
The Four Thieves Vinegar Collective - surlyadopter
https://motherboard.vice.com/en_us/article/43pngb/how-to-make-your-own-medicine-four-thieves-vinegar-collective
======
darawk
> Indeed, Laufer and his collaborators can’t stop pissing off powerful people
> because Four Thieves is living proof that effective medicines can be
> developed on a budget outside of institutional channels.

Synthesized. Not developed. Synthesizing medicines is easy. Developing them is
extremely difficult.

~~~
klipt
I can "render" a movie onto my harddrive from bittorrent in minutes. I don't
know why Pixar has to spend so much time on their rendering! /s

~~~
malkia
If stealing movies helped people survived, given financial difficulties, then
they'll do it. Survival beats "no-steal" laws.

~~~
wavefunction
in the face of immorality, morality stand supreme

~~~
lovich
Would you wait to die instead of stealing something to save yourself?

------
34k5uoi5ui
This is truly amazing work, and I hope they are able to achieve their goals.
The future of humanity depends on it.

If you want to help, they need someone to crack a rar file containing the
Chematica data (which was acquired by Merck pharmaceuticals)

[https://twitter.com/MichaelSLaufer/status/102263726560276889...](https://twitter.com/MichaelSLaufer/status/1022637265602768896)

~~~
imbruglia
I hate to be negative. But I have seen enough of these sort of initiative over
the years to be skeptical. In reality it seldom makes sense to do it yourself.
Few things in general needs to be built or invented. If they do chances are
they aren't the ones to do it. It almost always makes more sense acquire the
capability to do what you want somewhere else. But as soon as you do that all
the edgy rhetoric and potential goes out the window in favor of liability and
reality. So reality eventually becomes the enemy of the escapist fantasy. And
the powerful remain powerful while the real problems go unsolved. I would very
much like to be wrong though.

~~~
mplewis
Providing access to otherwise-inaccessible drugs is a real problem. The fact
that normal people can accomplish this through an anarchist collective is
incredible and should be lauded.

~~~
ethbro
_“Pursuing science is a human right,” Laufer said. “In fact, it’s the human
right from which all other rights flow. You have to be able to do whatever you
want to your body and to think the way you want.”_

~~~
mabbo
> You have to be able to do whatever you want to your body and to think the
> way you want.

The problem with most libertarian ideas like this is externalities. If you
take something made incorrectly and become incredibly sick, society has to
either take care of you or let you die- and no one wants to let people just
die. So instead, society foots the bill for taking care of you.

I'm not saying these guys aren't fighting a damn good fight. They're in the
right, in my mind. But if they start a large enough movement with enough
people then someone somewhere is going to eventually cut a corner or make a
mistake and get someone killed or made seriously ill. And what then?

~~~
dmix
Ultimately, either way it will create a new competition which will push the
hand of the legal market to adapt to being undercut. In that sense it's not
simply just the individual benefiting at expense of the wider society but
potentially the catalyst which benefits the whole market (even non-black
market buyers).

There is no reason why Epipens cost $300 other than the fact the FDA has a
huge backlog [1] and other regulatory constraints. There are plenty of
companies chomping at the bit to deliver that medication for cheaper.

Like you said, this alternative is less than ideal, these hackers weren't
driven to this just for fun - it was born out of what they saw as a lack of
other options, a necessity (same with their 'customers' who were pushed to the
shadier/riskier option). This necessity is generated when the primary market
is not delivering value properly/efficiently, creating a demand for it.

The more free the legal market, the more the black market will be far less
lucrative. The same applies to drugs and many other markets which artificial
controls/limitations.

This all must be factored into the balances of costs measured against the
externalities it imposes on society. It's riskier than pure top-
down/government intervention but sometimes it's a necessary risk when that
option continually fails to reform/change and nothing else pushes the hand of
the gov/industry to adapt.

Sure you could blame the black market, but the simpler solution would be to
fix the original problem which caused the black market to exist.

[1] [http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-
dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-
chairs/)

~~~
mabbo
> you could blame the black market, but the simpler solution would be to fix
> the original problem which caused the black market to exist

Tell that to 100 years of American drug policies.

