Primary care access problems in Massachusetts -- and the strange reporting thereof

The New York Times has a longish front page article on access problems in Massachusetts that could have been replaced by three bullet points:

1. Massachusetts' pseudo-universal coverage cut the uninsured in half, making another 340,000 eligible for non-emergent care.
2. The average radiologist in Massachusetts makes $380,000 dollars.
3. In the rural areas that are short of providers "...some physicians are earning as little as $70,000 after 20 years of practice...".

Gee, that's not so complicated is it?

Cut reimbursement to radiologists and other specialists by 30-40%, and increase reimbursement to rural family physicians by 60-80%, and I promise those access problems would melt away. I can even promise that overall quality of care would eventually improve across the board -- after an incredibly painful transition period.

This is roughly the income distribution that both Canada and the Mayo Clinic used to have, so it's known to work. Of course an income cut of that magnitude would put some specialists out of their homes, and a goodly number of senior people would simply retire. The transition would not be pretty, and perhaps not very fair. It would work though.

For me, the interesting thing about this story is not its unsurprising content, but its peculiar structure. The relevant information is oddly distributed, and few will read to to the meaningful paragraphs at the very end.

For example, here's the beginning:

In Massachusetts, Universal Coverage Strains Care - New York Times

...In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance.

Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care....

This is followed by filler, and then "page two":

... The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs.

Clinic administrators in western Massachusetts report extreme difficulty in recruiting primary care doctors. Dr. Timothy Soule-Regine, a co-owner of the North Quabbin practice, said it had taken at least two years and as long as five to recruit new physicians.

At the University of Massachusetts Medical School in Worcester, no more than 4 of the 28 internal medicine residents in each class are choosing primary care, down from half a decade ago, said Dr. Richard M. Forster, the program’s director. In Springfield, only one of 16 third-year residents at Baystate Medical Center, which trains physicians from Tufts University, plans to pursue primary care, said Jane Albert, a hospital spokeswoman.

The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs.

Then, at the very end, the two most important paragraphs ...

... Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice...

Where do editors and journalists learn this obscure form of writing?

In any case, the problem is relative income of course -- it always is. Relative not only to medical specialists, but also to corporate executives, business owners, lawyers, accountants, etc.

Incidentally, I'm fine with Bush eliminating the $48 millions in subsidies for primary care programs. In 2007 42% of family practice residents came from US schools -- that's low enough to be a serious quality issue. We probably need to close half of the remaining primary care residencies, and losing the subsidy would ensure that. Of course the access problems would worsen, but subsidizing training is the wrong answer. Perhaps a sudden drop in a tight supply would concentrate minds a bit ...

Update 4/10/08: Coincidentally, today's NYT editorial also mentions the Mayo example, but fails to make the important connection to May's relatively small specialty/primary care income ratio.

AT&T vs. Sprint: one is better

I don't think there are any truly good cell phone companies [2], but three months after switching from Sprint to AT&T I can say that for us these two are not the same.

Sprint has better service and costs less.

Alas.

We switched because I wanted to buy an iPhone, which I still haven't bought [1]. I wasn't as wise as this writer:

ATPM 14.04 - Bloggable: Shallow Depth of Field

...Then, there’s writing about the iPhone. You see, I don’t have one, because I don’t have AT&T service. And until my friends who do aren’t constantly cursing dropped calls, I have no intention of switching carriers and buying an iPhone...

My friends weren't as forthcoming, but I can personally confirm that in the midwest AT&T drops calls routinely. My phone may show "four bars", but that's just a little AT&T joke. I go from four bars to no carrier in an eye-blink.

Cost? AT&T costs us about 70% more than Sprint for a similar set of services. I think this huge gap is partly an artifact of our usage patterns (two phones, moderate voice use, frequent calls to Canada, very little roaming on Sprint) but I suspect AT&T would cost most people about 20% more than Sprint.

Contracting trickery? Sprint has a nefarious history of covert contract extensions, but they've been getting better since being sued in Minnesota. AT&T has the rebate scam from Hell.

Sprint wins across the board on voice quality, cost, and contracting. I'm amazed.

The only thing AT&T has is the iPhone, but that's a very big thing. If you aren't going to buy an iPhone immediately, however, don't switch to AT&T.

As a current AT&T customer, I join the world's pleas for a great Google Android phone, and for a future iPhone free of AT&T.

