Phishing traps via blog post comments - a newer variant

The other day I allowed a comment a bit like this one to be added to one of my blogs:

Hello. This post is likeable, and your blog is very interesting, congratulations :-). I will add in my blogroll =). If possible gives a last there on my blog, it is about the Smartphone, I hope you enjoy. The address is http://_____.blogspot.com.

The spelling and grammar was a bit better, but the form was similar (I removed part of the URL). I checked the site prior to approving the post and it seemed superficially legitimate.

Today I received two more pending comments, each with slightly different wording and different web topics.

Clearly, I got fooled. I shouldn't have allowed the first comment of this class. I'll have to hunt it down and delete it.

My guess is all the sites referenced in these comments are either compromised legitimate sites or they are trap sites. Maybe all they need is for someone reviewing the posts, like me, to check if the site is legitimate. The recent "breaking" of Google's CAPTCHA technology may be a part of the operation.

I just hope I used a Mac for my original site check, and not my XP machine! XP boxes are so vulnerable they really shouldn't be allowed on the web.

I'll be extra careful going forward.

Update 3/11/2010: I loved this comment I received today ...

So, you aproved one of the comments and received a few similar ones? What's bad about that? You don't have to approve the other ones if you don't want to. I don't see any trap here.

The author's name was linked. It didn't resolve to a person, it resolved to a spam blog (splog) article. It wasn't a direct phishing attack comment, but it was of the same genre of comment spam. In this case the desire is to increase pointers to a fraudulent web site, to do "search engine optimization".

Why do I love this example of comment spam? Because it's a fraudulent comment complaining that I'm dissing fraudulent comments. That's kind of funny.

DNA samples of poorly behaved children

This is as inevitable as the rising sun ...

Slashdot: News for nerds, stuff that matters:

... British police want to collect DNA samples from children as young as five who 'exhibit behavior indicating they may become criminals in later life'. A spokesman for the Association of Chief Police Officers argued that since some schools already take pupils' fingerprints, the collection and permanent storage of DNA samples was the logical next step. And of course, if anyone argues that branding naughty five-year-olds as lifelong criminals will stigmatize them, the proposed solution will be to take samples from all children.'...

More from the original Guardian article:

Primary school children should be eligible for the DNA database if they exhibit behaviour indicating they may become criminals in later life, according to Britain's most senior police forensics expert.

Gary Pugh, director of forensic sciences at Scotland Yard and the new DNA spokesman for the Association of Chief Police Officers (Acpo), said a debate was needed on how far Britain should go in identifying potential offenders, given that some experts believe it is possible to identify future offending traits in children as young as five.

'If we have a primary means of identifying people before they offend, then in the long-term the benefits of targeting younger people are extremely large,' said Pugh. 'You could argue the younger the better. Criminologists say some people will grow out of crime; others won't. We have to find who are possibly going to be the biggest threat to society.'...

Since black American males are over-represented in prisons, a future US version of this UK proposal could use the cord blood of all pigmented children*.

Or maybe we'll just do some SNP profiling of cord blood. People like Craig Venter, who exposed his oppositional-defiant traits when he published his entire DNA sequence, would be definitely entered in the registry. Why, we could probably have locked him up long before he sequenced (a version of) the human genome.

We could brand 'em too, or make them wear some distinctive clothing. That way we'd all be warned of their dangerous nature. We could watch 'em day and night, so the first time they blinked we'd pounce and lock 'em up. Then we'd lock up the siblings, because you just never know.

Or maybe we'll turn aside before we go over the abyss? Nahhhhh.

* Note -- this is what's known as satire. I am not actually in favor of this proposal. Just to be clear.

The Economist: a semblance of clever

I think CT nails the modern Economist magazine:

Crooked Timber - Are you smart enough to enjoy the Economist?

....The Economist succeeds in part by delivering a particular party line that accords well with the prejudices of many of its readers (Friedman quotes an acquaintance as saying that he loves the ‘unpredictability’ of the Economist which is quite odd; by the time I gave up on it, I could tell nine times out of ten what the magazine was going to say on a topic by looking at what the topic was). But it also serves as a kind of aspirational good. The Economist flatters readers who aren’t quite intelligent enough to realize how shallow it is into thinking that they are more intelligent than they are because they read it....

