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https://motherboard.vice.com/en_us/article/43pngb/how-to-make-your-own-medicine-four-thieves-vinegar-collective

Meet the Anarchists Making Their Own Medicine


The Four Thieves Vinegar Collective is a network 
of tech-fueled anarchists taking on Big Pharma with DIY medicines.

The first time I encountered Michael Laufer, he 
was throwing thousands of dollars worth of 
homemade medicine into a packed audience at 
Hackers on Planet Earth (HOPE), a biennial conference in New York City.

“Does anyone here suffer from anaphylactic shock 
and not have access to epinephrine?” Laufer asked 
the audience. A few hands went up and Laufer 
stuffed a homemade EpiPen into one of them. 
“That’s one of the original ones we made,” he said. “Use it well.”
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After a few minutes of gloating about 
<https://www.vice.com/en_us/article/xw79pk/where-is-martin-shkreli-now-prison-fort-dix-new-jersey>pharma 
bro Martin Shkreli “rotting at Fort Dix” for 
raising the price of Daraprim, a lifesaving HIV 
medicine, from $13 to $750, Laufer grew serious. 
“It’s been two years, but despite everything 
that’s happened, 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.

With a shaved head, dark beard, and an 
ever-present camo jacket, Laufer doesn’t look 
like the type of person you’d seek out for 
medical advice­but that’s exactly his point. As 
the founding member of 
<https://fourthievesvinegar.org/>Four Thieves 
Vinegar, a volunteer network of anarchists and 
hackers developing DIY medical technologies, 
Laufer has spent the last decade working to 
liberate life-saving pharmaceuticals from the 
massive corporations that own them. Laufer has no 
formal training in medicine and he’ll be the 
first to tell you he’s not a doctor. In fact, 
from a regulatory standpoint he’s more qualified 
to do mathematical work on nuclear weapons than 
treat patients. But Laufer’s never really been 
the type to let rules and regulations stand in his way.

I met Laufer at a bar across the street from HOPE 
after he finished his talk on DIY medicine. He 
was meeting with his Four Thieves collaborators 
who had flown in from all over the country to 
attend the conference and unveil the new medical 
technologies under development by the collective. 
Laufer kicked off the celebration with a toast.
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“A toast to the dead, for children with cancer 
and AIDS,” Laufer said, raising a glass of 
bourbon and 
<https://www.youtube.com/watch?v=USL3toR8grw>quoting 
the hip hop artist Felipe Andres Coronel, better 
known as Immortal Technique. “A cure exists, and 
you probably could have been saved.”

In the last decade, Four Thieves has run afoul of 
the Food and Drug Administration, billionaire 
pharma executives, doctors, and chemists at some 
of the United States’ most prestigious 
universities. 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.

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. In response, 
Four Thieves published the instructions for a DIY 
epipen online that can be made for 
<https://fourthievesvinegar.org/blog/2016/09/introducing-the-epipencil>$30 
in off-the-shelf parts and reloaded for $3. 
Shkreli drove the price of the lifesaving HIV 
medicine Daraprim sells up to $750 per pill. So 
Four Thieves developed an open source portable 
chemistry lab that allows anyone to manufacture 
their own Daraprim for just 25 cents apiece.

The pharmaceutical industry is valued 
at<https://www.statista.com/topics/1719/pharmaceutical-industry/> 
$446 billion in the US and its walls are tightly 
policed by regulatory agencies like the FDA and 
Drug Enforcement Administration. By freely 
distributing plans for medical devices and 
pharmaceuticals, a loose collective of anarchists 
and hackers is threatening to pull the rug out 
from under one of the most regulated and 
profitable industries in the world. And they’re just getting started.
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FREE DRUGS

Four Thieves claims to have successfully 
synthesized five different kinds of 
pharmaceuticals, all of which were made using 
MicroLab. The device attempts to mimic an 
expensive machine usually only found in chemistry 
laboratories for a fraction of the price using 
readily available off-the-shelf parts. In the 
case of the MicroLab, the reaction chambers 
consist of a small mason jar mounted inside a 
larger mason jar with a 3D-printed lid whose 
printing instructions are available online. A few 
small plastic hoses and a thermistor to measure 
temperature are then attached through the lid to 
circulate fluids through the contraption to 
induce the chemical reactions necessary to 
manufacture various medicines. The whole process 
is automated using a small computer that costs about $30.