--

[1] The timing of the switch was dictated by the impending death of my wife's beloved Samsung i500, I was waiting to see the shape of the SDK before committing to the iPhone. The SDK took so long to be revealed I ran into the pending iPhone 2.0 release!

[2] The contract lock-ins, switching costs, and the pricing costs all promote bad business practices.

Bush war crimes trial: exhibit A

Someday, many years from now, an aged George Bush may yet face a war crimes tribunal. If he does, the Yoo torture memo will be exhibit A:

There Were Orders to Follow - New York Times

...The March 14, 2003, memo was written by John C. Yoo, then a lawyer for the Justice Department. He earlier helped draft a memo that redefined torture to justify repugnant, clearly illegal acts against Al Qaeda and Taliban prisoners.

The purpose of the March 14 memo was equally insidious: to make sure that the policy makers who authorized those acts, or the subordinates who carried out the orders, were not convicted of any crime. The list of laws that Mr. Yoo’s memo sought to circumvent is long: federal laws against assault, maiming, interstate stalking, war crimes and torture; international laws against torture and cruel, inhuman or degrading treatment; and the Geneva Conventions.

Mr. Yoo, who, inexplicably, teaches law at the University of California, Berkeley, never directly argues that it is legal to chain prisoners to the ceiling for days, sexually abuse them or subject them to waterboarding — all things done by American jailers.

His primary argument, in which he reaches back to 19th-century legal opinions justifying the execution of Indians who rejected the reservation, is that the laws didn’t apply to Mr. Bush because he is commander in chief...

...When the abuses at Abu Ghraib became public, we were told these were the depraved actions of a few soldiers. The Yoo memo makes it chillingly apparent that senior officials authorized unspeakable acts and went to great lengths to shield themselves from prosecution.

The state of California needs to revoke John Yoo's right to practice law.

Those convicted of the Abu Grhaib war crimes should ask for a retrial, and submit the Yoo memo as evidence that they were following their leaders.

Over the hill

Older folk are slower at computer tasks:

Quoted : Good Morning Silicon Valley

...Does this mean that people in their 40s or 50s can’t do their jobs? Not at all. There are many other ways in which people get better with age...

We get more expensive, for one.

Oh wait, that's not a feature.

We need to move the retirement age to 40. Since many of us are in school and training to about age 30 that will give us ten years to work.

Today.

In ten years though, training will extend to age 33, and the age of incapacity will slip to 37.

I detect a problem.

How we perceive - a review of the art

Natalie Angier, while reporting on a science conference, provides a fascinating state of the art summary of visual perception.

We are again reminded that we live in our heads, and that the film that plays in there has only a loose connection to what's going on around us ...

Change Blindness - Natalie Angier - New York Times

.... Visual attentiveness is born of limited resources. “The basic problem is that far more information lands on your eyes than you can possibly analyze and still end up with a reasonable sized brain,” Dr. Wolfe said. Hence, the brain has evolved mechanisms for combating data overload, allowing large rivers of data to pass along optical and cortical corridors almost entirely unassimilated, and peeling off selected data for a close, careful view. In deciding what to focus on, the brain essentially shines a spotlight from place to place, a rapid, sweeping search that takes in maybe 30 or 40 objects per second, the survey accompanied by a multitude of body movements of which we are barely aware: the darting of the eyes, the constant tiny twists of the torso and neck. We scan and sweep and perfunctorily police, until something sticks out and brings our bouncing cones to a halt.

The mechanisms that succeed in seizing our sightline fall into two basic classes: bottom up and top down. Bottom-up attentiveness originates with the stimulus, with something in our visual field that is the optical equivalent of a shout: a wildly waving hand, a bright red object against a green field. Bottom-up stimuli seem to head straight for the brainstem and are almost impossible to ignore, said Nancy Kanwisher, a vision researcher at M.I.T., and thus they are popular in Internet ads.

Top-down attentiveness, by comparison, is a volitional act, the decision by the viewer that an item, even in the absence of flapping parts or strobe lights, is nonetheless a sight to behold. When you are looking for a specific object — say, your black suitcase on a moving baggage carousel occupied largely by black suitcases — you apply a top-down approach, the bouncing searchlights configured to specific parameters, like a smallish, scuffed black suitcase with one broken wheel. Volitional attentiveness is much trickier to study than is a simple response to a stimulus, yet scientists have made progress through improved brain-scanning technology and the ability to measure the firing patterns of specific neurons or the synchronized firing of clusters of brain cells.

