I have a drug problem. (Read before drawing conclusions)

Every 3 to 4 months, I have a check-up appointment with a Rheumatologist here in Center City Philadelphia. Basically, he looks at me, bends my arms, legs and fingers, pushes on my abdomen, shines a light in my ears and mouth, takes my blood pressure, asks me a bunch of questions I say "no" to, and then orders me to bleed and pee for the mean lady with the needle and rubber band in the patient-bloodletting closet.

See, I have a rare condition, with no known cause, that reared it's head in high school. Its called Leukocytoclastic Vasculitis which is basically just a really annoying, sometimes temporarily disabling, rash that appears and disappears for no known reason all over my body, but mostly my legs. There, I said it. Yeah, it sucks, but I get by very well, and most people would never know. But, the reason I get by so well is largely related to "my drug problem."...which is what you came here to read about, right? So...

This morning, during the 5 to 10 minutes that I had with my doctor, I was told that the drug I have been taking off and on, depending on my condition, for over 20 years, called Colchicine, was no longer going to be available in generic form. A Philadelphia, PA-based company called URL Pharma, Inc. apparently has convinced the FDA (according to my doctor, and PRESS RELEASE HERE) that there was not enough quality control in the generic Colchicine production market, and was able to get exclusive marketing rights to market Colchicine under their brand name "Colcrys".

I still have another few weeks worth of my old unsafely manufactured generic Colchicine, so I have not yet refilled, and thus don't know first-hand what the new price for Colcrys will be. But, according to a quick look on Wikipedia, the price per pill, has been raised from 9 cents, to $4.85. I take two a day. That means, that for a drug that used to cost me about $65/year (I know mine was a little more than that...), it will now cost me $3,540/year.

But, that's not even the best part...yes, it gets better.

I am very very fortunate to have a good health insurance program called "Personal Choice" through Independence Blue Cross. I pay for all of it myself, as I am self-employed. But, I do NOT have the prescription drug nor optical (eye) plans. Why? Because if I can pay for my own drugs (I only take 1 prescription drug, Colchicine) and doing so is cheaper than paying for the drug insurance, I figured that was the most logical, and honorable thing to do. So, I explained this to my doctor, and he said that I needed to revisit my decision not to have drug coverage, and also that URL Pharma had various patient assistance programs that I should explore.

So, I explored the patient assistance programs. I visited their website, reviewed their 3 programs, and chose the one that appeared to be the most appropriate for me: the "Colcrys Co-Pay Assistance Coupon" where you "Pay No More Than $25 For Your Colcrys Prescription". But, after printing the coupon, and reading the fine print, I found the following listed: "Not valid for cash-paying patients or rejected claims." So, I called them. And yes, if I want to pay for my own drugs, there are NO long-term assistance programs for me.

Do you think anything is wrong with this picture? I want to pay for my own drugs. But, the drug company wants to extort money from me with their grossly inflated non-generic drug prices, while ALSO lining the pockets of the health insurance companies by forcing me to buy their insurance too. And, who knows who else is getting the big fat bonuses we'll all be paying them this year...maybe some FDA officials, a few politicians, etc. All I know is there is going to be a lot more money sloshing around in a much more concentrated group of money-grabbing hands, and someone will be buying lots of new toys with all their big bonus money as a result.

This is just WRONG!!!

But, the good thing is, we always have choices, right?

- I could see if my doctor can find an alternate drug that is equally effective, and cheaper. (highly unlikely...nothing else is known to help my condition, or at least that is how I understand it)

- I could buy Colcrys at full price. ($3,540 per year? Right.)

- I could stop taking the drug. (maybe...that should be interesting...but I've done it before, only after all of my symptoms had already been completely gone for months)

- I could buy drug insurance coverage. (I HATE to give any more money to the insurance companies...but, this may be what I end up doing.)

- Write a stupid blog post, go drink a beer, and think about it a little longer until my prescription runs out...and worry about it then...I've got about another week...

Until then, maybe a history lesson on how evil and dangerous this Colchicine stuff is will make me feel better (history of Colchicine, as per Wikipedia)........

"Colchicum extract was first described as a treatment for gout in De Materia Medica by Pedanius Dioscorides in the first century CE. Colchicine was first isolated in 1820 by the two French chemists P.S. Pelletier and J. Caventon.[4] The alkaloid was later identified as a tricyclic alkaloid, and its pain-relieving and anti-inflammatory effects for gout were linked to its ability to bind with tubulin.