To date, Four Thieves has used the device to 
produce 
<https://fourthievesvinegar.org/download>homemade 
Naloxone, a drug used to prevent opiate overdoses 
better known as Narcan; Daraprim, a drug that 
treats infections in people with HIV; 
Cabotegravir, a preventative HIV medicine that 
may only need to be taken 
<http://www.natap.org/2013/CROI/croi_38.htm>four 
times per year; and mifepristone and misoprostol, 
two chemicals needed for pharmaceutical abortions.

Given the Trump administration’s 
<https://www.reuters.com/article/us-usa-court-abortion/top-supreme-court-candidates-views-on-abortion-under-scrutiny-idUSKBN1JT2BF>candidates 
for Justice Anthony Kennedy’s seat on the Supreme 
Court, the collective feels an increasing sense 
of urgency to perfect its abortion drugs. They 
fear that the federal government will soon allow 
states to choose whether or not abortions can 
legally be offered and many residents will be 
left without any recourse to abort a pregnancy. 
This was a motivating factor for Tim Heilers, a 
former Navy sonar technician from Louisville, to 
join Four Thieves last February.

“Kentucky is a very conservative state and I 
think we have a very real possibility of becoming 
the first state with no abortion access 
whatsoever,” Heilers told me. “Giving people the 
ability to make mifepristone if they need it is 
something I think is very important.”
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Although Four Thieves has successfully produced 
five drugs, so far only the Daraprim is available 
for download on the collective’s website. This is 
partly due to the disparities in how hard the 
various molecules are to produce. Naloxone, for 
example, is particularly challenging because the 
antidote to opiate overdoses uses the same 
precursors as the opiates themselves. These 
precursors are controlled by the federal 
government and only allowed to be possessed by 
approved labs in small doses. To get around this 
issue, Laufer and his collaborators adopted a 
seemingly counterintuitive protocol: They’d make medicine from poison.

Even though they couldn’t legally buy the 
Naloxone precursors, Laufer realized that the 
opiates themselves are remarkably easy to obtain. 
After obtaining oxycontin on the street, 
collective members were able to perform a few 
chemical reactions to extract the necessary 
precursors from the drug and used them to make the Naloxone.

"Would you rather break the law and live, or be a 
good upstanding citizen and a corpse?”

“Some very clever drug dealers in the 90s 
discovered that you can do a one shot reaction 
[with oxycontin] and get oxymorphone, which is 
something like six times as powerful,” Laufer 
said. “You can make Naloxone from oxymorphone in 
one step. It’s fairly easy and now you’ve made medicine from poison.”

These sorts of unorthodox approaches to 
healthcare are the name of the game in pharma 
hacking, where the goal is to help people at any cost.

There’s a drug called cabotegravir, for instance, 
which is a pre-exposure prophylactic that has 
been demonstrated to 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263045/>prevent 
the spread of HIV through shared needles in 
macaques. Unlike other pre-exposure prophylactics 
that need to be taken daily, cabotegravir may 
only need to be taken 
<http://www.natap.org/2013/CROI/croi_38.htm>four 
times per year to protect the user from HIV. 
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 
<https://aidsinfo.nih.gov/drugs/513/cabotegravir/0/patient>currently 
undergoing Phase III FDA trials, which means it’s 
being clinically tested on a large cohort of 
human subjects.) Moreover, based on other 
pre-exposure prophylaxis drugs, cabotegravir 
would almost certainly be sold at an exorbitant 
cost­Truvada, a comparable drug that needs to be 
taken daily, 
<https://www.npr.org/sections/health-shots/2018/06/30/624045995/rising-cost-of-prep-a-pill-that-prevents-hiv-pushes-it-out-of-reach-for-many>costs 
around $2,000 for a 30-day supply. So the group 
figured out how to make it themselves.

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. This would ensure that users would 
receive a regular dose of the preventative 
medicine every time they used heroin.

“Their heroin has a new side effect,” Laufer 
said. “You don’t get HIV from it any more.”

Clearly, Four Thieves Vinegar Collective walks a 
fine line when it comes to the legality of their 
enterprise. Although Laufer has turned subversion 
of the medical industry into an artform, 
litigation remains a perennial threat to his 
mission to liberate medicine. When a 
pharmaceutical company manufactures a new drug, 
they own the patent on the molecules that make 
the drug effective. Nevertheless, Laufer and his 
colleagues are able to reproduce these molecules 
because they are described in patent filings and 
often in academic journals. All it takes is the right technology.

