The Four Thieves Vinegar Collective is an

anarchist Anarchism is a political philosophy and Political movement, movement that seeks to abolish all institutions that perpetuate authority, coercion, or Social hierarchy, hierarchy, primarily targeting the state (polity), state and capitalism. A ...

biohacking group founded in 2015 by Michael Laufer. They have published instructions for the "EpiPencil", an

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands a ...

autoinjector An autoinjector (or auto-injector) is a medical device for injection of a premeasured dose of a particular drug. Most autoinjectors are one-use, disposable, spring-loaded syringes (prefilled syringes). By design, autoinjectors are easy to use an ...

, and the "Apothecary MicroLab", a

do-it-yourself "Do it yourself" ("DIY") is the method of building, modifying, or repairing things by oneself without the direct aid of professionals or certified experts. Academic research has described DIY as behaviors where "individuals use raw and semi- ...

(DIY) device intended to make a variety of

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

s, most notably

pyrimethamine Pyrimethamine, sold under the brand name Daraprim among others, is a medication used with leucovorin (leucovorin is used to decrease side effects of pyrimethamine; it does not have intrinsic anti-parasitic activity) to treat the parasitic disea ...

(Daraprim). The medical community has criticized them for causing potential harm to patients with the DIY instructions, but Laufer claims to defend people's right to attempt their medical treatment.

Members

Four Thieves' membership is generally composed of technically trained people, but does not include medical professionals.

Views

Laufer has compared his work to that of

Women on Waves Women on Waves (WoW) is a Dutch nongovernmental organization ( NGO) created in 1999 by Dutch physician Rebecca Gomperts, in order to bring reproductive health services, particularly non-surgical abortion services and education, to women in coun ...

, a group that provides

abortion medication Abortion is the early termination of a pregnancy by removal or expulsion of an embryo or fetus. Abortions that occur without intervention are known as miscarriages or "spontaneous abortions", and occur in roughly 30–40% of all pregnanci ...

to women in areas where abortion is illegal. His motivation in founding the group is to provide medication to people when it is too expensive for them to afford, illegal to acquire, or unavailable due to it treating an

orphan disease A rare disease is any disease that affects a small percentage of the population. In some parts of the world, the term orphan disease describes a rare disease whose rarity results in little or no funding or research for treatments, without financi ...

. He believes that providing lifesaving medication to those who need it justifies violating the

intellectual property Intellectual property (IP) is a category of property that includes intangible creations of the human intellect. There are many types of intellectual property, and some countries recognize more than others. The best-known types are patents, co ...

rights of pharmaceutical companies, and supports

cognitive liberty Cognitive liberty, or the "right to mental self-determination", is the freedom of an individual to control their own mental processes, cognition, and consciousness. It has been argued to be both an extension of, and the principle underlying, the ri ...

History

Laufer, trained in

mathematics Mathematics is a field of study that discovers and organizes methods, Mathematical theory, theories and theorems that are developed and Mathematical proof, proved for the needs of empirical sciences and mathematics itself. There are many ar ...

, formed the group in 2008 during a

graduate school Postgraduate education, graduate education, or graduate school consists of academic or professional degrees, certificates, diplomas, or other qualifications usually pursued by post-secondary students who have earned an undergraduate (bachel ...

trip to

El Salvador El Salvador, officially the Republic of El Salvador, is a country in Central America. It is bordered on the northeast by Honduras, on the northwest by Guatemala, and on the south by the Pacific Ocean. El Salvador's capital and largest city is S ...

. While visiting a local medical clinic he learned that despite the existence of many

clandestine chemistry Clandestine chemistry is chemistry carried out in secret, and particularly in illegal drug laboratories. Larger labs are usually run by gangs or organized crime intending to produce for distribution on the black market. Smaller labs can be run by ...

labs producing

methamphetamine Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug use, recreational or Performance-enhancing substance, performance-enhancing drug and less commonly as a secon ...

and

MDMA 3,4-Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy (tablet form), and molly (crystal form), is an empathogen–entactogenic drug with stimulant and minor Psychedelic drug, psychedelic properties. In studies, it has been used ...

, the clinic was out of

oral contraceptives Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control. The introduction of the birth control pill ("the Pill") in 1960 revolutionized the options for contraception, ...

. He investigated the possibility of DIY pharmaceuticals which culminated in the founding of Four Thieves in 2015. He took the name from four thieves vinegar, a legendary plague cure. Four Thieves had formerly partnered with Chematica to develop recipes for the group's medication, but this ended and they lost access to information and software they had been given after pharmaceutical company Merck bought the startup.

EpiPencil

In 2016, after the price for an

EpiPen An epinephrine autoinjector (or adrenaline autoinjector, also known by the trademark EpiPen) is a medical device for injecting a measured dose or doses of Epinephrine (medication), epinephrine (adrenaline) by means of autoinjector technology. It ...

was raised from $57 to $318 by its manufacturer

Mylan Mylan N.V. was a global generic and specialty pharmaceuticals company. In November 2020, Mylan merged with Upjohn, Pfizer's off-patent medicine division, to form Viatris. Previously, the company was domiciled in the Netherlands, with principa ...

, Four Thieves released instructions for how to build an "EpiPencil", a homemade

that can be built for $30. It is made from three off-the-shelf parts. It has been criticized for potential danger, with Yvette d'Entremont criticizing the lack of sterility in the EpiPencil assembly. d'Entremont also highlighted the error of margin when drawing up the epinephrine could easily be misjudged, putting people's lives at risk. Theresa Eisenman, a spokeswoman for the United States

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...

