NTFS Triforce - A deeper look inside the artifacts

Hello Reader,
            In our last post we discussed at a high level the relationship between the $MFT, $LOGFILE and $USNJRNL. In this post we will go into detail of the structures we can recover from each of the three and how they link allowing us to determine the historical changes made to a file or directory.

$MFT  - The Master File Table is a pretty well understood artifact. MFT structures are fully documented and there are a variety of tools out there for parsing it. With that said, I'm not going into any depth on how the MFT works but instead just highlight the two structures we are interested in.

(Thanks to Mike Wilkinson for making these MFT data structure diagrams I am referencing below. You can find the full version of his NTFS cheat sheet here http://www.writeblocked.org/resources/ntfs_cheat_sheets.pdf)

The first is the File Record shown below:

When a file is created, modified, or deleted this is the structure that gets added, changed, or updated. The field in the upper right at offset 0x08 labeled $Logfile Sequence Number or LSN is how the MFT refers to the most recent change recorded in the $logfile. Each $logfile record has an associated LSN, however the LSN is updated in the file record to correspond to the most recent change. There is no record that I'm aware of that shows what LSNs a file record previously had. The MFT Record Number is a unique identifier for this file record, and if we have a way to link a change to  it then it becomes easy to associate historical changes we recover to indicate which MFT file record they are referencing.

The $USNJrnl keeps the MFT Record Number to indicate which file it is operating on and the Parent Record number to reflect what directory that MFT file record resided in. If a $logfile entry records a change then that change can be easily linked back to the MFT file record number's LSN if it's the last change made to that file record.

The file record however is not the only record/attribute we care about in the MFT for our triforce historical analysis powers, we also care a lot about the Standard Information record shown below:

If a time stamp, owner id or SID of a file changes then it's the standard information block/attribute that gets written to the $logfile and not the entire file record with all its attributes. This was a problem before we found the triforce linkage because as you can see the standard information block does not refer to the file record number. We had to determine which MFT entry a $logfile record was pointing to by either the LSN (which is captured in the Logfile header per recorded change) and hope it hasn't been updated again. Alternatively we could determine the location of the MFT entry by doing some math using the VCN (virtual cluster number) and the MFT cluster ID recorded in the $logfile. Relying on the physical location in the MFT is also problematic because a defrag can remove deleted entries and change the VCN where the entry resides leading to false positives of which $logfile record points to which MFT record.

The good news here is that as you can see at offset 0x40 the standard information attribute does record the update sequence number! The update sequence number in turn will point to the file record number and parent file record number as discussed above. This means that through the link between the $USNJrnl and the $MFT we can associate a change made to the standard information attribute from the $logfile to the $USNJrnl which links back to a specific $MFT file record number. This is a reliable identifier as the file  record number's value does not change based on system activity! This then leads us to the $logfile structures.



$Logfile - Every change recorded in the $logfile starts with a header as shown below:

The LSN here relates back to the file record entry inside the MFT for the change that is being recorded. The  LSN for a file record in the MFT will be updated to reflect the most current $logfile entry for that file. Meaning the LSN for a file will change with every change recorded. That means than any $logfile entry whose recorded change does not reference either the USN or the MFT record number can only have its corresponding MFT record determined by doing a calculation using the recorded VCN seen at offset 0x48 above.

Why does the $logfile record the VCN? The process of repairing the file system using the $logfile is to overlay the data stored in the $logfile over the areas where a transaction failed to complete successfully. This allows the file system to be rolled back (using the undo records) or have a change reapplied (using the redo records) by just overwriting what previously located at those VCNs.

What comes after the LSN record header will vary on what change took place, the $logfile is storing the raw MFT record/attribute that has been modified so any MFT entry could exist in the $logfile. We focus on the File records and the Standard information attribute records as they reveal the most about changes occurring to a file. There are other MFT records/attributes that could be of interest to you and they also exist in the $logfile. Any change made to a MFT record/attribute will be recorded in the $logfile, the hard part is then referencing that logged change to the actual MFT record being modified to know which file record it relates to. So you can imagine that after every LSN header you have a copy of the MFT record/attribute being changed reflecting its before (undo) and after (redo) states.