It wasn't always this way. Fifteen years ago The Economist was a great "newspaper", but over the past decade it has become dull. I imagine a group of dedicated UK journalists swamped by one dimensional invaders from the Wall Street Journal, but I don't know what really happened.

I no long subscribe, but I do follow a few select feeds. The obits are almost always very good. Science and Technology, The Arts, and Africa have their moments. They still have some fantastic Africa journalists; few other media sources have any kind of Africa coverage at all. This week's coverage of the Lhasa riots reminds us that they still have some brave journalists in the field. Alas, most of the magazine is a better written and more pompous version of Time.

Like CT, I can understand why Tom Friedman would be a fan of the modern Economist.

Ever wonder where childhood memories go?

You'd think an 8 yo would remember events from age four pretty well -- but they don't.

Those four year old events might as well have occurred forty years ago.

Maybe this is why ...

Scientific American: Mind the Alzheimer's Switch

... neuroscientists at the Buck Institute in California made a startling discovery—young brains may experience memory loss due to the same mechanism responsible for Alzheimer's, but this memory loss could give young brains the ability to rewire. They say all brains may have a forward-reverse switch for making and breaking memories, but in certain older brains this switch can go awry, leading to Alzheimer's.

A protein called APP could control the switch. The researchers previously found they could stop Alzheimer's in mice by preventing APP from being cut in two. Recently they found that YOUNG brains have ten times more cut APP than the diseased brains of Alzheimer's patients—and you'd think that was a bad thing. But this isn't detrimental to young brains because they are constantly rewiring to make new neural connections—so some broken memories along the way don't hurt.

It's one of the lesser sorrows of parenting -- much of what one treasures as a parent is forgotten to the child. I'd long suspected it was due to brain rewiring occurring during childhood. Now the evidence is emerging.

Pet food poison and pithed America

We all know frogs will jump out of a beaker of slowly warming water -- long before it boils.

If they've been "pithed" however, they'll just lie there. Pithed frogs don't hop.

Americans have been pithed. Fifteen years ago any of the melamine/cyanuric acid pet food poisoning, Heparin contamination, surveillance society or a dozen similar stories would have resulted in general excitement and even regulatory action.

Now, we just give 'em a stunned look and move on. Maybe it's all we can do. After 12 years of GOP rule (8 of Bush, 4 where the GOP held the House and Senate) we're kind of crushed.

So I really shouldn't be quoting this SF Chronicle article telling us nothing has changed in the pet food world (emphases mine):

The Pet Food Recall: One Year Later, Has Anything Changed?

A year ago, Canada's Menu Foods announced it was recalling more than 60 million containers of dog and cat food sold in the United States. Although the name Menu Foods wasn't familiar to pet owners, the recalled cans and pouches bore the labels of dozens of the most familiar and trusted brands in the marketplace.

In the end, more than 1,000 brands of pet food were recalled over a period of about four months, and two chemicals, melamine and cyanuric acid, were blamed for kidney failure that killed thousands and sickened tens of thousands of pets from what came to be called melamine-associated renal failure....

...I didn't guess when I began covering this story with Gina Spadafori at Pet Connection that it would turn into the largest consumer recall in history, trigger an international trade scandal, launch congressional hearings, spur proposed legislation on food safety and get both American and Chinese businesses owners indicted. I couldn't have foreseen that the incident would put a spotlight on Chinese imports which would eventually reveal lead in children's toys and toxins in toothpaste, and prompt the recent recall of the drug heparin.

But it's equally hard to believe that after all that, the answer to the question "Could it happen again?" is probably "Yes."

The reason for that is simple: None of the changes that might prevent a repeat of last year's pet food recall have been implemented. There have been no improved inspections of pet food plants, no comprehensive overhaul of the patchwork of state, federal and industry manufacturing standards and regulations, no increased transparency and accountability — not even something as simple as printing the name and contact information of the actual manufacturer on pet food labels — and no revisions to pet food labeling laws. The Food and Drug Administration still does not have the authority to issue mandatory recalls.

Most of us closely involved in this story find all that hard to understand. "In this age of potential bio-terror and random cross-species crossover horrors like the avian flu, this is incomprehensible," said Pet Connection editor Gina Spadafori. "Our animals are the canaries in the coal mine, and as bad as the death toll was in our pets, it could have been much, much worse, in both animal and human populations. So why is there still not a national veterinary reporting system for a nationwide emergence of disease that is not only killing animals but could also potentially already be in or emerging in the human population? And why are we still unable to inspect all but the tiniest percentage of imported foods?"...

