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"content": "\u003cp>A \u003ca href=\"https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Monday by \u003ca href=\"https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia\" target=\"_blank\" rel=\"noopener\">Human Rights Watch\u003c/a> finds that about 179,000 nursing home residents are being given antipsychotic drugs, even though they don't have schizophrenia or other serious mental illnesses that those drugs are designed to treat.\u003c/p>\n\u003cp>Most of these residents have Alzheimer's disease or another form of dementia and \u003ca href=\"https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149866\" target=\"_blank\" rel=\"noopener\">antipsychotics\u003c/a> aren't approved for that. What's more, antipsychotic drugs come with a \"\u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020272s056,020588s044,021346s033,021444s03lbl.pdf\" target=\"_blank\" rel=\"noopener\">black box warning\u003c/a>\" from the FDA, stating that they increase the risk of death in older people with dementia.\u003c/p>\n\u003cp>The study concluded that antipsychotic drugs were often administered without informed consent and for the purpose of making dementia patients easier to handle in understaffed facilities.\u003c/p>\n\u003cp>Researchers focused on six states, including California and Texas, which have the most skilled nursing facilities. They used publicly available data, along with hundreds of interviews with residents, families and state ombudsmen, the officials who deal with complaints about long term care facilities.\u003c/p>\n\u003cp>In 2012, the federal government \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html\" target=\"_blank\" rel=\"noopener\">began a \u003c/a>program to reduce the use of antipsychotic drugs in nursing homes, in partnership with the nursing home industry, and advocacy organizations. \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-02.html\" target=\"_blank\" rel=\"noopener\">Since then\u003c/a>, the use of the drugs has dropped by about a third nationwide, from 23.9 percent of residents in 2012 to 15.7 percent at the beginning of 2017. The Centers for Medicare and Medicaid Services have called for an additional 15 percent reduction by 2019 for those nursing homes that have lagged in curtailing their use of antipsychotics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the Human Rights Watch study contends that the federal government hasn't done nearly enough. It faults the government for failing to enforce \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/rights-in-snf.html\" target=\"_blank\" rel=\"noopener\">laws that exist to protect nursing home residents\u003c/a> from what are sometimes called \"chemical restraints.\"\u003c/p>\n\u003cp>An NPR investigation into the first few years of the government's program to reduce the use of antipsychotic drugs found that \u003ca href=\"https://www.npr.org/sections/health-shots/2014/12/09/368538773/nursing-homes-rarely-penalized-for-oversedating-patients\" target=\"_blank\" rel=\"noopener\">only 2 percent\u003c/a> of cases were deemed serious enough to trigger a fine.\u003c/p>\n\u003cp>The study also calls for the government to strengthen informed consent procedures and to establish minimum staffing levels, something that has long been opposed by the nursing home industry.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\" target=\"_blank\" rel=\"noopener\">The American Health Care Association\u003c/a>, which represents most nursing homes, said in a \u003ca href=\"https://www.ahcancal.org/News/news_releases/Pages/AHCA-Responds-to-Human-Rights-Watch-Report.aspx\" target=\"_blank\" rel=\"noopener\">statement\u003c/a> that the report \"does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Risky+Antipsychotic+Drugs+Still+Overprescribed+In+Nursing+Homes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A \u003ca href=\"https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Monday by \u003ca href=\"https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia\" target=\"_blank\" rel=\"noopener\">Human Rights Watch\u003c/a> finds that about 179,000 nursing home residents are being given antipsychotic drugs, even though they don't have schizophrenia or other serious mental illnesses that those drugs are designed to treat.\u003c/p>\n\u003cp>Most of these residents have Alzheimer's disease or another form of dementia and \u003ca href=\"https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149866\" target=\"_blank\" rel=\"noopener\">antipsychotics\u003c/a> aren't approved for that. What's more, antipsychotic drugs come with a \"\u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020272s056,020588s044,021346s033,021444s03lbl.pdf\" target=\"_blank\" rel=\"noopener\">black box warning\u003c/a>\" from the FDA, stating that they increase the risk of death in older people with dementia.\u003c/p>\n\u003cp>The study concluded that antipsychotic drugs were often administered without informed consent and for the purpose of making dementia patients easier to handle in understaffed facilities.