‘Right to Repair for Your Body’: The Rise of DIY, Pirated Medicine

Hey Kaitlyn,

I've been wanting to write about Four Thieves Vinegar Collective for a long time, and am thankful I finally got the chance.

-Jason

I’ve been videochatting with Mixæl Swan Laufer for about 30 minutes about an exciting discovery when he points out that to date, the best way he’s been able to bring attention to his organization is “the old school method of me performing a bunch of federal felonies on stage in front of a bunch of people.”

I stop him and ask: “In this case, what are the felonies?” 

“Well, the list is pretty long,” he said. 

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Laufer is the chief spokesperson of Four Thieves Vinegar Collective, an anarchist collective that has spent the last few years teaching people how to make DIY versions of expensive pharmaceuticals at a tiny fraction of the cost. Four Thieves Vinegar Collective call what they do “right to repair for your body.” 

Laufer has become well known for handing out DIY pills and medicines at hacking conferences, which include, for example, courses of the abortion drug misoprostol that can be manufactured for 89 cents (normal cost: $160) and which has become increasingly difficult to obtain in some states following the Supreme Court decision in Dobbs. 

In our call, Laufer had just explained that Four Thieves’ had made some miscalculations as part of its latest project, to create instructions for replicating sofosbuvir (Sovaldi), a miracle drug that cures hepatitis C, which he planned to explain and reveal at the DEF CON hacking conference. 

Unlike many other drugs that treat viruses, Sovaldi does not suppress hepatitis C, a virus that kills roughly 250,000 people around the world each year. It cures it.

“Normally you have a virus, and your body fights it off or your body fights it to a standstill and you just have it forever, basically, and hope it remains dormant more or less,” Laufer said. “The holy grail for every virologist is to find a way to drain the viral reservoir, and Sovaldi does this. You take one pill of Sovaldi a day for 12 weeks and then you don’t have hepatitis C anymore.” 

The problem is that those pills are under patent, and they cost $1,000 per pill. 

“Literally, if you have $84,000 then hepatitis C is not your problem anymore,” Laufer said. “But given that there are other methodologies for managing hepatitis C that are not curing it and that are cheaper, insurance typically will not cover [Sovaldi]. And so we’ve got this incredible technology and it’s sitting on the shelf except for people who are ridiculously wealthy.”

Laufer with a DIY card of the abortion drug Miso

So Four Thieves Vinegar Collective set out to teach people how to make their own version of Sovaldi. Chemists at the collective thought the DIY version would cost about $300 for the entire course of medication, or about $3.57 per pill. But they were wrong. 

“It’s actually just a little under $70 (83 cents per pill), which just kind of blew my mind when they finally showed me the results,” Laufer said. “I was like, can we do the math here again?”   

I have been familiar with Four Thieves Vinegar Collective’s work since 2018, when I edited a (fantastic) feature about Laufer and the collective written by Daniel Oberhaus at Motherboard. At the time, Four Thieves had figured out how to make EpiPens and Daraprim—an HIV medication controlled at the time by “pharma bro” Martin Shkreli—for far below what they cost in the United States. Daniel began that article with a description of Laufer “throwing thousands of dollars worth of homemade medicine into a packed audience at Hackers on Planet Earth, a biennial conference in New York City.” 

Six years later, Laufer’s promotional tactics are largely the same. “It’s very vague,” he said when I asked him to list out the felonies he thought he’d be committing at DEF CON. “I’ll be on stage, handing out drugs that I made, that are under patent and not owned by me or licensed to me. When the moment comes, the list of things they can come after me with is very long because of how vaguely most of these laws are written.” 

Crucially, unlike other medical freedom organizations, Four Thieves isn’t suggesting people treat COVID with Ivermectin, isn’t shilling random supplements, and doesn’t have any sort of commercial arm at all. Instead, they are helping people to make their own, identical pirated versions of proven and tested pharmaceuticals by taking the precursor ingredients and performing the chemical reactions to make the medication themselves.

“We don’t invent anything, really,” Laufer said. “We take things that are on the shelf and hijack them. We like to take something established, and be like ‘This works, but you can’t get it.’ Well, here’s a way to get it.” 

A slide at his talk reads “Isn’t this illegal? Yeah. Grow up.” 

“I am of the firm belief that we are hitting a watershed where economics and morality are coming to a head, like, ‘Look: intellectual property law is based off some ideas that came out of 1400s Venice. They’re not applicable and they’re being abused and people are dying every day because of it, and it’s not OK,’” Laufer told me.