...The adulteration of protein concentrates with melamine and cyanuric acid was found to be both longstanding and widespread in China, so it seemed unlikely something like this hadn't happened before.

And in fact, it had. The Journal of Veterinary Investigative Diagnosis recently reported that melamine and cyanuric acid contamination was responsible for the deaths of thousands of pets in 2004.

Researchers working with tissue samples from animals who died in the U.S. recall compared them to samples from pets who died in a number of Asian regions including the Philippines, Japan, South Korea and Hong Kong. Those deaths led to a recall of Pedigree dog foods and Whiskas cat foods, and were blamed on mycotoxin contamination. But the study found that both groups of pets had the unmistakable crystals and damage in the kidneys caused by melamine and cyanuric acid.

While there's no evidence any other mycotoxin-attributed food recalls, pet or human, were misidentified, it does put the pet food recall squarely in the big picture of this country's broken food safety system.

A fix for that broken system may be coming, even if it's a bit slow. The FDA recently announced a meeting where it will discuss changes in the regulation of pet food ingredients, processing and labeling with representatives from the pet food industry, government agencies, veterinary medical associations, animal health organizations and pet food manufacturers at that meeting. One group not on that list is pet owners, but they have asked to hear from us. Comments should be made on docket number 2007n-0487 at www.regulations.gov/. [jf: I tried this. I don't think the site is accepting comments yet on this item. I'd recommend an email to your Senator or Representative instead.]

"The recalls exposed deep problems with food safety regulation in China as well as in the United States, and I see many signs of efforts to do something about them," said Nestle. "Lasting improvements won't happen overnight, and they won't happen at all unless people who care about these issues keep pressuring the industry and the FDA to do what they say they will do."

Did you catch the implication that we ought to be reexamining other "mycotoxin" or "fungal" related food poisoning episodes to see which were the result of fraud?

I'm sympathetic to the stunned -- I'm about half-pithed myself. It takes a lot of energy to put pressure on the FDA in the best of times, but this is Bush's FDA -- neutered, broken, led by people opposed to their own mission.

If we put McCain into the White House we deserve to eat Melamine and lead for breakfast.

How old is this retiring pastor?

I really don't know what "Obama's Pastor Wright" said, but I gather it wasn't very nice. In reading Obama's response though, I had only one thought.

How old is this retiring pastor?

When people start saying odd things inconsistent with past behavior, it's worth remembering that dementia is an exceedingly common disorder.

It's official. We live in a surveillance state.

Not a police state, not yet. Surveillance state is a good term.

INTEL DUMP - NSLs and the National Surveillance State

I agree with Yale law professor Jack Balkin -- we live today in a national surveillance state. This article in the Washington Post detailing the FBI's use of "national security letters" (NSLs) tells an important part of that story. According to the Post:...

....For reasons of convenience, expediency, secrecy and efficiency, federal law enforcement has increasingly turned towards surveillance and investigative methods which do not require ex ante review or approval by an Article III court...

...If you still think you've got a reasonable expectation of privacy in your daily life -- check again. The exceptions very nearly swallow the rule today.

Is this a problem? Depends on your perspective. What worries me here is the slow bureaucratic expansion of power -- like the ever-expanding Blob of movie fame. The FBI and intelligence community may need administrative tools like this. Ultimately, we may decide it's in our interest to allow law enforcement the use of these tools -- whether for targeting suspected terrorists, drug dealers, organized crime figures, or even Client No. 9. But that's got to be a public debate, and it's got to be a debate held by accountable officials, not agency officials behind closed doors. We have a stake in this policy, and we should get a say.

It's been a long transition. I think technologic progression alone would have brought us to this point by 2013 even if 9/11 had not occurred, but terrorism accelerated the timetable.

To think it was only a few years ago that pundits scoffed at claims of widespread domestic surveillance. Nobody's scoffing now.

Will Americans actually demand a public debate? I doubt it. We're a future shocked culture -- dazed, numb and pithed; hit by too much too fast. We're going to live with this.

We're all Singaporeans now.

Sheldon Brown - one of the original riders of the web

My old, long neglected web page on bike touring included a section on bike reference links. Surprisingly most of the links still work, including my link to Sheldon Brown's eclectic bicycle site.

