Earlier quoted context omitted.
> So a double strength dose of the racemic mixture has a much milder effect than a single strength dose of the strong enantiomer? Is that the angle here? I thought we were comparing the total mass of each substance. OP asked about noticeable differences, not paradoxical effects. 25mg of dextro is obviously going to have a weaker overall effect than 50mg of racemic amp. But that's not what OP asked and it's not the co…
You do realise we can prescribe whatever dose we like, right? Some drugs I prescribe in grams, some in milligrams and some in micrograms. The strength of a drug is somewhat irrelevant. I'm not going to prescribe a new and expensive drug just because the dose is 150mg when it's well-established, cheap cousin is available that happens to need a dose of 300mg. It certainly is the context, and I believe it's what OP aske…
I've no wish to argue here, but I am confused about how this has anything to do with it. No one brought up the idea that the doses would be different. We're talking equivalent doses of either an enantiopure or racemic substance.
> It would still have to somehow be quite different to the effect of the racemic version at any arbitrary dose to be preferentially prescribed.
Like I said, we don't know this about ketamine, thus the trials. But we do know this about amphetamine. You would simply have to experience each enantiomer and the racemic mixture in order to understand what I am saying here. The effects are markedly different. My analogy was coffee vs meth.