The precursor of colchicine Colchicum was described for treatment of rheumatism and swelling in the Ebers Papyrus, ca. 1500 B.C.[5] The use of Colchicum corm for gout probably traces back to ca. 550 A.D., as the "hermodactyl" recommended by Alexander of Tralles. Colchicum corm was used by ibn Sina Persian physician and other Islamic physicians, was recommended by Ambroise Pare in the sixteenth century, and appeared in the London Pharmacopoeia of 1618.[6] In 1833 P.L. Geiger purified an active ingredient, which he named colchicine.[7] Colchicum was brought to America by Benjamin Franklin; Franklin suffered from gout himself and had written humorous doggerel about the disease during his stint as Envoy to France.[8]"

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Bottom line, our health-care system is F-d.

Talent at Your Fingertips - Leverage the World to Build Your Dreams

I finally got around to reviewing my project history on both eLance.com and Guru.com and found that over the last few years, I've had over 10 projects completed, from providers in more than 8 countries. So, I figured I must have learned something worth sharing. Essentially, I just spent about 30 minutes dumping ideas, lessons-learned, best-practices, etc., and another 10 looking over what I typed, and then very quickly re-sorting them so as to help create some semblance of organization.

What I hope results is a list of ideas that you can keep in mind should you ever choose to build something while leveraging the many resources available to you online. I am not expert in this, but I do feel as if I've grown as a result of these experiences, and that something in here could be of use to you.

So, for some background on the types of projects I've completed, have a look:

Guru.com:
Project work = Logo design website design; website programming; email marketing message design; voice recording/acting.
Provider locations = Brasov, Romania; Cordoba, Argentina; Santa Fe, Argentina; Downingtown, PA USA.

ELance.com:
Project work = Website Programming; animation; mobile app development; mobile app GUI design; logo and website design.
Provider locations = Ukraine - Kharkiv, Kharkivska; India - West Bengal; Ukraine - Sevastopol, Crimea; Uzbekistan - Tashkent, Tashkent; Pakistan - Lahore, Punjab.

Directly with provider:
Project work = Website platform development; Website design and scripting
- Kyrgyz Republic; England.

Here is a brain dump of what I'd advise given the experiences I've had:

- Try different platforms: ELance, Guru, oDesk, vWorker, etc. They each have different strengths and weakness. Though, I have had the most success with ELance, with Guru being a very strong second.
- Write a very clear, thorough project description.
- Start with a project that is as scaled-down and simple as possible.
- Give same small/simple project to two providers, and continue with the best one of the two, nipping the other one in the bud.
- Be prepared with all project preparatory materials and information in advance or be ready to produce them quickly so as to not hold up the provider from getting started, thus causing frustration and undesirable delays.
- Make plenty of time in your schedule to review proposals. It takes time. Leverage your gut, and trust your instincts. But don't be hasty. Do your due diligence.
- Know what you need, and be prepared to answer questions from your provider.
- Beware of providers who only tell you about themselves, and don't ask you anything. Lean towards providers who ask relevant, meaningful questions.
- Get signed NDA (non-disclosure agreement) confidentiality agreement signed before divulging proprietary details (for your peace of mind, whether or not the security this provides is real or perceived; it feels good to have at least tried.)
- Be mindful that the providers are usually submitting many proposals a day/month. At the same time, lean towards those whose proposals clearly reflect a familiarity with your project, and lean away from those who've obviously copy and pasted a canned proposal response.
- Be aware that there is usually a sales/marketing person you'll be dealing with first, and then handed off to a project manager.
- Ask specific questions about the nature of their team, how many, what their skillsets are.
- Get all contact information, email, Skype, physical address, im, etc.
- Google them, find their website, look at messages they've posted on discussion boards, carefully review their work samples, the websites they've referenced in their work history and as much of their work portfolio and client history as is feasible. Bottom line, really try to get to know them, their expertise, and their quality of work.
- Don't be afraid to try out a new provider, but be ready to let them go to if it is clearly not working out. Often, to build a work history, and positive feedback, new providers will go to great lengths, and provide aggressive pricing in order to have an opportunity to get a foot in the door in what is a highly competitive, global marketplace.
- Ask for a future hourly billing rate up front for any follow-on work so as to not be surprised with a loss-leader situation.
- Always strive to find the providers with the highest feedback ratings, and a work history that is in alignment with your project work.
- Beware the largest providers, in terms of billing totals and number of projects, as you'll be less important to them in the grand scheme of their business, and you might not get the attention you desire. On the other hand, if they have great reviews and ratings and are communicating well with you, don't shy away from them for no good reason.
- Check to see if there is a team behind the person. There are many free-lance individuals out there who do great work. But, just be aware, if there is a single point of failure, and no other resources on staff, you'll be out looking for someone new should your independent person disappear.
- Ask for single point of contact for project management and accountability. Bouncing around from person to person can lead to communication failures, and dropped balls. Try to nail one person down as the "owner" of your project.
- Use escrow normally, but for small projects with providers having good review and a long work history, its fine to use direct payment without escrow.
- Break project into at least 2-3 milestones with payments associated with each successful completion.
- Make plenty of time in your schedule to spend the necessary time supporting the person you've hired.
- Get agreement on a regular meeting time to discuss progress, and STICK TO IT!!!
- Use Skype, Google Talk, or other IM client and log on all day/night.
- Agree on a central location for all communications and document sharing (ie, workspace, unfuddle, email, skype, etc.)
- Be prepared for holidays/vacations that you are not familiar with or accustomed to.
- Be empathetic to language differences, but don't lower your standards; demand great communication skills.
- It's rare to over-communicate. Communicate early, often, and clearly.
- Be open to providers from anywhere in the world, and be open to cultural differences.
- Kill projects early if they are not going well. Often though, the provider will bend over backwards to remedy a bad situation (don't wan't negative feedback) so don't be too quick with the axe; give them a limited, clear chance to get things back on track.
- Be prepared for either very early mornings and/or very late nights, due to differences in time zones.
- Be personable, but don't be offended if your provider does not seem very personable towards you. Again, the providers are from all over the world, and they often deal with many clients, and their workloads may be quite taxing. Additionally, their emotional freedoms and customs may not be like yours.
- Be prepared for mis-communications, and be willing to work through it. Blaming does not help. Clarification and persistence does.
- Don't be afraid to ask them if they understand you, and don't be afraid to ask them to demonstrate their understanding by re-stating back to you anything you've just explained to them.
- Leave feedback that is true; be generous, as the good karma pays returns.

