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Skip to comments.The Troika Of Duplicity
Posted on 04/28/2003 8:02:08 AM PDT by johnqueuepublic
The Troika Of Duplicity
By William A. Mayer
Now that Saddams regime has been pounded back into the desert sand brought about by what is likely the most stunningly effective use of military power in modern history - an awesomely updated lightning war - it is becoming clear that aside from ending Iraqs participation in the Islamic terror network, the key prize that is emerging is intelligence - detailed and verifiable - on the inner workings of this nebulous, world-wide irregular army of fanatics, tacticians, planners, arms merchants and financiers.
Indeed, hard copy evidence is now becoming available, which will radically redefine the nature of our relationships with many governments previously thought to be allies.
Documents are leaking out of captured Iraqi locations faster than they can either be reported on or really comprehended. At first blush, what they show is a pattern of relationships between the governments of Russia, France, Germany and the Iraqi regime. The nature of these associations demonstrates a malignant intent far beyond the petty bellicosity demonstrated by them during the UN Security Council's debates leading up to the grande impasse.
This increasing disclosure, in small part shows why Old Europe - to use Donald Rumsfeld's evocative phrase - was so eager to prevent real inspectors - the U.S. - from probing Saddams secrets.
The behavior, which is being chronicled, is damning. The treasure-trove coming out of places like the Iraqi Intelligence Service indicates a reciprocal affiliation between these three countries and Iraq that brands them as enablers of terror rather than as allies. It conjures up parallels between them and the cold war Soviet Union.
Ethically, it may actually be worse, because throughout its existence - pre and post World War II - even the Soviets never had the audacity to claim our friendship.
When you consider the amount of national treasure - including the blood of our young - wasted in rescuing them from a fight of their own making, its a little hard to handle.
Over the years many tens of billions of dollars of aid and arms were made available by these countries to the Iraqi dictator. Given his governments limited ability to pay - in any straightforward manner - these arms were used to curry favor as much as swell national coffers.
France: Anti-war for oil
The French will always be French, just about guaranteeing that the picture will never be soothing on the eyes or sensibilities.
For starters lets dispense with all the smoke and mirrors that fall so glibly from the lips of Dominique de Villepin. Until the war, the French oil conglomerate TotalFinaElf held Iraq's largest oil lease, guaranteeing it exclusivity in developing the large Majnoon and Bin Umar, oil fields.
Total reserves?
26 billion barrels - A figure difficult to explain away and one, which goes directly to the heart of Chirac's disingenuous breast-beating.
Richard Perle stated in February of this year that the deal was awarded solely as a result of French support for the Iraqi regime, he also gave the following review of the reasons behind France's attempts to shield Saddam - "The French interest in the propagation of contracts that will only go forward with this regime is perfectly obvious."
That Chirac's trade agreements with the deposed despot are now of dubious legality is a fitting reward for a nation who would knowingly deal with a regime that fed its enemies to hungry Dobermans. It shouldn't be surprising really, France has a history of subordinating human rights issues for mere commercial gain, witness their underwriting of the Hutu genocide against the Tutsis in Ruanda in which at least 500,000 were butchered.
The French participation in the arming of Saddam is sordid; having had a huge stake in building his war machine over the last 25 years, selling Baghdad hundreds of Mirage jets, helicopters, Super Entendard aircraft, anti-ship missiles and additional hardware.
The Iraqi's have a French telephone system - Alcatel, drive French cars -Peugeot and Renault, use French electrical equipment - Schneider Electric, use French water pumps - Hydrokit etc.
France is the largest supplier of goods to Iraq, period.
At the start of the war Iraq had at least 50 F-1 Mirage fighters and an unknown number of Gazelle attack helicopters. To keep them battle ready, the French also funneled spare parts for these two platforms - as late as January of this year - into the regime via an as yet undetermined French trading company, which then laundered the transaction through the Al Tamoor Trading Company, based in Dubai, according to a Washington Times report. US intelligence sources indicate that French armaments have made their way into Iraq - consistently - since the post Gulf War sanctions were in place.
A not insignificant consideration is that France built the Iraqi nuclear facility at Osirak, the same one the Israelis bombed in 1981.
Chirac claimed Hussein "was a personal friend"
Chirac, then French Prime Minister, was instrumental in seeing that Iraq received the help it needed.
Chirac [far right] hosting Saddam [second from left] at French nuclear facility
No lesser authority than Dr. Khadir Hamza - known today as Saddams bomb maker said:
"I went to France in 1974 to buy a reactor for a plutonium bomb It was a long-range project. The reactor would be inspected by the International Atomic Energy Agency (IAEA), and the French would be there...Just before the Gulf War, the crash program was ongoing to make one bomb from the French fuel Speech to the Carnegie Endowment - September, 2000
Hamza fleshed out the arrangement in an October, 2001 Frontline interview:
"We made a device, actually, minus the core...we sat down and did calculations...We would have had a small, probably 2 to 4 kiloton, explosion at the time...
Iraq already owes France an estimated 4 billion for arms previously delivered.
But this is just scraping the surface - another hint at what is involved was recently outlined by William Safire [The French Connection, March 14, 2003] and involves a complicated scheme involving collusion between China, Syria and the French to provide a key missile component [in this case an advanced missile fuel - hydroxy terminated polybutadiene or HTPB] to the Iraqis while attempting to conceal its true nature, the country of origin and its eventual destination.
The French Connection angle as Safire termed it, was that the above deal was put together by a well-known Parisian broker CIS Paris - that has a long history of arms dealings with Baghdad. Officials at CIS Paris admit to "knowing of the deal" but deny any involvement, French telligence is apparently aware of the details.
Subterfuge aside, the very idea of an Iraqi missile fueled by such cutting edge technology strongly underlines Saddam's intent to project power far beyond the confines of his own country. To make such a threat believable such a weapon would of necessity have a warhead of an advanced chemical, biological or nuclear design.
At this point in history and considering their political system, maybe we shouldnt reasonably expect much from the Chinese communists, however this type of behavior coming from a European partner whose relationship with us goes back over 200 years is another matter entirely.
Russia - Masque Of The Red Death
Vladimir Putin has been hailed perhaps as the pivotal post cold war Russian leader. He has executed a skillful dog and pony show, convincing both the Bush and Blair administrations that the former Soviet Union was not only no longer a military threat to the West but was indeed now becoming a close ally.
Obviously Russia's cooperation with the French and German UN delegation's intransigence in dealing with Iraq has done much to throw cold water on this heretofore-budding union.
It's important to note that such a relationship offered hope, though ultimately unfounded, of something really new and remarkable both as to its breadth and depth - to the degree that Mr. Bush had publicly voiced that he had "looked into his [Putin's] soul" and not found it wanting.
However disappointing might Russia's UN behavior have been to the Bush team, it could not be viewed as a reason for totally repudiating the new start.
Until recently a reasonable case could be made to continue pursuing it - with perhaps less evangelical fervor - all the while being cognizant that Putin was obviously more pragmatic than had been believed and that the reality was that though Russia had come a long way, it had much further to go before being considered reliable in any global sense.