------
gnicholas
> _At the pharmacy, a pair of single use Mylan epipens can cost over $600 and
> the company’s generic version costs $300 per pair, but an ongoing shortage
> means you probably can’t find them, even if you can afford them._

This was true years ago but not anymore. CVS sells a generic epipen two-pack
for $109 [1]. Still not cheap, but let’s not pretend that these cost $300 and
are not even available. I wanted to like this article but when I read this it
made me think either reading journalist didn’t check his facts or is more
invested in the narrative than reality.

1: [https://www.cvs.com/content/epipen-
alternative](https://www.cvs.com/content/epipen-alternative)

Edit: I posted this even though I figured it would attract downvotes. I’m
curious if downvoters think my claims are untrue or don’t like the way I’ve
phrased my comment.

To me, an article I can’t trust is basically worthless, which is why I pointed
these inaccurate facts out.

~~~
thatcat
The 109 price seems like the market responding to the 30 $ diy epipen hack
released 2 years ago.

[https://www.collective-evolution.com/2016/10/01/hackers-
prov...](https://www.collective-evolution.com/2016/10/01/hackers-provide-
solution-to-overpriced-epipen-create-it-yourself-for-30-dollars/)

~~~
gnicholas
It was definitely a response to the shortage and bad publicity around epipens.
Not sure it’s possible to know which was the more direct cause. It could have
just been CVS going for some good publicity.

------
refurb
As a former pharmaceutical chemist I’m calling bullshit.

Could they have made a few grams of nalaxone? Sure it’s pretty simple. Did
they make enough to make a difference? No. Did they make sufficiently pure
drug so that people don’t get poisoned? Probably not.

And did they make the AIDS drug? He’ll no. That synthesis is way more
complicated than their mini lab can handle.

It makes for good VICE articles, but these guys are amateurs who are likely
going to get someone killed.

~~~
vzcx
Is there some route to naloxone that I am not aware of that doesn't start from
some opiate or opium alkaloid? The morphine total syntheses I've read were
rather involved and low-yield. Perhaps progress made on the biosynthetic step
through reticuline? That would be exciting.

~~~
refurb
Article covers that. They start with oxycodone. From that a reduction to
hydromorphone and then methylation to nalaxone. Not easy chemistry, but only
two steps.

------
jgtrosh
I wish there was an equivalent of CI and peer-reviewed pull-requested
contribution to their system, to ease collaborative improvement to the
methods. You'd really want many sets of eyes able to look at all aspects of
the drugs to vastly reduce risk.

~~~
yosito
I saw one of Michael's talks. They do share the data about their hardware and
processes openly (though I don't know where/how, since it's not the kind of
info I understand). But one of the things he mentioned needing more open
information about is the chemistry. There are databases of chemical reactions
that can be used to train AIs to find new, easier and cheaper ways to
synthesize medications, but those databases are controlled by large for-profit
corporations who refuse to release the data. Presumably for "safety" reasons,
but it's not hard to imagine that "safety" isn't the whole story.

~~~
Footkerchief
Some of said databases: [http://www.organicworldwide.net/content/reaction-
databases](http://www.organicworldwide.net/content/reaction-databases)

------
monochromatic
> After a few minutes of gloating about pharma bro Martin Shkreli “rotting at
> Fort Dix” for raising the price of Daraprim

Except that’s totally unrelated to why he’s in prison.

~~~
JshWright
Yeah, and Al Capone just went to jail for "tax evasion"...

~~~
citrablue
He did go to jail for that, unless I'm confused.

He brought attention to his tax evasion for other reasons... but is it
difficult to acknowledge that the direct legal cause of his jail time was
evasion?

~~~
jakelazaroff
The claim being made is that the authorities wanted him in jail one way or
another, because he was a gangster. Tax evasion just happened to be the charge
they could make stick.

~~~
citrablue
The counter-argument is that some authorities have always wanted to jail some
people, but haven't been able to. Capone was jailed because he was caught on
tax evasion; the mechanisms to why they looked at his tax records become lost
in the argument around causality, which I don't think is fruitful in this
context.