I revisited the site tonight. It's very 1994 -- HTML 2.0 tables with links to his personal interests -- including my home province and his personal pages. It's only on the Harris Cyclery page though, that we learn Sheldon Brown died on February 3rd, 2008.

He kept a personal journal. There's an entry for the last day of his life:

... I've finally made up my mind, I'll be voting for Obama in the primary on Tuesday. When you live in Massachusetts, the primary is the only presidential vote that matters--if a Democrat can't carry Massachusetts in the final, there's no hope!

I'm still a big fan of Clinton, and would still be on the fence, except that my daughter is very strongly for Obama and has been working for him, which is enough to tip the balance for me...

The Times of London, has an extensive and affectionate obituary. He died of a heart attack after two years of progressive multiple sclerosis.

I hope one of his many fans will be archiving his pages and writings.

No more spouses at the press conference

I thought Gail Collins had the very best comment on the Spitzer story:

Unwelcome Surprises - New York Times

...Memo to future disgraced politicians: The nation has discussed this at length, and we do not want to see any more stricken spouses at the press conference. Not even if she volunteers...

If the politicians walks the plank alone, we'll consider forgiveness. Bring a spouse and forgiveness is off the table.

The only other comment I'd make on the Spitzer case is the young woman involved seems confused, lost, and vulnerable. That's not surprising given her employment. It's the only other part of the story worth any attention.

Mass disability and Great Depression 2.0

Wired magazine's front page claimed recently that "free" was the new cheap. That would be consistent with Robert Reich's latest "Great Depression" post (aka, GD 2.0. Emphases mine):

Robert Reich's Blog: Are We Heading Toward Depression (Part 3)?

American consumers are coming to the end of their ropes and don't have the buying power they need to absorb the goods and services the U.S. economy is capable of producing. This is likely to mean fewer jobs, which will force Americans to pull in their belts even tighter, leading to still fewer jobs – the classic recipe for recession. That recession may turn into a full-fledged Depression if fiscal and monetary policies can't make up for consumers' lack of buying power. And there's reason to worry they cannot because consumers are in a permanent bind. They're deep in debt, their homes are losing value, and their paychecks are shrinking...

...We're reaping the whirlwind of many years during which Americans have spent beyond their means and most of the benefits of an expanding economy have gone to a relatively small group at the very top. Adjusted for inflation, the median wage is below where it was in 1999. The nation's median hourly wage is barely higher than it was thirty-five years ago. The income of a man in his 30s is now 12 percent below that of a man his age three decades ago. The rich, meanwhile, can't keep the economy going on their own because they devote a smaller percentage of their earnings to buying things than the rest of us: After all, they're rich, and they already have most of what they want. Instead of buying, they're more likely to invest their earnings wherever around the world they can get the highest return...

... Go back to the years just before the Great Depression and you see the same pattern. As I've noted before, Marriner S. Eccles, who served as Franklin D. Roosevelt's Chairman of the Federal Reserve from 1934 to 1948, noted this in his memoir "Beckoning Frontiers":

"As mass production has to be accompanied by mass consumption, mass consumption, in turn, implies a distribution of wealth -- not of existing wealth, but of wealth as it is currently produced -- to provide men with buying power equal to the amount of goods and services offered by the nation's economic machinery. Instead of achieving that kind of distribution, a giant suction pump had by 1929-30 drawn into a few hands an increasing portion of currently produced wealth. This served them as capital accumulations. But by taking purchasing power out of the hands of mass consumers, the savers denied to themselves the kind of effective demand for their products that would justify a reinvestment of their capital accumulations in new plants. In consequence, as in a poker game where the chips were concentrated in fewer and fewer hands, the other fellows could stay in the game only by borrowing. When their credit ran out, the game stopped."...

There's so much opportunity for productivity driven growth in China, India, and even Africa that we ought to be able to dodge a GD 2.0, or even a Japanese-style 1990s depression. Of course if we really are entering Peak Oil territory, this is not a great time to have a markedly sub-optimal spending capacity distribution across America.

My take? I believe that about 20% of adult Americans aged 25 to 65 are effectively disabled in our current globalized post-industrial economy. I believe this number will rise as our population ages. I believe this is the fundamental problem, along with network effects, driving modern wealth concentration.

Over time the economy will change to develop niches for unused capacity (servant economy?), but the transition need not be comfortable. In the meantime technological shocks, such as ubiquitous robotics, may induce new disruptions to a non-equilibrium economic structure -- risking extensive economic breakdown.