Since there are no other $logfile structures other than the LSN header, RCRD header and Restart areas we are reliant on what is being recorded by the MFT record being changed to exactly know which file is being modified. When we are lucky (like we are with file records and $standard_information records) we get a link back to a unique file reference number. When we are unlucky (resident data found in $DATA attribute records) we have to rely on some math using the VCN and MFT Cluster index stored in the LSN header to determine what location within the MFT the record is pointing to. It's this possibility for false positives that keeps these records out of the public version of our $logfile parser.

Note: We will go into even more detail of the $logfile structures when we do the big $logfile post which is coming with the tool release I promise.

$USNJrnl - The USNJrnl or Update Sequence Number Journal has a pretty simple structure compared to the rest we've talked about and is fully documented as shown below:

Sorry no fancy hex offset data structure for this yet, just the record structure as taken from Microsoft's documentation of the USNJrnl.  As you can see for purposes of linking back $standard_information structures stored in the $logfile to the MFT we have the matching USN stored here as the sixth element down. Since each USNJrnl entry, and thus each open/close of a file, has a unique USN assigned  we have a great lasting artifact to look for when trying to match $standard_information records back to MFT records. The fourth and fifth items in the record entry link back to the MFT for not only the file record number but also the directory the file was located in as seen in the parent record number.

Taken just on its own the USNJrnl is a fantastic source of historical information that more examiners are beginning to utilize, you can get even more information out if it by taking it a step further. If you were to mine out all the unique USN records into a database table you could group them by file reference number to see all the changes including the renaming of a file or its movement between directories.This is because the MFT file record number (shown in the MSDN screenshot above as a reference number) does not change no matter how many times the file record or attributes change. Renaming a file, moving a file, editing its time stamps, filling it with random data, etc... none of these actions will change the file record number. What utilizing the triforce gets us is more granular details of those attribute changes that only exist in the $logfile extrapolated out through the $USNJrnl to a MFT file record.

Putting it all together - So that was a lot of words up there, if you read the last post you got the same information at a very high level but now you can see at a much deeper level how these things sync up. I don't believe that the developers actually intended this relationship to exist, or else I would expect more syncing for more record types stored in the $logfile, we just again get a happy overlap between what a developer made and what analysis can reveal to us.

If you followed everything I wrote above you will see that using the power of the NTFS triforce we can recover and identify:
1. The change of ownership of a file ($logfile)
2. The change of a file's SID (if that were to happen)  ($logfile)
3. The changing of timestamps ($logfile)
4. The movement of files between directories ($logfile and $USNJrnl)
5. The renaming of files (common during wiping) ($logfile and $USNJrnl)
6. The summary of actions taken against a file ($USNJrnl)
7. The changing of attributes to a file, important for things like tracking hard links to determine CD Burns ($logfile)

We can do all of these with little chance of error thanks to the combination of these three data sources. Additionally we can recover granular historical changes to files. Depending on your location in the DFIR spectrum (from digital forensics analyst, incident responder to malware analyst or all of the above) you will have different uses for this information. We are very excited about thee triforce and we are extending our $logfile parser to include these sources, of which the $MFT integration was already on our roadmap. Getting the full use out all of this information will require a database and were not sure if SQLLite is up to the task, hope to have something workable out there soon.

In the next blog post I'll talk about how to get access to the $USNJrnl, $MFT and $Logfile from volume shadow copies as not all access methods are equal. After that I'll likely move into updating some old 'what did they take' posts to reflect new artifact sources and post the results of our forensic tool tests.

Profil Raheem Sterling

You’ll Never Walk Alone - Manajer Liverpool Brendan Rodgers mengungkapkan, Raheem Sterling bakal menjadi idola baru fans The Reds setelah memperlihatkan performa mengesankan melawan Manchester City akhir pekan kemarin.

Sterling menjalani debut sebagai starter di Liga Primer bersama Liverpool di pertandingan melawan Manchester City yang berkesudahan 2 - 2. Performa apik pemain berusia 17 tahun itu mengundang pujian dari Rodgers. 

Namun Siapakah sebenarnya Raheem Sterling ?

Bernama lengkap Raheem Shaquille Sterling (lahir 8 Desember 1994; umur 17 tahun) adalah seorang pemain sepak bola berkewarganegaraan Inggris kelahiran Jamaika yang bermain untuk klub Liverpool pada posisi gelandang sayap.

