U.S. Bank's ID Shield makes me scream

U.S. Bank, alas, is my bank.

Recently they instituted new mandatory "security" feature they . I had to provide them with answers to a wide range of security questions.

Yes, the "security" questions that provide a yawning back door into your online data, because it's easier for a crook to get answers to the security questions than it is to get at a strong password. Security question attacks are how most celebrity email accounts are hacked.

Today I tried to sync my Quicken data and I was asked where my maternal grandparents live.

I don't know where the #$!%$ my maternal grandparents live. They died before I was born, back in the early part of the last century.

American Express does not do this to me. I respect American Express's security model; ever since I learned the hard way about the Visa/MC systems.

I can't tolerate the pain of switching checking accounts, but US Bank has earned my enmity. I'm going to make them send me paper statements until the last post person falls.

Update: It gets better. I looked up the answer to the security question in my password database. I'd used a longish passphrase, so I gave that back to US Bank. The web site croaked with an error (probably string overflow) and locked my account (yes, like this). They gave me a #$@% phone number to call. US Bank is dead to me.

In What City Did You Honeymoon?And other monstrously stupid bank security questions tells us these passphrases are the fault of RSA Mobile, who provides them to banks. I want a bank that's smart enough to pay for a smarter version of two factor authentication. For example:

... Instead of coming up with ever-more-ornate questions about teachers and toys, banks and security companies should push solutions that are safe and customer-friendly. While everyone hates calling customer service, confirming your identity on the phone (an out-of-band device) is way more secure than using an online form. RSA's Gaffan told me about a phone-based authentication system used by more than a dozen of the company's clients. At sign-up time, you enter your work, home, and cell numbers. If you lose your password, simply indicate whether you're at home, at work, or on your cell. To authenticate yourself, just answer your phone and type in a number that appears on your computer screen. There's nobody asking about your honeymoon and no stuffed animal names to remember. Sounds perfect to me. What's my favorite bank? The one that doesn't ask me stupid frigging questions...

Passwords are dying, and they may take the world's less intelligent banks down with them.

Update 7/1/09: Michael A. points out that parents and children know each other's secret questions (children may need to do a bit of social engineering). On the other hand, spouses don't. My wife and I share a US Bank account, and she doesn't know my "High School mascot". There's got to be a lawsuit in here somewhere. Children hacking parental bank accounts, spouses denied access, users denied access ... I fear we don't have enough hungry lawyers these days.

There's a simple solution for US Bank that would be a win-win. Provide an option for customers to choose an alternative authentication option. Customers using option B would be required to have a strong password (but not to change it routinely, that's been shown to harm security) and, if they need to reset it, to physically travel to a bank branch, present legal ID, and pay $20 cash to cover the extra costs.

Update 7/3/09: One common workaround for stupidity of this extraordinary magnitude is to come up with a single robust "backdoor" password and use it to answer every secret question. US Bank does not allow this, each "secret question" response must be unique. I need a smarter bank! I can't trust any entity this incompetent with our money and our identity.

I've asked Bruce Schneier if he could write an essay identifying banks who actually demonstrate a basic understanding of security principles. I've also written a note to REI, who's VISA card I like. Unfortunately REI use's US Bank ...

... I love my REI Visa card, and I use it all the time.

Unfortunately, US Bank has introduced new online banking security measures that are proof of security team incompetence...

... I can't use an online bank with an incompetent security team!

I'm sorry I'll have to give up my REI Visa card. I hope you'll consider this email when you evaluate your relationship with US Bank.

Dog food: now it's the fluoride

We don't know the safe levels for dogs. Apparently the fluoride comes from a high bone meal content in pet food ...

Fluoride in dog food - Pets' health at risk? | Environmental Working Group:

.... An independent laboratory test of popular dog food brands, commissioned by Environmental Working Group, revealed that the food we buy for our pets contains high levels of fluoride, a contaminant that may put dogs' health at risk.

Eight major national brands marketed for both puppies and adults contained fluoride in amounts between 1.6 and 2.5 times higher than the Environmental Protection Agency's maximum legal dose in drinking water... All 8 brands contain bone meal and animal byproducts, the likely source of the fluoride contamination.

Scientists have not studied the safety of high doses of fluoride for dogs....

It's hard to know what to make of this, except to reiterate that, in practice, libertarianism sucks.

Coleman is gone. At last.