The Microlab

Four Thieves’ work has resonated with me since I learned about it from Daniel’s article, in part because I have seen firsthand how patents owned by Big Pharma and the American healthcare industrial complex hurt and kill people in their cold machinations. In my early 20s, I watched my best friend have to forgo several different treatments for cystic fibrosis because she couldn’t afford them or because the medication was not available in the U.S. She died when she was 25. 

At the time, a miracle drug called Kalydeco had recently been approved for use on some patients with cystic fibrosis. It cost $311,000 per patient, per year. The article I wrote about my friend’s life and how it was difficult for me to not blame the American medical system was the most emotionally difficult I’ve ever written, and even now, years later, it is hard toTK

On the phone with Laufer, I told him about what happened to my friend. He started typing while I was talking to him. “K-A-L-Y-D-E-C-O,” I spelled out for him.

“What? This is a nothing molecule,” he said, pulling up the molecular structure of the drug on Wikipedia. “Look. You’ve got two benzine rings, an NH here, a second ring with an alcohol here, and then two ammonias coming off of it. I mean, that’s so fucked. Like, you can I could make that in a weekend.” 

The Microlab at DEF CON

For the next 15 minutes, Laufer showed me how someone would theoretically make a DIY version of Kalydeco using Four Thieves’ tools. The heart of what Four Thieves has built is called Chemhacktica, a forked version of an MIT-DARPA project called ASKOS that uses machine learning to map out chemical pathways for molecule synthesis, and to suggest potential chemical reactions that would yield the molecule that you want to make. Chemhacktica is a piece of software that allows users to input the desired molecule, and it will show “possible synthesis plans,” will suggest precursor materials and will search a database to see whether it is buyable, and will show what the potential chemical reactions might look like, among other features.

Another core piece of technology Four Thieves has created and open sourced is the Microlab, an “open source jacketed lab reactor made from off-the-shelf components you can buy online.” 

The Microlab is the lab equipment (called a controlled lab reactor or CLR) that you use to actually make medicine, using the suggested reaction pathways given by Chemhacktica. Costs for the materials to build this are between $300 and $500, depending on the features you want. Four Thieves has released detailed instructions about how to build and use the Microlab, as well as software that will make it run.

“A CLR is to organic chemistry what an espresso machine is to coffee. It is possible to make coffee over an open fire with nothing more than beans, water, and a tin can,” Four Thieves explains on its website. “But you will get a better, more consistent cup of coffee from an automatic machine that dispenses the right amount of water at the right temperature in such a way that ensures the water is in contact with the grounds for the right amount of time.”

The Microlab “won’t do every single step for you,” they say. But “the Microlab is designed to load a recipe for a chemical reaction, then automate the temperature control, reagent addition, and stirring that are needed. It is designed for small-molecule organic chemistry to make certain medicinal compounds in your own home or workshop.”

Chemhacktica showing how the process of making sofosbuvir would work

Four Thieves has also released the Apothecarium, a drag-and-drop recipe system that Laufer explains as “how you generate a file that the Microlab will run,” and which gives step-by-step instructions on how to make specific medications. 

Releasing the Microlab and its software is an iterative process that Four Thieves has been working on for years, and the latest version, called .6, was released just a few weeks ago.

“It’s a new version that is very well-documented, and easier to build, and simpler in its implementation,” Laufer said. “It does everything I was dreaming of, in a way, which is, I mean, you see me smiling. I’m just amazed at all the people I get to work with and what they do.”

On the call, Laufer inputs the Kalydeco molecule into Chemhacktica and waits for the program to run.

“All right, here’s your reaction,” he says, showing me the screen. Laufer explains that both precursors needed to make Kalydeco are available commercially, and that one costs $1 per gram and the other costs $28 per gram. He checks the daily dosage (roughly 300 mg per day), and Chemhacktica spits out a potential yield. He explains that, in back-of-the-envelope math, “me, a non-chemist doing a first pass,” Kalydeco could be made “in the range of $10 a day for raw materials.” When Kalydeco was first introduced, it cost roughly $820 per patient per day.

I tell Laufer more about my friend, and about how she sometimes couldn’t afford basic medications during periods when she lost her health insurance. I explained that some treatments she wanted to try were approved for use in other countries, but not in the United States. Laufer explains that, over the years, he’s learned about so many different medications for so many different types of diseases that are either very expensive or very hard to get. 

“There are so many of these that fall into this unbelievable fucking category, where it would just take nothing to make it,” he said. “Everybody’s got a story like this, and it’s just so heartbreaking and it never gets easier … we do have happy stories, and they keep us going, but there’s a lot of heartbreakers.” 

