I wondered whether I should do some performance testing on the site before the air date.  Piehole is written in rails, which has a name for poor performance.  That coupled with my slightly ropey programming expertise, could be a recipe for disaster.  On recommendation, I signed up for loadimpact.com and starting using their free account.

The page I tested was on this page.  This is what I got.

Holy crap. In English, that means I’m looking at a one minute loading time when there are 50 simultaneous people on the page.  I logged into my control panel and checked the memory usage and it seemed fine for the period of the test.  Something else was slowing things down other than a lack of memory.

My first step was to implement rails page caching which gave me a better performance.  This gave me about a 10% improvement but we were still looking at a very unacceptable page loading time.  Bear in mind, the average user will tolerate a 10 second wait – never mind one minute.

My next step was to see exactly where the bottleneck was.  Given that I was now serving up a plain HTML page but experiencing big delays, and there was no significant memory issue, it had to be the page contents that were holding things up.  I ran the same test on an empty test file and got this result.

Phew.  At least these numbers are a bit more acceptable.  The declining graph indicates that the server isn’t really being taxed at those load levels.  Lovely.  Now if I can just persuade the server to upload something more useful than an empty file.

I created a shorter version of our front page without much of the graphics.  Again, I got another acceptable declining response time.

I loaded up Y-Slow and started following its recommendations dutifully.  I spent some time fiddling with youtube videos (placing a loading image over them rather than loading the video on page load) but I was starting to hit a wall in terms of any improved performance  The load times were still way over what was acceptable for any page that had more than a couple of images on it.   I searched through the rest of the server and optimised some queries in other webapps on the same box.  In truth, I need not have bothered.

Rails does support moving your fixed assets (stylesheets, images, javascript resources) to a separate location so long as you use the image_tag to place images in webpages.  You can then specify an alternate server to serve your assets from.  I started off with using Amazon’s S3 service.

Bingo.  A 90% improvement.  The graph declines which means that we need to load it some more to find out what the upper limts are.  The only problem with using s3 is that it isn’t really designed as a content management network.  For one, it won’t compress css and javascript resources with gzip.  It also don’t add the correct MIME type headers and it is a bit of a pain to remember when to set the right permissions.

Next up I signed up for a $15 a month account with cachefly.com.  This bought me another 50% improvement to about a 1.5 second load time for 50 concurrent users.  So what did I learn?

1. Its easy to blame rails.  Give a dog a name and you’re likely to jump to conclusions – if that isn’t too much of a mixed metaphor.
2. Bundling javascript files, stylesheets, adding compression on your server to resources, yada yada, yada is all very well but if you spend more on wine than server costs each month – your easiest upgrade is probably to use a CDN.  It really isn’t as scary as it sounds.
3. Cachefly doesn’t seem to allow you to set the expir-header for resources.  This is a little annoying as it messes up your nice neat Y-Slow score but the performance is what matters – and it seems to be solid.
4. Loadimpact really is a great tool for identifying problems with loading times.

Of course this will all look rather redundant if the site falls over on Thursday night.

The Dragon’s Den is one of the only TV programs we watch.  Lampooning the contestants and guffawing at the terrible offers is addictive.  I have to say, it also makes you stop and think.  Would someone invest in our ‘business’?  How would we answer that question?  How could he possibly not know the answer to that?

While it is light entertainment, it is also helping to build a spirit of entrepreneurialism.  It might be difficult to measure accurately, but a mass market TV program like this could actually play a part in encouraging indigenous industry and ultimately help work towards a recovery.

Having said that, there was no bloody way you were going to catch me on there.  Until, of course, Priscilla cheerfully told me that she had sent off an application form.

There was no need to take it any more seriously than that – until the day that Shinawil Productions called to ask if we could come around for an interview.  The only slight problem with this was we were about 12,000km away in Mendoza, Argentina.  We were however planning on making a trip back to the old sod for Christmas so we went on a reserve list and promised to show up for a chat.