\u003c/p>\n\u003cp>Researchers focused on six states, including California and Texas, which have the most skilled nursing facilities. They used publicly available data, along with hundreds of interviews with residents, families and state ombudsmen, the officials who deal with complaints about long term care facilities.\u003c/p>\n\u003cp>In 2012, the federal government \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html\" target=\"_blank\" rel=\"noopener\">began a \u003c/a>program to reduce the use of antipsychotic drugs in nursing homes, in partnership with the nursing home industry, and advocacy organizations. \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-02.html\" target=\"_blank\" rel=\"noopener\">Since then\u003c/a>, the use of the drugs has dropped by about a third nationwide, from 23.9 percent of residents in 2012 to 15.7 percent at the beginning of 2017. The Centers for Medicare and Medicaid Services have called for an additional 15 percent reduction by 2019 for those nursing homes that have lagged in curtailing their use of antipsychotics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the Human Rights Watch study contends that the federal government hasn't done nearly enough. It faults the government for failing to enforce \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/rights-in-snf.html\" target=\"_blank\" rel=\"noopener\">laws that exist to protect nursing home residents\u003c/a> from what are sometimes called \"chemical restraints.\"\u003c/p>\n\u003cp>An NPR investigation into the first few years of the government's program to reduce the use of antipsychotic drugs found that \u003ca href=\"https://www.npr.org/sections/health-shots/2014/12/09/368538773/nursing-homes-rarely-penalized-for-oversedating-patients\" target=\"_blank\" rel=\"noopener\">only 2 percent\u003c/a> of cases were deemed serious enough to trigger a fine.\u003c/p>\n\u003cp>The study also calls for the government to strengthen informed consent procedures and to establish minimum staffing levels, something that has long been opposed by the nursing home industry.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\" target=\"_blank\" rel=\"noopener\">The American Health Care Association\u003c/a>, which represents most nursing homes, said in a \u003ca href=\"https://www.ahcancal.org/News/news_releases/Pages/AHCA-Responds-to-Human-Rights-Watch-Report.aspx\" target=\"_blank\" rel=\"noopener\">statement\u003c/a> that the report \"does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Risky+Antipsychotic+Drugs+Still+Overprescribed+In+Nursing+Homes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Was the EpiPen Hack Ethical?",
"title": "Was the EpiPen Hack Ethical?",
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"content": "\u003cp>\u003cstrong>Update June 5, 2017 \u003c/strong>\u003c/p>\n\u003cp>From The New York Times Sunday: Charles Duhigg \u003ca href=\"https://www.nytimes.com/2017/06/04/business/angry-about-epipen-prices-executive-dont-care-much.html\" target=\"_blank\" rel=\"noopener noreferrer\">writes\u003c/a> that last year's outrage over Mylan ratcheting up the price of the EpiPen, so that patients\u003ca href=\"http://www.reuters.com/article/us-health-epipen-costs-idUSKBN16Y24O\" target=\"_blank\" rel=\"noopener noreferrer\"> out-of-pocket costs\u003c/a> increased by over 500 percent in a few years, has not resulted in the company lowering the price of the product. Duhigg writes:\u003c/p>\n\u003cblockquote>\u003cp>Mylan has been called out again and again over the years — by the company’s own employees, regulators, patients, politicians and the press — and hasn’t changed, even as revenue has skyrocketed, hitting $11 billion last year. The firm is a case study in the limits of what consumer and employee activism, as well as government oversight, can achieve.\u003c/p>\u003c/blockquote>\n\u003cp>Meanwhile last week, Iowa Republican Sen. Charles Grassley\u003ca href=\"https://www.grassley.senate.gov/news/news-releases/grassley-latest-estimate-taxpayers-overpaid-127-billion-epipen\" target=\"_blank\" rel=\"noopener noreferrer\"> announced\u003c/a> that the government has estimated Mylan may have overcharged Medicaid by as much as $1.27 billion for the EpiPen under the agency's drug rebate program.\u003c/p>\n\u003cp>\u003cstrong>Original post from Jan. 23, 2017\u003c/strong>\u003c/p>\n\u003cp>Should we be free, as individuals, to make and take our own medicine at home? Who’s responsible if we get hurt or die? Do we have to right to do what we wish with our bodies in the interests of survival, healing and self-care? For years, such questions have been at the heart of public health debates over euthanasia – the right to die – and even drug addiction.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They also lie at the center of the infamous Mylan EpiPen pricing scandal. Last fall, Mylan CEO Heather Bresch appeared before the House Oversight Committee to explain the company’s 548 percent price hike for a simple device that injects a lifesaving anti-allergy hormone, FDA-approved epinephrine.