Since Four Thieves isn’t actually selling or 
distributing the medicines made by its members, 
what they're doing isn’t technically illegal in 
the eyes of the FDA, even though the agency has 
issued a public warning about the collective’s 
DIY methods. Shortly after Four Thieves unveiled 
its $30 DIY epipen, the FDA issued a 
<https://www.in-pharmatechnologist.com/Article/2016/09/22/US-FDA-warns-against-30-alternative-to-Mylan-s-EpiPen>statement 
to the media that said “using unapproved 
prescription drugs for personal use is a 
potentially dangerous practice,” but didn’t refer 
to Four Thieves by name. Ironically, only a few 
months later, the FDA 
<https://www.nytimes.com/2017/09/07/health/epipen-fda-malfunction.html>issued 
a warning letter to Pfizer for failing to 
investigate “hundreds” of complaints about epipen 
failures, some of which resulted in the death of 
the user. In May, the FDA 
<http://fortune.com/2018/05/09/epipen-shortage-fda/>issued 
another warning that declared a chronic epipen shortage.
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As for the DEA, none of the pharmaceuticals 
produced by the collective are controlled 
substance, so their possession is only subject to 
local laws about prescription medicines. If a 
person has a disease and prescription for the 
drug to treat that disease, they shouldn’t run 
into any legal issues if they were to manufacture 
their own medicine. Four Thieves is effectively 
just liberating information on how to manufacture 
certain medicines at home and developing the open 
source tools to make it happen. If someone 
decides to make drugs using the collective’s 
guides then that’s their own business, but Four 
Thieves doesn’t pretend that the information it 
releases is for “educational purposes only.”

“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.”

“So yeah, we are encouraging people to break the 
law,” Laufer added. “If you're going to die and 
you're being denied the medicine that can save 
you, would you rather break the law and live, or 
be a good upstanding citizen and a corpse?”


DOCTORS WITHOUT ORDERS

The catalyst for Four Thieves Vinegar Collective 
was a trip Laufer took to El Salvador in 2008 
when he was still in graduate school. While 
visiting a rural medical clinic as part of an 
envoy documenting human rights violations in the 
country, he learned that it had run out of birth 
control three months prior. When the clinic 
contacted the central hospital in San Salvador, 
it was informed the other hospital had also run 
out of birth control. Laufer told me he was 
stunned that the hospitals were unable to source 
birth control, a relatively simple drug to 
manufacture that’s been around for over 
half-a-century. He figured if drug dealers in the 
country were able to use underground labs to 
manufacture illicit drugs, a similar approach 
could be taken to life-saving medicines.
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Laufer started the collective shortly after he 
returned from Central America, but its existence 
was only made public at HOPE in 2016. During his 
first talk at the hacker conference, Laufer 
demoed the group’s $30 DIY “EpiPencil,” 
distributed some homemade Daraprim to the 
audience, showed off an early prototype of the 
MicroLab, and gave Martin Shkreli a call on stage 
(he didn’t answer.) When Four Thieves began, 
Laufer was mostly working by himself. Now that 
it’s emerged from the underground, the group is 
much larger, although Laufer said it’s impossible 
to know its actual size­members come and go as 
they please, contributing as much knowledge and time as they can.

Everyone I spoke with at Four Thieves comes from 
a technical background, but none of them were 
medical professionals. Laufer, for instance, has 
a background in nuclear physics and is the 
director of the math program at Menlo College in 
Silicon Valley for his day job. The result of 
Four Thieves’ diverse pool of technical expertise 
speaks for itself. The collective now has 
independent biology, chemistry, data science, 
programming, and hardware teams whose degree of 
collaboration is dictated by the project at hand.

Four Thieves doesn’t sell anything, but the 
collective has two core ‘products.’ The first is 
open source hardware like the epipencil and 
MicroLab chemical synthesizer, which can be made 
from off-the-shelf and 3D printed components. The 
second is the instructions for how to use these 
tools to produce the drugs, which includes 
everything from how to use the MicroLab to 
perform simple reactions to how to procure chemical precursors.
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“I think it’s absolutely imperative that 
information about how to make your own medicines 
should be as easily accessible as possible to 
everyone who might have even a passing interest,” 
Laufer told me. “The goal of the group is to make 
it possible for people to be able to do these 
things on their own. The idea that someone could 
download the instructions, read the list of 
materials, order them, read the instructions for 
how to assemble it and program it, upload the 
code, order precursor chemicals, and then manufacture medicine.”

All of Four Thieves’ tools were developed on a 
virtually non-existent budget­the only money the 
collective has is whatever its members supply out 
of their own pockets­and so far the medicines 
they have produced haven’t killed anyone. Yet 
some experts caution against taking medicines 
produced by DIY tech that hasn’t been sufficiently vetted.