The show is a major hit and we were told that half a million people have seen it.  We would have been silly to ignore the opportunity, even if it did mean trading in my chance at becoming the most esteemed business-man of 2010.  We started to come up with reasons why we should in fact go forward and give it a go.  For one, we kind of owe it to our customers to get them as much profile as possible.  For another, having been staunchly against taking any type of investment, it started us thinking ‘what if’.

Bizarrely, the prospect of having to open the Kimono in front of a couple of hundred thousand people began to act as motivation for business planning like we’d never planned before.  Although I have pretty much settled on my objective to find thousands of people who will pay tens of euro a month for some service, the conversion rates and marketing tactics, value proposition et al. that needed to be defined to make that a reality was never really put down on paper.

Once the flights back to Dublin were bought, we began planning in earnest. Why would anyone really want to invest in us?  One thing that seemed to make sense was, we were at least focused from the bottom up.  Rather than planning to get x% of a y million euro market, we knew how many free guides to getting into voiceovers we had to give away before someone would become a customer.  We knew how many people were working as voicevers and we pretty much had a lot of their names.   Before we got into all that however, we had to figure out what our objective was.

Whether or not we would be able to attract offers was an open question but we knew for a fact that we had to get into the 8 minute slot rather than one of the shorter 30 second slots available.  First up that meant making sure we stood out.  Thankfully, if you’ve ever met Priscilla, you’ll know this is something she can do in spades.  We made sure to mention in our interview with Shinawil what an impact we would make on the day.

Second up was trying to get our message across to the audience.  We had no control over how the show would be edited but we were fairly sure that we couldn’t control what got cut and what could not, as long as the general narrative included some key points, we would get some traction.  Particularly – we wanted people to know that we had a wealth of free and paid for training material for those looking to get into voiceover work.

After that – if we got an offer -great.  We’d have a great opportunity to work with someone used to making millions instead of thousands.  I was pretty sure that would lift our game and be worth giving away some equity.  We set about trying to find out about all the Dragons to figure out who would be our preferred investor.

Sean Gallagher has an excellent website and its clear that he enjoys mentoring businesses.  We have worked well with coaches in the past and currently pay someone to provide weekly planning sessions, so we knew we could work well with someone like that.  That aside, stupidly, he plays Judo which is something I have been doing for years and this somehow gave me an idea as to the type of guy he is.  It also explains why he has no neck.

Gavin Duffy He has a background in media and could obviously help us put some deals together which would help the businesses – especially when it comes to trying to sell.  Most people recommended him as the best fit for our business and while a little intimidated by his reputation as a tough negotiator and huge work habit, I knew for sure, having him on board would put some rocket fuel in the tank.

Sarah Newman had an obvious internet pedigree.  Priscilla likes her no-nonsense style a lot although I wasn’t quiet sure what the make of her.  Famous for not investing rather than investing – I somehow knew that whatever happened, it was important that she bought into the idea.  This would give confidence to the other Dragons and in my view, being the hardest to impress, having her onside would speak volumes to our competition.

Bobby Kerr was the only one I had a personal contact to.  While I had never met the guy – a friend is a friend of his and he gave a glowing reference.  I knew he would be a tough nut to crack however.  Internet business’ are a long way for fast moving consumer goods.  There are however more similarities than you might think and if we could convince him that we were good guys, I thought he might just enjoy the opportunity to work with us.  Getting a toe in the FMCG market is also something I’d love to do.  Perhaps not with Piehole, but if we could work with him, there were bound to be opportunities to be exploited.

Niall O’Farrell is all about retail, and again, it was going to be hard to figure out why he would be interested in us.  It didn’t do me any favours that I’d be standing in the Den wearing a Louis Copeland suit.  I only hoped his famous attention to detail didn’t extend to spotting a guy looking for money standing in a arch-rival’s tin of fruit.

So that was that.  I spent a lot of time bending the ear of friends who were more practiced in the art of looking for investment and I began to learn what it was an investor would be looking for. Handily enough, Sean pretty much spells this out on his own website.