Raheem Sterling baru memulai karier profesionalnya di klub Liverpool tahun 2012, setelah saat junior bermain untuk A.O.Y.FC di Jamaika, Queens Park Rangers kemudian pindah ke Akademi Liverpool.

Pada tanggal 24 March 2012, Sterling memainkan partai debutnya untuk tim utama saat melawan Wigan Athletic yang berakhir dengan kekalahan 1 - 2 pada usia 17 tahun 107 hari, menjadikannya pemain termuda ketiga yang pernah bermain untuk Liverpool.

Menjadi Bagian Dari Liverpool

Kontrak Sterling ditandatangani pada bulan Februari 2010 dengan biaya awal sebesar £ 600.000, tapi ini bisa meningkat menjadi £ 5.000.000 tergantung pada berapa banyak ia membuat penampilan untuk tim pertama. Dia membuat penampilan pertamanya untuk tim pertama dalam pra-musim persahabatan melawan Borussia Mönchengladbach di Jerman pada tanggal 1 Agustus 2010.

Messi Raih Ballon d'Or Keempat, Ronaldo Runner-up

You’ll Never Walk Alone - Dikutip dari kompas.com. Bintang Barcelona asal Argentina, Lionel Messi, terpiliih sebagai Pemain Terbaik Dunia 2012 atau FIFA Ballon d'Or 2012 yang berlangsung di Kongresshaus, Zurich, Senin (7/1/2013).

Gelar tersebut menjadi yang keempat kalinya diterima Messi dalam empat tahun terakhir. Sebelumnya, tak ada satu pun pemain di dunia ini yang mampu meraih penghargaan terbaik tersebut dalam empat kesempatan berbeda.

Messi memperoleh 41,60 persen suara dan berhasil menyisihkan dua saingannya, Cristiano Ronaldo (23,68 persen) dan Andres Iniesta (10,91 persen).

Sepanjang 2012, Messi hanya mampu membawa Barcelona menjadi juara Copa del Rey. Namun, catatan pribadi Messi yang sukses mencetak 91 gol selama satu tahun kalender Masehi bisa menjadi tolok ukur alasan para pelatih, kapten anggota FIFA, serta beberapa jurnalis mayoritas memilihnya.

Sumber

Lirik Lagu NOAH 'Tak Lagi Sama'

Tak Lagi Sama

Cerita ini tak lagi sama

Meski hatimu selalu di sini

Mengertilah bahwa ku tak berubah

Lihat aku dari sisi yang lain

Bersandar padaku, rasakan hatiku

Bersandar padaku

Dan diriku bukanlah aku tanpa kamu tuk memelukku

Kau melengkapiku, kau sempurnakan aku

Waktu yang telah kita lalui

Buatmu jadi lebih berarti

Luluhkan kerasnya dinding hati

Engkaulah satu yang aku cari

Bersandar padaku, rasakan hatiku

Bersandar padaku ooh

Dan diriku bukanlah aku tanpa kamu tuk memelukku

Kau melengkapiku, kau sempurnakan aku

Dan diriku bukanlah aku tanpa kamu menemaniku

Kau menenangkanku, kau melegakan aku

Dan diriku bukanlah aku tanpa kamu tuk memelukku

Kau melengkapiku, kau sempurnakan aku

Dan diriku bukanlah aku tanpa kamu menemaniku

Kau menenangkanku, kau melegakan aku

Lirik Lagu NOAH 'Hidup Untukmu Mati Tanpamu'

Hidup Untukmu Mati Tanpamu

Begitu banyak hal yang ku alami, yang ku temui

Saat bersamamu ku rasa senang, ku rasa sedih

Air mata ini menyadarkanku

Kau takkan pernah jadi milikku

Air mata ini menyadarkanku

Kau takkan pernah menjadi milikku

Tak pernah ku mengerti aku segila ini

Aku hidup untukmu, aku mati tanpamu

Tak pernah ku sadari aku sebodoh ini

Aku hidup untukmu, aku mati tanpamu

Air mata ini menyadarkanku oooh

Kau takkan pernah menjadi milikku ooo

Tak pernah ku mengerti aku segila ini

Aku hidup untukmu, aku mati tanpamu

Tak pernah ku sadari aku sebodoh ini

Aku hidup untukmu, aku mati tanpamu

Lirik Lagu NOAH 'Puisi Adinda'

