent to obtain medication he wants.

Depending on severity, OP may be stupid in this desire. But it is one's right to make stupid decisions for themselves, and produces better long-term outcomes than binding people to the stupid decisions of others.

Does your distrust of yourself mean you abstain from caffeine (for alertness) and alcohol (for social disinhibition), etc?

I'm not treating a disorder when I drink coffee or a bourbon.

And again, I was not asking anybody to justify anything. You read some "strong assumptions" into my question, Ms. Rand.

I'm abroad most of the time. Sure, I could go see a local doctor, but it would be much easier if I could just get the medication I need (and know to be working based on previous prescription) instead of wasting time and practically begging a doctor for those specific pills.

From experience, shrinks will prescribe whatever they want instead of what I ask for, since they know better and I'm a dumb foreigner who can't even explain things properly.

I understand Xanax, but why Adderall and Provigil? Both of those are stimulants, and if anything they would only increase the anxious tension you are already feeling. Maybe you meant Ativan? Not sure about the modafinil though.

Are you dealing with EDS as a significant symptom in addition to anxiety? ADHD?

Maybe the FDAs mandate could be changed to regulate drugs to maximise the benefit to society. That way things like Melatoin should be allowed and the shenanigans detailed in Bad Pharma (book by Ben Goldacre) should be dealt with. There seems a lot of stuff that is not entirely in the public interest at the moment.

Yes, regulation is always improved by additional regulation.

Unless you can prove that applying additional regulation always leads to bad outcomes, you need to prove that in this case it will before rejecting OP's idea off-hand.

I was thinking more changing the priorities rather than more.

Melatonin is already easily and cheaply available on any pharmacy or grocery store shelf in the US. Regulation of many older drugs still classed as 'supplements' is in fact very lax.

I study pharmacy in CZ. I know about the categories mentioned and the drugs any US (or western-based) Doctor should know, but also never heard about the Russian drugs that are mentioned.

Very eye-opening article. I remember coming in contact with the Chinese pharmaceutical/medical system through a discussion with a our Chinese guide. After the discussion I was left with the impression that Chinese medicine is still in the dark ages and for some reason doesn't wanna join the 21st century. Then our "History of Pharmacy" teacher let me know that Chinese medicine is as good as ours although their approach is strange to us, works extremely well for them hence there even might be many things worth to copy there. I still remember how stunned I was.

This was the state of HIV medications twenty years ago - the first medications were available in other countries, but not yet in the US. The movie Dallas Buyer's Club depicts this period of history excellently.

Even out of patent drugs that have effective off label uses get ignored.

I can't believe the linked article never says, "Eventually we'll know what these conditions are in a biological sense, after which this debate about drugs will go away, replaced by actual science, in which a drug either does or does not address an established, known cause."

So long as we administer drugs based only on their effect on symptoms but without understanding root causes, there will be all kinds of abuse and fads.

God forbid we should use treatments that could reduce suffering in patients...

Like recovered memory therapy, for example, or prefrontal lobotomy? There's a reason mainstream medicine forbids therapies that have no experimental verification, a wise practice that has yet to take hold in psychology.

ADHD therapy is very well "experimentally" verified in most of the hundreds of double blind studies you are refusing to acknowledge...

> ADHD therapy is very well "experimentally" verified ...

So is recovered memory therapy, with thousands of satisfied customers, each of which made a false outrageous claim about an imaginary sex crime, then went on to sue their parents, or boyfriends, or therapists -- and in some cases, all of them.

Your conception of science is below that required for astrology. No one knows what ADHD is or how to treat it. Therefore, there is no therapy for ADHD.

> verified in most of the hundreds of double blind studies ...

You mean the double blind studies you earlier claimed were unethical? There are no double-blind studies carried out with respect to ADHD, because there is no science taking place. And now that the NIMH has pulled the plug, such studies can no longer even be proposed for funding.

> you are refusing to acknowledge...

I did the research, and you are lying. Do your own research:

http://www.childmind.org/en/posts/articles/2013-4-9-most-com...

The linked article says the number one misdiagnosis among children is ... wait for it ... ADHD. The reason is that it's all based on symptoms, not causes, and this is part of the reason for the diagnosis rate and the many errors that are made.

In short, no science, no reliable diagnosis.

http://www.sciencedaily.com/releases/2010/08/100817103342.ht...

Quote: "Nearly one million children in U.S. potentially misdiagnosed with ADHD, study finds"

"Nearly one million children in the United States are potentially misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest -- and most immature -- in their kindergarten class, according to new research."

"ADHD is the most commonly diagnosed behavioral disorder for kids in the United States, with at least 4.5 million diagnoses among children under age 18, according to the Centers for Disease Control and Prevention. However, there are no neurological markers for ADHD (such as a blood test), and experts disagree on its prevalence, fueling intense public debate about whether ADHD is under-diagnosed or over-diagnosed ..."

You need to realize that the professional literature absolutely disagrees with your claims about ADHD, this has been brought to your attention, you have ignored the information readily available at your fingertips, which makes you a liar.

So essentially there are two kinds of science, one is the way I and millions of other scientists believe in, and then there is your own definition, which is the only true one? I'm giving up...

> So essentially there are two kinds of science ...

No there is ONE KIND OF SCIENCE, it is defined in the law, and it is why the DSM is being discarded. Science is not a matter of opinion as you seem to think, it is a matter of evidence and discipline.

> I'm giving up...

Your ignorance is astounding. There is ONE PROPERTY that all science must have, it is non-negotiable, and every freshman science student knows what it is. I asked this already, you ignored it out of embarrassment, NOW ANSWER THE QUESTION.

It can be expressed in a single word, science requires it, psychology doesn't possess it, what is it?

ANSWER THE QUESTION OR STOP POSTING.

How science is defined in the law (why Creationism cannot be taught in high school science classrooms):

http://arachnoid.com/building_science/index.html#Science_Def...

The solution is to have a public pharma: someone, maybe the NIH, that takes unpatentable, unprofitable drugs through the FDA process.

That would involve maintaining healthy research funding levels, rather than continually making cuts.

so is this article about drugs, presumably a complex molecule involving many elements, or actual new chemical elements?

About drugs that work well, are deployed around the world and US has no equivalent of, that somehow still don't get imported to America.

"Different elements" is a hard sell on this post, because aren't they sequentially increasing protons, neutrons, etc? How can you not have elements on one periodic table vs another?

Do you really think America needs more psychoactive drugs?

Author seems confused as to the naming of chemical elements. Just because the Russians might use different names for elements doesn't mean they have discovered chemically unique elements.

http://en.wikipedia.org/wiki/List_of_chemical_elements_namin...

The first bit of the article is an analogy to highlight the bizarre situation described in the second bit.

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