So that is pretty much all we can say for now.  I’ll be following up with some more posts on the various things we’ve had to do to get prepared, including making sure the website doesn’t fall over, our strategy behind our pitch and a post-mortem on Thursday night.

PS:  If anyone out there has access to a slingbox we could borrow – shout.  We’ve no way of watching the show live other than pointing a webcam at a TV right now.

Millions upon millions of pounds were spent, worldwide, telling young’un’s that “Cigaretets Kill”. Something we all know but mostly only those in their 30’s or older pay much attention to.

Why?

Dissonance

Telling young people that they will die from smoking contravenes a rather self-evident truth:  young people don’t die.  Certainly not in general and you would be unlucky to have reached the age of 13 (when most people start smoking) to have known anyone in your peer group that had passed on.

Saatchi & Saatchi changed tack and instead started running advertising pointing out how gross your breath smells after a cigarette.  Something that rings true and is oh so important when your still trying to get off your mark with Priscilla in 6b.

So here is the rub.  Entrepreneurs in Ireland don’t make it big.  We don’t really celebrate the successes and I think there is a tendency to expect failure.  This is especially acute when it comes to funded businesses.  At least two founders who raised multiple millions of dollars have both told me that they tell their founders that there was a 90% chance of failure.  Accurate and laudable as it may be – the intention can’t be helpful towards achieving success.

How can we plan on building world-class ‘google’ type businesses when there is no precedence for it?  It doesn’t make sense to encourage people to startup when the expectations for success are so low.

Contrast this with a plumber/accountant/solicitor/carpenter setting up a new business.  While they may be more ’self-employed’ than ‘running a business’ – it seems far more real and natural that these types of business make it.  We all know successful people in these fields.  Meanwhile I’ve been trying to build an online business for the last 10 years and I’ve met only a handful of successes (and believe me I had to dig to find them).

To encourage startups and avoid talking out of both sides of our mouths, we need to reset expectations of indigenous startups towards success.  Online businesses have a heritage in high risk funding backed ventures, but things have changed and the web has become more mature.  There is no reason that 90% of ventures should fail.  The business models that work are out there and available to be exploited.  Beyond that, even if individual ventures do not succeed, subsequent ventures by the same entrepreneur can and probably will.

Email gets a bad wrap.  Spam clogging up inboxs and untold hours of lost productivity.  Viagra and free visa’s to the US all go towards making it a touchy subject.  However, if email can elect an American president, I can’t afford to ignore it for developing a relationship with our customers.

Checking my own inbox, the oldest email newsletter I’m subscribed to goes back almost 10 years.  It is a technology newletter to do with MS Outlook, something I don’t work on anymore, but I stay subscribed in case some day I need it.  That is one hell of a relationship.

Nothing.  Not twitter, not Facebook or anything else comes close in turns of accessability and longevity.  Granted the social networks have only been around for a few years, but email is the original social network and eveyone online is plugged into it.

It is so powerful in fact, that infomarketers have taken it to their heart.  They practice alchemy on their ‘lists’ (aka: leads) until the parlay them into pure gold.  In a way, it is a cheap trick, but my own experience with email has taught me that you can’t really afford to not have an email marketing strategy.

So here is the challenge:  How can I have an email marketing strategy that doesn’t suck?

This is what I’ve figured out so far.

Copy :  When we first set up our email subscriptions using Aweber, we lashed in a set of follow up emails, scheduled to go out to memebers of the list on different dates over the space of six months. Then we revisited the emails several weeks letter.  Priscilla let loose her considerable copywriting expertise and transformed the copy to match our brand.  We cut the length of content down (to 1 or 2 paragraphs) and dialled up the punchy langauge.  The result was evident within weeks.  We had never really had many unsubscribes but now people were actually starting to email us back with comments.

Training: There are a bucket of online training courses out there.  Most of them look like ‘get rich quick’ schemes.  I wouldn’t be put off by this.  Shell out the $99, buy one and pick up a few tricks.  Just don’t be surprised if your are still poor after reading them.  Its the implementation which hardly anyone ever implements.