Most of all, have fun, yet be professional; be firm, yet flexible.

Good luck. Reach out anytime if you'd like me to expand on anything more.

Cheers,

Cliff

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This may go against blogging best practices, but I am, and will continue to edit this particular blog post, by creating a section here so that I can add good tips I receive from other folks. So, here goes:

- Contract with a developer first whose sole task is to help you nail down the "Statement of Work" before posting the actual development project itself. This way, you can invest an affordable $5/hour to have an expert help nail down the technical language first, so that the Statement of Work in your project is clear before you start getting bids. It shaves a lot of time off of development, because the communication is nailed down (for the most part) in the beginning and it's in a language that a developer will understand which is probably above and beyond what we could write on our own. - Michael Rosciolo

Pride sucks. Check it at the door. This is a start-up.

There's a very real reason why "pride" is one of the seven deadly sins. In fact, according to the write-up about the seven deadly sins on Wikipedia, "In almost every list Pride (Latin, superbia), or hubris, is considered the original and most serious of the seven deadly sins, and the source of the others."

And thus "pride" has no place in a start-up.

Pride makes you talk at your customer. Not with them. It closes your ears to that which you ought be hearing if you ever want your start-up to survive, yet alone have any chance at ever thriving. The last thing a customer wants to hear is how great you are. It's irrelevant. They can go talk to anyone else, and hear the same. Rather, they want to hear how you are going to solve their problem. How can you solve their problem with your mouth open? Shut it, ask, listen, and help solve their problem.

Pride makes you think you know better than your customer. Your customer is the only one who knows what they want. And as a start-up, it is your job to find out, as best you can, what that is. Otherwise, there's little chance they'll reward your start-up with their hard earned dollars. Telling the customer how great your company, product, service, business philosophy or whatever else you take pride in, is just noise to them. Ask them what they want, listen, engage, and use what you learn to help them help you be successful in your start-up.

Pride makes you vulnerable. I suspect that one of the major reasons so many people do not enter the world of entrepreneurship is because of the great unknown. There is NO CERTAINTY. There is no pre-defined organizational structure to climb. No job title that matters. No certification that says you've succeeded. No way to easily and concisely communicate just how much of your heart and soul, blood, sweat and tears you've pored into this thing you call your start-up, and how deeply important it is to you. There is no performance review and annual raise. No bonuses. Unfortunately, these are the things that far too many people cling to, and use as evidence of their own self-worth, confidence and sense of place within their social and professional networks. Forget about it. No one cares. What matters is what you believe about yourself and how you treat the people around you (ie, customers). And those who dare to believe in themselves are the ones who dare to set all that meaningless detritus aside, and go it alone, knowing that no matter what happens, everything is always going to be okay. Lose the pride, and watch your true, strong, confident self emerge. And your start-up will grow muscles like you never thought possible.

Pride makes you say things that have no value, but to serve your pride. How many times do you hear someone answer the question "So, what do you do?", with something along the lines of "I am the Director of XXX at ABC corp, I manage the XXX widget team, we did XXX dollars last year..." blah blah blah. Really, that's what you do? Good for you. It's got no place in a start-up. Building a business, from concept to market is a life pursuit, it's not about impressing your peers with a job title, with how much power you have, and how much money you make. It's about embracing the unknown, putting yourself out there and on the line, having the courage to live your dream, constantly iterating on the value and execution of your dream, and in so doing, checking your identity at the door. Your identity, your pride, will only ever get in the way, and will muddy the experience your customers will have with you and your start-up. Let it go. It has no value in a start-up. The next time someone asks you what you do, tell them about the dream you are living...you are living it right?