Recent studies with both macaques and humans indicate that attentiveness crackles through the brain along vast, multifocal, transcortical loops, leaping to life in regions at the back of the brain, in the primary visual cortex that engages with the world, proceeding forward into frontal lobes where higher cognitive analysis occurs, and then doubling back to the primary visual centers. En route, the initial signal is amplified, italicized and annotated, and so persuasively that the boosted signal seems to emanate from the object itself. The enhancer effect explains why, if you’ve ever looked at a crowd photo and had somebody point out the face of, say, a young Franklin Roosevelt or George Clooney in the throng, the celebrity’s image will leap out at you thereafter as though lighted from behind.

Whether lured into attentiveness by a bottom-up or top-down mechanism, scientists said, the results of change blindness studies and other experiments strongly suggest that the visual system can focus on only one or very few objects at a time, and that anything lying outside a given moment’s cone of interest gets short shrift. The brain, it seems, is a master at filling gaps and making do, of compiling a cohesive portrait of reality based on a flickering view.

“Our spotlight of attention is grabbing objects at such a fast rate that introspectively it feels like you’re recognizing many things at once,” Dr. Wolfe said. “But the reality is that you are only accurately representing the state of one or a few objects at any given moment.” As for the rest of our visual experience, he said, it has been aptly called “a grand illusion.” Sit back, relax and enjoy the movie called You.

This evening my son was using a Flip Video camera to record the midst of a chaotic bout of present opening. I happened to play it back about an hour after the event, so I still had some memory of what I perceived. The video showed there was much more going on than I took in, including my oldest son reading a letter included in his brother's gift.

Truly, there are vast rivers of reality going by, we live on a few sips and a lot of extrapolation. It is a miracle, given the imaginary worlds in which we live, that we are able to communicate at all.

CBS 60 Minutes expose: In a just world, Bush would face a war crimes tribunal.

The CIA destroyed the videos they made of the interrogation of Murat Kurnaz.

When someone destroys documentation, the legal presumption is that the material was incriminating. In addition to that presumption, there are these documents:

• FBI Memo
• German Intelligence Document
• U.S. Intelligence Document

On balance the evidence of Kurnaz's innocence is robust. In addition the destruction of evidence by the CIA and the correlation with other stories and verified evidence make him far more trustworthy than the US military.

So, I believe this CBS News 60 Minutes story of his five years of imprisonment, and years of torture: Ex-Terror Detainee Says U.S. Tortured Him, Tells 60 Minutes He Was Held Underwater, Shocked And Suspended From the Ceiling - CBS News

Note this part of the story, which took place in Kandahar Afghanistan ...

They used to beat me when my head is underwater. They beat me into my stomach and everything," he says.
"They were hitting you in the stomach while you're head was underwater so that you'd have to take a breath?" Pelley asks,
"Right. I had to drink. I had to…how you say it?" Kurnaz replies.
"Inhale. Inhale the water," Pelley says.
"I had to inhale the water. Right," Kurnaz says.
Kurnaz says the Americans used a device to shock him with electricity that made his body go numb. And he says he was hoisted up on chains suspended by his arms from the ceiling of an aircraft hangar for five days.
"Every five or six hours they came and pulled me back down. And the doctor came to watch if I can still survive to not. He looked into my eyes. He checked my heart. And when he said okay, then they pulled me back up," Kurnaz says.
"The point of the doctor's visit was not to treat you. It was to see if you could take another six hours hanging from the ceiling?" Pelley asks.
"Right," Kurnaz says.

Let us assume "the doctor" is an American MD. The number of physicians who served the US military at Kandahar Afghanistan cannot be that large. It should be possible to track him down, and bring him to justice. At the very least, his medical license can be revoked.

In turn, he will implicate others.

It is not inconceivable, though it is unlikely, that one day George Bush will be called before a war crimes tribunal. We might as well gather the evidence.

Project Virgle: See it while it's up

Virgin + Google = Virgle

Virgle: The Adventure of Many Lifetime

... starting in 2014, Virgin founder Richard Branson and Google co-founders Larry Page and Sergey Brin will be leading hundreds of users on one of the grandest adventures in human history: Project Virgle, the first permanent human colony on Mars...