Sprinkle interaction:  Rather than having a passive email list, we’ve started to try and get our guys to interact with us in some way.  We ask them to follow us on twitter, call in to test their voice on our Test my voice service.  The difference started to show up when talking over the phone.

Less is more:  Paring down the copy has meant the use of more bullet points and lots of PS’s.  There is a bunch of tacky advice out there on how to use the tricks of the trade to maximise your email interaction.  Everything from using calls to action to adding PS’s in every mail.  The problem is – everyone uses them.  Our brand a permits  little mild swearing and questionable innuendo (our most popular email, above, is entitled “How to get ahead in voiceovers without doing ‘favours’”).

Email warms up cold leads to warm prospects and provides an automated way to build relationships.  Done without style, it irks.  Done with a little balls – it seems to be doing us some favours.  We don’t use templates and we make sure one-click unsubscibe links are there for the world to see.

So why does it work?  Well here is my theory.  People only buy when the trust.  Trust is an emotion.  To build up that feeling of trust you need time.  Brands provide instant trust but we have to assume that we’re not known from a bar of soap.  It is pretty much hopeless to build up trust in the 7 seconds it takes someone to scan our web page.   Looking good enough to earn their email address however, means we can ‘touch’ them over and over again without having to spend man hours.  Everyone knows they are on an automated list but they can’t help it.  Its like looking at a cute little teddy bear with a missing eye.  We all know its just stuffing and cloth but we can’t help but empathise.  The same goes for email campaigns.  Despite the fact we know logically it’s automatically generated – our emotions can’t differentiate and it starts to build familiarity and trust.  Its fairly common for me to hear on the phone now I’ve been getting your emails, they are great’.  These leads are a LOT warmer and convert way easier.

Just a little footnote here.  I’ve been reading some other blogs recently and I’m kind of getting a little intimidated by the quality that is out there.  If you have read this far – thanks for putting up with the lack of research and befuddled thought patterns.  Now go read about email marketing somewhere more reputable for god’s sake.

To counter this I did a quick review of available products  before designing my own minimum viable CRM system (oh groan – another techy reinventing the wheel).  Here were the front runners.

• Fat Free CRM: an extremely nice ruby implementation in the mold of salesforce.  Opportunities, leads, contacts and cases are all there.  Very nice code and all open source.  This bad boy is best suited to someone with the ruby programming resources.  It can be dropped in and used stand alone but I wanted to tie in to our existing database (which can be done) but learning the comings-and-goings of the FFCRM system was a bit of a barrier for me.
• CapsuleCRM:  This used to be Javeline CRM and I do remember looking at it before but it seems to have come a long way.  Thankfully, its come a long way in simplifying things rather than adding stuff.  There are excellent integration options available including for MailChimp and Xero as well as a number of other accounting packages.  I was very tempted to go for this one.  If we ever get around to implementing Xero, we may yet.
• Google Spreadsheets:  Great because you can share them and sit there while you watch each other follow up on leads.  Bad because they are unstructured and after a week or two they look like  mine-field.  This is what we were going away from.

Right.  So here is my solution.  I was feeding my addiction to twitter and I started to wonder if there was a way to use some of the twitter meme’s to organise our notes a little better.  I also didn’t really like the way that most CRM systems seem to have separate database entries for leads vs contacts vs accounts.  I wanted something much simpler.  First up, I created a ‘contact’ object in our database and started piping in aweber sign ups into the same table as users in our database.  Not 100% efficient but it meant that we had our log in system and user management for free.

Admin users can get a pretty standard list of contacts in Piehole something similar to the below.

But we needed to be able to track who was supposed to be followed up and when.  Our sales process is pretty lightweight.  Our price points are pretty standard and generally, each customer is worth a similar amount to us – although some buy more and some buy less.  I’ve found the above CRM systems to be more aimed at a heavier sales process with varying proposal sizes etc.  Just too much configuration and training required.  So, the simplest thing we could come up with is this home screen for a customer

So opening a profile gives me their vital stats (how well their profile is performing, previous notes etc) and I’m auto-focused on a box where I can add comments.  Any comment I type in with a hash tag gets picked up and added to the listing on the left hand side.