------
peteretep
> These precursors are controlled by the federal government ... they’d make
> medicine from poison [by using the street drugs to get back to the
> precursors]

cf: “A Simple and Convenient Synthesis of Pseudophedrine from
N-Methylamphetamine”

[https://heterodoxy.cc/meowdocs/pseudo/pseudosynth.pdf](https://heterodoxy.cc/meowdocs/pseudo/pseudosynth.pdf)

~~~
thx11389793
is this actually a legit synthesis? as a non-chemist it has the air of
plausibility, author names and quips aside.

------
rubyn00bie
I don’t know if YC proactively seeks organizations to fund but these folks
look like a pretty small potential investment with a huge social win. If ever
there was a time to “do good” with that enormous pile of capital and
connections y’all have— this might be it.

------
spaceflunky
> _“...the price of Daraprim hasn’t changed,” he said. He reached into his
> pocket and produced a handful of white pills. “I guess I better hand out
> some more,” Laufer said as he tossed the Daraprim into the audience._

I found it hard to keep reading after that. What's it called when people get
so emotional about a cause they just start acting irrationally and doing more
harm than good?

~~~
TheSpiceIsLife
I'm not sure I understand what harm was done here?

~~~
citrablue
In that moment, representing the barriers to safe and effective medicine as
something that one can throw from their pockets.

In the long term, bring drugs to people without thorough testing and
regulations. It's one thing for e.g. stage 4 cancer. It's another to let a
Vioxx get through.

Strict regulations around the development and testing of drugs exist because
no human is capable of evaluating efficacy for themselves, absent stringently
controlled testing processes.

We laugh about "snake oil salesmen", but given the amount of money in
nutriceuticals, GNC, and the like... I'd say the only damn holding back the
torrent on the unsuspecting is the FDA.

~~~
Robotbeat
They also exist because it's INSANELY profitable to be able to hold someone
hostage for their literal life. As long as the IP is tightly controlled and
the ever-stricter regulations build your moat for you, you'll make insane
money.

Look, I agree this isn't likely to be the scalable and safe solution that
solves the cost crisis. But maybe we DO need someone to throw pills out for
free just to show the absurdity of our current system. Because if it's
something you need to live and the system is built to make something
fundamentally cheap ultra-expensive, it's REALLY hard to see what this man
could be doing wrong...

~~~
citrablue
What if he is wildly successful and brings down the profitability of future
drug development by an order of 10x? And because future profits aren't as
certain, investors decide to put their money elsewhere and those drugs aren't
ever explored?

I am not suggesting this is the truth, or even a prediction. But I reject the
emotionally charged language that people use to say there are no downsides.

There are always potential downsides; it is a dangerous way of thinking to be
unable to see possible negativities and use that as certainty of a position.
Otherwise, there's just no downside to Pascal's Wager, and we all must believe
in God.

~~~
namibj
The cost of testing a drug for "human compatibility", e.g. the whole clinical
trials series, is too high due to how many quality-adjusted life years are
saved due to this. Actually, even if you just compare the money the medical
system itself wastes on overtesting, instead of using it to help people with
existing technology, you see that a lot of this clinical testing money is
spend wrong. If we can fix this fearmongering with "bad" medicine, we can
reduce the regulation for this and thus allow many more novel drugs to be
developed or to spend much less on their development.

------
jessaustin
_...Chematica’s database is currently posted on a password protected website
on the dark web. During his talk at HOPE this year, Laufer implored the
audience to help with cracking the password and releasing the data into the
world._

They're talking about an encrypted file, right? If Merck just had this posted
on "the dark web", constantly hammering them with bad passwords would probably
clue them in. Incidentally, which did Merck value more, the database or the
opportunity to keep it away from this group?

~~~
zxcmx
RAR files can be cracked offline.

~~~
jessaustin
Sure, but "password protected website" is a weird synonym for "RAR file".

~~~
nowarninglabel
It's not saying the RAR file is that. It's saying you can only get access to
the file through a password-protected website on the dark web.

~~~
jsjohnst
See my sibling comment. The article told the story slightly misworded.

