I've seen a lot of excitement about that @404mediaco piece on #FourThievesvinegarCollective's instructions for home synthesis of patented pharmaceuticals, and I get that everyone's excited that it's all cool and cyberpunk but what I feel is missing from the fediverse discussion is any consideration of safety.
https://www.404media.co/right-to-repair-for-your-body-the-rise-of-diy-pirated-medicine/
1/n
There is a legitimate reason pharmaceuticals are made in highly controlled labs not just a profit driven one, and that is the need to ensure that the reagents and solvents are free of chemical contaminants and potential pathogens, that nothing toxic is going to leach out of the equipment into the solvent, that no toxic by-products are going to be formed, that the way it's formulated into a tablet or delivery method or whatever will ensure it's released at the correct rate.
2/n
It's like the argument for legalising and regulating recreational drugs, pure mdma at a known dose is incredibly safe but people die from ecstasy tablets all the time because the production process is illegal and uncontrolled and there's no safety testing.
3/n
People _will_ die doing this. And obviously people are already dying from lack of access to unaffordable drugs, and this will result in fewer people dying overall so in that sense it's a good thing and a harm reduction measure. But this isn't something we should be celebrating you know, this is something we should be horrified as a symptom of an economic system that puts lifesaving drugs out of peoples' reach for financial reasons.
4/n
@afewbugs I expect that the people celebrating this development broadly understand and agree that it's not a true solution, and that there are significant risks.
But people have been arguing for true solutions for many years now, to complete disinterest from those in power (formally or otherwise), so I can definitely understand people just focusing on the short-term solution and its positive implications here. For them, the conversations about the systemic issues have already been had.
@afewbugs (Relatedly, I think "working on concrete ways to collectively improve the safety of DIY medicine" is a more productive endeavour than "critizing people being hopeful", even if the criticism is nominally correct)
@joepie91 I'll be completely honest I don't think DIY medicine will ever be able to attain the same safety standards as what can be produced in a well regulated pharmaceutical laboratory with proper quality control and safety testing of inputs and proper safe operating procedures.
@joepie91 So personally I think DIY medicine is a dead end and I would rather put my efforts into broadening access to the safe option than trying to fractionally improve the option that will always be worse, though I do realise in the absence of access to the safe option the substandard option is better than nothing, obviously
@afewbugs I mean "DIY" in a very broad sense, in the sense of "existing outside of the existing for-profit pharmaceutical system" - obviously there's only so much that a single individual can do, purely by constraints of time and money. But what is possible collectively?
There is probably a limit to how safe it can be made, purely because having permanent controllable infrastructure makes you a legal target for patent enforcement, and informal things are easier to get away with legally but harder to make safe. But I also doubt that there's no room for improvement at all compared to what we have now, with some collective work.
So yes, the safe options *should* be made more accessible, but I don't think it's an either/or. Fixing those systemic issues is likely going to take a very long time, and in the meantime, ideally the DIY processes would be made as safe as they can be within the constraints. But that will require expert input and collaboration to achieve.
(An additional complicating factor is that you'll find many people who believe the nominally 'proper' way to be a dead end, and that is why they prefer to focus on improving DIY processes. This sort of thing is why diversity of tactics and mutual support is important.)
@joepie91 there are a lot of different issues here about patenting of medicine and who funds drug development and how and I realise these aren't going to get fixed any time soon. The completely theoretical long term ideal I'd like to see would be a system like is used for generic drugs (those out of patent or that were never patented) being manufactured in factories that have a proper regime of safety testing of the products, safety audits, environmental safety checks on waste etc.
@joepie91 but obviously the problem right now is that the drugs people can't afford _are_ patented to so can't be made legally in a regulated factory run by a coop. But having looked more closely at the method talked about in the article it basically seems to be instructions for how to build a waterbath that will hold reactions at particular temperatures and a program that calculates theoretical biosynthesis pathways and tells you what to buy to make them. Like what I'd want to see at the
@joepie91 very minimum would be safety instructions to maintain sterility and not, say, end up injecting immunocompromised people with infectious agents, some sort of analytical method to check that you'd made what you expected in the concentration you expected so you didn't end up under or overdosing or taking something else entirely and some method of checking the inputs for contaminants and the outputs for unexpected side products - you could probably come up with a reagent-based test for
@joepie91 much of this if you were just using the setup to make the same drug over and over again, but if you were making lots of different things or using different sources of the inputs every time you'd at minimum want a mass spectrometer and they're not affordable or portable enough for individual use.
@joepie91 the way I see it, and I'm making up the numbers here out of thin air it's the relative proportions that matter, is say 10 people were going to die because they couldn't afford access to the safe drug. Making it themselves mean that only 4 people die, from contamination, infections or inaccuracies in dosing. Yes that's an improvement, 6 people saved, and yes maybe we could through a lot of work on optimising the process get that down to two people dying.
@joepie91 but it would be better still if we could save all ten of them by working on getting them access to the safe drug. there are just some processes that are too complex to do safely as individuals at home, and complex chemical synthesis is one of them
DIY medicine discussion
@afewbugs I certainly agree on the end goal :) But yeah, I *would* also like to see that 'metaphorical' reduction from 4 to 2.
Regarding the analysis - it seems that the objective is to provide a toolkit for figuring out manufacturing procedures for a wide variety of drugs, but with the expectation that any one single user of said toolkit would only be manufacturing one or a few types of drugs (and so would repeatedly carry out the same process).
In that context, would it not be viable to extend the toolkit so that it can also determine drug-specific validation mechanisms with simple/affordable tests? As opposed to a universal(-ish) tool like a mass spectrometer. Or is that not something that can be automated/assisted to the same degree as the original biosynthesis calculations?
DIY medicine discussion
@joepie91 just throwing a random caffeine tablet into the mix you'd want to check not just for concentration of caffeine specifically, but everything else in there that *wasn't* caffeine. That's where mass spec or some sort of high performance chromatography come in, you'd want to see if there's anything else in there you weren't expecting. And Everclear isn't pure ethanol, as soon as you get to a reaction more complex than dissolving something then crystallising it out
DIY medicine discussion
@joepie91 again you'd want to start looking out for that other stuff potentially turning into something unexpected too
DIY medicine discussion
@joepie91 also it doesn't say anything about how to dispose of what you're left with safely, which is going to become an issue when you're looking at more serious solvents
DIY medicine discussion
@joepie91 assuming the accuracy of the toolkit, or the database the toolkit was working from, it would theoretically be possible to have instructions for a quantification test for various potential products. But I had a look at the example instructions for caffeine extraction https://vinni.fourthievesvinegar.org/projects/NVXg2yPAKaMu and for a start the specified ingredients are Everclear and a caffeine tablet. it doesn't specify what brand of caffeine tablet, and without this assuming you were just