\u003c/p>\n\u003cp>The cost drove desperate allergy patients to seek alternatives, including \u003ca href=\"http://www.thedailybeast.com/articles/2016/09/22/please-do-not-hack-your-own-epipen.html\">the dangerous practice\u003c/a> of shooting epinephrine straight from a vial into a muscle.\u003c/p>\n\u003cp>Enter a new challenger: the pharmaceutical hacking collective \u003ca href=\"https://fourthievesvinegar.org/\">Four Thieves Vinegar.\u003c/a> The group is led by Michael Laufer, a math professor by day at Menlo College in Atherton, California, who shot to internet fame overnight last August when he uploaded a DIY instructional video that went viral, showcasing his homemade version of a copycat EpiPen he called the EpiPencil. \u003ca href=\"https://www.the-parallax.com/2016/09/19/epipencil-hack-costs-fraction-epipen-exclusive/\">His device costs around $35 to construct\u003c/a>– a fraction of Mylan’s $600 brand name dual-pack EpiPen. Anyone can make it at home for personal use, he claims.\u003c/p>\n\u003cp>Laufer isn’t a medical doctor and doesn’t pretend to be. But he’s a numbers guy, well versed in computer science, and has dipped into biology and chemistry. It took him two weeks to research and assemble the plastic components of the EpiPen, an auto injector created by a NASA researcher and marketed in 1980 for $20. Mylan later picked up the patent and has benefited from a monopoly.\u003c/p>\n\u003cfigure id=\"attachment_323237\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-323237\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg\" alt=\"Close-up of packaging used in the Epi-Pencil. \" width=\"800\" height=\"1013\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-160x203.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-768x973.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1020x1292.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1920x2432.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1180x1495.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-960x1216.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-240x304.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-375x475.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-520x659.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Close-up of packaging used in the EpiPencil. \u003ccite>(Four Thieves Vinegar Collective)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Four Thieves Vinegar is named after a folk remedy made from vinegar and spices to ward off bubonic plague. The collective is part of the fast-growing DIY Biology movement, a subculture in which tech meets pharma--a Maker Faire for bio-geeks. In the video, Laufer carefully demonstrates how anyone can do what he did: combine a cheap off-the-shelf needle injector made for diabetics that is easy to buy on the internet, and combine it with a syringe that can be preloaded with a $1 dose of epinephrine.\u003c/p>\n\u003cp>Under fire, Mylan soon released\u003ca href=\"http://newsroom.mylan.com/2016-12-16-Mylan-Launches-the-First-Generic-for-EpiPen-epinephrine-injection-USP-Auto-Injector-as-an-Authorized-Generic\"> a $300 generic of its EpiPen\u003c/a>, but that did little to quiet critics. Georgia Congressman Buddy Carter accused the company of failing to disclose the truth about its profiteering. “There is no transparency, that's the problem here,\" he declared.\u003c/p>\n\u003cp>Leaders also criticized the FDA for its slow-paced approval of generic rivals. Teva Pharmaceutical Industries failed to get approval \u003ca href=\"https://consumerist.com/2016/09/12/teva-will-try-again-to-get-fda-approval-on-epipen-competitor-by-2018/\">for its generic EpiPen\u003c/a> in late 2016, but expects approval by 2018. Meanwhile, CVS Pharmacy has just released a $109.99 generic \u003ca href=\"http://www.pharmacytimes.com/sap-news/cvs-offers-2pack-adrenaclick-for-fraction-of-epipen-price\">two-pack EpiPen called Adrenaclick\u003c/a>. At $55 a pen, it’s close to Laufer’s DIY price -- and provides consumers with a safe, FDA-approved product.\u003c/p>\n\u003cp>That’s exactly what Laufer hoped might happen. As he sees it, his EpiPencil hack was a classic example of The Emperor Has No Clothes: It revealed the actual cost of the plastic auto injector – and showed others how they could make such a device cheaply.\u003c/p>\n\u003cp>It’s a mixed victory, though. The media spotlight gained supporters for Laufer's collective, but also opened him up to criticism. “I get a lot more fan mail then hate mail,” he says, including from parents. But others sharply condemn his actions, and his hacking group’s broader mission: making medicine at home.\u003c/p>\n\u003cp>\u003cstrong>Home Pharma Hacks Raise Safety Questions\u003c/strong>\u003c/p>\n\u003cp>Shortly after Laufer’s hack, the FDA issued a strongly worded warning against its use: “Using unapproved prescription drugs for personal use is a potentially dangerous practice,” an FDA spokesperson \u003ca href=\"http://www.in-pharmatechnologist.com/Regulatory-Safety/US-FDA-warns-against-30-alternative-to-Mylan-s-EpiPen\">told\u003c/a> the website in-PharmaTechnologist. “Unapproved drugs may be contaminated, sub-potent, super-potent or counterfeit.”