HARM REDUCTION

Eric Von Hippel, an economist at MIT that 
researches “open innovation,” is enthusiastic 
about the promise of DIY drug production, but 
only under certain conditions. He cited a pilot 
program in the Netherlands that is exploring the 
<https://www.nature.com/articles/nbt.3888>independent 
production of medicines that are tailor made for 
individual patients as a good example of safe, 
DIY drug production. These drugs are made in the 
hospital by trained experts. Von Hippel believes 
it can be dangerous when patients undertake drug production on their own.

“If one does not do chemical reactions under 
just-right conditions, one can easily create 
dangerous by-products along with the drug one is 
trying to produce,” von Hippel told me in an 
email. “Careful control of reactor conditions is 
unlikely in DIY chemical reactors such as the 
MicroLab design offered for free by the Four Thieves Vinegar Collective.”
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His colleague, Harold DeMonaco, a visiting 
scientist at MIT, agreed. DeMonaco suggested that 
a more rational solution to the problems 
addressed would be for patients to work with 
compounding pharmacies. Compounding pharmacies 
prepare personalized medicine for their customers 
and DeMonaco said they able to synthesize the 
same drugs Four Thieves is producing at low 
costs, but with “appropriate safeguards.”

“Unless the system is idiot proof and includes 
validation of the final product, the user is 
exposed to a laundry list of rather nasty stuff,” 
DeMonaco told me in an email. “Widespread use [of 
Four Thieves’ devices] would provide an entire 
new category for the Darwin Awards.”

Von Hippel and DeMonaco were in agreement that 
the ability to purify DIY drugs and run quality 
control tests on the final product is paramount 
for their safe use by patients. Von Hippel 
suggested that scientists with a background in 
medicinal chemistry will be necessary to address these issues in DIY pharma.

“I see Michael Laufer’s activities as a valuable 
form of social activism that points the way to a 
promising future,” von Hippel said. “But I think 
the equipment and the medicinal science issues 
have to be much further developed before DIY medicine production will be safe.”

In a way, Four Thieves is just doing a 
small-scale version of what many hospitals are 
doing already. Faced with rising drug prices and 
shortages, many hospitals have 
<https://www.nytimes.com/2018/01/18/health/drug-prices-hospitals.html>started 
to manufacture their own medicines on site to 
save costs. The difference, however, is that 
these hospitals often have access to 
sophisticated laboratories and trained medical 
personnel, which significantly lowers the risk of something going wrong.
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Four Thieves isn’t naive about the risks of 
providing the documentation to allow others to 
make their own medicine. It’s always possible 
that someone follows the group’s instructions 
incorrectly and inadvertently produces a toxic 
chemical. Yet there are ways to reduce the 
likelihood of this happening and one of Four 
Thieves’ most significant contributions to DIY 
medicine is prioritizing harm reduction in its research and development.

There’s more than one way to produce a given 
molecule and some synthesis pathways are simpler 
or allow for far greater margins of error than 
others. Thus Four Thieves aims to discover 
synthesis pathways that lower the risk of toxic 
reactions to the lowest possible level. When the 
collective was first starting out, they had help 
doing this from a startup called Chematica, which 
had collected 250 years of research on organic 
chemical synthesis into a database and developed 
software that used this data to predict and 
create new synthesis pathways to desired 
molecules. With this database and software, Four 
Thieves was able to create simple and safe 
synthesis pathways that would produce life-saving drugs.

This worked great until 
<https://www.chemistryworld.com/news/merck-kgaa-to-buy-chematica/3007276.article>Chematica 
was bought by Merck, an international 
pharmaceutical giant, last year. After the sale, 
Four Thieves lost access to the software and, 
more importantly, the database. Laufer told me 
that the Four Thieves data science team has 
created an open source version of Chematica’s 
software and has even compiled a small database 
of organic chemicals to test it on. The software 
is crude compared to Chematica’s, but Laufer said 
that it works well enough. To improve the 
software, however, the collective needs more 
data, which is now the property of Merck.
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But as any hacker knows, sometimes data “falls 
off a truck,” which is a nice way of saying that 
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. 
Getting access to Chematica’s data on synthesis 
pathways would blow open the door for a new suite 
of DIY medicines, but until then it’s going to be pretty slow going.