It's a bit anti-climactic, but it's still good ...

The Associated Press: GOP's Coleman concedes, sending Franken to Senate

... Republican Norm Coleman has conceded to Democrat Al Franken in Minnesota's contested Senate race, ending a nearly eight-month recount and court fight.

Coleman conceded at a news conference in St. Paul, a few hours after a unanimous Minnesota Supreme Court ruled Tuesday the former 'Saturday Night Live' comedian and liberal commentator should be certified the winner...

...A spokesman for Senate Majority Leader Harry Reid says the earliest Franken would be seated is next week, because the Senate is out of session for the July 4 holiday."

Coleman steered to the wind. When Bush was powerful he was a conservative, when Bush weakened he was a "moderate". He was never a GOP rebel like the Senators from Maine.

Health Care reform and Climate change response (aka the survival of civilization) both got a big boost today. Of course there really aren't 60 certain votes for anything, but we're closer.

Now if we could just get rid of Pawlenty ...

States nobody should live in: add Georgia

One less state that a moral person would choose to live in ...

Editorial - Two Meals and Not Always Square - NYTimes.com

... Three days a week, Georgia now serves inmates only two meals...

Texas is another such.

Minnesota is a better choice.

Human progress and global climate change – are we good enough?

We are not what we were 20,000 years ago. We are not the people of 2,000 years past.

Hell, we’re not even the people I was born to.

We’re better than we were.

We’re better at damned near everything. I don’t know the how or why, but we’re still around 50 years post-fusion weapons. We got rid of Freon. We don’t routinely torture children in public schools. We have the ADA. We don’t smoke on airplanes. We have Obama. Gay unions, by whatever name, are inevitable. Religious fundamentalism in American is on the wane. We got rid of the torturers. Maybe this year, maybe ten years from now, America will guarantee good-enough health care to every American.

Progress happens. Lots of progress. Yeah, we go backwards, just like real estate, the Dow, and average July temperatures. Backwards – in the short term. Long term it’s one hell of a trend.

So I think that if the climate change riff on our smoldering Malthusian crisis had come along in 2060 that we’d be ok. Fifty more years of Singularity-free progress and we’d be ready to handle our CO2 problem.

Except it isn’t 2060, and we’re struggling big time. The US Congress has passed a bill that gets us about 5% of the distance, and the Senate is expected to suffocate it. To add injury to injury, those who argued against the bill were babbling gibberish.

I think we’ll still work something out. It’s the Obama effect; the boundaries of the impossible have moved. It’s going to take a lot of effort from the Rationalists however.

So I’ll start with an exercise. I’m going to try to invent a plausible argument against a Carbon Tax-equivalent like Cap and Trade.

For my first Denialist argument I’ll admit that the earth has been been growing warmer, on average, over the past 150 years. There’s no sense fighting on this point.

Then I’ll grant that CO2 might warm the earth, but I’ll say that particulates also cool the earth. Moreover, I’ll claim, we can’t trust simulation data so we  really don’t have good evidence that CO2 emissions are warming the globe. The effect may be solar in nature, and the historic relationship of global warming to CO2 rise is merely coincidence [1]. Therefore, I’ll argue, we need to do more research before acting on CO2 emissions.

That’s one. For my second argument I’ll grant that the earth is getting warmer and CO2 is the cause, but over the next 100 years it’s cheaper to adapt (build submerged homes) than it is to reduce CO2 output. Most likely, assuming we don’t vent the methane, we’ll only have a 3-4 degree Celsius warming by 2100 and that will only reduce GDP by 5%. By the time we get to 2060 we’ll be sucking yottawatts from parallel universes and we can dump the CO2 back into whatever cosmos we’ve depleted.

For my third argument I’ll grant the earth is getting warming, and that CO2 is the cause, and that we can’t “adapt” without risking human civilization and the lives of billions of people. In this case we should invest in terra-forming and climate engineering, such as CO2 sequestration or high altitude aerosol deposition, and forget about Carbon taxes.

So far I’ve come up with three semi-rational contrarian arguments all opposing a Carbon Tax (equivalent). I’ll call them “Solarian”, “Adaptionist”, and “GeoEngineering”. The three cover a spectrum from very weak (Solarian) to worthy of discussion (GeoEngineering).