\u003c/p>\n\u003cp>Critics agree. Yvette d’Entremont, known as SciBabe, is a former chemist-cum-blogger who quickly labeled the EpiPen hack a potential major fail if misused. “It seems like such a bad idea,” she told the Daily Beast. “It’s all fun and games until your product gets contaminated and you get a giant abscess in your muscle.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'I believe in empowering people, in sharing information. We need to talk about alternatives to expensive medication regimens.’\u003ccite>Michael Laufer\u003c/cite>\u003c/aside>\n\u003cp>Contamination and improper dosing can happen with approved drugs too. Epinephrine is a serious drug, used to shock the heart. Laufer defends his device as safe. “In most ways it is equivalent” to Mylan’s EpiPen, he argues, pointing out that it features a safety cap like approved EpiPens, and only carries a single dose.\u003c/p>\n\u003cp>But it’s still untested. And as the father of toxicology himself, Paracelsus, famously warned: all medicine is poison at a certain dose.\u003c/p>\n\u003cp>Oncologist Ezekiel Emanuel, a bioethicist and senior fellow at the Center for American Progress, adds to the chorus of concern, cautioning strongly against using the device.\u003c/p>\n\u003cp>“We have the FDA for a reason. We want to protect the American public from dangerous drugs, which they have no ability to evaluate independently,” he says. “So now we’re going to have some guy who’s going to make a drug and a drug delivery device, put it out there -- no testing, no evaluation of whether it’s safe or effective -- and who the hell knows how many people are going to be hurt -- or not.”\u003c/p>\n\u003cfigure id=\"attachment_323239\" class=\"wp-caption aligncenter\" style=\"max-width: 678px\">\u003cimg class=\"size-full wp-image-323239\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg\" alt=\"Michael Laufer demonstrates how to lead the Epi-Pencil in a DIY video posted to YouTube.\" width=\"678\" height=\"487\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg 678w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-160x115.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-240x172.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-375x269.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-520x374.jpg 520w\" sizes=\"(max-width: 678px) 100vw, 678px\">\u003cfigcaption class=\"wp-caption-text\">Michael Laufer demonstrates the EpiPencil in a DIY video posted to YouTube. \u003ccite>(Anne-christine d'Adesky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Adds Emanuel: “In this case he may turn out to be lucky and no one’s hurt. But we don’t want that regime.”\u003c/p>\n\u003cp>He said the solution to high pharmaceutical prices was \"not this cockamamie 'let people throw drugs out there untested,'\" but to reduce the market power that drug companies rely on to set prices.\u003c/p>\n\u003cp>\"We give drug companies monopolies through the patent law, and marketing exclusivity,\" he said. \"No other country gives a monopoly and then expects good behavior on pricing.\u003c/p>\n\u003cp>\"So what we’ve done is say, 'Oh we’re giving drug companies monopoly pricing power and then we’re like shocked, shocked they're raising prices.\"\u003c/p>\n\u003cp>Margaret McLean, director of bioethics at the\u003ca href=\"https://www.scu.edu/ethics/focus-areas/bioethics/\"> Markkula Center for Applied Ethics\u003c/a> in Santa Clara, also agrees using Laufer's device could be dangerous. She herself, carries an EpiPen. It carries a higher copay than her other medicines, so she sympathizes with parents who can’t afford even generic versions. But the safety risks remain serious.\u003c/p>\n\u003cp>“There is always user error,” says McLean, citing incorrect dosing as a concern. “That is true with FDA-approved drugs too. But the error is less if I don’t have to draw up the right amount of epinephrine myself. I’m grateful for the standardization and check on the injector itself, and that the dose in there is appropriate for me.” She doesn’t want to worry about bubbles in the syringe, which are very dangerous. “There are a lot of steps here,” she says of Laufer’s DIY epinephrine device, “where sitting at home in your kitchen, never having done this before, it puts you in a higher risk category then buying it from the pharmacy.”\u003c/p>\n\u003cp>Still, she understands the urgent unmet need for affordable EpiPens. “The FDA is not able to move things through in an expeditious way, so people rightly get antsy.”\u003c/p>\n\u003cp>Perhaps surprisingly, Laufer agrees about the warnings on safety. “Chemistry is science. So, yes, it’s a concern. You have to think immediately, ‘What if it’s misused?’ But that’s a first-order reaction,” he says. “Ideologically, I believe that more access to more information is inherently better for everyone.” He supports FDA safety reviews and clinical trial tests for new drugs and devices that are marketed to consumers. But he stresses, he’s not marketing anything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We have the FDA for a reason. We want to protect the American public from dangerous drugs which they have no ability to evaluate independently.'