It's a wonderful effort, with many links to explore. Of course it helps to know that Branson, Page and Brin really do want to go to Mars ...

For example, I wouldn't be surprised if the site of the colony were used one day.

Google Gmail and Calendar flailing

Ok, so the rest of the net seems to be working, but in the past few days I've either experienced or received direct reports of recurrent hour length outages of Gmail and Calendar.

I've not received any direct reports of problems with Google Apps or Search. I'm writing this on Blogger, so it also appears to be operational!

I have hard drives fail on my desktop machines every 6 months or so, so it's not like my desktop environments are rock solid. Drive failure are so painful that, even including ISP related network failures and personal LAN issues, my Google Gmail is still somewhat more reliable than my desktop email products. (Of course drive failure can knock out a machine used to access Gmail, but I have multiple access options.)

So, on balance, Gmail probably still squeaks by on average downtime compared to my desktop apps. This ain't good though. I wonder if it's going to merit a blog posting.

Gwynne Dyer: four new essays

The historian and journalist Gwynne Dyer has four new essays online:

• Pakistan: Bhutto's assassination voided any deals with Musharraff and thus ended his power. Dyer detects a faint ray of hope.
  
• Tibet: China will crush the uprising just as they did in 1959, Olympics or no Olympics. China has been uncharacteristically restrained up to this point.
  
• Iraq: Iraq's ethnic partitioning will aid recovery. Even Lebanon stopped fighting. Was it worth it? We'll never know.
  
• Abkhazia: Dyer makes a peculiar argument that Russia actually likes International law and the UN, and therefore won't truly advance Abhkazian separation from Georgia. I have to admit it's a novel idea! That never would have occurred to me.
  

Bush's brilliant ploy, and why we should abolish the presidential pardon

The Presidential pardon (think Marc Rich) is an anachronism, a legacy of royalty.

The pardon system allows Bush to run illegal operations, and to guarantee protection to his minions. It incents Bush to run the clock until pardon time.

Bush's latest clock running gambit is to freeze the Office of Legal Counsel until the end of his term (emphases mine) ...

My Way or the Highway - New York Times

... In a lower job in that office, Mr. Bradbury signed off on two secret legal memos authorizing torture in American detention camps. The first approved waterboarding, among other things. When Congress outlawed waterboarding, the other memo assured Mr. Bush that he could ignore the law.

Mr. Bradbury is widely viewed on both sides of the aisle as such a toxic choice that he will never be confirmed. The Senate has already refused to do so twice...

...The head of the Office of Legal Counsel is one of the most important jobs in the Justice Department, charged with telling the executive branch whether it is acting legally. His advice is supposed to be based on the law, not the party line.

Mr. Bradbury, however, continues to defend his cynical memos, and the odious practices they blessed. In a Senate hearing, he tried to justify the way the Central Intelligence Agency does waterboarding by comparing it with the Japanese military’s World War II practice of forcing prisoners to drink huge amounts of water and then jumping on their stomachs.

Human rights experts say the Bush and Bradbury-approved method of waterboarding — strapping down a prisoner under gushing water to make him fear drowning — puts the United States in the company of the Khmer Rouge in Cambodia, the French in Algeria and the security services of the Burmese dictatorship. There is certainly no comfort in that.

When Mr. Bush refused to withdraw the Bradbury nomination, the Senate’s Democratic leaders decided to stop processing other controversial nominations. Senator Harry Reid, the majority leader, twice offered to resume confirmations and compromise on candidates if Mr. Bush withdrew Mr. Bradbury — and forwarded the names of six Democrats chosen for bipartisan panels like the Federal Election Commission. The White House refused, and Mr. Reid took to keeping the Senate in pro forma sessions during vacations to prevent Mr. Bush from making a recess appointment of Mr. Bradbury and other objectionable choices.

At this point, according to a review by Politico.com, the election commission, the Consumer Product Safety Commission, the Mine Safety and Health Review Commission, the Chemical Safety and Hazard Investigation Board and the National Labor Relations Board do not have enough members to do their jobs. Scores of federal judgeships are vacant. The Council of Economic Advisers is down to one adviser...

This is brilliant, in a perfectly evil way. Bush needs to disable the Office of Legal Counsel, and by nominating a toxic figure he's done that. At the same time he's disabled a bunch of government services he'd prefer to eliminate forever: "the election commission, the Consumer Product Safety Commission, the Mine Safety and Health Review Commission, the Chemical Safety and Hazard Investigation Board and the National Labor Relations Board".