So for – so great.  It is easily the most profitable bit of development I’ve done on Piehole for a long time.  While the spreadsheets were unwieldy and SugarCRM was too clunky, this is doing well so far.  There are some obvious problems of course.  Not least you can easily add the wrong hash tag and it does take some maintenance to make sure that this doesn’t get out of hand.  You’ve also got to be clear on what hash tags are being used for what.  We’ve started to allocate tasks by tagging in the manner of #james.  When I’m finished the task I delete the note, indicating its done.  I guess you could take this a little further and notify people when tasks were completed.  I’m not so hung up on this but it does mean I’ll have an accurate record of the number of calls made each week which is one of big KPI’s.

A simple reporting screen is next up so we can track the number of completed calls.

So we’ve moved somewhere, where

• the average temperature is about 20 degrees C warmer than Dublin
• cut our living costs by 2/3rds
• allowed us to focus all our time on building our own wealth
• avoided having to go to work (unless we’d like to)

But it can’t all be good.  And here are a few gotcha’s. In a week when its been too hot to walk down here, I thought I’d put a few down for posterity.  Lets see if I can mitigate them.

1. Motivation: “Millions long for immortality who don’t know what to do with themselves on a rainy Sunday afternoon” writes  Susan Ertz.  Now imagine having a Sunday afternoon every day of the week.  We’re not the worst at this – and being honest – we can’t afford to put our feet up completely but there is a lot to be said for having to turn up for work on a Monday morning.  We’ve mitigated this by trying to stick to our 5 tasks a day (do five things then stop).   We’ve recently engaged a coach who will help crack the whip and keep us on track.  I guess there is a bit of a stigma (especially in Ireland) with having a ‘coach’ but I’m willing to bet pretty-much anyone could benefit from being called to book now and again.  It works in the gym and we’ve found it to work for building our cash-flow.
2. Weather: “hold on – its bloody georgeous down there”  - yes, yes  - it is in general, but when it tops 40 degrees, there isn’t much to be done about it.  Productivity goes down the toilet.  If we had our way we’d probably leave Argentina for a few months while the hottest of the summer passes.  This year we did that by going back to Ireland for a bit but we should have stayed until the end of Feb to really miss out on the heat.  Mendoza is actually not so bad as the humidity is low, but Buenos Aires is a killer.
3. Networking: I’m someone who did a lot of networking back in Dublin.  As well as joining local business networking groups and attending various nerd events such as Ruby Ireland and Bizcamp’s, I really enjoyed getting out and meeting people.  Watching the twitter feed I am a little envious of some of the great events which are being organised.  I’ve met some great entrepreneurs down here but there aren’t as many as I’d like.  We should probably move back to Buenos Aires where there is a much greater concentration.  Having said that, I probably we over-doing the meet-and greats a little and there is something to be said for just getting my head down.  Listening to Pegram Harrison’s Evaluating a Venture Idea lecture, I do get the sense that perhaps it might be a better idea to move to Silicon Valley rather than Dublin if networking is really the name of the game.  Perhaps a few months there might do it. Pegram posits in his talk that the greatest entrepreneur in the world can’t survive without the right environment in which to flourish.  Granted, he is talking about ‘big bang’ ideas rather than simply earning more than you spend without having to sell hours.
4. So what? Its all very nice not having a day job.  I guess the next step would be to avoid having customers (eg:  sell Piehole and live off the interest) but at the end of the day you do need a challenge.  We took August off to spend on the personal and ‘giving back’ type projects which were thoroughly enjoyable.  It was a month more than we could spend on these projects in Dublin, but at the same time, in order to hit the top run of Maslow’s over quoted hierarchy of needs, doing something ‘big’ starts to look more attractive.
5. Security: Stuff happens.  Accidents, long forgotten tax returns, emergency trips to visit sick relatives.  We can’t really afford to flit around the globe at will and while this provide motivation – at the same time – a life abroad does feel a little unsettled.  Going home for Christmas felt good and it might be a little time yet before Argentina or wherever we will be next year feels like home.  Part of what is contributing to this is the fact we don’t have a plan for where we will be past getting hitched in January 2011.  A 5 year plan always sounded ludicrous to me, but perhaps there is some sense in it.