At the outbreak of the war, Iraq owed Russia at least 8 and possibly as much as 12 billion dollars for arms already supplied. As was the case with France, this credit was extended - having been bet on the come line - against much hoped for oil and other commercial considerations.
[As a side note it must be pointed out that Russia has no qualms about dealing with other regimes hostile to the US. They have provided the Chinese with a withering array of technologies. DEBKAfile has reported that the Russian state arms merchant Rosoboroneksport has provided state of the art ship-borne air defense systems for heavy cruisers and other blue water naval vessels. This system is to become the primary defensive shield for a fleet of 10,000 ton heavy cruisers and modern aircraft carriers with which it intends to have the capability to assault Taiwan, maybe as soon as 2005 or 2006.]
Russia has supplied Saddam with military technology running the gamut of its capabilities - from retro T-72 tanks and BTR troop transports, to highly sophisticated weaponry. After hostilities in Iraq had commenced they supplied such items as night vision equipment, GPS jamming devices that could cause some of the Allies' precision guided weapons systems to be rendered ineffective and anti-tank Kornet rockets considered pivotal in the disabling of at least 2 M -1 Abrams tanks the first time they have ever been destroyed in battle.
In an article written for Radio Free Europe/Radio Liberty by Gregory Feifer:
"Independent military analyst Pavel Felgenhauer said that, although he has seen no concrete evidence of how the Kornets got to Baghdad, Iraqi forces "would not have been able to put up any resistance" were it not for violations of United Nations sanctions on the country. "Over the past 12-plus years that the sanctions have been in place, Russia, like Ukraine and Belarus, has taken part in violating them. During all those 12-plus years, military materiel and weaponry have been sent to Iraq," Felgenhauer said."
As it proceeded to Baghdad, the Army's Third Infantry Division came upon a Republican Guard run factory set up to refurbish Russian military heavy equipment, according again to Radio Free Europe, this time by imbedded correspondent Ron Synovitz:
"The letter [detailing current Russian - Iraqi arms dealing], dated July 2001 and written in broken English, is signed by Colonel General Vladislav Achalov, who identifies himself as a representative of a Moscow-based company, FTW Systems Ltd.
At this time there are no means to ascertain whether the letter was in fact sent by Achalov. The Associated Press, citing the Interfax-Military news agency, recently reported that Achalov, a former Soviet deputy defense minister, said he had repeatedly visited Iraq just before the war and had found Iraqi defenses to be strong.
AP also cited Achalov as saying Soviet military advisers had been based in Baghdad until the early 1990s and had made a "significant contribution" to the Iraqi armed forces.
The letter apparently signed by Achalov says it is in response to an Iraqi request for the "delivery of equipment." It offers 50 new gun barrels for T-72 tanks at the price of $124,000 each -- a total of $6.2 million. It also offers 400 new engines for BTR troop carriers at $7,500 each -- an additional $3 million."
The Secret Intelligence War
Perhaps most chilling, in US and British eyes, is Russia's apparent involvement in intelligence sharing with Saddam. From a ground breaking article, "Revealed: Russia spied on Blair for Saddam" by David Harrison of the Daily Telegraph UK.
"Top secret documents obtained by The Telegraph in Baghdad show that Russia provided Saddam Hussein's regime with wide-ranging assistance in the months leading up to the war, including intelligence on private conversations between Tony Blair and other Western leaders."
"Moscow also provided Saddam with lists of assassins available for "hits" in the West and details of arms deals to neighboring countries. The two countries also signed agreements to share intelligence, help each other to "obtain" visas for agents to go to other countries and to exchange information on the activities of Osama bin Laden, the al-Qa'eda leader."
On April 6, 2003 a convoy of Russian diplomats was hit in an attack originally termed as a friendly fire incident. Allegedly the Russian Ambassador to Iraq, Vladimir Titorenko, was injured in the attack, as was Ilya Morgunov a member of the party.
An Australian SAS patrol came upon the scene shortly after the shooting stopped and rendered first aid assistance. They offered to airlift the diplomats out of harms way, which seemed reasonable given the circumstances.
"We treated the ambassador of Russia and his colleagues from the embassy courteously and professionally, and after the appropriate checks ... they were allowed to go on their way," Australian Prime Minister John Howard
The Russians inexplicably refused the offer, despite the serious condition of a member of the party, and proceeded on to Syria, of all places and from there Titorenko was flown back to Moscow.
By Wednesday April 9 Titorenko was back in Baghdad, the Russian evacuation of the Baghdad embassy cancelled.
Why this madcap flight across the desert through a hail of American lead?
Speculation is pointing in the direction that the Russians were using the convoy as a cover to remove highly classified and potentially highly embarrassing Iraqi Special Services documents to a safer environment.
The Russian newspaper, Nezavisimaya Gazeta, reported on April 9th that the convoy was carrying secret Iraqi archives and that U.S. forces had fired on it as part of a CIA attempt to seize the documents. It is speculated that U.S. commandos had tried to stop the convoy without hurting its passengers, the newspaper claimed, but their attempt to seize the archives was foiled when accompanying Iraqi forces returned fire
The US denies that any attack was launched against the convoy, which may or may not be the case.
Regardless, the degree of already substantiated or strongly suspected cooperation between Russia, Belarus, other fragments of the former Soviet empire along with France and Germany in enabling Saddam's war making capacity - of times even after Operation Iraqi Freedom began - is so disturbing as to cast a severe pall on any future dealings with these governments.
He [Assad] is trying to achieve this by placing Iraqs entire chemical and biological weapons arsenal in a safe repository, also placing the scientists and officials employed on Iraqs unconventional weapons programs out of reach in hidden locations. In this clandestine operation he was almost certainly assisted by Russian and French intelligence services, which share Assads ambition to deny the United States any proof that its war on Iraq was just. - DEBKAfile
Germany - Springtime For Gerhardt
There have been rumors for years of German firms actively aiding Iraq in its quest for nuclear weaponry; there are even murky stories about secret flights to South America where German high-tech firms demonstrated small concealable nuclear processing equipment. The International Herald Tribune was reporting this as far back as November, 1990:
"...These were the machines. needed to make the centrifuges that enrich uranium. Iraq brought in engineers from Germany to install and run the centrifuge-making machines, and imported from German firms the special steel needed to make centrifuge parts. The German government has also investigated charges that the engineers supplied the centrifuge blueprints from which Iraq has been ordering parts. The German government does not dispute the widely reported fact that it licensed all of the material and equipment for export, despite the fact that it was on international control lists.
To see German-style centrifuges in action, Iraqi engineers visited a secret site in Brazil."
A yet classified but leaked UN arms report lists 80 German companies [including Siemens and Daimler-Chrysler] which have supplied arms to Iraq, much of it in the last 10 years.