Puisi Adinda

Malam berseri, indah damai dalam hati

Kau berikan rasa ini hingga dapat ku bermimpi

Tentang maaf yang bersemi

Tentang cinta yang tak letih

Dan ku harapkan kau kasih

Tak perlu bertengkar lagi

Tak perlu menangis lagi

Biarkan kita mengalir sampai nanti

Lirik Lagu NOAH 'Sentuhlah Cinta'

Sentuhlah Cinta

Dalam pikiranku ini, kau seakan telah hilang

Cinta di dalam hidupmu, kau tak pernah merasakan

Dimanakah cinta, sentuhlah hatinya

Kau tak bisa merasakan

Hingga cinta mendekati dirimu

Cinta di dalam hidupmu, kau tak pernah merasakan

Dimanakah cinta, sentuhlah hatinya

Kau tak bisa merasakan

Hingga cinta mendekati dirimu

Kau tak bisa menggapainya

Biar cinta mendekati dirimu oooh

Biarkanlah cinta oooh memberimu rasa

Kau tak bisa merasakan

Hingga cinta mendekati dirimu

Kau tak bisa menggapainya

Biar cinta mendekati dirimu oooh

Biarkanlah cinta oooh memberimu rasa

Semua demi cinta oooh semua demi kita

Lirik Lagu NOAH 'Jika Engkau'

Jika Engkau

Apa yang telah terjadi yang telah membuat kau tak mengerti

Maaf ku tak sadari yang telah membuat kau ingin pergi

Saat ku tak bicara, berjuta kata yang ku ungkapkan

Walau kau tak merasa, cinta yang ada begitu nyata

Ku ingin engkau tahu berartinya dirimu

Ku tak inginkan kau ragu, aku kan bertahan dalam hidupmu

Jika engkau pergi hilang dariku

Meninggalkan mimpi dalam tidurku, bersamamu dan tanpamu

Ku ingin engkau tahu berartinya dirimu

Ku tak inginkan kau ragu, aku kan bertahan dalam hidupmu

Jika engkau pergi hilang dariku

Meninggalkan mimpi dalam tidurku, bersamamu dan tanpamu

Jika engkau pergi hilang dariku

Meninggalkan mimpi dalam tidurku, bersamamu dan tanpamu

Lirik Lagu NOAH 'Raja Negeriku'

Raja Negeriku

Yang terdiam dari suara

Sabar jiwaku, sabar seluruh bangsaku

Aaah perih tangismu, perih jiwamu

Tersisihkan oleh kawanan hitam

Semua telah lelah menanti

[pidato Ir. Soekarno]

Bersuara untuk mereka, raja negeriku

Kau telah lama terdiam

Perubahan jerit hatiku, cermin jiwamu

Berikan terang untuk masa depan wooo

[pidato Ir. Soekarno]

Berpegangan semua saudara

Tegar berdiri dalam mimpi yang satu

Perubahan untuk tanahmu, tanah airmu

Untuk negeri dan mimpi bangsamu

Lirik Lagu NOAH 'Ini Cinta'

Ini Cinta

Percaya padaku ini bukan nafsuku

Perasaan yang utuh dari dalam hatiku

Percaya kataku ini bukan akalku

Keinginan yang tulus tuk dapatkan hatimu

Ini cinta bukan namanya

Ini cinta bukan namanya

Tatap terus mataku, jangan ragukan itu

Lihat dalam mataku ooh kau hanya temukan itu

Ini cinta bukan namanya

Ini cinta bukan namanya

Percaya padaku ini bukan nafsuku

Perasaan yang utuh dari dalam hatiku

Lirik Lagu NOAH 'Sendiri Lagi'

Sendiri Lagi

Tinggallah ku sendiri dalam sepi ini

Tiada temanku lagi

Tak sanggup hati ini sendiri begini

Tanpa dirimu kasih

Tak ada arti hidupku

Bila kau tak di sisiku

Mengapa oh mengapa kau tinggalkan diriku

Tak tahu, ku tak tahu salahku padamu

Hingga kau pun tega biarkan diriku sendiri, sendiri lagi

Tak mungkin ku mencari pengganti dirimu

Walau kini ku sepi ooh

Ku ingin kaupun tahu cinta suci ini

Ku bawa sampai mati

(tak ada arti hidupku

Bila kau tak di sisiku)