------
agotterer
Michaels first HOPE talk in 2016 is really worth watching -
[https://archive.org/details/livestream-130731041](https://archive.org/details/livestream-130731041).

I was at his 2018 talk and the Vice article did an excellent job of summing it
up. Usually the HOPE videos come online a few weeks after the conference (it
was last weekend).

~~~
Something1234
I was there too. I loved his talk, but I didn't get a good picture of the file
hash or link he wanted us to download.

~~~
agotterer
This was the one I took:
[https://pasteboard.co/HwyMWYX.jpg](https://pasteboard.co/HwyMWYX.jpg)

------
dsr_
These people are Hackers.

------
anonu
This sort of reminds me of the ability to 3D print guns. Technology gets
cheaper and more efficient and ultimately democratizes access to "things"...
Physical printed items, transportation, drugs... I think we're only scratching
the surface here with this.

------
robbiep
An interesting approach to the criminal lack of healthcare to vulnerable
populations in the US (and potentially other places with third world health
systems)

~~~
briandear
Is there actually a criminal lack of medical care? What is Medicaid? Tens of
billions of dollars are going to help nobody?

~~~
JshWright
Medicaid is great[1], but it serves a relatively small fraction of the
population. I assume the parent comment is referring to the fact that most
other developed nations provide universal healthcare, at lower per capita
cost, with better outcomes and doctor/patient satisfaction ratings.

[1]:
[https://www.youtube.com/watch?v=vx1-X9wpUk4](https://www.youtube.com/watch?v=vx1-X9wpUk4)

------
scythe
The essential problem here seems to be that the FDA approval process for
medicine laboratories is impractically severe and probably represents an
instance of regulatory capture.

While this is cool, it doesn't seem to generate attention in a way that could
fix the underlying problem, except by dint of people who already know about
it. Legislators are infamously subject to undue influence from medical
companies that want to protect their oligopolies. A better hacking initiative
might work to expose and excoriate those pharmaceutical and medical device
companies which have abused the right to lobby in order to generate profits.

------
yosito
I met Michael at free software conference in Havana, Cuba in November. Didn't
know who he was at first, after one of the talks he approached me and asked me
if I wanted to get a beer. Unfortunately, I wasn't feeling well and turned him
down. Later I saw him give a talk and realized he was the EpiPencil guy. He
gave a great talk and I had the opportunity to have a few more conversations
with him. He's obviously very intelligent. But he's also a deeply empathetic
and passionate person who's giving his best effort to make the world a better
place. Super inspiring!

------
shoo
If you like pharma piracy, and dystopian science fiction, you may also like
Annalee Newitz's novel _Autonomous_
[https://www.torforgeblog.com/2017/11/15/read-the-first-
four-...](https://www.torforgeblog.com/2017/11/15/read-the-first-four-
chapters-of-autonomous-by-annalee-newitz/)

------
tfolbrecht
Love these guys, last press I saw on them was their OTS epipen, glad to hear
they aren't defunct.

------
horsecaptin
Didn't Shkreli make Daraprim available for free to anyone who couldn't afford
it?

~~~
ceejayoz
Such "patient assistance programs" are common, and they're designed to further
maximize profits at the expense of heightened insurance premiums over time.

~~~
refurb
What? Giving away free drugs causes insurance premiums to rise? How does that
work?

~~~
ceejayoz
> What? Giving away free drugs causes insurance premiums to rise? How does
> that work?

So, as an example, I'm on Stelara. It's $10,000/shot.

Their patient assistance program will, without any consideration to income,
pay up to $20,000/year of my copays/deductibles.

Why? Because the marginal cost to them of producing the shot is probably $10,
so by paying (for example) someone's $4k deductible (or even $13k, if I'm a
family on a Bronze plan) they make the remaining $36k that year off insurance.
That person might picked a cheaper option or not have taken the shots at all
if they'd had to pay the $4k out-of-pocket.

It _feels_ awesome as a patient, but that's because I'm insulated from the
enormous cost. Over time, though, it's pushing my premiums up, but in a way
that's totally disconnected (from my perspective as the patient) to the pharma
benefit I'm getting.

