Hacker News new | comments | show | ask | jobs | submit login
The Four Thieves Vinegar Collective (vice.com)
218 points by surlyadopter 4 months ago | hide | past | web | favorite | 137 comments



> 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.


Eh, it's not as simple. From what it looks like, they're not just copying syntheses from the patent application. With this Chematica data, it seems like they were pursuing novel syntheses for a variety of drugs in order to minimize side product formation or make the synthesis easier, which is an impressive feat.

That being said, they aren't running clinical trials or evaluating drug efficacy, which is another difficult part of drug development.


You're right, they are doing something a bit novel, which is cool from a technical/hacker perspective. But clinical trials and efficacy aren't just 'another difficult part', they are the difficult part. Synthesis routes are an after-thought to any serious pharmaceutical company.


It‘s interesting to see how negative the comments are here, compared to the civil disobedience of SciHub — in fact it‘s much of the same thing.

And while there is an argument to be made about how developing new medicine costs real money, the re-investment of profits into research is around 10%, we‘re talking about a deeply corrupt industry here. And while it‘s definitely still morally questionable to clone new drugs, the case is much more clear cut for substances like epinepherine or insulin, for which the patents have long expired. If pharma corporations keep these meds at insane prices with dirty tricks like biosimilars or application patents (the equivalent of „doing X on a computer“ software patents), that‘s at least as immoral. I for one welcome these hackers for some fresh air in the market.


> It‘s interesting to see how negative the comments are here, compared to the civil disobedience of SciHub — in fact it‘s much of the same thing.

Those things are worlds apart, in my view. Pharmaceutical companies add serious value to the world. They expend enormous amounts of money researching and testing drugs, and then shepherding them through the obscenely expensive FDA approval process.

Journal publishers like Elsevier do not fund research. They don't pay the authors of the articles they publish. They add literally zero value to the ecosystem. It's honestly a modern marvel that they still exist. They provide absolutely nothing of value to the world.


Yes Big Pharma does add incredible value to the world. That is indisputable, and the drugs we have today are incredible. There are a few big questions, about the net value they provide to civilization, however.

One is where are these immense sums going that they claim to spend on developing the drugs? I can understand that many prototypical drugs don't make it to market, most likely being found to be either unsafe or ineffective by FDA trials and other strictures that are the envy of and model of the rest of the world in terms of providing value to public health. I simply do not trust the accounting that makes up these amounts claimed spent on developing many of these medicines.

Scientists and engineers are not costing these companies millions each, yet its claimed that the current cost of bringing a drug to market is almost $3 billion. There simply must be synergies in drug development that are going unreported. Are development costs going to building research centers that will be used for later drugs? Further, what is being done to reduce the costs of developing these life-saving drugs (without allowing drug risk to rise) and is this even discussed or attempted by Big Pharma?

A second question regarding their net value is how they keep costs high and maximize their take by gaming the patent system in a number of ways to avoid losing sales to generics. AstraZeneca, in 2002 altered the molecule of an existing drug (prilosec) just enough to qualify for a new drug patent (Nexium). Another more recent example was how Allergan transferred their patent rights in Restasis to a New York indian tribe (St. Regis Mohawk) and licensed it back from them , all purely as a ploy. The tribe enjoys sovereign immunity and this will protect it in disputes against generic makers. These are just two simple examples of this type of abuse.

So, I'm less than sympathetic to Big Pharma's plight when the public's growing desperation for affordable medical care leads them to infringe on these patents.


> Yes Big Pharma does add incredible value to the world. That is indisputable, and the drugs we have today are incredible. There are a few big questions, about the net value they provide to civilization, however.

Agree, although I was specifically here arguing against the notion that they are comparable to academic journals. Academic journals are the absolute economic scum of the earth. Literally beneath contempt. I don't think pharmaceutical companies are comparable, though I agree there is an argument that their net value add might be close to zero, or negative. Academic journals don't even have to be netted for their social value to go to zero.

> Scientists and engineers are not costing these companies millions each, yet its claimed that the current cost of bringing a drug to market is almost $3 billion.

Well, they do employ quite a few people. However, a big chunk of their cost is navigating the approval process. This means conducting large scale clinical trials. These get extremely expensive, and take a long time.

The overall transition probability from Phase I to approval is 9.6% [1]. So that means to get one new drug approved, you have to get 10 to Phase I. Just getting a molecule to the point of Phase I trials is quite difficult, too. I don't know how to quantify that process, but I imagine it's akin to locating a needle in a haystack.