Even if we avoid GD 2.0 this time around, we need to rethink our economics and social models.

Update 4/4/2010: Changed the title of this post - the original was kind of meaningless.

NBC's "To Catch a Predator". Please tell me this is satire ...

Please tell me this is satire...

What’s on TV Tonight? Humiliation to the Point of Suicide - New York Times

In November 2006, a camera crew from “Dateline NBC” and a police SWAT team descended on the Texas home of Louis William Conradt Jr., a 56-year-old assistant district attorney. The series’ “To Catch a Predator” team had allegedly caught Mr. Conradt making online advances to a decoy who pretended to be a 13-year-old boy. When the police and TV crew stormed Mr. Conradt’s home, he took out a handgun and shot himself to death.

“That’ll make good TV,” one of the police officers on the scene reportedly told an NBC producer. Deeply cynical, perhaps, but prescient. “Dateline” aired a segment based on the grim encounter. After telling the ghoulish tale, it ended with Mr. Conradt’s sister decrying the “reckless actions of a self-appointed group acting as judge, jury and executioner, that was encouraged by an out-of-control reality show.”

Mr. Conradt’s sister sued NBC for more than $100 million. Last month, Judge Denny Chin of Federal District Court in New York ruled that her suit could go forward...

No, I suppose it's real. I honestly didn't realize that American television had fallen this far. I live in a different world.

I'm sure NBC is now begging to settle, but I hope Mr. Contradt's family nails them publicly. I've vote for  a $30 billion dollar fine myself ...

Whatever happened to medical progress?

By an odd bit of synchronicity I'm simultaneously engaged with leading edge research in "Translational Bioinformatics" and refreshing my very dusty knowledge of family medicine.

How dusty? It's been about ten years since I took care of a patient, though other work has kept me somewhat connected to clinical practice. My medical school ended in 1986, so we're talking antique knowledge with dust on it.

Problem is, my old knowledge is more topical than it should be.

In 1983 I wrote a friend an enthusiastic note boasting of how quickly medical knowledge was moving. I was sure that the future was bright for treating and preventing diabetes, the "Haitian disease" (later HTLV, then HIV), rheumatoid arthritis, ALS, autoimmune disease, osteoarthritis, lupus, hypertension, heart disease, migraine, asthma, schizophrenia, dementia, viral and bacterial infections, multiple sclerosis ...

Ok, so I was a tad naive -- but the twenty years from 1962 to 1982 had been amazing. Infectious disease, nutritional disorders, thyroid disorders, insulin, hypertension, angina, -- we were doing great. All we had to do was keep up the pace ...

Splat.

We hit a wall. Now we're relearning how to fear bacterial infections, and the antibiotic pipeline is dry. We can't even treat menopause any more -- estrogen is a bad word. Lipitor and Glucophage are great, but we thought Diabetes Mellitus would be cured by now. We can slow the progress of HIV, but we still don't have a vaccine. Our progress against everyday medical conditions has been lousy over the past twenty years. Mostly we've learned to stop doing silly things, like given people with heart oddities antibiotics prior to minor dental work.

Forget the propaganda about zillions of articles being published -- that's not translating to big changes in people's lives. Yes, we do make progress -- but automobile-style progress, not computer-storage type progress. No wonder we're expecting to spend 99% of our GDP on health care -- we're not getting any big productivity boosts from breakthrough treatments.

Which brings me back to the "translational bioinformatics" stuff. This is the dream that we can apply enormous progress in computational power, and basic science breakthroughs in genomics, to the intractable diseases that have been jeering at us for 20 years.

I'd really like to see us knock off just one of those suckers before I retire. Multiple sclerosis would be a good start. Make my 20 year old knowledge completely obsolete. Please!

Support Tom Harkin's Complete Streets legislation - write your senator

In a nation heading to $7/gallon gasoline and malignant obesity Tom Harkin's "Complete Streets" legislation is both good business and good public health:

Tom Harkin Introduces "Complete Streets" Legislation || Integrated Road Planning || Ride Boldly!

Senator Tom Harkin (D-IA) introduced a bill last week designed to promote proper road planning - designing facilities that are safe for all street users, including motorists, public transit, bicyclists, and pedestrians.

Tom’s office has put out a complete media release, including the list of organizational supporters, on his Senate site. Many organizations devoted to promoting livable communities have signed on to this bill.