~~~
refurb
That’s different, that’s not free drug, that’s co-pay assistance.

Drug companies do give free drug and that doesn’t cause insurance premiums to
go up.

------
1996
> “The rhetoric that is espoused by people who defend intellectual property
> law is that this is theft,” Laufer told me. “If you accept that
> axiomatically, then by the same logic when you withhold access to lifesaving
> medication that's murder. From a moral standpoint it's an imperative to
> enact theft to prevent murder.”

Exactly what I would also say as pro capitalist but anti patent.

The article is not about anarchism. It is about not staying idle while people
can't afford drugs. The methods may be questionable, like the partnership with
dealers. But at least they try to do something.

I just hope there is a way for them to make money without legal risks

~~~
lovich
I don't see how that's a pro capitalist argument. Your not getting rid of a
monopoly on the IP, you are compelling people to give up there property to
prevent a worse evil

~~~
1996
You asked before that I clarify my arguments.

If the recipe is so secret, do not patent it. Some companies forgo patents for
that reason.

Here nobody is compelling anyone. My anti patent point just means not letting
the government enforce IP rights. In case like these, it is not just ideology
- it is morally wrong as explained in the quote.

~~~
lovich
I am fairly against IP laws as well without being capitalist. My point was
that the argument in the quote, "If you accept that axiomatically, then by the
same logic when you withhold access to lifesaving medication that's murder.
From a moral standpoint it's an imperative to enact theft to prevent murder.”
was not a capitalist argument itself.

Forcing people to give up property that was legally acquired, to avoid a worse
evil, seems more socialist than anything else to me

~~~
1996
I believe IP laws cause net loss on the economy as a whole - just like
restricting immigration.

Here, I think the pro capitalist and socialist arguments are aligned. I quoted
the argument because I felt taking the extreme of the opposing idea was quite
good

Murder is also bad because a dead person no longer participates in the economy
after the funeral. This is a loss for the economy as a whole. Even people
completely lacking any morality can understand that.

------
blhack
These people are going to kill somebody. But hey, lets do it and be legends!
Think of the instagram likes!

------
darawk
> “The rhetoric that is espoused by people who defend intellectual property
> law is that this is theft,” Laufer told me. “If you accept that
> axiomatically, then by the same logic when you withhold access to lifesaving
> medication that's murder. From a moral standpoint it's an imperative to
> enact theft to prevent murder.”

If it's murder to apply intellectual property law and withhold drugs...what do
we call the untold number of deaths that will result in the absence of a
profit motive for developing new medicines? Is that murder?

The views of these people are childish and dangerous. I love their spirit, but
their actual message here is just stupid and illiterate of basic economics.

~~~
skadamou
I see your point but I think that there is a middle ground to be struck here.
I don't think medical care and drug research can be ethically applied upon the
basis of economic motivation alone. Through this lens Laufer makes some sense.
You raise a strong and valid counterpoint however. There is currently a huge
profit motive to develop new medical treatments (so long as they are indeed
profitable). What will the effects be if we reduce that profit motive? This is
a complex question that I think requires a nuanced answer that takes into
account both our moral responsibility to take care of the sick but also
recognizes the incentives innate to human nature

