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.
Wednesday, February 9, 2011
Thursday, January 13, 2011
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
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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
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
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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
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