The left wing Berlin newspaper, Tages Zeitung, broke the story, as recounted here by Deutsche Welle:
"The most contentious piece of news for Germany is that the report names it as the number one supplier of weapons supplies to Iraq...They have delivered technical know-how, components, basic substances and even entire technical facilities for the development of atomic, chemical and biological weapons of mass destruction to Iraq right since 1975...conventional military and technical dealings between Germany and Iraq are said to date till 2001, ten years after the second Gulf war and a time when international sanctions against Saddam Hussein are still in place...the dossier contains several indications of cases, where German authorities right up to the Finance Ministry tolerated the illegal arms cooperation and also promoted to it to an extent."
Fueling speculation, the German government has turned a blind eye to the exporting of "medical devices" sold to Iraq that have set off alarms among the US national security community.
American weapons experts have recently voiced concern that the German Government has permitted Siemens to sell Baghdad at least eight medical devices which contain components that are vital for nuclear weapons. The machines, known as "lithotripters", use ultrasound to destroy kidney stones in patients. However, each machine contains an electronic switch that can be used as a detonator in an atomic bomb, according to US experts. Iraq was reported to have requested an extra 120 switches as "spare parts" during the initial transaction. Independent UK Dec 18, 2002
It's inconceivable that while Saddam was engaged in systematically starving his own population, in an attempt to convince the world that US led sanctions were actually causing the misery, that providing lithotripters, out of "humanitarian" concern, would be of any interest to him at all.
On the chemical weapon front, BND [the German Intelligence Service] director, August Hanning, put it this way:
The BND's warnings didn't stop with that report. In April 2001, Hanning told the Welt am Sonntag newspaper that Iraq was developing a new class of chemical weapons, reiterated his alert on Iraq's missile and nuclear programs, and said that several German companies had continued to deliver to Baghdad components needed for the production of poison gas. In March 2002, he told the New Yorker magazine that, "It is our estimate that Iraq will have an atomic bomb in three years." Asia Times February 5, 2003.
One might have thought that considering Germany's history, they would be especially sensitive to the politically charged subject of poison gas and nerve agents.
So there you have it, an outline at least of the reality behind the sophistry.
Chemical, biological, nuclear and conventional weapons, precursors, components, hardware, software, manufacturing know how and technology often coordinated by freelancing intelligence agencies operating wholly beyond the bounds of civilized behavior - all brought to bear against the security of free world in general and the US in particular by three dissembling countries which should indebted to America, in perpetuity, for services already rendered at incalculable cost.
It is a rancid state of affairs to be sure and one which will only grow even more disquieting as the evidence mounts.
That a wholesale re-assessment of our relationship with this Troika will present one of the greatest challenges since these alignments were forged during World War II is a given.
Added to post 9/11 security realities, the charge falling upon the shoulders of the Bush administration becomes even more acute - fortunately the foreign policy acumen of the current team is nonpareil.
In the best of all possible worlds maybe the not-so-loyal opposition in Congress would put aside their, now even more dangerous, gamesmanship and join in a united front committed to destroying the terror network.
That prospect - considering the moral midgets running the Democrat machine - renders such hope more a pipedream than a real possibility.
© 2003 PipeLineMedia, Inc.
Maybe its just the lack of character in the three leaders thats causing it, I dont know but its hard to image three worse people guiding these countries at this point in time.
Would you care to back that up with details -- specific actions taken, dates, money amounts?
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[Reposting from mohaps.com]
Had a ton of fun at Wondercon 2013, Anaheim over the easter weekend. Archaia, the publishers of Mumbai Confidential had arranged for signings of advance copies of the hardcover edition (a WC exclusive prior to the scheduled release on April 30th. Amazon Preorder : http://bit.ly/mcprint). It's always fun to meet up with the Archaia team.
As soon as the show floor opened, I was pleasantly surprised to find that a couple of fans actually came seeking to buy Mumbai Confidential hardcover (as they had read the PREVIEWS magazine interview I had given). Joe (pictured here) set a record of sorts by becoming the first-ever person to purchase a hardcover copy of Mumbai Confidential vol 1 "Good Cop, Bad Cop"
On Saturday, I was on a panel about "Writing For Comics" with other Archaia writers (moderated by Archaia EiC Stephen Christy). It was a fun time shooting the breeze about being a writer in comics and responding to audience questions.
As usual, had a lot of fun catching up with friends and other creators, and generally geeking out watching the cosplayers.
Mumbai Confidential is a creator owned crime-noir comic book series created by Saurav Mohapatra and Vivek Shinde. The "Digital First" issues are available on ComiXology and the print hardcover is due out in April 2013 from Archaia. Please do follow us on Facebook and/or Twitter.

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"We knew this system was a winner from the beginning, because we designed it with the most demanding requirements in mind," said Patrick Brand, president of Pitney Bowes Document Messaging Technologies. "It is a great solution for customers who mix different types of mail and don't want to lose productivity due to overly long setup times."
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Bill Otis points out that, contrary to widespread belief, the great majority of felons either never lose their voting rights or automatically get them restored upon completion of their sentence. And because felons overwhelmingly favor Democrats, their vote represents a potential gold mine for President Obama.
Generally, it's not considered good politics to pitch for the felon vote. According to Reuters, however, the Obama campaign has reached out to felons in Ohio, where only those behind bars on election day are barred from voting. Estimates put the eligible felon vote in Ohio at more than 700,000.
In three swing states, Virginia, Iowa, and Florida, felons cannot vote unless the governor decides otherwise. Florida governor Rick Scott, overturning Charlie Crist's policy, has imposed tough hurdles on would-be felon voters. Similarly, in Iowa, Gov. Branstad reversed the pro-felon voting policy of Tom Vilsack and has approved only a small number of felon voters.
In Virginia, things are trending in the opposite direction. Gov. McDonnell has pledged to restore the right to vote to more felons than any governor in Virginia history, and is closing in on keeping this promise. Even so, we're talking about approximately 4,000 new felon voters.
Ohio, though, is another story, and one worth watching.


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April 2, 1974 "The Sting" sweeps the Oscars and ragtime composer Scott Joplin gets his due
The name Scott Joplin is now nearly synonymous with ragtime—the loose, syncopated musical style that swept the nation in the late-19th century and laid the groundwork for the emergence of jazz in the early 20th. Yet the most important figure in the history of ragtime was a virtual unknown as recently as the late 1960s. It was then that a grassroots ragtime revival began making Joplin and his music known within a growing community of dedicated enthusiasts. It took the star-making power of Hollywood, however, to transform him from a relatively minor cult figure into a household name. The transformation was completed on this day in 1974, when the musical score to The Sting earned Scott Joplin a share of an Oscar, more than five decades after his death in 1917.
The Sting starred Robert Redford and Paul Newman in a story of good-guy con men in 1930s Chicago. Ragtime music had passed out of fashion more than three decades before the events depicted in The Sting, but director George Roy Hill had fallen for Scott Joplin's piano music after hearing his son play an album by classical musicologist and ragtime revivalist Joshua Rifkin. Hill gave the job of scoring The Sting to a young Hollywood composer named Marvin Hamlisch, who worked largely from 1909 sheet music to arrange and orchestrate six of Joplin's compositions for use in The Sting—the melancholy "Solace" and upbeat "The Entertainer" most prominent among them. Historical accuracy aside, Joplin's music proved to be an incredibly effective choice for evoking the mood of Depression-era America.
