An Iron Curtain Has Descended Upon Psychopharmacology

August 16, 2014

Imagine if a chemist told you offhandedly that the Russians had different chemical elements than we did.

Here in America, we use elements like lithium and silicon and bismuth. We have figured out lots of neat compounds we can make with these elements. We’ve also figured out useful technological applications. Lithium makes batteries. Silicon makes computer chips. Bismuth makes pretty gifs you can post on Tumblr.

The Russians don’t use any of these. They have their own Russian elements on their own Russian periodic table, with long Russian names you can’t pronounce. Apparently some of these also have useful technological applications. One of them is a room temperature superconductor. Another improves the efficiency of dirigibles by 500% for some reason.

No one in America seems remotely interested in any of these Russian elements. Many American chemists don’t even know they exist, even though each element has its own English-language Wikipedia page. When informed, they just say “Yeah, the Russians have lots of stuff,” and leave it at that.

American research teams pour millions of dollars into synthesizing novel elements in order to expand their periodic tables and the number of useful compounds they can make. If anyone suggests importing and studying some of the Russian elements, the chemists say “Huh, that never occurred to us, maybe someone else should do it,” and go back to spending millions of dollars synthesizing entirely novel atoms.

If a chemist told you this, you would think they were crazy. Science, you would say, is science everywhere. You can’t have one set of elements in Russia and another in the US, everyone would work together and compare notes. At the very least one side would have the common decency to at least steal from the other. No way anything like this could possibly go on.

But as far as I can tell this is exactly the state of modern psychopharmacology.

Consider anxiety. I would kill for a good anti-anxiety drug. Right now my choices are pretty limited. Benzodiazepines and barbituate work great but are addictive and dangerous. SSRIs work okay but need a month to take effect. Neurontin, Vistaril, and Buspar are safe, fast-acting, and totally ineffective. And Lyrica is expensive and off-label. As a result, a lot of my anxious patients tend to stay anxious.

Any textbook, database, or lecture you care to check on anti-anxiety medications will list the ones I just listed above plus a couple of others I’m forgetting.

But if you look the matter up on Wikipedia, you see all these weird names like mebicarum, afobazole, selank, bromantane, emoxypine, validolum, and picamilon. You can show these names to your psychiatrist and she will have no idea what you’re talking about, think you’re speaking nonsense syllables. You can show them to the professor of psychopharmacology at a major university and your chances are maybe like 50-50.

These are the Russian anti-anxiety drugs. They seem to have pretty good evidential support. Wikipedia’s bromantane article gives a bunch of studies of bromantane in the footnotes, including a randomized controlled trial in the forbiddingly named Zh Nevrol Psikhiatr Im S S Korsakova.

And look what else Wikipedia’s bromantane article says:

Study results suggest that the combination of psychostimulant and anxiolytic actions in the spectrum of psychotropic activity of bromantane is effective in treating asthenic disorders compared to placebo. It is considered novel having both stimulant and anti-anxiety properties.

Imagine reading about a Russian element on Wikipedia, and at the end there’s this paragraph saying “By the way, this element inverts gravity and has to be tied to the ground to prevent it from falling upwards”. An anxiolytic stimulant is really really cool. But somehow generations of American psychopharmacologists must have read about bromantane and thought “No, I don’t think I’ll pay any more attention to that.”

My guess is the reason we can’t prescribe bromantane is the same reason we can’t prescribe melatonin and we can’t prescribe fish oil without the charade of calling it LOVAZA™®©. The FDA won’t approve a treatment unless some drug company has invested a billion dollars in doing a lot of studies about it. 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. You’ve got to have the entire thing analyzed by the FDA and then rejected at the last second without explanation (yes, I have just been reading Marginal Revolution’s review of Innovation Breakdown: How the FDA and Wall Street Cripple Medical Advances; I do need to check out the actual book). 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.

Given this situation, it’s perfectly reasonable for doctors not to prescribe them. Certainly I don’t plan to prescribe any Russian drugs when I get my own practice. Imagine if a patient gets liver failure on one – and remember that people are getting liver failure all the time for random reasons. The patient’s family decides to sue and I’m stuck defending my decision in court. “Yes, Your Honor, I admit I told the deceased to buy a medication no other psychiatrist in the state has ever heard of from a sketchy online Russian pharmacy. But in my defense, there was a study supporting its use in Zh Nevrol Psikhiatr Im S S Korsakova. Which I didn’t read, because I don’t speak Russian.”

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

Luckily, this hasn’t stopped a lively gray market trade in these chemicals, which I totally one hundred percent approve of. Noopept, for example, is a prescription drug in Russia but is sold over-the-counter by online suppliers here. You can even get some bromantane for two bucks a pill.

Don’t worry. I’m sure these people are on the level. How could a site with a background like that possibly be unreliable?

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