> A second question regarding their net value is how they keep costs high and maximize their take by gaming the patent system in a number of ways to avoid losing sales to generics. AstraZeneca, in 2002 altered the molecule of an existing drug (prilosec) just enough to qualify for a new drug patent (Nexium). Another more recent example was how Allergan transferred their patent rights in Restasis to a New York indian tribe (St. Regis Mohawk) and licensed it back from them , all purely as a ploy. The tribe enjoys sovereign immunity and this will protect it in disputes against generic makers. These are just two simple examples of this type of abuse.

Here's where you're approaching a more real issue, IMO. There's a very odd sort of anti-competitive thicket that's formed between regulators, pharmaceutical companies, and most importantly, doctors. The example of Nexium you cite, for instance. You're totally right that that pharmaceutical company did that. And in my view, there should be nothing wrong with them doing that. The question we ought to be asking is: why did anyone buy it? You have two drugs, prilosec and nexium that are nearly identical. Since Nexium is on-patent, it's going to be multiples more expensive, for efficacy improvements that are marginal at best. In a competitive market, this should not happen. The pharmaceutical company shouldn't even bother to get Nexium approved, because they should know that nobody would pay 10x the price for a drug that's only a little bit better.

But for some reason this does happen. Again and again. The reasons why, as best I can triangulate, are:

1. Heavy advertising to doctors, who are not paying for the drugs themselves, and therefore are not incentivized to compare on cost.

2. Side-effect smoothening, and extreme risk aversion on the part of the FDA, insurance companies, and doctors. I don't know much about Nexium, but if I had to guess, they probably purified a stereoisomer or made some other trivial tweak to the molecule that slightly improved its side-effect profile. What this means is that for a doctor to recommend Prilosec, they are essentially saying "Hey, patient, why don't you take on a bit more risk on this prior generation medicine so that you can save some money". The doctor doesn't save any money on that pill, but he does assume some malpractice liability for the side effects of his recommendations. Hence, he's strongly incentivized to choose the drugs that are the "safest" without considering whether going from .1% risk of headaches to .01% risk of headaches is worth $1,000/month to the patient.

And in fact, this is sort of the essence of the problem with pharma, right here. Because of this incentive thicket that we're stuck in, pharmaceutical companies are very strongly incentivized to innovate at the margins of what they already have, rather than develop bold new therapies. If going from Prilosec to Nexium gets you the same return as curing cancer, why bother with a cancer cure?

[1] https://www.bio.org/sites/default/files/Clinical%20Developme...


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


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


in the face of immorality, morality stand supreme


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


Sorry but that is not a valid comparison.

Movies are for fun & profit.

Medicine is for people's health / survival and profit.

You can live without the first but without the second you'll probably die soon and maybe painful as well (depending on the first fatal desease you contract).


Equally, my personal utility gained from new innovations in the pharmaceutical space is much higher than the entertainment space. As long as the pharmaceutical industry doesn't go the way of the post-piracy entertainment industry, this is great. I don't think anyone is arguing that big pharma is perfect, but I do enjoy the fact that a lot of money goes into finding new drugs.


this is the worst analogy ever


Not really. Pixar has to render a movie before you can download it. Pfizer has to develop the medicine before you can synthesize it.


A more apt analogy would be to make the movie again, frame by frame, using different voice actors maybe and slightly changing the character looks. Sure, they are skipping over the long process of writing and refining a script, painfully planning and directing the movie over many years and then carefully editing it to perfection, but it's not quite the same as downloading the finished movie.


Most of the replies to this comment don't seem to understand that "/s" indicates sarcasm.


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...


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.


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.


I made an argument that it isn't practical, but people will still prefer the fantasy. And you are saying that "it should be lauded" without addressing any of my concerns. Doing the exact same thing I said people would do. I would be easier just to admit that you care about as much as bankers going to charity dinners.

There is no need for an anarchist collective. You can just go to a third world country an import the drugs. Or you can start a pharma company. Or you can buy proper equipment and hire experienced people. The only reason for doing it yourself, and go to hacker conferences be applauded by people with no knowledge of the subject whatsoever, is to live a fantasy that can't exist if it is effective. And there is no way to loose because ignorant people will always say you did what you could in the face of Goliath even though anyone who was competent knew what would happen.

It is all fake. Just look at every other diy initiative to date that hasn't affected big companies in the slightest. "Hackers" are still perfectly happy about their "successes" while they make six figure salaries helping the oligopoly. Because there is always a new hacker conference, online forum or meetup you can visit to feel good about yourself by excluding people who know better.

These opinions can only exist in a place where the popularity of ignorance is favored over reason. And you'll deserve each other.


“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.”


> 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?


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...


> 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.


> 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

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.


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...


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.


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.


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.


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.


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.


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.



that sounds like a magnificent startup idea that I completely lack the expertise to execute on. hopefully someone else tackles it.


> 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.


He went due to securities fraud but one could argue that, if it weren't due to the drug price thing, he could have flown under the radar, since the investors didn't lose any money.