The Sting and Marvin Hamlisch both had big nights at the 46th annual Academy Awards on April 2, 1974. The Sting won Best Picture, among seven total Oscars, and Hamlisch won three, including Best Song and Best Dramatic Score for The Way We Were along with the award for Best Song Score and/or Adaptation for The Sting. The win for the Joplin-based score of The Sting brought the ragtime revival to the mainstream. Less than two weeks after the Oscars, "The Entertainer" was released as an instrumental single, reaching #3 on the Billboard pop charts in mid-May, while the soundtrack album from The Sting reached the #1 spot on the album charts simultaneously. At the Grammy awards the following year, "The Entertainer" helped propel Marvin Hamlisch to a win in the Best New Artist category, prompting Hamlisch to call Scott Joplin "the real new artist of the year" in his acceptance speech.


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Smoller JW, Pollack MH, Wassertheil-Smoller S, et al. Panic Attacks and Risk of Incident Cardiovascular Events Among Postmenopausal Women in the Women's Health Initiative Observational Study. Arch Gen Psychiatry. 2007;64(10):1153–1160. doi:10.1001/archpsyc.64.10.1153
© 2023
Previous studies have documented an association of depression and phobic anxiety with cardiovascular morbidity and mortality, but little is known about the cardiovascular sequelae of panic anxiety.
To determine whether panic attacks are associated with risk of cardiovascular morbidity and mortality in postmenopausal women.
Prospective cohort survey.
Ten clinical centers of the 40-center Women's Health Initiative.
A total of 3369 community-dwelling, generally healthy postmenopausal women (aged 51-83 years) enrolled between 1997 and 2000 in the Myocardial Ischemia and Migraine Study who completed a questionnaire about occurrence of panic attacks in the previous 6 months.
Main Outcome Measures
Cardiovascular/cerebrovascular outcomes (fatal and nonfatal myocardial infarction and stroke) and all-cause mortality were ascertained after a mean of 5.3 years of follow-up.
A 6-month history of full-blown panic attacks, endorsed by 10% of postmenopausal women in this cohort, was associated with both coronary heart disease (hazard ratio, 4.20; 95% confidence interval, 1.76-9.99) and the combined end point of coronary heart disease or stroke (hazard ratio, 3.08; 95% confidence interval, 1.60-5.94) after controlling for multiple potential confounders. The hazard ratio for all-cause mortality, excluding those with a history of cardiovascular/cerebrovascular events, was 1.75 (95% confidence interval, 1.04-2.94).
Panic attacks are relatively common among postmenopausal women and appear to be an independent risk factor for cardiovascular morbidity and mortality in older women.
While it has been consistently reported that depression is a risk factor for cardiac events,1-3 there have been relatively few outcome studies of the role of anxiety in incident cardiovascular disease outcomes, particularly among women. A study of 34 000 male health professionals aged 42 to 77 years indicated that men with high levels on the Crown-Crisp index of phobic anxiety had a 6-fold increase in sudden deaths (hazard ratio [HR], 6.08; 95% confidence interval [CI], 2.35-15.73), which was unchanged after controlling for other risk factors.4 There was no association between phobic anxiety and nonfatal myocardial infarction (MI). More recently, the Nurses' Health Study found that among women (mean age, 54 years) with no history of cardiovascular disease, high levels of phobic anxiety were associated with increased risk of fatal coronary heart disease (CHD) after 12 years of follow-up.5
Phobic anxiety (as measured by the Crown-Crisp index) assesses unreasonable fear of situations such as enclosed spaces, incurable illness, heights, crowds, being alone, and travel. Panic attacks, in contrast, involve sudden episodes of fear, anxiety, or extreme discomfort accompanied by 4 or more associated (cognitive or autonomic) symptoms. Panic attacks may occur sporadically6 or as a feature of several anxiety disorders, including panic disorder, social anxiety disorder, and specific phobias.7
Recent evidence suggests that panic attacks are more common among postmenopausal women than previously suspected.8 In the Myocardial Ischemia and Migraine Study (MIMS), which included 3369 women, 18% reported full-blown or limited-symptom panic attacks in the past 6 months.8 Another report from this study9 indicated that a 6-month history of full-blown panic attacks, reported by 10% of postmenopausal women, was associated with both ischemic and nonischemic chest pain on 24-hour ambulatory electrocardiogram (ECG) monitoring, although there was no effect of panic attacks on silent ischemia.9 Women with full-blown panic attacks were 79% more likely to report chest pain during monitoring than women with a history of recent panic (HR, 1.79; 95% CI, 1.24-2.59). Although panic attacks are associated with prevalent CHD and thus may be a consequence of CHD, the relationship of a history of panic attacks to incident cardiac events is unknown. The objective of this study was to examine prospectively the relationship of panic attacks to fatal plus nonfatal MI, to stroke, and to all-cause mortality among postmenopausal women.
The study population consisted of 3369 community-dwelling postmenopausal women enrolled between 1997 and 2000 in MIMS who completed a panic questionnaire at enrollment. The objective of MIMS was to investigate the relationships among migraine, ischemia as measured on a 24-hour ambulatory ECG Holter monitor, and panic symptoms. The MIMS was conducted in 10 clinical centers selected from among the 40 centers of the Women's Health Initiative (WHI) Observational Study. The WHI Observational Study is an ongoing multicenter prospective study of risk factors for heart disease, cancer, fractures, and other causes of morbidity and mortality among 93 676 postmenopausal women. A detailed description of the WHI study design and the baseline characteristics have been reported elsewhere.10,11 The WHI Observational Study participants, after giving written informed consent approved by each of the participating institutions' institutional review board, completed questionnaires at baseline and annually, had a physical examination, and provided blood samples at baseline and again 3 years later. The MIMS participants could join concomitantly with the WHI baseline visit (which took place between 1993 and 1998), at the WHI third-year visit, or between these 2 visits; in several cases, they joined after the third-year WHI visit.
Participants enrolled in the WHI clinical trials of hormone therapy or dietary modification were ineligible for the WHI Observational Study and, thus, for MIMS. On the basis of self-report responses to screening questionnaires asking about long-term illness, heart failure, or liver disease, which triggered clinical practitioner evaluations of the selected conditions, participants were deemed ineligible if their survival was expected to be less than 3 years because of the illness. Clinical practitioner judgment, with guidance from the clinical center principal investigator, was used to determine the ineligibility of participants who self-reported depression, drug use, or excessive alcohol intake that would prevent them from active study participation and adherence to protocol.
Participants in MIMS completed a questionnaire about occurrence of panic attacks in the previous 6 months and about migraine headaches before being fitted with the Holter monitor. Participant age at WHI enrollment was 50 to 79 years; age at MIMS enrollment was 51 to 83 years, and mean ± SD age was 65.9 ± 7.16 years.