The appropriate response to this behavior would be to impeach Bush, but that would put Cheney in power. There's not enough time or votes to impeach both Cheney and Bush, and any impeachment effort would probably help Bush's latest protege -- John McCain.

Diabolical. Bush and Cheney win, again. He ain't stupid, unfortunately.

So for now we resist as best we can, and work for whoever the Democratic nominee is. If McCain loses, however, we really ought to look at abolishing the presidential pardon. That would require a constitutional amendment, but if a Democratic president proposes the fix then Republican senators might go along ...

Google: creating the missing ecosystems

This simple statement is both emintently reasonable and quietly astonishing:

A Letter from Larry Page

...Sometimes you don't get a good answer to a search because the information simply isn't available on the web. So we are working hard to encourage ecosystems that can generate more content from more authors and creators....

Google Search has to work so that Google's advertising revenue grows. When content is missing, Google does not build the solution (can't scale), they build the ecosystem.

Blogger is one obvious example. I'm still amazed by how often what I write in my tech blog appears at the top of Google searches -- despite a very small subscription readership. I write things that fill content gaps, and Google finds them.

Google Books is a less obvious example that might yet have a big influence. On the other hand, Google gave up on Google Answers -- a ecosystem that failed.

I wonder how far Google will go to provide an ecosystem for content producers, and to open new knowledge fronts. They have very large levers! Google Scholar is being used to increase readership of open journals, and thus weaken the publishing empires that keep vast amounts of knowledge hidden from most of the world. Regular Google Search was used to crack open the New York Times and end their experiment with paid access.

Google could buy the Encyclopedia Britannica, but I suspect they're looking for ways to pressure them to run off Ad Words ...

I wish Google would try micropayments other than through advertising, but that's only a weak wish. So far humans have been really resistant to the idea.

What is schizophrenia? Not what we thought.

Some recent results for a study of the genetics of schizophrenia got a lot of press attention. Among other things, the studies are one more indication that the term "schizophrenia", like the term "autism", is obsolete.

First, here's the best of the coverage I read. One came from a blog, the other from the Washington Post. The rest of the coverage, including the NYT and Scientific American, was pretty bad. (Unfortunately Science does not allow public access to articles, I really wish they'd go out of business):

Schizophrenia involves an increased rate of mutations (Ars Technica)

... schizophrenics displayed a high rate (three times the expected level) of genetic mutations at the chromosomal level, where individual genes were either absent, or present multiple times, leading to over-representation. In patients with early-onset schizophrenia, this rate of mutation was four times the expected level.

The genes involved turned out to be important in brain development including neuregulin and glutamatergic signalling, along with ERK/MAPK signaling and genes that are involved in adhesion and synaptic plasticity. Interestingly, the mutations were not common across the schizophrenic patients, instead differing along familial lines...

Schizophrenia Linked to Rare, Often Unique Genetic Glitches (Rick Weiss, Washington Post)

Patients with schizophrenia are three to four times as likely as healthy people to harbor large mutations in genes that control brain development, and many of those glitches are unique to each patient, researchers reported yesterday.

The findings are forcing scientists to rethink the reigning model of how genes and environment conspire to cause the debilitating disease, which affects about 1 percent of the population worldwide.

In part, scientists said, the new view is daunting because it suggests that many people with schizophrenia have their own particular genetic underpinnings.

At the same time, the study shows that new screening techniques can find and differentiate among those various mutations. In the long run that could help doctors choose the best medications for individual schizophrenics and speed the development of drugs tailored to certain patients' needs.

"If the genetics tells us that schizophrenia is really 10 different disorders, then let's have 10 treatments that optimize the outcomes for everyone and not just use the same drugs for everybody," said Thomas Insel, director of the National Institute of Mental Health, which helped fund and conduct the study.

The work also offers evidence that autism shares some genetic roots with schizophrenia.

"Take away schizophrenia's hallucinations and delusions," said Jon McClellan, a child psychiatrist at the University of Washington and a leader of the study, published in yesterday's online issue of the journal Science, "and the symptoms that remain, the lack of social interest and withdrawal, are what we call autism. There is clearly an intersection of the brain systems involved."

