Pill or will, it's about 'free' speech

Elmer Fudd made you laugh with it, as did Dada Kondke. Stammering remains a cheap but sure-fire gig in comedian’s routine. But it may now become amenable to drug therapy if the results of a recent clinical trial deliver on their promise.

The efficacy needs to be tested in still larger trials over the next two to three years. But if they should succeed, the drug, pagaclone, might become the first medical treatment approved for stammering.

Pagaclone is also giving the US pharma industry a déjà vu experience of sorts: it was approved earlier for reducing social anxiety.

As in the case of the diamond-shaped blue pill against impotency, Viagra, the anti-stuttering effect of the medication was accidentally discovered during a clinical trial of the tranquiliser.

Pagaclone works as a selective receptor modulator of a crucial nerve chemical called gamma amino butyric acid (GABA). Making larger amounts of GABA available in the brain somehow seems to alleviate stammering with its painful halts and pauses.

What is even more serendipitous, the anti-stuttering trials also uncovered a potentially lucrative effect against premature ejaculation (PE) among some patients.

Obviously, with its sights set on the estimated third of the adult males who suffer from PE as potential customers, the company has already filed for a new patent and launched clinical trials for their magic bullet.

But this is not as surprising as it may sound: the normal ejaculatory response is controlled by a number of neurotransmitters including serotonin and GABA. Doctors know that drugs that help stimulate or increase the action of the GABA in the brain can delay the ejaculatory response. All this also raises a veritable hornet of ethical questions including those concerning potential abuse and the impact of new medicines on normal people.

Incidentally, earlier trials of two anti-schizophrenia drugs had also shown some effectiveness. But the companies involved, Eli Lilly and Johnson & Johnson, did not take them up for larger testing.

To be sure, the so-called ‘pill power versus will power’ tussle remains inconclusive. But over the last decade, the medical view of the condition has been radically transformed. Earlier it was widely regarded as a ‘nervous or
emotional’ handicap.

Now thanks to advances in brain imaging, genetics and pharmacology, it is increasingly being accepted as a neurological condition with a possible genetic component. (About half of those who receive treatment for stammering have an immediate family member who’s afflicted.)

But we still do not know why men who stutter outnumber women by a ratio of about 4 to 1. Nor do we know why three quarters of the children who start stuttering between ages 2 and 6, become fluent without any intervention.

In contrast, neurological stuttering typically occurs in late adulthood, usually brought on by a stroke or an accident. Emerging evidence from magnetic scan studies has implicated abnormalities in the brain areas related to speech motor control. Some studies point at an excess of the neurotransmitter dopamine in the brains of those who stammer.