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


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?


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.


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.


Seems like that's exactly why he's in prison, legalisms aside.


How else would they spam their Shkreli interview done when he was hip


It's a Vice article. Read it for the sensation, not the facts.


Right, that bothered me a little too.


Just goes to show.


> 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


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


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.


>“...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?


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


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.


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...


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.


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.


Throwing home made medicine in to a crowd is a bit cavalier.

Perhaps they could get their point across while acting a bit more professional?


He`s literary throwing homemade pharmaceuticals like they are candy. These drugs have side effects. They probabally haven't been tested for impurities. If someone took them they could have gotten seriously hurt. I like their ideas though(especially the DIY epi pen).


You have to keep in mind that just because there are some impurities, it is automatically dangerous. Compare the risk of not having an epi pen available when needed to the cost of keeping one stocked if you are not particularily high-risk, and you see that it doesn't make sense for the unnecessarily expensive ones. If they were cheap enough I'd keep some stocked to have handy when handlign potentially allergenic substances, just in case I happen to actually be allergic. But this <5% chance of having an allergic reaction of significance, and then figuring that only a small part is life-threatening, as well as the cost of one's live, and setting this agains the cost of keeping stock (it goes bad), it doesn't work out....


It's definitely a stunt, but I don't see it as being particularly irresponsible. Daraprim's use is quite narrow and its side effects are pretty unpleasant; nobody's going to abuse it. It's not like he's throwing handfuls of homemade Ritalin.


I think it's pretty irresponsible to throw a handful of pills with nasty side effects into a crowd.


Why, on the off chance one flies into someone’s open mouth and the surprise triggers a swallowing reflex? I wouldn’t have a lot of sympathy for an adult who ate the homemade pills a guy threw at him and then suffered serious side effects.


I'm surprised I have to argue about whether it's irresponsible to throw dangerous things into a crowd. It's irresponsible because they're dangerous.

He can't be sure what will happen with pills that people accidentally carry out on their shoes or clothing. Any pills that don't get cleaned up from the venue could be eaten by children or animals at a later date.

We're talking about a drug that we don't even let sick people buy until they've talked to a doctor and a pharmacist. Maybe someone in the crowd wrongly believes that they need it or rightly believes that they need it but doesn't know how to take it properly.

Also, if you don't have sympathy for an adult who eats homemade pills and suffers from it, then you're pretty much arguing that this whole plan is irresponsible from the start.


> if you don't have sympathy for an adult who eats homemade pills and suffers from it, then you're pretty much arguing that this whole plan is irresponsible from the start.

I have plenty of sympathy for an adult who is forced to take homemade pills to save their life. An adult who swallows random pills a stranger threw at them, not so much.


Maybe that commenter is using the same logic that distributing guns to anybody is fine, misusing guns is a personal failing.


You're really stretching to find negative consequences there.


What easy-to-reckon category do you assign the vast swathes of youths who might occasionally be easily convinced to take or buy drugs from strangers in the street?


If a stunt, then why throw away and waste potentially useful medicine like that? I understand the point he's trying to make, but the way he goes about it underlines his childish view of everything.


> If a stunt, then why throw away and waste potentially useful medicine like that?

It reinforces the point that this stuff is, in fact, extremely cheap and easy to make. The idea that prescription pills are expensive and precious is the scam that he's fighting.


...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?


It is an encrypted zip file. Not a password protected website. Not a rar. I downloaded it and ran file on it. Oddly the filename is .tar.

    $ file .reaxys.tar 
    .reaxys.tar: Zip archive data, at least v2.0 to extract
As one of the other top level comments said, the links to it are here: https://twitter.com/MichaelSLaufer/status/102263726560276889...


RAR files can be cracked offline.


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


The RAR file was posted on a “dark web” site. The password needing to be cracked is the one on the RAR file itself, not the site.

Source: I was at the HOPE talk he gave and also talked to Michael at the conference about it too.


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.


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


Michaels first HOPE talk in 2016 is really worth watching - 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).


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.


This was the one I took: https://pasteboard.co/HwyMWYX.jpg


These people are Hackers.


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.


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


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


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


I guess you’re being downvoted because it’s not “tens of billions of dollars” at all!

More like $574 billion dollars in FY2016.

https://www.kff.org/medicaid/state-indicator/total-medicaid-...


They sure aren't helping everyone.


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.


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!


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-...


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


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


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


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


> 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.


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.


The money has to be made somewhere.


> “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


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


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.


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


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.


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


> “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.


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


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).


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


Right. Because exorbitant profit is the only motivation for research.


Someone has to buy the lab equipment and pay the scientists. If you think their profit is 'exorbitant', then you should be investing in pharma. But historically and as a whole, they generate returns comparable to the rest of industry.


