EpiPen is an epinephrine-based medicine and delivery system that means the difference between life and death for allergy sufferers. It is has recently come under scrutiny from the U.S. government for its hefty pricetag which has seen steep increases over the last decade.

The company, Mylan, who makes it is now charging upwards of $600 for a two-pack set of EpiPens which used to cost just $94 in 2007. While its maker claims that much of the cost lies in the injector mechanism, and not epinephrine itself, critics have disputed this justification and now, many enterprising patients have devised their own homemade solutions.

Homemade EpiPencil by “medicine hackers”

Michael Laufer is a PhD mathematician and co-creator of the EpiPencil. He combines medical equipment bought at a pharmacy, akin to a puzzle, and then injects himself. The cost? An astonishing $35 - representing a 95% discount over Mylan’s offering.

He is part of the hacker group Four Thieves Vinegar Collective, and their aim is to democratise pharmaceutical manufacturing and enable people to inexpensively produce their own drugs and/or medical devices.

Laufer said, "we're giving people the requisite information to empower themselves to manage their own health.”

The sky-high prices, coupled with increased elderly prescriptions due to heightened awareness of allergic reactions, has also contributed towards increasing numbers of Medicare claims (which is the US equivalent of Singapore’s MediSave), where claims have increased by a shocking 1,100% from 2007 to 2014.

DIY pens not without its risks

Four Thieves Vinegar Collective’s alternative took only two weeks to bear fruition, from research to prototyping. The components can be bought over-the-counter in America, with epinephrine from a doctor’s prescription. It has its downsides though, with its bulkiness and relative difficulty of transport.

Notwithstanding, production of medical devices at home is risky. Sterilisation of the needle and other equipment is necessary and contamination is a key issue.

However dangerous, the Food and Drug Administration has no jurisdiction over EpiPencil due to the components being legal. Despite this, the FDA spokesman Theresa Eisenman warns that "using unapproved prescription drugs for personal use is a potentially dangerous practice. Neither FDA nor the American public have any assurance that unapproved products are effective, safe or produced under Current Good Manufacturing Practices. ‎Unapproved drugs may be contaminated, sub-potent, super-potent or counterfeit."

Under-prescribed in Singapore

A study by the National University Hospital in 2011 found that only less than 10% of peanut and tree-nut allergy sufferers in Singapore are prescribed an EpiPen. Nut allergies are common causes of food-induced anaphylaxis worldwide.

In a stark contrast, more than 60% of expatriate children in Singapore with the same allergies are given a prescription. One suspected reason is believed that such allergies are more commonplace in the foreign populations than Singaporeans.

However, a worrying suspicion is the potential under-prescription of the EpiPen, or the rejection due to cost (as of 2011, it costs S$150) or finding it as unnecessary, according to associate professor Lynette Shek, co-author of a study analysing allergies and EpiPen usage in Singapore.

Potential alternative in development

Dr. Douglas McMahon, a Minnesota-based allergy and asthma specialist, is the man behind the EpiPen alternative, AllergyStop. It can fit on a keychain and expires in 15 months, which is three months longer than EpiPen.This has been in development for the last seven years, and his drive stems from his own severe allergies, and personally carries AllergyStop around in case of an emergency.

One key advantage of AllergyStop lies in its cost: an estimated $50 per dose.

However, his four-person team is facing funding issues; the crowdfunding response on Indiegogo has been lukewarm – he has since turned to fundraising from investors with similar ethos of providing affordable medicine.

It is currently seeking FDA approval, which would take an estimated a two years.

"Competition drives price down, and if there's more competition the medicines won't be as expensive," said McMahon. MIMS

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