Mengapa oh mengapa kau tinggalkan diriku

Tak tahu, ku tak tahu apa nanti jadinya

Mengapa oh mengapa kau tinggalkan diriku

Tak tahu, ku tak tahu salahku padamu

Hingga kau pun tega biarkan diriku sendiri, sendiri lagi

Lirik Lagu NOAH 'Separuh Aku'

Separuh Aku

Dan terjadi lagi

Kisah lama yang terulang kembali

Kau temukan lagi

Dari cinta rumit yang kau jalani

Aku ingin kau merasa

Kamu mengerti aku mengerti kamu

Aku ingin kau sadari

Cintamu bukanlah dia

Dengar laraku

Suara hati memanggil namamu

Karena separuh aku

Dirimu

Ku ada di sini

Pahamilah kau tak pernah sendiri

Karena aku selalu

Di dekatmu saat engkau terjatuh

Aku ingin kau merasa

Kamu mengerti aku mengerti kamu

Aku ingin kau sadari

Cintamu bukanlah dia

Dengar laraku

Suara hati memanggil namamu

Karena separuh aku

Dirimu

Dengar laraku

Suara hati ini memanggil namamu

Karena separuh aku

Menyentuh laramu

Semua lukamu telah menjadi lirihku

Karena separuh aku

Dirimu

Lirik Lagu NOAH 'Terbangun Sendiri'

Terbangun Sendiri

Katakan katakan alasan mulai

Karena akhirnya begitu berat terasa

Dunia tak seindah katamu

Dunia menelan hatiku

Katakan entah kemana perginya

Masa yang indah dan gelak tawa yang cerah

Dunia yang terdiam tanpamu

Dunia yang menelan hatiku

Aku tak ingin terbangun, terbangun sendiri

Aku tak ingin terjaga, terjaga tanpamu

Kurangi kurangi lukaku ooh temani sepiku

Ooh temukan aku terlepas

Ooh kemana harus berjalan

Aku tak ingin terbangun, terbangun sendiri

Aku tak ingin terjaga, terjaga tanpamu

Kurangi kurangi lukaku ooh temani sepiku

Aku tak ingin terbangun, terbangun sendiri

Aku tak ingin terjaga selama-lamanya

Ooh terbangun sendiri, terbangun sendiri, terbangun sendiri

Terbangun sendiri, terbangun sendiri

Terbangun sendiri, terbangun sendiri

cara menghapus cache mozilla firefox

 Bismillah.....Assalamualaikum Sahabat. Alhamdulillah setelah mutar-mutar di mbah google, Ahirnya ketemu juga nih ide posting hari ini, Yang Admin kasih judul cara menghapus cachee mozilla firefox.

 Sahabat tentunya tidak asing dengan mozilla firefox, Ternyata mozillah firefox  juga meninggalkan bekas-bekas browsing kita loh, Atau bahasa kerenya cache, hemmm baru tau ya Admin ... hehehe admin baru tau Sahabat, Maklum lah ana masih pemula,

 Mungkin itu pengertianya yang ana fahami....oh iya ada satu lagi rupanya cache itu memperlambat computer kita juga loh, kenapa ? karena memakan memory computer kita...udah ah.. di lanjut teman...pertama teman buka mozilla firefox,dan di menu bar firefox teman click menu tool selanjutnya click options, Setelah teman click options nanti akan muncul jendela baru.selanjutnya:

Pertama teman click advanced terus click network dan click clear now dan click ok selesai deh, nah itu yang cara manualnya,

 Kalau sahabat ingin firefox yang menghapus cache secara otomatis saat firefox di restar, teman click privacy yang gambarnya seperti topeng itu loh......
Kemudian sahabat click  remember history dan ganti menjadi us costum settings for history dan centang clear history when firefox closes..selanjutnya teman click setting

 Nanti akan muncul pesan baru selanjutnya sahabat tinggal centang mana-mana yang akan di hapus secara otomatis selanjutnya teman click ok.. selesai
mungkin itu saja teman mudah-mudahan bermanfaat dan wassalam sahabat blogger.