THE FUTURE OF DIY MEDICINE

The most expensive drug on the market is called 
<https://www.thebalance.com/the-8-most-expensive-prescription-drugs-in-the-world-2663232>Glybera 
and is used to treat familial lipoprotein lipase 
deficiency, a hereditary disease found in 
<https://ghr.nlm.nih.gov/condition/familial-lipoprotein-lipase-deficiency#statistics>only 
about 7,000 people worldwide. Lipoprotein lipase 
deficiency prevents the normal breakdown of body 
fats, which results in abdominal pains, acute 
pancreatitis, enlarged livers and kidneys, and 
the buildup of fat deposits under the skin. 
Glybera helps treat these symptoms and is 
critical to the quality of life of those with 
FLLD. The only catch is the medicine costs each 
patient $1.2 million per year­if it’s even 
available to them. In 2017, UniQure, the company 
that produces Glybera, 
<http://uniqure.com/GL_PR_Glybera%20withdrawal_FINAL_PDF.pdf>stopped 
selling the drug in Europe due to the extremely 
limited demand. This means that the approximately 
<https://www.thebalance.com/the-8-most-expensive-prescription-drugs-in-the-world-2663232>1,200 
Europeans with FLLD are out of luck when it comes to treatment.

The situation is more or less the same for those 
afflicted with other orphan diseases, which are 
defined as conditions that affect 
<https://www.fda.gov/drugs/resourcesforyou/consumers/ucm143563.htm>fewer 
than 200,000 people worldwide. If a drug for the 
disease exists, it is generally 
<https://www.thebalance.com/the-8-most-expensive-prescription-drugs-in-the-world-2663232>prohibitively 
expensive to obtain. If the company doesn’t see 
enough demand for its product, it will likely 
pull it from the market. So for many rare 
diseases, a cure or palliative medicine may exist 
but is too expensive for patients or not 
profitable enough to put on the market.
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In the future, Laufer wants Four Thieves to focus 
on manufacturing drugs for orphan diseases so 
that those with rare conditions will never be 
without their medicine. Yet these types of 
medicines come with their own unique problems.

For instance, Laufer said that many of the 
medicines for orphan diseases are made of 
biological material, such as fungus. Laufer said 
that Four Thieves is working to create a 
BioTorrent site to distribute the organic 
material need to manufacture orphan medicines. 
BioTorrent would be like a normal file sharing 
site like the PirateBay, but instead of 
downloading music and movies, people could 
download instructions for how to synthesize their 
own medicine and share the organic material among 
one another. Since biological cells are 
self-replicating, this would simply require one 
user to grow a sufficient amount of cells for 
themselves before shipping some cells to another 
user who would repeat the process, similar to the 
way people ‘seed’ a media file on torrent sites.

The question, then, would be how to ship the 
biological material cheaply and without getting 
caught. To this end, Four Thieves is 
investigating the use of books and CD cases as 
grow media for biological precursors. Mycelia are 
basically the ‘roots’ of many fungi and feed on 
cellulose, which is found in abundance in the 
pages of a book. So Laufer and his collaborators 
began injecting books with mycelium, which feed 
upon the pages and grow out of the book. 
Similarly, compact discs are similar enough to 
petri dishes that if they’re streaked properly 
they can be used as a growth medium for bacteria 
and other biological precursors. The advantage of 
this is that Four Thieves members using the 
BioTorrent site could ship these cells using the 
cheaper 
“<https://about.usps.com/notices/not121/not121_tech.htm>media 
rate” charged by the US Postal Service for items 
like books and compact discs while avoiding scrutiny from law enforcement.
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In the meantime, however, Four Thieves is still 
mostly focused on improving its MicroLab and 
synthesizing new medicines. Recently the 
collective began producing its own custom circuit 
boards for the MicroLab, which will make it even 
easier to set up the device at home. Laufer said 
he plans to begin giving these circuit boards 
away as early as next month. At the same time, 
the group is working on perfecting the synthesis 
of Solvadi, a one-time treatment that can cure 
Hepatitis C. This drug has been on the market for 
nearly five years, but its $84,000 price tag 
<http://www.latimes.com/opinion/op-ed/la-oe-stone-solvadi-drug-pricing-20160705-snap-story.html>makes 
it inaccessible to many people who need it. If 
Four Thieves has its way, Hepatitis C will soon 
be a thing of the past for everyone, regardless of their income.

At a time when many Americans lack even basic 
health care services, Laufer’s ideas seem as 
intuitive as they are radical. His work is 
predicated on the notion that too many critical 
decisions about our health have been outsourced 
to private actors who care more about their 
bottom line than their customers’ well being. For 
Laufer, Four Thieves is as much about medicine as 
it is about the right to the free flow of 
information and personal autonomy. As far as he's 
concerned, one cannot exist without the 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.”


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