So there you have it – some catches with this whole geoarbitrage thingy.   That is not to say there not considerable upsides, but its not all milk and honey in the land of steak and red wine.

I have been steadily working my way through the Building a Business podcast from the Oxford University.  All the topics covered are pretty standard but there are a lot of insights available from the top people in their field.  The podcast on negotiation, given by Owen Derbishire,  has some real nuggets.  I’m going to try and summarize them here.  You can listen to the whole lecture here.

No deal is sometimes a good deal

Ever go shopping for the day and come back with absolutely nothing?  It is kind of a bummer.  All that effort and nothing to show for it.  We are naturally biased towards doing a deal.  Its worth remembering that when in any negotiating.  I have a natural tendency to do some deal rather than walk away – even if that deal might be bad.  You can see this in the Dragon’s Den, every episode where entrepreneurs give away large chunks of their business.  This tendency isn’t limited to small timers either.  The infamous 3g auctions of the early 00’s left supposedly smart phone companies over-paying massively for licenses which never made a return.  In short, don’t be afraid to walk away.

If you can: auction

The name of the game in an auction is to guess what a particular item is worth to you.  In our case, this most commonly means bidding on an adword keyword.  The price I pay for adwords is based on what others are paying (eg: if the guy ahead of me bids €1.99, I pay €1.98 per click).  Now, thinking about this for a moment, on average, in any group of people there will be those who guess correctly as to the value of the ad and those that do not – and overbid.  The Google system is set up to reward the overbidders but providing a higher positioning.  This is exaserbated by the fact that there are always people floating into the market, overbidding – losing their shirt, floating away to be replaced by the next over-bidder.

A straight auction is even worse.  In a packed auction room, the highest overbidder wins.  Now, of course, when it comes to ad words, it all depends on how efficiently you convert, and it may be that the highest bidder has a new-fangled foolproof way of converting visitors at a higher rate than the others.  Odds are though, if you are a #1 ranked ad in adwords, you are paying too much.  We aim for position 3 – 4 which gets almost the same number of click throughs.

The first number matters

The first number that is mentioned in a negotiation matters.  Often times – know one really knows what the right price is (buyer or seller).  The first number that is mentioned anchors the discussion however.  That number doesn’t necessarily have to be brought up in the context of your fee.  You can do this explicitly or implicitly.  Something like “I quoted my last client €35,000 but we managed to come in €30,000″.  You could also just wear a really expensive watch or have the latest mac-book air with you in the meeting.  An ostentatiously expensive item in the room will get the client thinking in bigger numbers.  There is a great example of this in the podcast.

I’m OK, your OK

Sorry, what I mean is, cliched as it sounds, there is normally a win/win to be found.  Digging into what either party is looking for is the key to finding the underlying motivation for a bargaining position.  Sometimes, there will be posturing involved, but the basic advice here is to spend a lot of time on communication until both parties really understand what each is trying to get out of the deal.  This means trying to remember that ‘what is good for them, isn’t necessarily bad for me” and vice versa.  One study quoted found that 39% of deals are not done simply because both parties can’t get by this ‘you win, I lose’ type mindset and look for a third way.  Owen describes this as an ‘integrative bargain’.

Stepped so deep in blood, tis easier to go forward than back

Well Macbeth said it better but the idea is that people are twice as motivated by a fear of loss than by gain.  In particular, that means if you can get someone to spend a little with you, they are more likely to want to spend more.  I’ve seen this technique at play for a lot of training courses. An introductory €95 course upsells to a €1,500 course which upsells and upsells until your account is empty.  The implicit message used is ‘in order to get the most of this €95, you really need to go on the next course’ – or put another way “unless you go on the next course, you’ve just wasted €95″.