"cara menghapus cache mozilla firefox" 

Why Did the "Dean of Health Care Economics" Urge Reforms that "Appeal to Some Special Interests?"

We have often discussed, some would say belabored, the importance of the "anechoic effect" in health care.  Particular issues which would make those who benefit the most from our current dysfunctional health care system uncomfortable are often considered not to appropriate for polite conversation. 

A prominent recent article in JAMA provided a great example of  how there are certain topics that health care, services, and policy experts avoid discussing.

Summary of the Article

The article was by Victor R Fuchs, who has been called the" dean of health care economics."  His topic was why US health care is so expensive compared to those in other countries, but provides little additional value for the extra expense.  [Fuchs VR. How and why US health care differs from that in other OECD countries.  JAMA 2013; 309: 33-34.  Link here.]

His explained the differences as follows:
-  "US individuals appear more distrustful of government...."  Thus presumably they shun government operation of health systems, which can lead to lowering administrative costs, and more effective negotiating "with drug companies and physicians and to control investment in hospitals and equipment."
-  "reluctance to achieve more equal outcomes for the population through redistributive public policy."  He attributed this to attitudes stressing personal responsibility for success, and the heterogeneity of the population leading to decreased sympathy to those who are unfortunate but "whose identity may differ greatly from one's own."
- "the opposition [to health care reform] of 'special interests,' such as pharmaceutical and device manufacturers, physicians (especially those in high-income specialties), and hospitals."  He noted that other countries have special interests, but attributed the power of US special interests to the country's system of government, especially "checks and balances," which provide "'choke points' for special interests to block or reshape legislation."

He ended with three policy prescriptions for more and better health care reform:


-  "government's role should be limited to what is necessary, not just desirable."
-  "provision of basic coverage for all should not require equality for obtaining additional coverage."
-  "reform should have features that would appeal to some special interests, or to some elements within each special interest group (for example, some physicians or some health plans."


I believe this essay, because it is in a prominent journal and by the supposed dean of US health care economists, provides a good example of some of the things that ail the discussion of health care policy. First, the author made rather cavalier use of evidence to support his points.  Second, he avoided even mentioning any of the unpleasant issues we discuss on Health Care Renewal.  Third, he not only failed to challenge any of those who benefit the most from the current system, but also suggested further appeasement at least of some of them.

Cavalier Use of Evidence

Prof Fuchs' justification for the role of distrust of government was based on a rather casual review of American history, and a single survey.  In fact, the proportion of people who appear to trust the government appears to depend on who asks the question and how it is asked.

For example, Gallup polling from 1998 to 2012 showed from 65% to 80% of people expressed “a great deal/ fair amount of trust in state and local government.”  Gallup polling from 1997 to 2012 showed from 51% to 83% of people had “a great deal” or “fair amount” of “trust in federal government to handle international problems.”  On the other hand, the Pew Research Center for the People and the Press showed public trust in government peaking at nearly 80% during the administration of President Johnson, then precipitously declining, rarely exceeding 50% over the ensuing years, and now around 20%. Furthermore, although Prof Fuchs argued that distrust of government is uniquely American, he provided no data comparing such poll results from the US with those from elsewhere.

Nor did he compare results of polls about trust of the government with those about trust of other organizations involved in health care.  However, while people in the US may be distrustful of government, polling shows even bigger distrust of health care special interests (like pharmaceutical companies and health insurance).    While Edelman marketing showed relatively constant trust in the pharmaceutical industry at around 50% from 2009-2012), a Harris Interactive 2010 poll showed that only about 10% of people thought the pharmaceutical industry was honest and trustworthy from 2003 to 2010, while health insurance companies and managed care companies were trusted by even fewer.

Avoiding Unpleasant Issues

While Prof Fuchs acknowledged the role of "special interests," he avoided mentioning how these special interests might negatively affect health care, and thus how their role could be altered or countered.