The latter two are reasonable enough that most Rationalists would include aspects of them in a full-spectrum response. Personally I believe the “Adaptionist” argument makes unrealistic assumptions about the willingness of millions of humans to go gently in the night, and I think the GeoEngineering is astoundingly unlikely to work. Still, I think we’ll have to have some Adaptation (Leaving New Orleans…) and the GeoEngineering approaches do deserve study and testing.

Are there any quasi-Rational arguments against a Carbon Tax (or equivalent) that I’ve missed?

[1] An odd coincidence of course.

Finance transactions aren't so standard after all

In my job I'm familiar with the hellish stew of healthcare IT transactions.

Honestly, I'm a bit of an expert about that.

We always assume things are better in the simpler world of bank transactions.

That's probably true, but apparently they weren't so great 10 years ago ...

Charlie's Diary: How I got here in the end, part nine: the little start-up that could:

.... 1998 was a painful learning experience. It turns out that while the British banks all adhered to the APACS protocols for exchanging financial transactions, the protocols in question were prone to, ah, flexible interpretation — and each and every one of the banks interpreted them differently, seemingly in order to lock out their competitor's suppliers' EPOS terminals....

Standards are hard work, particularly when one's income depends on the standards not quite working.

Cyclopath.org: A GeoWiki for the Twin Cities metro area

Cyclopath is a Twin Cities Metro area bicycle map and "GeoWiki". It's operated by the University of Minnesota's GroupLens Research group. An associated Wiki provides news and documentation...

Welcome to Cyclopath, the geowiki for Twin Cities bicyclists. You can use Cyclopath to find routes and share information with other cyclists.Nobody knows where you can go, and what you will find when you get there, better than you, the bicycling community. Cyclopath enables bicyclists to harness this collective knowledge and build a comprehensive, up-to-date information resource by and for the community

This is what I'd thought long ago I might do with msptrails.org, but it's always been a future project for me.

A very nice local development.

Mysteries of Annandale Minnesota

Parental anxieties, not without foundation, led me to a secret location a few miles from my eldest son’s overnight camp. I was under cover, he was not to know I was positioned for first night emergency response.

My bolt hole was a very small AmericInn in Annandale, Minnesota, a town of 2,700 white people that’s somewhere southeast of Lake Wobegone …

My home is the “A” in the above, and Annandale is the “B”.

In the late 19th and early 20th centuries Annandale was a railway stop that morphed into an agricultural service center and a resort community. It later became a summer lake town and probably struggled economically. Now it’s gradually being absorbed into the monster sprawl between Minneapolis and St. Cloud. If life continues on the current path (unlikely post-Peak Oil) it will be fully exurban within 15 years.

Of course I had to explore. I started with the downtown, which looks like it made a serious effort at being tourist-friendly in the past decade. There’s a genuinely artistic fountain by the library, for example. On a Sunday things are quiet, so I ended up at Tootsie’s Bar and Grill here seen in the Google Street View ..

Yes, the friggin’ Google Street view. Think about it.

I’d had enough sense to put pants on, so they didn’t beat me up. Still, it ain’t the kind of place that sees a lot of strangers on a Sunday night. I made the mistake of sitting at a table. I think I could have died of old age there. I did better at the bar.

The white skin didn’t fool the locals. They could tell I didn’t belong.

I went to check out the library since I’ll need a place to work tomorrow. While I was sitting there the local cops pulled in. Coincidence, I’m sure.

I knew there had to be a mystery in Annandale, so before the cops chased me away I scanned the sat view of the town on my iPhone. Sure enough, this looked odd …

What was laid out in a grid like that, and what were the flat greenish areas? Street view didn’t go in there, and the satellite res was too low. It looks like a big parking lot, but the scale is wrong.

What could all those units be?

Think …

This is what used to be called a “trailer park”, the more correct term is modular home community (See also – a lot of American live in these communities, 10-15% maybe. They’re often hidden just out of sight). I’d guess there are about 300 units, so a good portion of Annandale lives here. These communities are too intimate for me to drive around in, but I did navigate back to check out the green area and I drove by some homes. The community looked more occupied than the rest of the town, with groups of teen and pre-teens in the streets.

The mystery areas, by the way, appear to be a manufactured wetland and the town dump. I think the latter is commonly found by modular home communities.

There are other mysteries near Annandale. One is a sign saying “Big Woods”. I had to chase that down, but the road turned to dirt and I ended up at in farmland. A sat map check didn’t show anything even remotely woody. So that one’s still a mystery.

