The Fox and the Hounds

So this is a long overdue tale. And because I’ve put off telling it for so long we have to go back in time to the beginning. So first I have to tell you the story of my little sister, Fox. Actually, you hear about her occasionally in the pages of this blog, but I don’t think I’ve ever told you the story of how we met. You see, she is my little sister--but we have different fathers. Different mothers too.

Say, what??? you ask. How can she be your sister if you two share no genetics what-so-ever? Well, we do share a defective gene or two. She, like me, is T-1. Why that makes her my sister rather than my cousin or kinswoman, I’m not sure. It just felt right.

Here is how I met her. Once upon a time, the state diabetes control and prevention program gave us meters and strips. The powers-that-be in the state government decided that I should get enough for 30 diabetics at a time when I had 80 uninsured patients. So I had to be creative. At one point a year or two ago the program ran out of money for a while and I got zero meters and strips for 80 uninsured diabetics. The first I knew about it was when the mob showed up at my office door with torches and pitchforks.

Yeah, we manage crisis to crisis out here on the frontier.

Thus began the mad scramble to find the holy grail of diabetes: affordable test strips. Let us review. There are no generic test strips. The strips can only be used with a matching meter. There are no patient assistance programs for strips. The test strip biz in the US alone is a nineteen billion one hundred seventeen million two hundred thousand dollar per year enterprise. And that’s just how much I personally spend. When we add the rest of you in, it really starts to sound like a lot.

Now remember that I work at a non-profit clinic. We also have a non-profit pharmacy for the un- and under-insured. As such, we generally get a discount on drugs that can run anywhere between 50% off retail price to 95% off retail price. But in the case of strips, the major players (low-down dirty dogs that they are) generously grant us, no shit, anywhere between 3% and 5% discounts. Off of retail price. Great. Now a strip is 95 cents instead of a dollar. Without insurance, and without a fairy god mother, you cannot afford to check your blood sugar out-of-pocket.

After calling everyone I know we finally found a cheap strip. Ten cents each. No free meters, we had to buy them. And they were really ugly. They looked like Russian Garage Door Openers. From 1975. And the accuracy of the strips was…..dicey. And the software only let me download ten patients. Ever.

It got me over the crisis, but was no solution. Then we discovered AgaMatrix. Yeah, the folks that make the I-podesque WaveSense meter with its high-tech red blood cell-counting strips that are twice as accurate as the other major players with an amazing 10% strip-to-strip variance rather than the FDA approved 20%. They actually offered us a REAL discount. But their meter required coding and I was sick of coding problems.

Even so, I chatted with their corporate folks, who told me a self-coding meter was only months away. They generously supplied me with a ton of samples of the older WaveSense for evaluation. And they sent a rep all the way to the wilds of New Mexico to meet me.

Now the first question I always ask the Ken and Barbies who visit me from drug companies is the same: Are you diabetic?

First place winner for bad answer: “No, but my dog is.”

So imagine my surprise when the rail thin, pretty, and intense (down boys, she’s taken) meter rep responded to my opening question with “Yes.”

I sat up with a shock and knew in a flash that something unusual had just happened. Two Type-1s had just met in the wild.

We tested the WaveSense and my Peer Educator gang loved it. We compared a wide variety of readings with our in-house Hemocue, which is lab-grade accurate. The bottom line was that these strips work. Really work. They were much tighter than anything else I’d seen or tested before.

The day after the FDA approved the self-coding version, called the Presto, a FedEx package arrived at my office. I opened it and out fell a blue meter the size of a small deck of cards. Here I was in the mountains of New Mexico and I was one of the first diabetic educators to hold the latest technology in my hands. AgaMatrix didn’t even have boxes or manuals for it yet.

Very cool. I emailed and thank you and added that they needed to send 8 more so my Peer Educators wouldn’t fight to the death over who got the one and only Presto.

But now I had a problem on my hands. Well, come to think of it, I always have a problem on my hands. But I had thousands of the not-so-great strips still in house. We could sell them for $10 per vial of fifty; and the Presto strips would be $15 per vial of fifty. How would the Patients react to the extra five bucks?

In the end I decided to run a comparison test. I made up posters with both meters on them and posted them at key locations in the clinic. You know, in my office, at the pharmacy window, in the bathrooms….

Nearly universally, my patients jumped on the Presto band wagon. Some because of the feature set, a backlight for instance. Some because they’d had issues with Brand X. Seems like about every twenty strips or so you’d get a crazy-assed reading. I had warned folks to retest anything that seemed unlikely, but it was still a hassle. And although I don’t know this for sure, I think most changed because they found the little blue meter to be sexy. Ya got diabetes. Ya gotta test. Might as well have a meter you feel good about. And the meter is sexy, filling Amy’s “I-pod factor” requirement. The lancing device is the second best out there (after the one that comes with the OneTouch Mini—two inches short and one-handed operation) with 8 different depth settings. The software, while not Abbott’s Co-Pilot, is pretty damn good. More on that in a sec.

So with all my under- and un-insured patients on the Presto, I found myself using the Presto’s ZeroClick software a lot. It isn’t perfect, but there is a lot to be said for it. One nice thing is that the cable is USB instead of those maddening nine-pin serial ports used for most meters.

I have what looks like a dead octopus on my desk. It is a tangle of wires to connect every meter known to man to the sole serial port on my tower. I’m constantly plugging, unplugging, plugging again, bumping the power cord, crashing the computer and then using a lot of Anglo Saxon English that really shouldn’t be used in front of women and children. (The other day six-year-old Rio told me that school gives him a ficken’ headache).

Now some meters need to be ‘on’ to download. Others ‘off.’ Sometimes different models of a given brand go one way or the other. Presto meters just need to be plugged in. The software doesn’t even need to be spooled up. Just plug it in and BOOM. The software opens, if that meter has been downloaded before it knows which patient in belongs to and the data is sucked out of the meter and dropped into the right folder. You can even merge data from multiple meters for those folks who have a work meter, home meter, car meter.

So recently I said, screw this. I’m putting everyone on Prestos. Starting with my 60 Medicare diabetics. So I called Fox, Hey little sister, how are you? Ummmm….hey, I was wondering if you could, you know, like, send me sixty meters………tomorrow?

Now I want to be clear about the facts that while Fox is a Fox, and that she is one of our tribe, those facts have nothing to do with my adopting the Presto meter. That’s just icing on the cake. I realized, late, that as a matter of good ethics you should support those that support you. Especially in a collapsing economy. You should also support those firms that do the right thing. And you should not support firms who don’t or won’t do the right thing.

So that’s why I’m supporting the Fox rather than the Hounds. I’m doing everything I can do to help AgaMatrix because they are the only meter company doing the right thing. They sell a top-flight strip a price that lets a patient afford them at cash pay. They give non-profits a good break. They have managed to get their product into Wal-Mart, at a price that is around half that of the major players. That, and they have a damn fine product. Good intentions with a crappy product get nowhere with me. Oh yeah, and I really like seeing a diabetes company making an effort to hire diabetics. Much rarer than you would expect.

I’m rooting for the Fox. And I kind of think the Fox just might eat the Hounds for lunch.