Some issues we discuss on Health Care Renewal, but which he ignored were:

Concentration of Power

We have frequently discussed how health care organizations have grown ever larger, increasing their market power, and hence their ability to command revenue.  Although we often hear arguments that larger organizations are more efficient, this historic excuse of monopolists has little evidence in support.  In fact, large organizations seem mainly efficient in extracting money for the benefit of their insiders.  For a recent discussion of the push toward monopolies that has some health care angles, see this post on Naked Capitalism.   


Commercialization of Health Care 

The US seems to be unique in that it allows a larger role for private, for-profit corporations in health insurance and the actual provision of health care.  In the US, many health insurance companies, some hospitals and hospital systems, and many other types of health care providers, like hospices and dialysis centers, are now for-profit.  Furthermore, the physicians who provide direct patient care are more frequently employed by corporations (rather than being in solo or small group practice), and these corporations are increasingly for-profit  (look here).

This increase in the provision of health insurance and direct health care by for-profit corporations is a historical change.  Through the 1970s, the American Medical Association declared "the practice of medicine should not be commercialized, nor treated as a commodity in trade." (Look here)   In most states, the corporate practice of medicine used to be banned.


Commercialization in an Age of Financialization -

This commercialization took place in an era in which economists were advocating that corporate leaders ignore all goals other than increasing "shareholder value" (look here).  This de facto meant increasing short-term stock price and/or revenue.  Clearly focusing only on short-term revenue increased the risk of management that ignored or was even hostile to the health care mission.  The focus on short-term revenue lead to strong incentives for employees to "make their numbers," that is, to achieve financial goals, no matter what it took (see examples here).  This likely lead to many examples of unethical behavior.  Furthermore, physicians were not immune to such requirements (look here).

 Abandonment of Government Regulation

As was noted in the comments on the post on Naked Capitalism,enforcement of anti-trust law that could prevent concentration of power has generally been abandoned by recent US administrations.  Furthermore, as we have discussed here, enforcement of laws against fraud, kickbacks, etc have lead to numerous legal settlements, but almost never any penalties against individuals who authorized, directed or implemented such actions within large health care organizations.  Thus, the leaders of health care organizations, particularly large health care corporations, have experienced impunity.  In some cases, there has been outright regulatory capture.  Conflicted regulators have proliferated, often through the mechanism of the "revolving door."

Executive Compensation 

Thus protected by such impunity, executives of large health care organizations often have become rich, and seem to be able to do so without any accountability for their organizations' actions.  As noted above, their incentives push them to put short-term financial goals ahead of the health care mission.  Furthermore, another currently fashionable business school doctrine is that health care managers may and perhaps should be generic, and thus need not know anything about health care, have experience caring for patients, or have sympathy for health care values.  All this has lead to health care management that ignores or even is hostile to the health care mission. 

Deception Undermining Clinical Research and Education 

Furthermore, this impunity and lack of accountability has been correlated with a rising tide of unethical behavior.  In particular, corporations that make drugs and devices have taken over clinical research meant to evaluate their own products.  They have often manipulated research to favor their products, and suppressed research that even when manipulated does not favor these products.  Thus they have corrupted the clinical research base on which physicians and patients rely to make the best possible health care decisions.  Marketers have launched stealth campaigns that have also included corruption of medical education.  In particular, they have paid influential health care professionals, called key opinion leaders, to support marketing under the guise of medical education.  Thus distorting health care and medical research and education decision making has distorted decision making, likely leading to increased costs and decreased quality.  

Other examples of poor, that is ill-informed, unaccountable, self-interested, conflicted and corrupt leadership are strewn around Health Care Renewal.  He have also shown how the governance of health care organizations often lacks accountability, integrity, transparency, and honesty.  All these problems can lead to increased costs, and decreased quality and access.  Yet almost never do any of these issues make it into polite discussion within health care research and policy circles.

Appeasement of Special Interests

Over eight years of  effort by a few dedicated academic researchers, health care professionals, investigative reporters, whistle-blowers, and watch dog organizations,  chronicled to some extent on this blog and by other bloggers and commentators, has shown bad leadership and governance of, and resulting unethical behavior by health care "special interests."  Yet, the example essay by Prof Fuchs failed to deal with any of these issues.  Instead of discussing how they might be approached, he suggested continuing appeasement of special interests, which would likely make our problems even worse.  Why he ignored all the privileges the leaders of special interest have, and felt the need to treat them even more nicely, remains unclear. 