\u003ccite>Ezekiel Emanuel, Center for American Progress\u003c/cite>\u003c/aside>\n\u003cp>Where Laufer draws a hard line – and marks his battleground -- is the domain of the private individual. “What I’m saying is, here is something you can think about... If you decide you’d like to adopt it, then that’s the whole ethic: Here is an idea, play with it, if you like -- no strings attached.”\u003c/p>\n\u003cp>\u003cstrong>More Drug Hacks On the Horizon\u003c/strong>\u003c/p>\n\u003cp>In his cramped faculty office, Laufer greets visitors with a warm smile, eager to share his mission and rebut critics who, he feels, have misperceptions about the true goals and the impact of his hacking action. Online, he looks like a steampunk rebel hero in a metal-studded leather jacket, rimless glasses shoved high on his forehead. Offline, he’s natty in a dark suit, purple tie and tie pin, and fancy abacus-shaped cuff links befitting a math geek.\u003c/p>\n\u003cp>“I believe in empowering people, in sharing information,” Laufer says, citing his hacker creed. “We need to talk about alternatives to expensive medication regimens.” He compares the need for a cheap drug delivery device like his EpiPencil to IKEA furniture: something that should be easy to make, with simple instructions for the average consumer.\u003c/p>\n\u003cp>What people do with that information is not his business, he declares. “I don’t know if anyone has built it besides me,” he says of the EpiPencil. “I don’t want to know. I believe in giving people information they can use to make important decisions about their self-care. That’s what I can offer.”[contextly_sidebar id=\"ucdOGkeG5JNKwxC6hhmw4jS3XUbH2VRU\"]\u003c/p>\n\u003cp>Anyone who copies a patented device risks running afoul of patent law. It's a form of civil disobedience with life-or-death stakes. That make it easy to justify, according to Laufer's group, whose \u003ca href=\"https://fourthievesvinegar.org/faq\">website asks\u003c/a>, \"If the choices presented to you are to die, because you cannot afford medication, or violate a copyright, which would you choose?\"\u003c/p>\n\u003cp>Four Thieves Vinegar is presently focused on “small batch” chemistry--medicines that are easy to make with at-home equipment. Laufer’s first successful hack was pyrimethamine (brand name Daraprim), a decades-old drug used to treat toxoplasmosis in AIDS, cancer and malaria patients. Turing Pharmaceuticals purchased the patent in August 2015 and, a month later, \u003ca href=\"http://www.cbsnews.com/news/generic-drug-price-increases-5000-percent-overnight/\">hiked the price for a single Daraprim pill overnight\u003c/a> by 5,000 percent, from $13.50 to $750. Turing CEO Martin Shkreli became a Big Pharma pariah. In response, Laufer made a batch of DIY Daraprim for $2 a pill. So did a group of \u003ca href=\"https://qz.com/851416/why-martin-shkreli-and-turings-daraprim-still-costs-750-in-the-us-when-australian-schoolkids-can-make-it-for-2/\">Australian high school students\u003c/a>.\u003c/p>\n\u003cp>Laufer has now set his sights on several drugs he feels urgently merit greater public access, including the\u003ca href=\"http://www.rawstory.com/2016/05/american-women-increasingly-turn-to-diy-abortion-drugs-after-gop-laws-shut-down-health-clinics/\"> abortion drugs RU-486 (Mifepristone) and Misoprostol\u003c/a>; Solvadi, a hepatitis C drug; and Glaxo’s HIV prevention pill, GSK-744. He’s keenly aware his choices remain controversial and politically charged.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Looking ahead, Laufer foresees a future of medicine more like Socrates, less like Big Pharma: “Maybe in not too long, the idea of doing chemistry on a personal and individual level and applying it to medicine will be more commonplace. I like dreaming about that.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update June 5, 2017 \u003c/strong>\u003c/p>\n\u003cp>From The New York Times Sunday: Charles Duhigg \u003ca href=\"https://www.nytimes.com/2017/06/04/business/angry-about-epipen-prices-executive-dont-care-much.html\" target=\"_blank\" rel=\"noopener noreferrer\">writes\u003c/a> that last year's outrage over Mylan ratcheting up the price of the EpiPen, so that patients\u003ca href=\"http://www.reuters.com/article/us-health-epipen-costs-idUSKBN16Y24O\" target=\"_blank\" rel=\"noopener noreferrer\"> out-of-pocket costs\u003c/a> increased by over 500 percent in a few years, has not resulted in the company lowering the price of the product. Duhigg writes:\u003c/p>\n\u003cblockquote>\u003cp>Mylan has been called out again and again over the years — by the company’s own employees, regulators, patients, politicians and the press — and hasn’t changed, even as revenue has skyrocketed, hitting $11 billion last year. The firm is a case study in the limits of what consumer and employee activism, as well as government oversight, can achieve.\u003c/p>\u003c/blockquote>\n\u003cp>Meanwhile last week, Iowa Republican Sen. Charles Grassley\u003ca href=\"https://www.grassley.senate.gov/news/news-releases/grassley-latest-estimate-taxpayers-overpaid-127-billion-epipen\" target=\"_blank\" rel=\"noopener noreferrer\"> announced\u003c/a> that the government has estimated Mylan may have overcharged Medicaid by as much as $1.27 billion for the EpiPen under the agency's drug rebate program.\u003c/p>\n\u003cp>\u003cstrong>Original post from Jan. 23, 2017\u003c/strong>\u003c/p>\n\u003cp>Should we be free, as individuals, to make and take our own medicine at home? Who’s responsible if we get hurt or die? Do we have to right to do what we wish with our bodies in the interests of survival, healing and self-care? For years, such questions have been at the heart of public health debates over euthanasia – the right to die – and even drug addiction.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They also lie at the center of the infamous Mylan EpiPen pricing scandal. Last fall, Mylan CEO Heather Bresch appeared before the House Oversight Committee to explain the company’s 548 percent price hike for a simple device that injects a lifesaving anti-allergy hormone, FDA-approved epinephrine.\u003c/p>\n\u003cp>The cost drove desperate allergy patients to seek alternatives, including \u003ca href=\"http://www.thedailybeast.com/articles/2016/09/22/please-do-not-hack-your-own-epipen.html\">the dangerous practice\u003c/a> of shooting epinephrine straight from a vial into a muscle.\u003c/p>\n\u003cp>Enter a new challenger: the pharmaceutical hacking collective \u003ca href=\"https://fourthievesvinegar.org/\">Four Thieves Vinegar.\u003c/a> The group is led by Michael Laufer, a math professor by day at Menlo College in Atherton, California, who shot to internet fame overnight last August when he uploaded a DIY instructional video that went viral, showcasing his homemade version of a copycat EpiPen he called the EpiPencil. \u003ca href=\"https://www.the-parallax.com/2016/09/19/epipencil-hack-costs-fraction-epipen-exclusive/\">His device costs around $35 to construct\u003c/a>– a fraction of Mylan’s $600 brand name dual-pack EpiPen. Anyone can make it at home for personal use, he claims.\u003c/p>\n\u003cp>Laufer isn’t a medical doctor and doesn’t pretend to be. But he’s a numbers guy, well versed in computer science, and has dipped into biology and chemistry. It took him two weeks to research and assemble the plastic components of the EpiPen, an auto injector created by a NASA researcher and marketed in 1980 for $20. Mylan later picked up the patent and has benefited from a monopoly.\u003c/p>\n\u003cfigure id=\"attachment_323237\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-323237\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg\" alt=\"Close-up of packaging used in the Epi-Pencil. \" width=\"800\" height=\"1013\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-160x203.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-768x973.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1020x1292.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1920x2432.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1180x1495.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-960x1216.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-240x304.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-375x475.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-520x659.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Close-up of packaging used in the EpiPencil. \u003ccite>(Four Thieves Vinegar Collective)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Four Thieves Vinegar is named after a folk remedy made from vinegar and spices to ward off bubonic plague. The collective is part of the fast-growing DIY Biology movement, a subculture in which tech meets pharma--a Maker Faire for bio-geeks. In the video, Laufer carefully demonstrates how anyone can do what he did: combine a cheap off-the-shelf needle injector made for diabetics that is easy to buy on the internet, and combine it with a syringe that can be preloaded with a $1 dose of epinephrine.\u003c/p>\n\u003cp>Under fire, Mylan soon released\u003ca href=\"http://newsroom.mylan.com/2016-12-16-Mylan-Launches-the-First-Generic-for-EpiPen-epinephrine-injection-USP-Auto-Injector-as-an-Authorized-Generic\"> a $300 generic of its EpiPen\u003c/a>, but that did little to quiet critics. Georgia Congressman Buddy Carter accused the company of failing to disclose the truth about its profiteering. “There is no transparency, that's the problem here,\" he declared.\u003c/p>\n\u003cp>Leaders also criticized the FDA for its slow-paced approval of generic rivals. Teva Pharmaceutical Industries failed to get approval \u003ca href=\"https://consumerist.com/2016/09/12/teva-will-try-again-to-get-fda-approval-on-epipen-competitor-by-2018/\">for its generic EpiPen\u003c/a> in late 2016, but expects approval by 2018. Meanwhile, CVS Pharmacy has just released a $109.99 generic \u003ca href=\"http://www.pharmacytimes.com/sap-news/cvs-offers-2pack-adrenaclick-for-fraction-of-epipen-price\">two-pack EpiPen called Adrenaclick\u003c/a>. At $55 a pen, it’s close to Laufer’s DIY price -- and provides consumers with a safe, FDA-approved product.