On the other hand, I did turn up the Minnesota Pioneer Park in Annandale.

An Annandale historian tells the story. The Pioneer Park was built in the 1970s from the remnants of a train depot with the help of a group of reasonably prosperous and well connected summer residents who appeared to have an insane amount of time and energy. Thirty years later the park has seen better times, but I’ll look for a chance to get the kids out when it’s open.

Which led me to Annandale Online, the personal project of a Ms. Jill Bishop (emphases mine) …

Jill Bishop started the Annandale Online Website in 1999 while studying for a Masters of Liberal Studies. She had considered ethnography of the Annandale area for her project when she came across another city’s community website. In March 1999, Annandale Online became part of the internet after the City of Annandale okayed it. Now eight years later, Jill is still the website administrator of the site, which is sponsored by the City of Annandale. The website has grown from 50 pages when it was introduced to 600 pages of information. (A “page” can include many screens of information.)…

…The Annandale Online home page features a picture which is changed every week or two. Currently, it features a 1945 Annandale street scene. The sections include Events, Government, Library, School, Business, History, Advocate, Civic Groups, Religion-Spirituality, Health, Visitors, Other, and Weather.

The Events section includes the what, where and when of what’s going on each month in Annandale…

… There is also a link to a website in Finland listing Annandale area cemeteries and an alphabetical listing of burials in those cemeteries. This is a project completed by Ernest S. Lantto.

Annandale Online includes most everything a person would want to know about Annandale.

Actually, I don’t think it says much about the sociology and history of the modular homes, but it does hold rather a lot of information, including an explanation of how the town came to be (the page counter reads 1,263 today. If you read this, please do visit and kick the counter up a notch).

Mysteries, mostly, resolved.

I’m a great tourist.

Update: A visit to Tootsie’s should be balanced with a cup at In Hot Water on the other side of the tourist area (old main street). Superb organic/free trade coffee, great outdoor seating, small and welcoming indoor seating.

 

Alternative medicine and celebrity illness

Wealthy celebrities seem particularly prone to fantasy cures (see also - the Fall of Oprah). Unfortunately, they encourage others to make the same mistakes ...

What celebrity patients like Farrah Fawcett can teach us about cancer. - By Barron H. Lerner - Slate Magazine

Fawcett's case had another component that potentially sent the wrong message to other patients. In addition to the traditional cancer treatment she was receiving in the United States, the actress traveled to Germany six times to receive a combination of natural supplements and immune treatments not approved by the U.S. Food and Drug Administration. These trips were chronicled in a moving documentary, Farrah's Story, that aired on NBC in mid-May. In seeking this type of therapy, Fawcett mirrored a choice made by actor Steve McQueen, who futilely traveled to Mexico in 1980 in search of a cure for his malignant mesothelioma. McQueen's Mexican doctors treated him with dozens of enzymes and vitamins, coffee enemas, and an anti-cancer drug called Laetrile, which was ultimately shown to be worthless.

Did the alternative treatments help Fawcett? It is unlikely. As Laurence R. Sands, a Florida surgeon who treats anal cancer patients, told WebMD, there is no scientific proof that such immune system stimulants work. Nevertheless, one of the German doctors involved in Fawcett's case claimed that the treatments had shrunk her tumors and substantially prolonged her life.

Once again, media coverage of Fawcett's case, while ostensibly providing useful information, ran the risk of sending the exact wrong message. Thousands of desperate end-stage cancer patients traveled to Mexico upon hearing Steve McQueen's story. The new destination may now become Germany...

Well, maybe not so much to Germany given Fawcett's recent death.

I've written about science-free therapies before.

Health wars: The armies muster

Towards the end of the Lord of the Rings the armies of the West march upon Mordor. In the movie they're dwarfed by the vast hordes of Sauron.

That's how I see Obama's army (link mine, and I corrected the British "organising") ...

Healthcare - it's make or break for Barack Obama | World news | The Observer

... the town hall meeting is just one aspect of the political machine that Obama is deploying in order to force through healthcare reform. Obama's vast network of online supporters built up during his election campaign is now being swung behind the effort. Called Organizing for America, it has got 500,000 people to commit to volunteering for the healthcare cause. It has released its first advertisements and put paid staff in 31 states to organise locally. Another group, Healthcare for America NOW!, has raised $35m. It has 120 staff in more than 40 states and in April alone staged 102 events related to campaigning for change.