~~~
darawk
Yep, totally agree. I think people get mad when they see that a cure for a
disease exists that they can't have. They don't think about the institutions
that created it in the first place. On the other hand, I think we could do a
better job at providing medicines to people who genuinely cannot pay, or
cannot obtain it for some odd reason (like the company stopped making it).

~~~
Robotbeat
The institutions that created it are VERY often government-funded.

------
eezurr
>Although the initial clinical results with cabotegravir were extremely
promising, Four Thieves grew impatient with waiting for it to become
commercially available. (The drug is currently undergoing Phase III FDA
trials, which means it’s being clinically tested on a large cohort of human
subjects.)

>After Four Thieves synthesized cabotegravir, it was just a matter of
convincing at-risk populations to use it. According to Laufer, some Four
Thieves affiliates began partnering with heroin dealers to cut their product
with the cabotegravir.

I know nothing about chemistry/medicine, but this seems stupidly dangerous.
There are good reasons to be patient and wait for drugs to go through the
phase trials.

It also seems stupidly dangerous to allow uneducated/untrained people to make
their own drugs at home by following directions. What if they unknowingly miss
a step? For instance, the article is stating that opioids are needed to create
Naloxone. That would be a costly mistake to make. They should never release
this particular recipe.

These are truly brilliant people who probably have not spent a lot of time
hanging around the average person. One reason governments and systems are in
place is to prevent the non-well-rounded geniuses from giving an untrained
mind an opportunity to make a devastating mistake.

EDIT: This reminds me of the guy who attempted to develop a nuclear reactor in
his parents shed.
[https://en.wikipedia.org/wiki/David_Hahn](https://en.wikipedia.org/wiki/David_Hahn)

~~~
phyller
It's ironic to me that some anti-control people that buck against the system
don't seem to have a problem when it's them making decisions for others.

Making the drug and trying it on yourself is one thing. Sharing it with
someone else who understands you and how you made it is somewhat similar.
Convincing random people who don't know you to take it is crossing some sort
of line, and setting up a situation where people are taking your homemade
version of a non approved medication without even knowing it is just plain
wrong. I know they are already taking heroin, but these are still people and
not your lab rats. You shouldn't be making their decisions for them about what
goes in their body.

In their do it yourself lab, what are they doing to remove stereoisomers?

~~~
ethbro
Their point that the paternalist-legal argument falls in the face of life-or-
death circumstances has merit though.

How many unprosecuted crimes have been allowed in the course of war? Because
it "had to be done"?

Prohibiting access to highly addictive narcotics? Makes some sense.

Prohibiting personal access to whatever you want to put in your body
otherwise? Not such a strong argument.

If people want to risk killing themselves trying to cure their Hepatitis C
infection, that's their business. In the same way we allow them to smoke,
drink alcohol, drive vehicles, and own firearms.

~~~
eezurr
You assume people understand the risks involved. I dont think they are capable
of understanding the risks without having a background in chemistry. It's
myopic to give uneducated people the ability to do chemistry in an
uncontrolled environment that does not have proper ventilation, disposal, and
safety/sanitary equipment.

Tobacco, alcohol, driving vehicles, and fire arms have all been regulated to
limit use to prevent as much collateral damage as possible. It's no longer
just their business when they're behind a steering wheel or holding a gun, or
smoking/drinking in public.

~~~
ethbro
That feels like banning the good because it's not perfect.

Are you comfortable with telling a heroin user using dirty needles that "We
can't allow you access to HIV retardants because we can't guarantee your
safety"?

Concern for the public is valid, but it's a slippery slope that freedom often
gets pushed down.

~~~
eezurr
That isn't a legitimate scenario. They were asking the drug dealer(s) to cut
their heroin with the drug. Now an untrained individual is responsible for
mixing in the proper dosage for their clients (for a drug that has not been
proven to be safe/work, and maybe certain ratios dont dissolve quickly enough,
or maybe smoking the heroin causes the drug to under go a molecular
transformation from the heat), which is completely uncontrollable anyways
because everyone shoots w/ different amounts and frequencies? AND assuming the
dealer cares enough to notify each of their clients? You think that is
ethical?

To answer your direct question though, yes, I am comfortable telling heroin
users they cannot have access to HIV retardants until they have been proven
safe, because you've made the false claim that this drug is actually an HIV
retardant, when in reality it is untested.

~~~
ethbro
Well, we have fundamentally different moral valuations of situations then.

------
waluigi
This owns. It's important to realize that a lot of at-risk populations that
would most benefit from medication are often the most economically
disadvantaged, and that our current healthcare system often excludes them from
the help they need. Obviously, lab-grade medication is less risky than stuff
that's been produced in a mason jar, but when the choice is between having
access to life-saving medical equipment or not, the choice is pretty clear. If
you have concerns with how this could hurt people, then the best solution
would be to make sure that everyone has access to the care they need, rather
then allocating care on the basis of how much they can afford.