Thus it appears that the anechoic effect is leading to failure to grapple with the real reasons for health care dysfunction, thus ensuring that health care costs will continue to rise while access and quality fall.

Real health care reform will first require honest, unflinching consideration of what has gone wrong.  As long as the conversation seeks to avoid offending those who benefit the most from the current system dysfunction, that dysfunction will only get worse. 

US President Theodore Roosevelt had the courage to challenge the "malefactors of great wealth" who engineered the first gilded age, at the expense of the public at large.  During this second gilded age, will we have the courage to take on the new malefactors of great wealth, including those who benefit from health care's dysfunction?

Speaking of Eating Disorders ...

I'm trying to figure out why Stefani Ruper advocates for paleo (for women!) when: {colored emphasis mine, plain bold is hers}

When you discover the paleo diet, it just sort of makes sense in that basic way, and you leap head first into an orgy of statistics and science and success stories.   But for me–as probably for a fair portion of paleo dieters–my excitement was mostly at the promise of being effortlessly thin.  With the paleo diet, I wouldn’t have to feel so restricted.   The “satiation power” of fat and protein would make the burden of my weight maitenance efforts slide off of my shoulders.   I’d eat sardines.  I wouldn’t feel hungry.  I’d be skinny.  Life would be perfect.  Hooray!

Needless to say that wasn’t quite how the story went down at all.   As a matter of fact, it was at this point in my life, for the first time ever, that episodes of overeating became real food binges, in which I might eat half of a pumpkin cheesecake after a whole Thanksgiving dinner, a whole serving tray of gourmet desserts on my birthday, or a few loaves of dessert bread at Christmas parties.  The fact that I had forbidden carbohydrates of nearly all forms from my diet meant that I needed them all the more strongly.  This phenomenon is one of the great monsters I try to tackle with this blog:macronutrient restriction.  If your diet is actively restricting you and making you feel deprived, chances are quite good that food intake, choices, and willpower will all domino behind that.

Read more »

Jadwal Konser NOAH di 25 Kota 2012-2013

You'll Never Walk Alone - Bagaimana kabarmu hari ini? Semoga baik-baik saja. Kali ini Saya akan membagikan Jadwal Konser Noah di 25 Kota 2012 - 2013. Sahabat NOAH pasti sudah menunggu-nunggu kehadiran Ariel dan kawan-kawan di Kota tempat tinggal kalian kan?. Nah, berikut ini adalah jadwal lengkap Konser NOAH di 25 Kota 2012 - 2013

Jadwal Konser Noah di 25 Kota 2012 - 2013

TANGGAL	TEMPAT KONSER	WILAYAH KONSER
30/11/2012	Stadion Panunjung Tarung	Kapuas
02/12/2012	Stadion Sanaman Mantikei	Palangkaraya
05/12/2012	Stadion Gawalise Duyu	Palu
06/12/2012	Pantai Akkarena, Tanjung Bunga	Makassar
06/12/2012	Lap. Koni Sario Manado	Manado
09/12/2012	Lap. 23 Januari Talaga	Gorontalo
16/01/2013	Lap. Kuncup	Pringsewu
18/01/2013	Lap. Saburai	Bandar Lampung
19/01/2013	Lap. Puri Jaya	Tangerang
20/01/2013	Harapan Indah	Bekasi
23/01/2013	Lanud	Tasikmalaya
24/01/2013	Kodim	Sukabumi
27/01/2013	Yon Bekang	Bogor
30/01/2013	Stadion Joyokusumo	Pati
31/01/2013	Stadion Kamal Junaidi	Jepara
02/02/2013	Alun-alun Utara	Solo
03/02/2013	Stadion Kridosono	Yogyakarta
06/02/2013	Dor Delta Sidoarjo	Sidoarjo
07/02/2013	Lap. Batalyon	Madiun
09/02/2013	Lap. Gumul	Kediri
10/02/2013	Lap. Belanegara	Malang
15/02/2013	Sempaja	Samarinda
17/02/2013	Lanud	Balikpapan

Terima kasih sudah membaca artikel tentang Jadwal Konser NOAH di 25 Kota 2012-2013. Mohon maaf bila banyak terdapat kesalahan. Semoga bermanfaat.