Thirty-five million dollars.

That's so sweet.

Sauron must be shaking in his booties.

Oh well. In the Lord of the Rings the point of Aragon's tiny army was to distract Sauron from the real goal -- tossing the Ring into the pit of fire. Maybe Obama has a top secret plan, and our pathetic forces need only distract the Enemies ....

How to choose a city to live in

Imagine you are an active geek, and that you can live in any city on earth.

Where do you go? For that matter, where might you want to visit?

There are all kinds of metrics you might consider, but there’s a single metric that produces this particular list:

1. Copenhagen, Denmark
2. Portland, Oregon
3. Munich, Germany
4. Montreal, Quebec
5. Perth, Australia
6. Amsterdam, Netherlands
7. Seattle, Washington
8. Paris, France
9. Minneapolis, Minnesota
10. Bogota, Columbia (yes)

What does Minneapolis have in common with Paris?! What joins Copenhagan and, yes, Bogota?!

Think ….

Think ….

This list. These are the world’s top 10 cities for bicycling.

I’ve lived most of my life in Montreal and Minneapolis, and I’ve bicycled Munich. It know it’s hard to credit, but there is something similar about those 3. Paris is an outlier, but then there’s no accounting for Paris.

Ok, so Bogota, which people my age associate with drug wars and extreme violence, is another outlier. Until I summarized this list I’d never have considered visiting Bogota. Now I guess I have to.

If you’re a US citizen you might now be considering Portland, Seattle and (yes!) Minneapolis. I know, it’s a bit mind blowing. Now consider this list …

1. Wisconsin
2. Minnesota
3. Massachusetts

These are the top 3 states for health care quality in a the recent NHQR State Snapshot report (I must confess, by the way, that Wisconsin is a better bicycling state than Minnesota, it’s just that it doesn’t have much in the way of an urban life.)

I live in Minnesota’s Twin Cities (St. Paul, the sleepier sib of Minneapolis), which in addition to being the #3 bike city in the USA is also home to the world’s largest and most attractive legal dog park.

Sometimes, you just get lucky.

Update: chrismealy tells us that his Seattle hometown doesn't belong on the list, and that Portland has cyclists but not infrastructure. He writes recommends a terrific bicycle blog (http://hembrow.blogspot.com/, I just subscribed) so I'll take his word for it.

I know Munich is extreme, and Montreal is only very good, so there's clearly a big drop after #3 on the list. That moves Minneapolis even further up.

Incidentally, this update gives me an excuse to post a picture of the bicycle I bought in 1976. My Raleigh International (see Sheldon Brown's page for an original ad photo) is going for the full refurb treatment at the local racing shop in honor of a coming birthday. This is the pre-refurb shop ...

In appreciation of RealClimate

I don't know how the RealClimate crew is able to keep fighting for Reason, but I sure appreciate them.

Today they respond to yet another burst of Reason-free denialism....

RealClimate

.... Some parts of the blogosphere, headed up by CEI ('CO2: They call it pollution, we call it life!'), are all a-twitter over an apparently 'suppressed' document that supposedly undermines the EPA Endangerment finding about human emissions of carbon dioxide and a basket of other greenhouse gases. Well a draft of this 'suppressed' document has been released and we can now all read this allegedly devastating critique of the EPA science...

It's a devastating takedown, but imagine how boring it must be to read this drivel, and how painful it is to regurgitate the same old facts.

We owe these stout warriors a great debt. Beverages are on me if the RealClimate crew should happen to visit the Twin Cities.

Alas, despite their diligence, Reason is losing this battle. Most Americans have checked out on both health care revision and dealing with global climate change.

Sprint while you commute?

If you're under 25 and in reasonably good shape, I suppose you could try this exercise regimen ...

Can You Get Fit in Six Minutes a Week? - Well Blog - NYTimes.com

... In one of the group’s recent studies, Gibala and his colleagues had a group of college students, who were healthy but not athletes, ride a stationary bike at a sustainable pace for between 90 and 120 minutes. Another set of students grunted through a series of short, strenuous intervals: 20 to 30 seconds of cycling at the highest intensity the riders could stand. After resting for four minutes, the students pedaled hard again for another 20 to 30 seconds, repeating the cycle four to six times (depending on how much each person could stand), “for a total of two to three minutes of very intense exercise per training session,” Gibala says.