... scientists [had concluded] that the mutations contributing to schizophrenia are probably common in the population but have little impact individually, and that only when several occur together is a critical mass of neurological trouble achieved.

The model emerging from the new study is quite different. It says most cases of schizophrenia may be caused by rare genetic glitches that are individually potent.

The turnaround is the result of sophisticated gene scans conducted on 233 schizophrenics, including 83 who got the disease in childhood, a more serious condition. The scans looked for rare stretches of DNA where more than 100,000 "letters" of genetic code were either missing or mistakenly present in duplicate.

About 15 percent of schizophrenics, and 20 percent of those affected in childhood, had such glitches, compared with 5 percent of healthy individuals who were also studied. Yet the glitches, including one previously associated with autism, were different in each person.

Unlike previous scans based on older technology, which could at best find general genomic "neighborhoods" where mutations associated with schizophrenia are present, the new scans pinpointed the individual genes affected...

...The genes implicated are diverse, but many are known to play crucial roles in how the brain gets wired early in life. Normally that process starts with a huge overproduction of neurons, followed by a controlled winnowing that leaves only those that have made proper connections.

"Changes in these genes could bias the way circuits get sculpted out and could perhaps lead to a brain in which signals that would normally get filtered out don't get filtered out," which could interfere with thinking and prompt hallucinations, Insel said.

The delayed onset of the disease can be explained by the fact that some genes and brain connections do not take on central roles until young adulthood, said Jonathan Sebat of Cold Spring Harbor Laboratory, one of the study leaders...

Rick Weiss of the Post did a far better job than anyone else on summarizing these results. The NYT coverage, in particular, was disappointing.

This feels big, but note that that only 15% percent of "schizophrenics" fit this pattern. This is not the whole story, but it's the biggest piece we've gotten so far.

I'll summarize the key implications:

• Schizophrenia is not a disease. It's the name given a fairly large number of unique disorders of brain development that have, among their endpoints, social withdrawal, hallucinations, and fixed beliefs.
• A good number of cases of "autism" and "schizophrenia" are different manifestations of overlapping sets of mutations.
• There may be"no genes for most instances autism and schizophrenia". There are sets of large scale mutations that are similar between close genetic relatives, but similar appearances are resulting from disorders of quite different components of brain development.
• One in twenty seemingly normal people have big, ugly looking mutations that ought to be messing up their brain development. Yet they seem "normal". Seventeen in twenty persons with "schizophrenia" do NOT have these nasty scattered "sledgehammer" mutations. (So called because it's as though something took a sledgehammer to the genome.)
• The age onset of schizophrenia is determined by when the disordered developmental genes are activated. There's a lot of this going on in late teen years. The implication is that the same thing explains why "autism" presents around ages 2-3, and why it can seem to appear fairly suddenly. This may also explain why some conditions seem to improve at other ages. Schizophrenia syndromes often improves in middle age, for example.
• If every person with autism has a somewhat unique disorder, then treatments and prognosis are also unique. This validates the age old practice of asking someone with a cognitive/psychiatric disorder what treatments have worked for relatives.

The puzzle is far from complete, but one part of it has been filled out. We don't know what's causing these scattershot mutations, though a viral infection in very early development is one obvious possibility. I think this picture is also consistent with my earlier speculation that schizophrenia and autism are evolutionary disorders (see also).

Incidentally, Emily reminds me that autism was once considered a childhood variety of schizophrenia.

To me one of the most amazing results of the study is that 1/20 randomly selected health individuals have major derangements of genes responsible for brain development -- yet their brains still work. That's a group I'd really like to study!

See also:

• A mouse model for calcineurin-type Schizophrenia: exciting news indeed

• Regions of rapidly evolving genes: evidence of genetic control of the rate of adaptation and disorders of evolution

• Schizophrenia and Bipolar disorder both have shared pathophysiology?

• Reversing a severe brain disorder in adult mice

• Neuregulin: Monster gene of madness

• Is schizophrenia the price we pay for an evolving brain?

• Schizophrenia and autism: evolutionary disorders?

• Myelin disorders underlie schizophrenia?

• More evidence of hacked wetware: the DARPP-32 gene and schizophrenia

• Schizophrenia and the increased attractiveness of the non-conformist

• The extraordinarily rapid selection and evolution of the human brain

• Autism-like findings in relatives of autistic children and the evolutionary biology of autism

• A mouse model for schizophrenia

• Redefining mental retardation and autism - the revolution ahead

• Very annoying: the diagnostic criteria for Asperger's are not all that useful

Juggling identities: Udell, Cameron and Identity Woman

I've written about identity and reputation management, including a call for identity management services ...