Panic episodes were defined on the basis of responses to a questionnaire adapted from the DSM-IV Panic Disorder Field Trial.12 As described previously,8 participants were asked to complete a self-report "Anxiety Questionnaire," which begins with 2 screening questions referring to the past 6 months adapted from those used to screen primary care patients in the DSM-IV Panic Disorder Field Trial.12 The first question asks whether the participant has experienced a sudden attack of feeling frightened, anxious, or extremely uncomfortable; the second asks whether she has experienced a sudden episode of rapid or irregular heartbeats. The first question was modified from that used in the field trial12 by referring to "a sudden attack" rather than labeling it a "panic attack." If the answer to either of the screening questions was yes, the participant was asked which panic attack symptoms occurred during the last bad episode. Because of a clerical error, the panic symptom of sweating was inadvertently omitted from this symptom list, so that the panic symptom checklist included 12 rather than 13 panic attack symptoms. A full-blown panic attack was therefore conservatively defined by a positive response to the anxiety attack stem question and 4 associated symptoms not including sweating.
This questionnaire was administered at the clinic visit during which ambulatory ECG monitoring was initiated and before the start of recording. Full-blown panic attack was defined as an attack of sudden fear, anxiety, or extreme discomfort during the past 6 months accompanied by 4 or more panic attack symptoms from a 12-symptom checklist (n = 330). Limited-symptom panic attack was defined as above except that 1 to 3 panic symptoms were endorsed (n = 273). Women were considered to have indeterminate panic attack if they endorsed only the second screening question (an episode of sudden or irregular heartbeats in the past 6 months but not an attack of fear, anxiety, or extreme discomfort) along with 4 or more panic symptoms. This last group of women (n = 126) likely included a mixture of women with and without true panic attacks, and thus were excluded from the analytic cohort. The definition of full-blown or limited-symptom panic does not specify whether these attacks were spontaneous, isolated, or part of panic disorder. The comparison group was women classified as having neither full-blown nor limited-symptom panic attacks in the past 6 months (n = 2640). Further details on panic definitions were provided in a previous publication.8
Depression, as described in more detail elsewhere,1 was measured by means of an 8-item screening instrument developed for the Medical Outcomes Study13 that incorporates 6 items about depressive symptoms in the past week from the Center for Epidemiologic Studies Depression Scale (CES-D)14 and 2 items about sad or depressed mood within the past 2 years from the Diagnostic Interview Schedule.15 These latter 2 items were (1) "In the past year, have you had 2 weeks or more during which you felt sad, blue, or depressed or lost pleasure in things that you usually cared about or enjoyed?" and (2) "Have you had 2 years or more in your life when you felt depressed or sad most days, even if you felt okay sometimes?" and (if yes) "Have you felt depressed or sad much of the time in the past year?" A logistic regression prediction equation based on these 8 items was used to assign a scale score based on a weighted combination of item responses. This screening instrument has been widely used (including in other large-scale studies of postmenopausal women16) and has demonstrated good sensitivity and positive predictive value for detecting depressive disorder in the past month in both primary care and mental health user populations,13 using a cutoff point of 0.06; this cutoff point was therefore used to define a positive depression screen in our sample.
History of CHD before the MIMS was defined as self-report of MI, coronary artery bypass graft surgery, or angioplasty before WHI baseline or one of these outcomes after WHI baseline but before enrollment into MIMS and the administration of the panic questionnaire. History of cardiovascular/cerebrovascular disease before MIMS was defined as history of CHD or stroke before enrollment into MIMS. Hypertension status was based on self-report as follows: no hypertension meant that the participant had never been told by a physician that she had high blood pressure; treated hypertension, the participant had a medical diagnosis of hypertension and was taking medication for hypertension; and untreated hypertension, the participant had a medical diagnosis of hypertension and was not taking medication for hypertension. The WHI definitions of diabetes mellitus and high cholesterol are incomplete and rely on self-report of taking insulin or oral drugs for diabetes and self-report of having high cholesterol level requiring medication; serum glucose and cholesterol measurements were not available. Thus, models including these 2 variables likely underestimate their effects.
Outcomes of interest were cardiovascular events occurring after the panic questionnaire was administered and include CHD (defined as MI or CHD death), stroke, the combined end point of CHD or stroke, and all-cause mortality. These end points were ascertained from Medical History Update Questionnaires mailed annually to participants or by direct report to staff from participants or third parties between annual questionnaires. Such reported hospitalizations or potential events of interest triggered a telephone interview with the participant or with the proxy the participant had identified when joining the WHI to obtain further details. Medical records, laboratory and other diagnostic results, and, when necessary, death certificates were obtained. Trained physician adjudicators at each site evaluated the complete information and made the decision on cause of event. Coronary heart disease events were documented by ECG and laboratory test results and, where appropriate, death certificate information and autopsy reports. For participants not responding to the mailed questionnaires or to follow-up telephone calls, proxy respondents identified for each participant at baseline were contacted. In addition, the National Death Index was searched and death certificates were obtained to determine cause of death. Stroke diagnosis was based on rapid onset of a neurologic deficit attributable to an obstruction or rupture of the arterial system. The deficit was not known to be secondary to brain trauma, tumor, infection, or other cause, and must have lasted more than 24 hours unless death supervened or there was a demonstrable lesion compatible with acute stroke on computed tomography or magnetic resonance imaging. Follow-up data were missing for only 1 participant in MIMS, and that participant was in the no-panic group.
The mean ± SD duration of follow-up after enrollment in MIMS was 5.30 ± 0.81 years (range, 0.41-7.32 years).
Baseline characteristics of women with a history of full-blown panic attacks and those with no panic were compared by χ2 test for categorical variables or Fisher exact test where appropriate. Continuous variables were compared by 2-tailed t test or analysis of variance if there were more than 2 categories. The HRs were obtained from Cox proportional hazards regressions to evaluate the association between 6-month history of full-blown panic attacks vs no panic attacks and the outcomes of interest; HRs are presented for unadjusted regressions, as well as with adjustment for age (continuous), race/ethnicity (black, Hispanic, or other vs white as the reference group), and family income (< $20 000 and $20 000-$50 000 vs > $50 000) and with adjustment for multiple variables. The fully adjusted models included baseline variables that were significantly different between the full-blown panic attack and no-panic attack groups: age, race, income, and body mass index as continuous variables; history of diabetes treatment (yes or no); history of smoking (current or past vs never); history of depression (yes or no); history of atrial fibrillation (yes or no); and history of MI, coronary artery bypass graft surgery, angioplasty, or stroke (yes or no). Each of these variables has been associated in the literature with cardiovascular end points. Additional variables previously shown to be related to risk of cardiovascular events were also included: hormone use (current and past vs never), high cholesterol level requiring medication (yes or no), hypertension status (controlled hypertension and uncontrolled hypertension vs not hypertensive), and physical activity (number of episodes per week of moderate or strenuous exercise of > 20 minutes' duration). Collinearity was considered by examining the correlations among variables in the model. Almost all such correlations were less than 0.10, and no correlation was above 0.19. For participants with no events of interest, time to censoring was the minimum of days to the last contact form or days to death. All analyses were conducted with SAS statistical software (SAS Institute Inc, Cary, North Carolina).