For all but one of the specific drugs mentioned in the article, the lab equipment and scientists were paid for a long long time ago.

One is a common hormone produced in the human body that was isolated over 120 years ago and has been used for medicinal purposes almost as long.

Another was discovered in 1952 and has been used in medicine since 1953.

Another was patented in 1961 and approved by the FDA in 1971.

The two related to abortion were developed in 1973 and 1980, respectively.


You make a good point here. I think the article should have discussed this a bit, I made the assumption that they were cavalierly trying to copy drugs currently under patent. If that is not the case, I mostly retract my criticism of them. Thanks for pointing this out.


> If you think their profit is 'exorbitant', then you should be investing in pharma.

is not necessarily true. Expected future returns are already priced into stock of incumbents.


You're correct. But look at their PE multiples and their margins. They're not wildly out of line with other companies.


Returns comparable. That doesn't mean the rest of the money is all lab equipment. Pharma ends up poaching work developed at Universities.


Well if we could just rich people to find their projects.

/s


Ok. Let's imagine a world where he achieves his dream. We've democratized access to molecular synthesis with no quality issues. Anyone, anywhere can safely and effectively produce any medicine of their choosing, without regard for IP laws.

Now what? Well, on the one hand, everyone on earth will have cheap, timely access to every medicine that currently exists. That's pretty awesome. On the other hand, who's going to fund the development of new medicines? I'm certainly not going to invest in it, are you?


A large proportion of pharmaceutical development is funded (directly or indirectly) by public funds. There's a very strong argument that single-payer healthcare systems should issue a blanket moratorium on buying new patented medicines and direct the funds to research. Major pharmaceutical companies spend significantly more on marketing than on R&D, so it'd be a net win for the taxpayer if they just paid for drug development directly.


Nice idea. Why don't single-payer healthcare systems (the ones who are already enlightened, compared to the backward USA, right?) fund that research today?

If pharma geniuses couldn't make a fortune in pharma, would they work for the government on the Federal wage scale, or would they go to coding bootcamp (which they could easily thrive at, based on the biochem->coding converts I know) and go work for Facebook?


> Nice idea. Why don't single-payer healthcare systems (the ones who are already enlightened, compared to the backward USA, right?) fund that research today?

They (and even our multi-payer system) already do. See: Public universities, NIH grants, etc.


Those two sources pay for a fraction of what goes into R&D at private companies.


because some people want to save lives, rather then enslaving them. If you think working at facebook is the pinnacle of human achievement, I respectfully request you consider where we are, and how many humans around you are suffering.


Then why are those people working at for-profit pharma companies? They can go start a non-profit one right now. They could do research.


Well, I can think of a few countries that might find it worthwhile to invest in the health of their citizens. In America we’ll have to make it part of the department of defense in order to get it funded.


Yes, socialized funding is a viable, serious option. There's reasons to be skeptical of the results it would produce IMO, but it's definitely a legitimate proposal.


I suppose for the same reason people still create movies, despite the fact that they are easily copied and expensive to produce.


If you want your medicine quality to go from hollywood blockbuster to home movie, I guess that's viable :).


What OP is saying is that movies are already copyable and yet blockbusters are still being made.


He edited his post. It said something a bit different originally. But to your point, drugs are a pretty different animal. A lot of drugs have a relatively niche market. Take the Hep C cure, for instance. The company that sells it charges something like $80,000 for it, which seems exorbitant to a lot of people.

But how much did it cost them to develop that drug? To get it through the FDA approval process? Their breakeven price on that drug is definitely in the tens of thousands per dose, before you get to any profit. Which means that at a minimum, they're charging $10,000/dose. In the case of movies, sure, i'll pay for netflix because it's more convenient than torrenting, because Netflix costs $10. If Netflix tried to raise their prices to $10,000/month, i'm going to start torrenting again.


RoI may go beyond financial measures for some of us.

I'd invest even if the only yield is longer/better life rather than $.

More $ - not terribly important beyond a threshold.

Longer/better life - yeah, that's important no matter how much money I have.


Sure. But in order to understand this, think about your own personal finances. Not theoretical super-rich you - current actual you. Are you going to buy the stock of a pharmaceutical company that develops drugs that aren't profitable? I'm not. And what that means is that companies developing unprofitable drugs don't get funding.


Yes I agree with you. Apparently it wasn't obvious from my /s, but the entire narrative around this is absurd.

There are people in this thread who seem to be both decrying capitalism, and also asking that extremely rich venture capitalists fund the projects with their riches.

It's absurd. Capitalism has given us the most prosperous, longest living, most peaceful grouping of people in the history of mankind. The drugs these people are synthesizing exist BECAUSE of capitalism.


>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


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?


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.


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.


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.


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.


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


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.




Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact

Search: