 Here's a toast to the dead, for children with cancer and AIDS, a cure exists and you probably could have been saved. Sad to see medicine divorce morality, corporate home records, pimping up for salaries. Friends, fellow hackers, biohackers, and friends of 4th Eves Vinegar, this is Michael Laufer recording for you from a secure, undisclosed location and don't worry, we'll actually have a live Q&A after this session, so I will be available and excited to chat with all of you. I am Chief Spokesperson for the 4th Eves Vinegar Collective and I do want to emphasize the fact that we are collective, often times it gets forgotten because the many people who do the work for this are in the shadows, they have to for understandable reasons keep themselves safe and can't be known to the public but there are so many people who work on the 4th Eves projects and there are so many teams who do so much amazing work and I just want to emphasize that it really does take a village and when you're going for a project like this it takes a lot of people with a lot of expertise and I just want to recognize how amazing all of these people that I'm lucky enough to get to work with are and maybe some of you out there will be inspired to come and help us because you can always use more people with great talents. So I want to go through and talk about some of the things that we have coming up. I can't talk about all of them of course we have about eleven different projects on the boards but I'd like to talk about three or four of them and specifically how they connect and relate to our main mission, our main mission being that we look to develop ways that people can get access to medicines and medical technologies without having to interface with the medical infrastructure, do-it-yourself methodologies which of course rings with the hacker spirit. First thing I want to chat about is drug delivery methodologies. Now we often sort of forget about this that somebody says they're taking a drug or that some medication was administered to them but the way that drug is administered we sometimes forget. Usually we think about taking pills but there are so many other ways that a drug can make its way into your body, often times you'll get an injection of course there are different types of injections, we've seen of course that there are also different types of pills there are tablets and there are capsules and there are time release versions and instantaneous release versions, additionally you see things that are more advanced nowadays, you see things like transdermal patches of course everybody's familiar with nicotine patches but you see that also with nitroglycerin, other medications that make their way through, even fentanyl is delivered in a patch for people who have chronic pain, inhalers of course. And so looking at some of these images here I wanted to just take a moment to remember this really fun workshop that we did last year at DEF CON here in the Biohack Village where we were talking about hacking different drug delivery methodologies and that you see that that's actually of course not an inhaler that's a vape pen but you can hijack a vape pen to work as an inhaler and there are certain things that make their way into your body more efficiently through the lungs than they do through other means. Transdermal patches when you buy them off the shelf of course are made with these specialized gelatins but you can make them yourself using gauze pads and DMSO and some saran wrap and some medical tape and these things are all hackable but these aren't the ones I wanted to talk about there's a different one that is very exciting. So take a moment to see if this looks familiar to you at all in any regard what you're looking at here is a cylindrical piece of flexible plastic and what it is it is a piece of plastic which is biocompatible and it's doped with the active pharmaceutical ingredient which needs to be put into a person's body. Now I'm sure some of you have heard of this before in the 90s the first generation this was called norplant and it was a birth control drug is placed in the upper arm and you can see the more modern version that's called nexoplanon or nexplanon and it's being inserted with a hollow needle here in the upper arm of someone you can see in the the upper right hand corner. Now for those of you who are not familiar with this or just seeing it for the first time and those of you who've seen it before take a moment to just look and see if this reminds you of anything. I want that percolate in your brain while we move on. Now the question is of course how is this made and how do you use it? Now the uses are incredibly widespread now it's been already used for birth control and it's currently being tested I believe it's in phase 2A trials for pre-exposure prophylaxis which is really huge. You think about something that could be put under your skin that could protect protect you from HIV infection for a decade that's extraordinarily powerful and this really applies to anything that is something that anybody has to take regularly and where adherence is a big problem. Sovaldi is arguably the most incredible thing that's ever been put out by the pharmaceutical industry. It literally cures hepatitis C in 12 weeks. The problem is is that if you do not take that pill every day in the same way at the same time when you fall off adherence it doesn't take and then you have to start over and that's an $82,000 treatment it shouldn't be and needn't be for reasons that you all know but of course it's tragic when you get it together to get treatment to somebody and it doesn't happen because somebody just forgot a dose one day. If this could instead be put into an implant and somebody could get it put under their skin and 12 weeks later it gets taken out and they are hepatitis C free that would solve that particular problem and then you'd get 100% adherence instead of only 40%. Again looking at all manner of things if you think for a moment about whether you or anybody who know has any medication that they take every day why take the time and the attention to take it every day when you could merely have something put under your skin and it would just sit there and you wouldn't have to worry about that. Autoimmune issues hormone replacement therapy is one that I'm very excited about I know so many trans people who are so worried about having their pipeline interrupted and if we could instead place hormones in an implant which we know is possible because it was done with birth control and say hey you don't have to worry about taking your shots or interfacing with the medical infrastructure for five maybe 10 years at a time I think that would solve a lot of really amazing problems. The naloxone pro drug that we were looking at a couple of years ago would be really great to be able to put into this so this would essentially be an overdose safeguard antidote that you could put under somebody's skin and they wouldn't overdose I mean amazing even things as basic as vitamins most people are vitamin b deficient and you could just have a vitamin b complex implant that would continue to dose your body with vitamin b around the clock for years and again anything where people have to take something every day if you know anybody over the age of 16 the United States they have several medications typically that they take every day and again as years go on and days blur together it can be harder and harder to remember to take something at the same time every day and that takes care of that particular problem so it's a very exciting technology in general and of course the question is you know how do we hijack it how is it made so the plastic has to actually be extruded and so you have this big industrial machine that's full of the active pharmaceutical ingredient as well as the plastic and then it's pushed down through this screw and then heated along the way and it's pressed out of die here's a diagram that sort of shows that and you can see the spot there where everything's put into the feeder and that's the pharmaceutical ingredient along with the plastic the plastic is usually PLA or PLA and another plastic again some of you will start to see where this is heading and it gets pressed out of die at the end and then you get these little pieces of filament which are then broken off and the question is well how do we do that well this is the same as the 3d printing filament that is made by hobbyists all over the world people who are enthusiasts of 3d printing of course take their old failed prints shred them up and re extrude them and if you can look at the image on the right you can of course get ones that are manufactured in such a way that they're kind of a commercial they're the kits like the filler shooter in the upper right and there are ones that are home built like on the the lower right and this is basically all it takes concerns of course of trying to make sure the densities are homogeneous and you don't get the active pharmaceutical ingredients separating away from the plastic it's simple to fix at a small scale you merely extrude the plastic shred it again and then re extrude and eventually you can have something where you merely load it into the same sort of thing that you use to plant an RFID implant into your hand and be able to put these in however you need them now of course the natural question that comes up is well then what do you do about getting the active pharmaceutical ingredient and of course there are ways to source those in some cases but one of the big things that we've been focusing on for very long time is how do you manufacture your own drugs and so i'm very excited to present to all of you the new apothecary microlab and this is a picture of me holding the 3d printed case that has the brains of the machine in it and you can see at the top there there's the embossed logo and there's the touchscreen interface and inside you have a raspberry pi and a shield that sits on top of that with relays and it is connected then also to an Arduino which has a cnc shield on top of it and i'll show you a little diagram for each of those sub assemblies here's the raspberry pi and the relay board and then the touchscreen interface and then this is the the separate part the cnc shield that sits on top of the arduino Arduino sends over gcode then sends information so i put this together because the part of this graphic was actually put together by some yellow journalists who were trying to shame us when i was quoted as saying shouldn't be any harder than putting together ikea furniture to build the microlab and at this point it it really isn't and the hardware team has done a just spectacular job of coming together with finding parts that are literally off the shelf no manufacturer required and no soldering required these literally snapped together which is so cool it really means that anybody could build it and here's a little diagram of how everything's connected those are stepper motors that drive the syringe pumps and also that drive the stirring motor and there's a sensor with the heat thermocouple and all bits and pieces what you're looking at here is a video in real time of the head of the hardware team actually assembling the entire microlab and in addition to the fact that this is happening in real time what you see on the table here as he's working is everything that is required and including the tools i guess it's just slightly out of frame but his three tools are a hex key a small screwdriver and a pair of scissors and using nothing else it takes him about 25 minutes to assemble this so um it probably won't finish quite by the time i'm done but hopefully if the editing goes well what will occur here is that as i go to the next slide this video will go into a corner and you'll be able to see it continue in real time as i continue to talk about some of the other stuff that we've been working on um so you see these 3d printed parts that he's uh bolting onto the stepper motors those are the syringe pumps the electronics that he snapped together just a moment ago was the control module that i talked about and the circular piece that's 3d printed on the lower right of the screen that you see is the core for the actual reaction chamber and then you see some miscellaneous parts along the left side of the screen tubing uh the fish pumps that circulate the water along with the bars and the um the threaded rod that allows the syringe pumps to work so hopefully this will now move into the corner and um you'll be able to continue to watch it while i talk about the other developments now of course the big question always is the chemistry and this is where our chemistry team has done such great work in the past of trying to find ways to synthesize to actually manufacture the active pharmaceutical ingredients from things that were easily available cheap having high margins for error having um no specialized materials needed or specialized techniques used this was uh fairly tricky and um some of you i'm sure remember that in the early days we had to deal with a company called Comatica that had developed some very sophisticated machine learning algorithms that would crawl through the databases of chemistry and give good guesses as to what might or might not work in terms of trying to do retro synthesis on chemistry now they of course were bought by merc and that process is now proprietary used internally they don't farm it out they don't share it and one thing that we had this idea to do was to say gosh you know uh we have a data science team and they've looked at some things and they said you know we could probably do the same thing it wouldn't be that hard and if you look on the right this is the the NIST database that we had used with only a thousand reactions and of course it had the same structure but reacts is the one that um Comatica used which is premium and paid for of course has six million reactions well some of you remember the narrative and one thing and another we got our hands on that data and we're able to actually run and analog of that software now the problem is is you needed supercomputer for this a very congenial fellow was working with me and he tried to put together a raspberry pi cluster and then when he looked at the software that the data science team had passed along he said oh this isn't going to work and i asked why and he said well this is not something that lends itself to parallel computing you need a traditional supercomputer you need something with a tremendous amount of ram and you need a lot of cores running and so when you need a supercomputer the regular thing that most people will suggest is using google cloud and i have some opinions on that and then other people will suggest using amazon web services and i have feelings about that too which i'm sure most of you share and so the question is if you need a supercomputer and you don't want to play ball and pay for it what do you do well we figured out a solution to this and we got very lucky um this is the glitter supercomputer and it's an hp proland dl 580 it's a 4u rack mount unit and um it's extremely powerful if you look at the specs this is a 40 core unit with half a terabyte of ram it's optimized in a lot of ways it draws a tremendous amount of power but um we were very lucky that we managed to find one used for $300 usually these go for uh upwards of $6000 i mean i think that's what the baseline unit costs and i think it's more like you know double that for something with the specs that we have but we just got very lucky that we found a used one that some company just wasn't using and managed to get our hands on it so in addition to running the software uh we're hoping that this can actually become an open source supercomputer that everybody in the hacker community can use so somebody has something that they want to run and they need a supercomputer for it that they can just use some time on the supercomputer so i'm going to try and um pull it up here uh this is sort of what it'll look like um these are sort of markups but just so you can get sort of a sense of what things should look like when the machine is booting and running just wanted to give you guys a sense and of course you know you want things to look pretty while they're starting so if you'll bear with me here all right so this is sort of what the um should look like when you uh start things up and when it says the smile string smiles is uh it's a protocol for being able to use essentially ASCII to input the structure of molecule and you'll see this looks a little goofy but at the same time you can see it's sort of suggested of of the structure of a molecule that of course is a double bond to no and here you have again another group that's specified and where it is and and this is all standardized in databases so it's it's good and it's easy to use and um and if this is all work then um this should be here we go there and you'll see the computer come up here now with recommendations and uh along the right column you'll see how likely it is that this is actually going to be plausible um and point nine nine nine of course is is really good when you see the one that means they are actually found it in the literature nine nine four may seem like it's pretty good but again this is fairly iffy the thing that's important to remember when looking at this sort of thing is that the really great strength of machine learning AI is not to replace human intuition but to augment it so this is something that could change things so that instead of needing say oh months to years with a team of really gifted chemists you could have this with a a good chemist and just one of them and be able to do it in a few days when you see these things that say cannot buy that's part of one of the uh kinks we're working out is you know trying to show what's available commercially and if something isn't available commercially you'll notice that each of these are of course hyperlinks and what you can do is you can actually click on them and then do the retro synthesis on one of those and work your way back to see do you have to make the thing that you need to make the next thing and again what is purity and yield look like and how do you work forward from there so to sort of sum up as as we're going you look for treating yourself when you look for taking control of your own health the thing to do of course is at the end is you need to package your treatment right you need that delivery mechanism whether it's something that you load into a syringe or something that you pack into a tablet or something to load into an inhaler you need to package it but of course before that you need to manufacture it you need to generate that active pharmaceutical ingredient somehow and again the packaging we have these ideas for specifically we're trying to develop these these implants which is really exciting the manufacturer we're hoping to make happen with the new version of the micro lab and of course developing a process for manufacture we're hoping to do with the glitter computer and chemactica the new system for trying to do retro synthesis but there's one extra piece which of course before all of that having all of these things at your fingertips means almost nothing if you don't know what it is you actually need to manufacture this is sort of the antecedent problem that comes before everything and the question comes of course how do you determine what it is you need we all have health issues but going from I understand what's wrong or I understand what is not right I recognize my symptoms to understanding what is ailing you and what would ameliorate that is quite a jump so I'm very excited to announce this that we're working on this is the anarchist medical book and we're trying to develop a compendium that will be a reference that people can use when they are not well and yet do not wish to interface with the medical infrastructure we're really excited we have a bunch of things that are going into this book and of course to all of you out there if you have things that you think should be included about this if you know some cool trick or some secret some treatment that is not popular that very few people know about that other people could benefit from please please please get in touch and let us know about it so that we can include it we're trying to make this the best book we can and try to include as much as we can gather and so all the secret little folk wisdom of all the wonderful hacker anarchist communities out there we'd really love to pack it in so please send us anything you can we'd love to see all of it this is about where I end and I always end with this slide because it's a it's an important reminder that that helps not on the way that we really need to work to help each other keep each other safe and there's nobody but us so let's take care of each other thank you all so much it's been wonderful being with you and after this video closes out we'll have a little Q&A and I look forward to talking with all of you thanks so much matter-fitting