Postmenopausal women who experienced at least 1 panic attack in the preceding 6-month period differed on demographic characteristics and were more likely to have cardiovascular risk factors of smoking, higher body mass index, diabetes mellitus, hypertension, and depressive symptoms, as well as a history of cardiovascular morbidities (Table 1), as previously reported.8
As shown in Table 2, there were 41 CHD events (fatal or nonfatal MI), 40 strokes, and 147 deaths from all causes after an average of 5.3 years of follow-up.
Recent history of full-blown panic attacks was associated with excess risk of the combined end point of CHD or stroke and with all-cause mortality in unadjusted analyses (Table 3). In the fully adjusted model, controlling for age, race, income, body mass index, alcohol intake, smoking, hormone use, high cholesterol level requiring medication, hypertension, physical activity, depression, history of diabetes, atrial fibrillation, and history of cardiovascular disease, full-blown panic attacks appeared to be an independent risk factor for both CHD (HR, 4.20; 95% CI, 1.76-9.99) and the combined end point of CHD or stroke (HR, 3.08; 95% CI, 1.60-5.94), as well as all-cause mortality (HR, 1.75; 95% CI, 1.04-2.94). Although we adjusted for history of cardiovascular disease in these models, we also ran the analyses excluding the 149 women who had such a history before the assessment of panic attacks. The HRs in these analyses were similar: CHD: HR, 3.5; 95% CI, 1.29-9.54; combined CHD or stroke: HR, 2.77; 95% CI, 1.37-5.59; and all-cause mortality: HR, 1.98; 95% CI,1.15-3.41. In the fully adjusted model that included panic attacks, depression was not significantly related to death (HR, 1.08; 95% CI, 0.61-1.94) or to the combined end point of CHD or stroke (HR, 0.89; 95% CI, 0.39-2.03). Thus, the finding that panic attacks were significantly associated with cardiovascular events after controlling for depression but that depression was not significantly associated with cardiovascular events after controlling for panic attacks, suggests that panic attacks are a risk factor for cardiovascular events independent of depression.
Hazard ratios for limited-symptom panic attacks compared with no panic attacks showed similar, although weaker, associations with outcomes. The risk associated with limited-symptom panic attacks for the combined end point of CHD or stroke in the fully adjusted model was an HR of 2.05 (95% CI, 0.99-4.23) and was nonsignificant for either end point separately and for all-cause mortality.
We found that postmenopausal women aged 51 to 83 years who reported at least 1 panic attack in the previous 6 months were at increased risk of subsequent cardiovascular events during a follow-up period of 5.3 years. After adjustment for multiple potential confounders and known cardiovascular risk factors, recent history of full-blown panic attack was independently associated with a nearly 4-fold increased risk of fatal or nonfatal MI and a nearly 3-fold increased risk of the combined end point of CHD or stroke. The HR for stroke alone, while elevated, did not show statistical significance; thus, the association with panic attacks may be stronger for CHD than for cerebrovascular disease. Limited-symptom panic attacks, which have previously been associated with levels of impairment similar to that seen with full-blown attacks,8,17 were associated with nonsignificant increases in risk of cardiovascular morbidity and mortality. The risks in the limited-symptom group were intermediate between those of the no-panic attack and full-blown panic attack groups.
To our knowledge, ours is the largest study to examine prospectively the association between panic anxiety attacks and cardiovascular morbidity and mortality. Previous studies examining the association between panic disorder and coronary artery disease have primarily involved clinical samples of patients with chest pain in emergency department or cardiology settings (see Katerndahl18 for review). In contrast to our study, most of these studies examined clinician-diagnosed panic disorder. While summary estimates from these studies have not established an association between panic disorder and coronary artery disease,18 a few studies have suggested that panic attacks or panic disorder may be associated with ischemia or increased mortality.19-22 Two small early studies suggested that men with panic disorder have an increased risk of cardiovascular death.19,20 A subsequent study of 5034 individuals from the Epidemiologic Catchment Area's New Haven cohort found an elevated risk of self-reported heart attack and stroke among 60 individuals with panic disorder compared with 3778 individuals with no psychiatric disorder.23
Our study adds panic attacks to the list of emotional states and psychiatric symptoms that have been linked to excess risk of cardiovascular disease and death in nonclinical samples. Numerous large-scale prospective studies have documented an association between depression or depressive symptoms and ischemic heart disease.24 In a prospective study of the full WHI cohort (N = 93 676), postmenopausal women completed a baseline shortened 6-item CES-D questionnaire asking about depressive symptoms in the past week; those scoring above a cutoff point of 5, which corresponds to the cutoff point of 16 generally used to classify people as depressed on the full 20-item CES-D questionnaire, had a 50% higher risk of death from cardiovascular disease during 4.1 years of follow-up than those scoring below this cutoff point even after controlling for major cardiac risk factors. Women who reported a history of depressive symptoms during the past 2 years had similar results.1 The present study demonstrates that panic attack is a predictor of hard cardiovascular end points, independent of depression. Phobic anxiety, measured on the Crown-Crisp index, has been shown to predict sudden cardiac death in studies of both men4,25 and women.5 Albert and colleagues5 found an association between self-rated phobic anxiety and both fatal CHD and sudden cardiac death (but not nonfatal MI) in a cohort of 72 359 women (mean age, 54 years) from the Nurses' Health Study during 12 years of follow-up. Chronic worry has also been associated with excess risk of nonfatal MI and CHD in a prospective study of men.26 Several studies have also documented an association between anger or hostility and risk of MI.27 Although we were not able to control for hostility or phobic anxiety, we did find that panic attacks were associated with cardiovascular outcomes independent of depression in our analyses.
If panic anxiety is associated with cardiovascular morbidity and mortality, what might be the mechanism? One possibility is that the relationship is mediated through an association of panic attacks with other cardiovascular risk factors, such as hypertension.28 This does not appear to be the case in our study because the association with CHD and CHD or stroke persisted after controlling for major cardiovascular risk factors and history of cardiovascular disease, and also among those who had no earlier history of cardiovascular disease or stroke. A second possibility is that anxiety itself has adverse cardiovascular effects.29 Several studies have suggested that episodes of anger, anxiety, or depressed mood may trigger acute coronary ischemia,30,31 and negative emotional states may be associated with heightened platelet activation and altered hemodynamic reactivity.27 Panic attacks have been associated with increased sympathetic outflow and coronary vasospasm,32 which might trigger ischemia. In a recent study of 65 patients with coronary artery disease, Fleet et al21 found that panic attacks induced by carbon dioxide inhalation were associated with reversible myocardial perfusion defects. In a previous study of the MIMS cohort, our group observed an elevated risk of ischemic chest pain (but not silent ischemia) during 24-hour ambulatory ECG monitoring among postmenopausal women with a 6-month history of panic attack (odds ratio, 4.94; 95% CI, 1.41-17.30).9 Alterations in cardiac vagal tone may provide another pathophysiologic link between panic and risk for increased cardiac morbidity and mortality. Several studies have documented a relationship between reduced heart rate variability, an index of autonomic dysregulation, and panic disorder.33-35 Studies documenting an association between phobic anxiety and risk of sudden cardiac death among men4,25 and women5 have invoked proarrhythmic effects of anxiety as a mediating cause, and reduced heart rate variability has been documented among men with high levels of phobic anxiety.36
Our results should be viewed in light of several limitations. First, our panic attack questionnaire was a cross-sectional measure assessing the presence of at least 1 panic episode during a 6-month period. Thus, we cannot distinguish cardiovascular outcomes among women who may have had multiple recurrent attacks (or who may have met criteria for panic disorder) from those who may have had infrequent or sporadic attacks. Second, the use of a self-report measure may have led to underreporting or overreporting of panic attacks relative to what might have been seen with direct interview methods. Of note, however, previous research has shown that a self-report measure comprising simply the 2 screening questions of our measure had excellent negative predictive value (0.94-1.00) but low positive predictive value (0.18-0.40) for detecting panic disorder when compared with a diagnostic interview in samples of primary care patients.37 Because panic was assessed before the cardiovascular outcomes, misclassification would likely bias results toward the null. Third, it is possible that panic attacks reported by women who went on to develop adverse cardiovascular outcomes were in fact episodes of cardiac abnormality (eg, ischemia or arrhythmia). If so, self-reported panic attacks might represent a marker of underlying cardiovascular disease that may presage MI or stroke. Finally, although we found a similar pattern of results for limited-symptom panic, they did not reach statistical significance; because of the smaller number of women reporting these attacks, we cannot rule out the possibility of type II error.
In summary, we found that postmenopausal women who had experienced panic attacks in the previous 6 months had a 3-fold higher risk of heart attack or stroke during a 5-year follow-up period than those who did not experience such attacks, after controlling for standard cardiovascular risk factors and concurrent depression. These results suggest that panic anxiety is a marker for increased risk of cardiovascular morbidity and mortality among postmenopausal women. Future studies are needed to clarify the causal connection, if any, between panic attacks and cardiovascular events. Our results imply, however, that older women with a recent history of panic attacks represent a subgroup at elevated risk of MI and stroke in whom careful monitoring and cardiovascular risk reduction may be particularly important.
Correspondence: Jordan W. Smoller, MD, ScD, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 185 Cambridge St, Ste 2200, Boston, MA 02114 (firstname.lastname@example.com).
Submitted for Publication: November 30, 2006; final revision received February 9, 2007; accepted February 20, 2007.
Author Contributions: Dr Wassertheil-Smoller had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosures: Dr Smoller has received honoraria from Hoffman-La Roche Inc, has served on an advisory board for Roche Diagnostics Corp, and may receive an honorarium for a lecture he may give to an Eli Lilly and Company Advisory Board in the near future. Dr Pollack serves on advisory boards and provides consultation for AstraZeneca, Brain Cells Inc, Bristol Myers Squibb, Cephalon, Forest Laboratories, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, Eli Lilly and Company, Medavante, Neurocrine, Neurogen, Novartis, Otsuka Pharmaceuticals, Pfizer, Predix, Roche Laboratories, Sanofi, Sepracor, Solvay, Tikvah Therapeutics, Transoral Pharmaceuticals, UCB Pharma, and Wyeth; has received research grants from Bristol Myers Squibb, Cephalon, Forest Laboratories, GlaxoSmithKline, Janssen, Eli Lilly and Company, NARSAD (formerly, National Alliance for Research on Schizophrenia and Depression), National Institute of Mental Health, National Institute on Drug Abuse, Pfizer, Sepracor, UCB Pharma, and Wyeth; is in the speaker programs for Bristol Myers Squibb, Forest Laboratories, GlaxoSmithKline, Janssen, Eli Lilly and Company, Pfizer, Solvay, and Wyeth; and holds equity in Medavante and Mensante Corporation. Dr Wassertheil-Smoller received a grant from Glaxo Wellcome for this study. Dr Jackson has received research support from and is on the speakers bureau for Procter & Gamble Pharmaceuticals, has received research and conference support from Novartis, and has received an honorarium as a Continuing Medical Education speaker for Aventis/Alliance for Better Bone Health.
Funding/Support: The WHI program is funded by the National Heart, Lung, and Blood Institute, US Department of Health and Human Services. The MIMS was funded by Glaxo Wellcome (now GlaxoSmithKline) (Dr Sheps).
Role of the Sponsor: Glaxo Wellcome had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Additional Contributions: Victor Kamensky, MS, programmed the statistical analyses.
Program Office
Barbara Alving, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Clinical Coordinating Center
Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, and Anne McTiernan, Fred Hutchinson Cancer Research Center, Seattle, Washington; Sally Shumaker, Wake Forest University School of Medicine, Winston-Salem, NC; Evan Stein, Medical Research Labs, Highland Heights, Kentucky; Steven Cummings, University of California at San Francisco, San Francisco, California.
Clinical Centers
Sylvia Wassertheil-Smoller, Albert Einstein College of Medicine, New York, New York; Jennifer Hays, Baylor College of Medicine, Houston, Texas; JoAnn Manson, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Annlouise R. Assaf, Brown University, Providence, Rhode Island; Lawrence Phillips, Emory University, Atlanta, Georgia; Shirley Beresford, Fred Hutchinson Cancer Research Center; Judith Hsia, George Washington University Medical Center, Washington, DC; Rowan Chlebowski, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Evelyn Whitlock, Kaiser Permanente Center for Health Research, Portland, Oregon; Bette Caan, Kaiser Permanente Division of Research, Oakland, California; Jane Morley Kotchen, Medical College of Wisconsin, Milwaukee, Wisconsin; Barbara V. Howard, MedStar Research Institute/Howard University, Washington, DC; Linda Van Horn, Northwestern University, Chicago, Illinois; Henry Black, Rush Medical Center, Chicago; Marcia L. Stefanick, Stanford Prevention Research Center, Stanford, California; Dorothy Lane, State University of New York at Stony Brook; Rebecca D. Jackson, The Ohio State University, Columbus; Cora E. Lewis, University of Alabama at Birmingham; Tamsen Bassford, University of Arizona, Tucson; Jean Wactawski-Wende, University at Buffalo, Buffalo, New York; John Robbins, University of California at Davis, Sacramento, California; F. Allan Hubbell, University of California at Irvine; Howard Judd, UCLA, Los Angeles, California; Robert D. Langer, University of California at San Diego, La Jolla, California; Margery Gass, University of Cincinnati, Cincinnati, Ohio; Marian Limacher, University of Florida, Gainesville; David Curb, University of Hawaii, Honolulu; Robert Wallace, University of Iowa, Iowa City; Judith Ockene, University of Massachusetts/Fallon Clinic, Worcester; Norman Lasser, University of Medicine and Dentistry of New Jersey, Newark; Mary Jo O'Sullivan, University of Miami, Miami, Florida; Karen Margolis, University of Minnesota, Minneapolis; Robert Brunner, University of Nevada, Reno; Gerardo Heiss, University of North Carolina, Chapel Hill; Lewis Kuller, University of Pittsburgh, Pittsburgh, Pennsylvania; Karen C. Johnson, University of Tennessee, Memphis; Robert Brzyski, University of Texas Health Science Center, San Antonio; Gloria E. Sarto, University of Wisconsin, Madison; Denise Bonds, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Susan Hendrix, Wayne State University School of Medicine/Hutzel Hospital, Detroit, Michigan.


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We know you know it! But this short guide will help the new comers!
what is a condom? A thin rubber sheath worn on a man's penis during sexual intercourse as a contraceptive or as a protection against infection.
How to use a condom?
Always follow the instructions in the condom pack. Check the expiry date on the condom wrapper before you use it. Tear the wrapper open from the serrated edge and handle the condom carefully, as it can be damaged by fingernails and sharp objects like jewellery and body piercings.
Either of you can put the condom on the erect penis. Just make sure you put the condom on before you have any sexual activity. This helps to prevent an unplanned pregnancy and the possibility of catching sexually transmitted infections.
Check the roll is on the outside. If it's on the inside, the condom is inside out. Squeeze the teat end of the condom so there's no air trapped inside.
Still squeezing the teat, put the condom on top of the penis and roll it down with your other hand. If it starts to roll back up during sex, just roll it back down again straight away. If it comes off, stop and put a new condom on.
Soon after ejaculation, and while the penis is still erect, the condom should be held firmly in place at the base of the penis before withdrawal. Then just take it off, wrap it in a tissue and put it in the bin. Please don't flush it down the toilet.


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The value of software
It is interesting how different parts of my life intersect with one another. I am thinking of my working life in embedded software and an aspect of my personal life: my lifelong interest in photography. Years ago, they were very separate activities, but the move from film to digital has brought them closer together.
A particular incident occurred last week that raised interesting questions about the value of software …
Everyone has heard of Photoshop, which is the definitive software tool used by digital photographers. This product, along with a bunch of other similar tools, is quite expensive – many hundreds of dollars, which, for an amateur photographer, is quite steep. Although there is a very low cost, "amateur" version available [which is amazing value for money IMHO], many people yearn to have the "real thing". Most of them dig deep and spend the money. However, there are always some who try to cut corners.
I belong to a local camera club and a new member advertised the availability of a range of pro quality software at a very reasonable price. I expressed interest – I always like a bargain – but said that I was only happy if it was legal, licensed and shrink-wrapped. He got back to me and was quite up-front about the fact that it was not legal – it was a "cracked" pirate copy and that many others did not have my "high standards". When I said that I [and the club] could not support or condone such an illegal activity, he told me that all he was doing was helping people, who could not afford this fancy software, to get the tools they needed. I pointed out that this was equivalent to stealing cars for people who could only afford to take the bus.
This incident has sparked much discussion among club members about the value and cost of software. On the negative side, there were comments about Adobe "ripping off" customers. This in unfair, as Photoshop is aimed at pros, who are actually getting a good deal. From a positive perspective, club members are now much more aware of the low cost and free options available to them. They now have a clear choice: spend little/nothing, spend a lot, or break the law.
This discussion is almost directly parallel to that had among engineers and managers of embedded software projects. Why should they pay high prices for tools, when there are free options available? Can they "make do" with fewer licenses? There are lots of options and I discussed some interesting possibilities here a few weeks ago. But the bottom line for embedded software developers is the same as it is for photographers: if you have the right tools, you will get the best results. For embedded software engineers, that means that they would introduce fewer bugs and finds other bugs more quickly; the saved time quickly pays for the tools.
I have always wondered why our products need to have sophisticated license management. Surely "real" companies would not pirate software, when they consider the legal implications [= costs] of being caught doing so? Certainly, at Mentor Graphics the rules are clear: using illegal software can be a just cause for dismissal. However, we frequently encounter customers who infringe the license terms for both tools and runtime software. It is clear that the value of software really is not clear to everyone.


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Martin Landau as Dexter and Norman Paris in Season 2, Episode 8: "Double Shock", Air Date: March 25, 1973
The Columbo Encyclopedia is a Tumblr blog by Brooklyn-based artist Rick Baker that features pen-and-ink drawings based on characters from the long-running television detective mystery show, Columbo. Volume I of the Encyclopedia features the show's murderers/villians and future entries will include illustrations of the victims. Here's a look at the entire archive of images from The Columbo Encyclopedia.
Gene Barry as Dr. Ray Flemming in Pilot 1 – "Prescription: Murder", Air Date: February 20, 1968
Laurence Harvey as Emmett Clayton in Season 2, Episode 7: "The Most Dangerous Match", Air Date: March 4, 1973
Susan Clark as Beth Chadwick in Season 1, Episode 5: "Lady in Waiting", Air Date: December 15, 1971
images via Rick Baker
submitted via Laughing Squid Tips


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Rio Grande, Puerto Rico – Andres Romero and Cameron Percy posted matching rounds of 7-under 65 on Thursday and they share the lead after the opening round of the Puerto Rico Open.
Romero has one PGA Tour title to his credit, while Percy is searching for his first tour victory.
Blayne Barber carded a 6-under 66 and shares third place with Jon Curran on the Composite Course at Trump International Golf Club.
Two-time major champion Angel Cabrera is one stroke back at minus-5. He stands alongside Bill Lunde, Steve LeBrun, Brad Fritsch, Justin Bolli, Morgan Hoffmann, Brian Stuard, Peter Uihlein and Rafael Campos.
K.J. Choi, the highest ranked player in the field at world No. 65, opened with an even-par 72 and is tied for 80th place.
Romero, the 2008 Zurich Classic of New Orleans winner, played the back nine first on Thursday and got going with back-to-back birdies at 12 and 13. He converted a birdie effort at the par-3 15th and made the turn at minus-4 after making birdie at the par-5 18th.
The Argentine jumped to 6-under after he eagled the par-5 second. Romero followed with three birdies in the next four holes to get to 9-under.
However, Romero stumbled to a bogey at the seventh. He also bogeyed No. 8 to slip back to minus-7. Romero parred the last to end there.
Percy opened with birdies on the first and second. He faltered to a bogey on the fourth.
The Australian bounced back with three birdies in the next four holes to climb to minus-4.
Around the turn, Percy stumbled to another bogey on No. 10. He righted the ship with birdies at 12 and 13. Percy birdied the 16th and 18th to join Romero atop the leaderboard.
"Well, they were all pretty short except for on 12. I holed about a 25-footer on 12, just a little left-to-righter. That was a nice one. The rest of them were all five and six feet sort of thing," Percy said of his birdie putts. "Just drove the ball really nicely. I've been trying to not hit the ball too hard, so I just tried and hit three-quarters drivers and just kept the ball in play and I did that today and it was quite nice."
NOTES: Defending champion George McNeill mixed three birdies and two bogeys in a round of 1-under 71, which left him tied for 64th ... Scott Gardiner had a hole-in-one at the par-3 11th ... 17-year-old Si Woo Kim, who got his tour card via Q School last fall, withdrew after his round due to a back injury.