We need more identity management tools that let us rapidly switch our personae (visible identities) and facets, while tracking our associated reputations and providing a visual cue as to our current identity. These tools can also remind us what each identity is designed for; it's not hard to forget the purpose or a persona, and thus to misuse it.

Obviously such a tool should have a biometric component, though it would need to be optional at first. One way to generate a revenue for such a service would be to provide the service free, but charge for the associated token*, biometric authentication component, or personal VPN add-on...

I figured there had to be people thinking deeply on these topics, but I couldn't make a good connection. I finally found one in an older post of Jon Udell's that's been sitting in my reading queue for months:

A conversation with Dick Hardt about British Columbia’s digital identity initiative « Jon Udell

On this week’s ITConversations show I chatted with Dick Hardt about that project. According to Kim’s Information Card thermometer, 10 percent of desktops are now running CardSpace or an equivalent identity selector technology such as DigitalMe. I’m not sure where the tipping point will be, but even if you’re in that 10 percent it’s hard to find concrete examples of how the technology will simplify your life...

DigitalMe? CardSpace?

This if from the Wikipedia CardSpace article:

...Windows CardSpace (codenamed InfoCard), is Microsoft's client software for the Identity Metasystem. CardSpace is an instance of a class of identity client software called an Identity Selector. CardSpace stores references to users' digital identities for them, presenting them to users as visual Information Cards. CardSpace provides a consistent UI that enables people to easily use these identities in applications and web sites where they are accepted...

...Because CardSpace and the Identity Metasystem upon which it is based are token-format-agnostic, CardSpace does not compete directly with other Internet identity architectures like OpenID and SAML... Information Cards can be used today for signing into OpenID providers, Windows Live ID accounts, SAML identity providers, and other kinds of services...

Microsoft initially shipped Windows CardSpace with the .NET Framework 3.0, which runs on Windows XP, Windows Server 2003, and Windows Vista. It is installed by default on Windows Vista and is available as a free download for XP and Server 2003 via Windows Update. An updated version of CardSpace shipped with the .NET Framework 3.5.

So. I think I've picked up the scent now. Then from Jon Udell to the Cameron blog he mentioned: "This blog is about building a multi-centered system of digital identity that its users control." The most recent post promotes a conference run by "Identity Woman Kaliya"...

User-centric identity is the ability:

• To use one’s identifier(s) on more then one site
• To control who sees what information about you
• To selectively share presence and profile information
• To maintain multiple identities and personas in the contexts you wish
• To aggregate attention, navigation, and purchase history from the sites and communities you frequent
• To move and share your personal data, relationships, documents, and other publications as you wish

Ok, that sure sounds like the "identity management services" I was asking for.

So I've found sources to track. Here's the odd part. Both Jon Udell and Kim Cameron work for the Borg.

I've read Udell since his BYTE days, and now I've added Identity Woman (not Microsoft) and Kim Cameron to my blogroll.

The American corporation and the centrally planned economies of the soviet empire

Once in a while two loose neurons bang together and I look at the world differently.

That happened earlier today.

I'm almost always sure somebody's explored the idea, but in the dark ages there was no easy way to find out. I'd write my thoughts down move on. Now I just have to toss a few terms at Google.

Which is how I came to discover that this morning's unoriginal insight was the subject of a Brad DeLong paper written in 1997 when he worked for the Clinton administration.

My version of this insight struck because I've recently been thinking about some of the things all corporations have trouble with. This is work related rather than my usual idle speculation, so I can't provide details here. Suffice to say that my topic started small and concrete, but soon became quite grand. In the end I needed to consider three different sorts of exchanges of goods and services:

1. exchanges within a corporation
2. currency-based exchanges within a market economy
3. collaborative exchanges between academics at different institutions or departments.

Sometime in the midst of this review, the obvious smacked me in the face:

The best publicly traded companies are an almost exact analog to the most finely tuned centrally-planned "command economies" of the Soviet empire, particularly the Czechoslovakian command economies of the late 1970s.

No wonder so many Soviet  and Communist Chinese bureaucrats had smoothly shifted into running massive corporations. Everything must have seemed so familiar. Conversely, the designers of the Czechoslovakian central planning process must have based it on their knowledge of American corporations.