Each of the two groups exercised three times a week. After two weeks, both groups showed almost identical increases in their endurance (as measured in a stationary bicycle time trial), even though the one group had exercised for six to nine minutes per week, and the other about five hours. Additionally, molecular changes that signal increased fitness were evident equally in both groups. ... In other words, six minutes or so a week of hard exercise (plus the time spent warming up, cooling down, and resting between the bouts of intense work) had proven to be as good as multiple hours of working out for achieving fitness. The short, intense workouts aided in weight loss, too, although Gibala hadn’t been studying that effect.

The response has been found in rat studies, so it's a little bit plausible.

If you're not under 25 several caveats apply

• The study results need to be replicated with larger groups and older participants.
• The news article didn't mention gender. Maybe this only works for young men with lots of testosterone on board.
• The risk of injury with extremely intense workouts is high.
• This is a good way to die if you're over 25 and aren't accustomed to repeated levels of intense exertion.
• I suspect when they say "intense" they mean an intensity level that most older people can't reach (short of death).
• Most Americans are exercising for weight loss.
• Maybe we'll find out it causes accelerate atherosclerosis (you never know ...)

That said, if you're young, healthy and reasonably fit, it would be easy to work this kind of routine into a commonplace 30 minute bicycle commute. Just don't do it on a 10 mph bicycle trail!

Facebook observations

I've been enjoying Facebook, though the iPhone client is overdue for an overhaul. My conclusions about what's interesting with FB are a bit different from what I usually read, so, inevitably, I'm compelled to share:

1. Internal identity - no anonymity. This means control over communications, which means spam is manageable. The FB equivalent of spam is metastatic "apps", but, for the moment, you can opt out of those. Spam free communication environments are worth much more these days than they were 7 years ago.
2. It's AOL 2.0. I remember when AOL was interesting, back when it was a Mac only spinoff of one of Apple's many failed online communities. I'll call that AOL 1.0. Of course in those days there was no spam, no phishing, no viruses -- essentially the proto-Net was risk free. That meant AOL didn't have an enormous amount to offer, but it still did quite well. Now the Net is extremely risky, especially for XP users. AOL 2.0 has a much bigger value proposition than AOL 1.0.
3. I love pub/sub, especially as implemented in feeds and readers. Unfortunately, this technology was a bridge too far for the vast majority of humanity. Only the uber-geeks knowingly use feed readers like Google Reader; all the good desktop XP feed readers have died. Facebook is all about pub/sub, but they've made the technology feel natural to their base. That's a real accomplishment.
4. Facebook has shown (sigh) that logic and usability are not all that important for a social application.

I've never paid much attention to the alleged role Facebook played in electoral politics. I'm still unsure how much of that is real, but there is some potential to gradually encourage specific memes in one's FB network. It has to be done judiciously. I actually streamed my Google Reader "notes/shares" into FB for a while and I think I about vaporized my friends. Now I restrict the meme injections to 1-2 a week.

The dark side of FB, of course, is data lock. (Privacy you say? Surely you've given up on that 20th century dream.) They're providing more APIs and sharing more identity information than they have, but I would never put my photo library on FB. It's a place to put things that are intentionally transient.

Kristof points out the AMA doesn’t represent physicians! (At last)

Congratulations to one of my favorite columnists. He’s the first commentator I’ve read to point out that the AMA doesn’t represent physicians!

Nicholas Kristof The Prescription From Obama’s Own Doctor - NYTimes.com

… the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan…

He only gets partial credit for the explanation however. Membership fell because the AMA was more or less created to represent surgeons in their negotiations for procedural reimbursement. Non-proceduralists have a direct economic conflict with the AMA.

Kristoff continues …

… when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal…

… most physicians expect better as well, which is why the A.M.A. is on the decline.

“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.

For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care…

Physicians know that real health reform will be a mixed bag for them. Some things will get better, some things will get worse. Proceduralists will lose income, but primary care physicians might disappear. Or they might do relatively well. All physicians know is that the transition is going to hurt like hell.

I think if we could poll physicians (which is very hard to do) we’d find a majority do support major change – even though they’re going to get hurt in the process. Even many of the physicians who are likely to lose income (which translates to losing things like homes) may be more supportive than logic would dictate – especially if the transitions can be staged.

If I’m right, that’s worth of praise.

As for the AMA, please stop paying them so much attention.