\u003c/p>\n\u003cp>That’s exactly what Laufer hoped might happen. As he sees it, his EpiPencil hack was a classic example of The Emperor Has No Clothes: It revealed the actual cost of the plastic auto injector – and showed others how they could make such a device cheaply.\u003c/p>\n\u003cp>It’s a mixed victory, though. The media spotlight gained supporters for Laufer's collective, but also opened him up to criticism. “I get a lot more fan mail then hate mail,” he says, including from parents. But others sharply condemn his actions, and his hacking group’s broader mission: making medicine at home.\u003c/p>\n\u003cp>\u003cstrong>Home Pharma Hacks Raise Safety Questions\u003c/strong>\u003c/p>\n\u003cp>Shortly after Laufer’s hack, the FDA issued a strongly worded warning against its use: “Using unapproved prescription drugs for personal use is a potentially dangerous practice,” an FDA spokesperson \u003ca href=\"http://www.in-pharmatechnologist.com/Regulatory-Safety/US-FDA-warns-against-30-alternative-to-Mylan-s-EpiPen\">told\u003c/a> the website in-PharmaTechnologist. “Unapproved drugs may be contaminated, sub-potent, super-potent or counterfeit.”\u003c/p>\n\u003cp>Critics agree. Yvette d’Entremont, known as SciBabe, is a former chemist-cum-blogger who quickly labeled the EpiPen hack a potential major fail if misused. “It seems like such a bad idea,” she told the Daily Beast. “It’s all fun and games until your product gets contaminated and you get a giant abscess in your muscle.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'I believe in empowering people, in sharing information. We need to talk about alternatives to expensive medication regimens.’\u003ccite>Michael Laufer\u003c/cite>\u003c/aside>\n\u003cp>Contamination and improper dosing can happen with approved drugs too. Epinephrine is a serious drug, used to shock the heart. Laufer defends his device as safe. “In most ways it is equivalent” to Mylan’s EpiPen, he argues, pointing out that it features a safety cap like approved EpiPens, and only carries a single dose.\u003c/p>\n\u003cp>But it’s still untested. And as the father of toxicology himself, Paracelsus, famously warned: all medicine is poison at a certain dose.\u003c/p>\n\u003cp>Oncologist Ezekiel Emanuel, a bioethicist and senior fellow at the Center for American Progress, adds to the chorus of concern, cautioning strongly against using the device.\u003c/p>\n\u003cp>“We have the FDA for a reason. We want to protect the American public from dangerous drugs, which they have no ability to evaluate independently,” he says. “So now we’re going to have some guy who’s going to make a drug and a drug delivery device, put it out there -- no testing, no evaluation of whether it’s safe or effective -- and who the hell knows how many people are going to be hurt -- or not.”\u003c/p>\n\u003cfigure id=\"attachment_323239\" class=\"wp-caption aligncenter\" style=\"max-width: 678px\">\u003cimg class=\"size-full wp-image-323239\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg\" alt=\"Michael Laufer demonstrates how to lead the Epi-Pencil in a DIY video posted to YouTube.\" width=\"678\" height=\"487\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg 678w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-160x115.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-240x172.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-375x269.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-520x374.jpg 520w\" sizes=\"(max-width: 678px) 100vw, 678px\">\u003cfigcaption class=\"wp-caption-text\">Michael Laufer demonstrates the EpiPencil in a DIY video posted to YouTube. \u003ccite>(Anne-christine d'Adesky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Adds Emanuel: “In this case he may turn out to be lucky and no one’s hurt. But we don’t want that regime.”\u003c/p>\n\u003cp>He said the solution to high pharmaceutical prices was \"not this cockamamie 'let people throw drugs out there untested,'\" but to reduce the market power that drug companies rely on to set prices.\u003c/p>\n\u003cp>\"We give drug companies monopolies through the patent law, and marketing exclusivity,\" he said. \"No other country gives a monopoly and then expects good behavior on pricing.\u003c/p>\n\u003cp>\"So what we’ve done is say, 'Oh we’re giving drug companies monopoly pricing power and then we’re like shocked, shocked they're raising prices.\"\u003c/p>\n\u003cp>Margaret McLean, director of bioethics at the\u003ca href=\"https://www.scu.edu/ethics/focus-areas/bioethics/\"> Markkula Center for Applied Ethics\u003c/a> in Santa Clara, also agrees using Laufer's device could be dangerous. She herself, carries an EpiPen. It carries a higher copay than her other medicines, so she sympathizes with parents who can’t afford even generic versions. But the safety risks remain serious.