At DEF CON, Laufer begins his talk by explaining that, a few years ago, he had a mystery illness that caused him to lose his hair and shed layers of his skin. Ultimately, he had a tumor removed.

“I don't know who needs to hear this but I'm scared too all the time of losing the health that I have. I know what it feels like,” he says. “I know what it feels like to not know what's wrong with your body and to have to go shop for a stranger who has the authority to maybe or maybe not give you what you need. I know what it feels like to know what's wrong with your body and to know what you need and to be told you can't have it because the infrastructure has failed and it's not available.”

“This is wrong,” he says. “And I hope to show you all some tools so that it doesn’t ever have to happen again … most medications, you can make a better, cheaper version of, yourself, at home.”

Throughout his talk, Laufer explains how Four Thieves was able to make cheaper versions of Daraprim, the epipen, and abortion medication. 

“Daraprim is still $750 per 50mg pill,” his presentation slides say. He holds up a full pill bottle of DIY Daraprim that he made for $80. “You want it? I’ll toss it out.” He tosses it into the audience. 

Then, Laufer explains how the collective was able to make sofosbuvir to treat Hepatitis C at an enormously cheaper price than Gilead, which makes Sovaldi. He pulls up a photo of Daniel O’Day, the CEO of Gilead, and says he has obtained O’Day’s phone number. He calls the number on stage. A woman answers.

“This is Dr. Mixæl Laufer. I’m calling from Four Thieves. He’s expecting my call,” he says. The woman goes to grab O’Day. O’Day answers the phone. “I don’t know how you got my number but please don’t call again.” He hangs up.

“Well, I tried,” Laufer tells the crowd. 

Later in the talk, he details how the team made sofosbuvir and pressed it into a small pill. He pulls some out, and hands them to members of the crowd. He shows the crowd testing Four Thieves did to show that the pills they made are, chemically, the same as Sovaldi. He takes out a pill, swallows it on stage, and pumps his fist. 

Laufer showing Sovaldi, and Four Thieves' version of sofosbuvir

Laufer swallowing a pill of Four Thieves' sofosbuvir at DEF CON

After his talk, I told Laufer that I got the sense that he actually wanted to talk to O’Day, and didn’t just want to yell at him. “I would have been interested to hear more of his perspective, because I am of the general impression that most people in most situations do what they do because they think it’s the right thing,” Laufer told me. “When you find someone doing something you think is really wrong, they’re usually dealing with a different set of assumptions and logical structure than you are. It’s not that there’s no logic. Usually people have thought it through and their manner of thought is different than yours.”

“If the science [of Big Pharma] didn’t work, I wouldn’t care what they fucking charged,” Laufer said. “The point is the science works and people can’t get it. There’s often this ‘good guy, bad guy, black-and-white disconnect that happens in the rhetoric. And I’m like, ‘No, pharmaceutical science is amazing. That’s the whole point.”

Laufer’s point is that the research that goes into making a new drug is hard, but that actually producing some of these medications after they’ve been invented is sometimes easy and inexpensive. Charging astronomical prices to people who are dying is immoral, and Four Thieves seeks to normalize the idea of making some types of medicine yourself. 

“Most people kind of cower,” he says at Def Con. “Chemistry seems hard. It seems like a specialized thing. Well, sure, if you’re doing research chemistry, that’s why there’s a PhD in it. Of course. But if you just need to operate it, similar to the difference between building a computer, and using a computer, it’s significantly easier.”

On the call, Laufer told me that, “for the first time, we are possibly at least within striking distance of our ultimate goal of being able to disband as an organization.”

“Our ultimate hope is to get to a point where we’re no longer necessary because the notion of DIY medicine, no matter anybody’s opinion of it is common enough that if it comes up in conversation, someone can say ‘Oh I’m just going to 3D print a replacement,’” he said. “Or, you know ‘there’s this migraine medication that I like, can’t get a prescription for, and it’s so expensive,’ and someone says ‘just try making that.’ I want to get to where that sort of exchange is common.”

“I can’t tell people that they should use what we make, because I don’t think that’s morally defensible,” he said. “We develop things that we think are a good idea, and the tools to make them. We leave them on the table and people can use them or not, but we’re never going to push it. I would much rather the world be like ‘We thought about this really carefully, and capitalism is here to stay.’ If people decide for themselves that ‘Look, the infrastructure does abuse us, but this is the system we like, and we like it better.’ If that’s the way it breaks, that’s the way it breaks.”