I’ve seen it a lot in software dev circles too.  The initial quote is competitive but changes (which always arise) are charged on less favourable terms.

Less maniacally, you can get people to spend a little with you at first, and then encourage them to spend more.  In our case, we send people some information on getting into voiceovers.  By spending time reading the book, they are in effect investing.  If they don’t want that time to be waisted, the next logical step is to go on our demo day, and so on.

Now, I should say, that it really shouldn’t take this long and I will admit to not giving it 100% attention as some day job issues are pretty pressing right now.  I guess I took on some responsibility when I launched the service and right now I don’t feel like I’m living up to that responsibility.  In part I am relying on the kindness of friends to keep agtweet running and I don’t want to abuse that by pestering them all the time for help.  I’ve been getting a lot of questions about when the 085 number will be back … to which I’ll say I’m not totally sure right now.

For the moment, accept my apologies and bear with me.

thanks

James

“Unless you have the cure for cancer, there probably isn’t the need for your product you thought there was”

“I know how to cure cancer”, I thought, “maybe I should do something about that”.

Now, I am perhaps being a little dramatic for effect, but there is an opportunity for someone to literally prolong and enhance the lives of millions of people.  Lets run through some stats and see if you can guess how.

• One fifth of patients don’t fill out their prescriptions
• 125,000 American’s die annually by virtue of not taking their pills properly
• 60% of patients cannot identify their own drugs
• 1 in 4 people in nursing homes are there because they can’t figure out their own meds

You should be starting to get the idea.  Basically, hundreds of thousands of people die annually simply because they don’t take their pills right.  The problem is especially acute for diseases where the symptoms are apparent when taking the pills.  Hypertension is a good example.

“as many as half of ‘failures’ of treatment to bring elevated blood pressure down to normal levels may be due to unrecognized lapses by patients in taking antihypertensive drugs as prescribed.” source

So how do we solve this?  Send the text messages morning, noon and night?  Well.  Not really.  They get ignored quickly enough.  The real enemy here is confusion.  People don’t understand why they should be taking their meds until they are in the middle of a heart attack.  Then it suddenly sounds like a much better idea.  There are a couple of things to be done …

• Patient reminders
• Patient education
• Incentives
• Peer support
• Self-supervision

All well and good but where is the money?  Well, in theory, there are a lot of people who can gain by patients taking more pills

1. Patients:  they get to live and stuff.
2. Doctors:  ’refill’ appointments take less time and more profitable than regular diagnosis appointments.  Also a chance to up-sell.
3. Pharmacists:  More product getting refilled puts more money in their pocket.
4. Pharma companies: ditto
5. Goverment:  More peope self-medicating means less stress on public infrastcuture.

So what is the problem?  Why isn’t anyone fixing this?  Well there are various approaches which have been tried but it seems to me like something could be done in the technology space.  What exactly, I’m not sure.  Here is my progress so far on getting something off the ground.

• Pitched to a pharama company that has a hypertension product (twice).  You need a serious looking piece of kit parked in the car park to sell to these guys though, and I normally catch the Dart.  I could buy a better suit and try again but I’m thinking you’d need someone with serious big ticket sales experience to get it over the line.
• An innovation centre in Dublin had a look at it.  In a kind of chicken and egg scenario though – I’d no industry backer to get their interest with.
• Pitched to a GP.  He was actually interested.  Refill appointments are good money for doctors with a quick turn-around.  He is up for running a trial but I should perhaps rack up a few other volunteers before I dive in.

Ideally I’d like to run some kind of trial with one of the medical organisations and get the results published in a medical journal.

So if this is such a great idea – why am I blogging about it?  Well, in truth, ideas aren’t worth that much and I thought if I am not going to do anything with it, it might as well provide some blog content.

Did I mention that I really love this chick?