There is no easy way to distinguish between a human and a spambot. It’s an arms race which we’ll always be behind. I’m talking here about spam in more general—not only on e-mail but also on for instance Wikipedia or on blogposts. Even if we would have a perfect-solution to test whether there is a human behind something, we still have to combat cheap labour in India: real people spamming “by hand”.
I think the solution is a Web of Trust similar to that of PGP. An identity (not necessarily a person) publishes who she trusts (not to be spammy/phishy) or not trusts. Ideally everyone would be in one big web. Only someone who my blog via-via trusts may post.
Obviously one still may gather trust of people over time and enter the web of trust and then start spamming with that identity. However, then that identity will be marked untrusted by people and also the people who initially marked the identity as trusted will be less trusted. Also, there are way more sophisticated measures of establishment in the web/trust to conceive than just being trusted via-via by one identity.
There is no way to prevent spam perfectly, but the amount of work that has to go in to making an identity trusted and established in the web is several orders of magnitude greater than any other protection we have. The big problem: we don’t have such an ubiquitous web of trust yet. (Yes, it’ll be in SINP if I’ll get around to working on it)