Writing your own Senator to encourage passage of this bill is best done by e-mail in the post-anthrax Senate, per a friend who used to be a Harkin advisor. If you need info on contacting your Senators, check out the Senate web site.

Please shoot off a supportive email. I know I will.

Oil price speculation: is it rational investment or a bubble?

I've read recently that oil prices "now" are driven by "speculation" rather than "fundamentals". In other words, based on near term supply and demand curves, including our current recession, prices should be stable or dropping, not rising.

Yet rise they do.

In August of 2007 I'd thought that, absent any surprises, gas would hit $5/gallon in the midwest around 2011:

2011: The year American life changes (Aug 2007)

When will energy costs in general, and gasoline costs in particular, fundamentally change the way middle-class Americans live and work? We know gasoline prices will rise until something changes, even if the US never implements a carbon tax...

...I think a reasonable marker is the year that the baseline gasoline price hits $5 a gallon...

So when does it happen? I'll pull a number out of the air, extrapolating from my amateur chart and the Copernican Principle, and guess, even without a carbon tax or the complete collapse of Iraq, that it's 2011.

I'm in California today, and it's $4/gallon here in early 2008. My 2011 prediction for a change in American life is looking conservative.

So, is today's oil price rational speculation or bubbly speculation?

Well, I haven't read any good discussions of this lately, so I'll say something and hope Brad DeLong decides to clear things up

One way this speculation could be rational is of the people who are paid to know believe that peak oil is coming any time in the next 10-15 years -- especially given the current bleak options for alternative investments. For non-economist readers, here's why:

Gordon's Notes: Gasoline and the rule of 72 (May 2007)

... There's some smaller rate of return that would make retaining rather than selling petroleum products the right way to invest. This is what all the "peak oil" crowd get excited about; but the term is a bit misleading. It's not that oil production needs to peak, it's simply that demand has to persistently outstrip supply. Prices, of course, don't wait for demand to outstrip supply, they begin rising as soon as a demand/supply gap can be reasonably anticipated within the time frame of investment decisions (10 years roughly).

This, by the way, is a very good thing. It means that prices rise long before we run out of oil, giving everyone time to adapt and adjust.

I do wonder what the sober experts calculate. They can look at supply curves and demand curves and the available substitutions within the next decade. Do they see a significant supply/demand gap opening up? If the price of gas will be $7/gallon in six years (well within the lifespan of your next Ford F-250), is that enough of rate of return to justify holding products now?...

So here's my proposal for deciding if Peak Oil is on the way.

If the price of oil craters ($65) in the next 6 months then we're living in an energy bubble today and Peak Oil is more than 10-15 years away.

If the price of oil is above $105 a barrel in August of 2008 then Peak Oil is on the sooner rather than later, and the world I grew up in is shuffling away -- sooner than I'd expected.

So American Life may change in 2008 - not 2011.

Shocking news: incenting physicians towards one goal has negative impacts on other goals

I am so surprised by this shocking, impossible to predict, outcome:

AMNews: March 17, 2008. CMS metric may prompt excessive antibiotic use ... American Medical News

...A new study says physicians are 39% more likely to misdiagnose hospital patients as having community-acquired pneumonia due to the high-stakes environment fostered by mandatory public reporting of quality measures -- in this case, whether pneumonia patients got antibiotics within four hours of arriving at the hospital.

The results, published in the Feb. 25 Archives of Internal Medicine, are similar to those found in a Chest study published last year and echo many physicians' complaints about the measure of initial antibiotic timing, known as door-to-needle time. A February 2007 Infection Control and Hospital Epidemiology study tied excessive use of antibiotics encouraged by the performance metric to a severe outbreak of Clostridium difficile at a small rural hospital...

I trust my sarcasm is sufficiently dripping.

The CMS pay-for-performance programs will be eventually recognized as the most harmful health care innovation since Evaluation and Management coding killed primary care in the 1990s.

Alas, that recognition is still 18 months away -- and here I'm being atypically optimistic. E&M coding, for example, has now been a 13 year disaster.

There are many ways to improve health care quality that have been shown work and to be relatively free of perverse consequences. "Pay-for-performance", however, is an ideologically driven program that was reasonable to experiment with -- before the evidence of failure emerged. Now it needs to die -- but it won't until the Bush team leaves CMS.