Of course, all of this is much easier said than done. All of us have vulnerabilities we might prefer to hide, as well as those things we've accomplished in life that make us feel good and that we wish more people would know about. Regardless, the point I am trying to make, and reinforce and re-emphasize to myself more than anything, is that when you've committed to starting your own business/es, you've got to be willing to wear many hats; deal with constantly shifting dynamics; and be willing to do just about anything that your start-up requires to succeed. And you absolutely have to be comfortable with recognizing your own limitations and be willing to engage and rely on others who can help you in the co-created actualization of your dream, your start-up. Notice, pride has no place in any of this...this is a start-up.

Embracing the Value of an Imperfect Solution

Life's littlest moments can behold the most enlightening lessons. This morning, during a seemingly routine exercise - that of making breakfast - I experienced a delicious realization. It was an idea that arose from the minutiae of flipping fluffy pancakes - a particularly delightful way to start the day and one I feel compelled to share.

I laid everything out on the kitchen countertop: a brand new box of Hungry Jack buttermilk pancake mix, fresh eggs, vegetable oil, milk, measuring cups, measuring spoons, and two spatulas: a wooden one for mixing, and a flat plastic one for flipping. On top of the gas-lit range warmed an iron griddle already hot enough to spit water. In hungry anticipation of ingredient-mixing nirvana, I scanned my hotcake-cooking arsenal, and noticed something was dreadfully wrong - no mixing bowl.

This wouldn't happen "back home" (in Philadelphia). We have pretty much everything we "need", including a wide array of glass, aluminum, ceramic and plastic bowls. But since we're still getting set up in our new place here in Cochabamba Bolivia, there's no such thing. So I rooted around our still relatively sparse kitchen cabinetry, and came upon my first possible solution: a cereal bowl. But after a crusty-eyed inspection of its dimensions and volume, I surmised it would likely lead to an unbearably cramped mess of batter-mixing frustration. Next option: plastic containers usually reserved for storing and refrigerating leftovers - but just too flimsy, too small, and too square. What about drinking glasses, coffee mugs, plates or plastic bags - no way! The only thing left was a shelf containing 4 shiny-new, teflon-coated, cooking pots and frying pans...bingo!

Within moments, like a half-starved short-order chef, I was manically mixing pancake batter...in a range-top pasta-pot. Maybe not the "perfect solution" by definition, meaning it wasn't a "mixing bowl", but without a doubt, the most perfect "imperfect solution" given the circumstances. And therein lies my epiphany...

There is meaningful value in the process of arriving at an "imperfect" solution. And, that the satisfaction derived from experiencing that process, can quite possibly equal or exceed the satisfaction derived from the application of a more conventionally "perfect" solution.

As we look about the world, it's impossible not to notice the problems that need solving: war, poverty, disease, hunger, environmental degradation, corruption, and so on. It's especially difficult if you give any portion of your attention to the non-stop, over-commercialized "news" being spun online, over the air, and over the wires...I digress (that'll be a topic for another post, soon).

But, if we can just remember, that our own solutions to problems, no matter how "perfect" they may seem to us, may very well not be perfect solutions for others. We've got to be willing to take into account other people's culture, history, family, economic means, sympathies, beliefs and priorities before we start doling out solutions. And we've got to give at least equal weight to the value of the process of arriving at solutions as we do to the highly subjective value of the solution itself. And finally, we've got to be willing to allow that process to unfold naturally, with mindful engagement and respect.

Becoming more empathetically inclined this way could enable each and every one of us to experience more satisfying interpersonal and inter-societal relationships that lead us to solutions for the world's most vexing problems, I am sure of it.

You might say extracting all this "meaning" from mixing pancake batter is a bit of a stretch...but I can hardly wait to see what's cook'n for lunch!

Finally, A Personal Blog Without Constraints

I started "blogging", according to my Blogspot records, back in 2007.  My efforts to date have been pretty esoteric in nature: 1) StevensOnLeave is for publishing our personal travel memoirs, 2) PhillyITStaffing is for publishing statistics and information relevant to our business at www.TheITStaffingCompany.com, and 3) EverySAPJob - The Blog has been moved to WordPress hosted on our own server for improving SEO at our other business  www.EverySAPJob.com.

Now though, "This is Cliff" will give me the means to write about anything on my mind.  I've already written a few things of length elsewhere, such as notes on my Facebook page, some ramblings inside my EverNote and MyWriting iPad apps, and even a book published on LuLu.com.  But here, I will write whatever I want, whenever I want, and just enjoy the process of writing without constraints.

I've got a few ideas brewing, so let's see how it goes.