\u003c/p>\n\u003cp>“There is always user error,” says McLean, citing incorrect dosing as a concern. “That is true with FDA-approved drugs too. But the error is less if I don’t have to draw up the right amount of epinephrine myself. I’m grateful for the standardization and check on the injector itself, and that the dose in there is appropriate for me.” She doesn’t want to worry about bubbles in the syringe, which are very dangerous. “There are a lot of steps here,” she says of Laufer’s DIY epinephrine device, “where sitting at home in your kitchen, never having done this before, it puts you in a higher risk category then buying it from the pharmacy.”\u003c/p>\n\u003cp>Still, she understands the urgent unmet need for affordable EpiPens. “The FDA is not able to move things through in an expeditious way, so people rightly get antsy.”\u003c/p>\n\u003cp>Perhaps surprisingly, Laufer agrees about the warnings on safety. “Chemistry is science. So, yes, it’s a concern. You have to think immediately, ‘What if it’s misused?’ But that’s a first-order reaction,” he says. “Ideologically, I believe that more access to more information is inherently better for everyone.” He supports FDA safety reviews and clinical trial tests for new drugs and devices that are marketed to consumers. But he stresses, he’s not marketing anything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We have the FDA for a reason. We want to protect the American public from dangerous drugs which they have no ability to evaluate independently.'\u003ccite>Ezekiel Emanuel, Center for American Progress\u003c/cite>\u003c/aside>\n\u003cp>Where Laufer draws a hard line – and marks his battleground -- is the domain of the private individual. “What I’m saying is, here is something you can think about... If you decide you’d like to adopt it, then that’s the whole ethic: Here is an idea, play with it, if you like -- no strings attached.”\u003c/p>\n\u003cp>\u003cstrong>More Drug Hacks On the Horizon\u003c/strong>\u003c/p>\n\u003cp>In his cramped faculty office, Laufer greets visitors with a warm smile, eager to share his mission and rebut critics who, he feels, have misperceptions about the true goals and the impact of his hacking action. Online, he looks like a steampunk rebel hero in a metal-studded leather jacket, rimless glasses shoved high on his forehead. Offline, he’s natty in a dark suit, purple tie and tie pin, and fancy abacus-shaped cuff links befitting a math geek.\u003c/p>\n\u003cp>“I believe in empowering people, in sharing information,” Laufer says, citing his hacker creed. “We need to talk about alternatives to expensive medication regimens.” He compares the need for a cheap drug delivery device like his EpiPencil to IKEA furniture: something that should be easy to make, with simple instructions for the average consumer.\u003c/p>\n\u003cp>What people do with that information is not his business, he declares. “I don’t know if anyone has built it besides me,” he says of the EpiPencil. “I don’t want to know. I believe in giving people information they can use to make important decisions about their self-care. That’s what I can offer.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Anyone who copies a patented device risks running afoul of patent law. It's a form of civil disobedience with life-or-death stakes. That make it easy to justify, according to Laufer's group, whose \u003ca href=\"https://fourthievesvinegar.org/faq\">website asks\u003c/a>, \"If the choices presented to you are to die, because you cannot afford medication, or violate a copyright, which would you choose?\"\u003c/p>\n\u003cp>Four Thieves Vinegar is presently focused on “small batch” chemistry--medicines that are easy to make with at-home equipment. Laufer’s first successful hack was pyrimethamine (brand name Daraprim), a decades-old drug used to treat toxoplasmosis in AIDS, cancer and malaria patients. Turing Pharmaceuticals purchased the patent in August 2015 and, a month later, \u003ca href=\"http://www.cbsnews.com/news/generic-drug-price-increases-5000-percent-overnight/\">hiked the price for a single Daraprim pill overnight\u003c/a> by 5,000 percent, from $13.50 to $750. Turing CEO Martin Shkreli became a Big Pharma pariah. In response, Laufer made a batch of DIY Daraprim for $2 a pill. So did a group of \u003ca href=\"https://qz.com/851416/why-martin-shkreli-and-turings-daraprim-still-costs-750-in-the-us-when-australian-schoolkids-can-make-it-for-2/\">Australian high school students\u003c/a>.\u003c/p>\n\u003cp>Laufer has now set his sights on several drugs he feels urgently merit greater public access, including the\u003ca href=\"http://www.rawstory.com/2016/05/american-women-increasingly-turn-to-diy-abortion-drugs-after-gop-laws-shut-down-health-clinics/\"> abortion drugs RU-486 (Mifepristone) and Misoprostol\u003c/a>; Solvadi, a hepatitis C drug; and Glaxo’s HIV prevention pill, GSK-744. He’s keenly aware his choices remain controversial and politically charged.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"soldout": {
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