I knew this insight couldn't be original, so I went looking for affirmation. Using the terms "corporation" and "planned economy" Google gave me a good hit on the first page:

The Corporation as a Command Economy by J. Bradford DeLong

University of California at Berkeley, and National Bureau of Economic Research July 1997

Most of us spend more than one-third of our waking lives working for large, modern corporations: organizations where we do not know personally either those at the top or the bulk of those at the bottom of the organization's administrative hierarchy. This is a striking change from two centuries ago, when a productive organization of more than thirty was unusual, and one of more than three hundred an extreme oddity....

...I am going to focus on the issues of corporate control. A corporation is a hierarchical organization. It has a boss--today the he (almost always a he) called the CEO, whose theoretical power is autocratic throughout the scope of the corporation, and subject only to the periodic continued approval of the Board of Directors and the annual meeting of the shareholders. But we were all told a decade ago, when the Soviet Union collapsed, that hierarchical organizations simply did not work as modes of organizing economic life--that you needed a market in order to achieve anything better than low-productivity, bureaucracy-ridden economic stagnation.

What, then, are all these large corporations--ATT and IBM, General Motors and Toyota, Microsoft and USX--doing? What methods of corporate control have saved them from turning into smaller versions of the unproductive Soviet economy?

So my comparisons are not original, and yet, as I scanned Brad's article, I was left with the impression that he gave too much credit to the efficiencies of General Electric , and not enough credit to the remarkable persistence of the planned economies.

My own prejudice is that today's corporations struggle mightily with the same challenges that brought down the planned economies of the Soviet era, and that they succeed more from their impressive ability to hold critical resources and to eliminate weaker competition, than through a unique gift for channeling and distributing resources.

If a new entity were to arise that combined the brute power of the corporation with the intelligence of a true market I think the modern corporation would go the way of the Soviet planning bureau.

That's a large if however. I am not aware of any serious challenger to the corporation, and so the planned economies of the world shall continue into the 21st century ...

XPonlinescanner: malware attack or very nasty ad? Interesting, either way.

Last week I ran into Firefox attack while browsing a local website. I posted about XPonlinescanner.com: Malware infection on Star Tribune and other news sites.

I figured I'd hear something more about this, but a Google search today only shows my original post. So maybe I was imagining things.

Except my original post continues to attract about one comment a day, along the lines of:

I've never heard of or been to the Star Tribune website, but this pop up has appeared on starting up firefox on both a Linux and a Mac computer. I don't use MS Windows.
It would appear that this is wider spread than just a rogue web site.

I just received it this morning. But I believe this one actually popped up while I was on Photobucket.
I closed it but it just opened into a window saying it was scanning and then I just closed it again. I'm hoping it didn't do anything else.

Started this weekend on the jsonline.com (Milwaukee Journal Sentinel) site. Complaint has been filed with site owner.

I've seen several versions of the install file over the past week which is an indication that someone is up to no good.
The source was: hxxp://xponlinescanner.com/2008/download'
XPantivirus2008_v77011816.exe
XPantivirus2008_v880136.exe
XPantivirus2008_v77024205.exe
XPantivirus2008_v880181.exe
I submitted these files to TrendMicro and they all came back as malware containing a Trojan downloader.

This popup is a Trojan Horse malware, users should close the window and not use any buttons presented in main popup.

just got the same treatment from them via salary.com and I notice it didn't install anything. They have a script that just resizes the browser really small and then they put a confirmation dialog on top of it. I closed the confirmation window and it resized my browser to the height and width of my screen and claimed to be scanning my computer....

I do wonder what's going on. If this is indeed a malware attack, it's interesting that it's propagating without comment across multiple sites. If it's not a malware attack, then it says something about the state of web advertising and the desperation of news sites.

Update 10/2/09: I wonder if the NYT breach of 9/15/09 was something similar...

...According to security experts, groups that are often based in Russia and Ukraine create the fake antivirus software and then recruit people to help distribute it by giving them a cut of any money made by selling the software. These so-called affiliates can mimic the advertisements of legitimate companies, learn their techniques for submitting ads to networks and sites, meddle with ad servers and then go so far as to provide customer support for people who install the software, keeping the scam running as long as possible...

Did the Strib ever realize it had been hacked? I don't think they ever admitted it.