, stated that using such a device is a "potentially dangerous practice". The device is not known to have actually been used.

Apothecary MicroLab

Four Thieves has released instructions for building an "Apothecary MicroLab", a DIY

controlled lab reactor In chemistry, a Controlled Lab Reactor or CLR is any reaction system where there is an element of automated control. Generally these devices refers to a jacketed glass vessel where a circulating chiller unit pumps a thermal control fluid through ...

claimed to be able to synthesize a variety of medications. The group released instructions for manufacturing

(Daraprim) from

acetonitrile Acetonitrile, often abbreviated MeCN (methyl cyanide), is the chemical compound with the formula and structure . This colourless liquid is the simplest organic nitrile (hydrogen cyanide is a simpler nitrile, but the cyanide anion is not class ...

ethyl bromide Bromoethane, also known as ethyl bromide, is a chemical compound of the haloalkanes group. It is abbreviated by chemists as EtBr (which is also used as an abbreviation for ethidium bromide). This volatile compound has an ether-like odor. Prepara ...

, and dicyandiamide with it. Laufer claims that it can also be used to make

naloxone Naloxone, sold under the brand name Narcan among others, is an opioid antagonist, a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. Effects begin within two ...

cabotegravir Cabotegravir, sold under the brand name Vocabria among others, is an antiretroviral medication used for the treatment and prevention of HIV/AIDS. It is available in the form of tablets and as an intramuscular injection, as well as in an inject ...

mifepristone Mifepristone, and also known by its developmental code name RU-486, is a drug typically used in combination with misoprostol to bring about a medical abortion during pregnancy. This combination is 97% effective during the first 63 days (9 wee ...

, and

misoprostol Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. It is taken by mouth when used ...

. Jeremiah Johnson, a researcher at the

Massachusetts Institute of Technology The Massachusetts Institute of Technology (MIT) is a Private university, private research university in Cambridge, Massachusetts, United States. Established in 1861, MIT has played a significant role in the development of many areas of moder ...

, has stated that using it would be very dangerous as it could create the wrong drug or the wrong dose.

Eric von Hippel Eric von Hippel (born August 27, 1941) is an American economist and a professor at the MIT Sloan School of Management, specializing in the nature and economics of distributed and open innovation. He is best known for his work in developing the ...

, an economist at MIT who supports DIY medication, has stated that the design could create chemical byproducts as well as or instead of the intended medication. Laufer claims that they have successfully synthesized cabotegravir, an experimental new

integrase inhibitor Retroviral integrase (IN) is an enzyme An enzyme () is a protein that acts as a biological catalyst by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme ...

, and asked

heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the Opium, dried latex of the Papaver somniferum, opium poppy; it is mainly used as a recreational drug for its eupho ...

dealers to cut their product with it in order to help lower the rates of

HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the im ...

infection among heroin users.

Abortion

In 2022, Four Thieves released detailed instructions for how to make an abortion pill, and subsequently distributed business cards at a hacker convention in

Queens, New York Queens is the largest by area of the Boroughs of New York City, five boroughs of New York City, coextensive with Queens County, in the U.S. state of New York (state), New York. Located near the western end of Long Island, it is bordered by the ...

, that were labeled "This Card is an Abortion" and had three doses of misoprostol embedded in them.

Reception

Jose Gomez-Marquez, who is researching pharmaceuticals at MIT, has stated his belief that the group is more about publicity than medication, and is concerned about the danger of unvetted information being published.

Vinay Prasad Vinayak "Vinay" Kashyap Prasad is an American hematologist-oncologist and health researcher. He is a professor of Epidemiology and Biostatistics at the University of California, San Francisco (UCSF). He is the author of the books '' Ending Me ...

, a professor of medicine at

Oregon Health & Science University Oregon Health & Science University (OHSU) is a public university, public research university, research university focusing primarily on health sciences with a main campus, including two hospitals, in Portland, Oregon. The institution was founded ...

, believes that DIY medication is "foolhardy". Jo Zayner, another biohacker, believes that the group's work is more symbolic than anything else. Chemist

Derek Lowe Derek Christopher Lowe (born June 1, 1973) is an American former professional baseball pitcher. During his career, he played in Major League Baseball (MLB) for the Seattle Mariners, Boston Red Sox, Los Angeles Dodgers, Atlanta Braves, Cleveland I ...

described the ''Vice'' magazine article on the collective as "largely bullshit". He noted that they had synthesized known substances rather than producing new ones. He also pointed out that their proposal to combat

Hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include ...

could accidentally cause treatment-resistant strains of Hepatitis C. In September 2024 Derek Lowe replied to further publicity for the group, pointing out that they don't address the fact that

Sofosbuvir Sofosbuvir, sold under the brand name Sovaldi among others, is a medication used to treat hepatitis C. It is taken by mouth. Common side effects include fatigue, headache, nausea, and trouble sleeping. Side effects are generally more commo ...

is given as part of a combination therapy or how they calculated the figure of $70 for a whole course of treatment. He also pointed out that the group doesn't address waste disposal, purification, solvents or availability of starting materials.

Legal status

Patricia Zettler, a former attorney at the FDA, believes that Four Thieves' work is legal because they are only providing information rather than drugs themselves.

References

External links

* {{official website, https://fourthievesvinegar.org Anarchist organizations in the United States Citizen science Hacker culture DIY medicine Intellectual property activism