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Prescription painkillers are among the most widely used drugs in America. In the decade since New York Times reporter Barry Meier began investigating their use and abuse, he says he has seen the number of people dying from overdoses quadruple — an increase Meier calls "staggering."
"The current statistic is that about 16,000 people a year die of overdoses involving prescription narcotics. ... It's a huge problem. The number of people dying from these drugs is second only to the number of people that die in car accidents," he tells Fresh Air's Terry Gross.
Meier's new e-book, A World of Hurt: Fixing Pain Medicine's Biggest Mistake, is published by The New York Times Co. and explores opiate painkillers and the consequences of long-term use. He focuses in particular on OxyContin — how it came to be prescribed for chronic pain, what the consequences have been, and how it became a street drug.
Meier explains how, in its initial form, OxyContin was designed as a time-released version of oxycodone — meant to ease pain for many hours at a time without interruption. It became a street drug when people looking to get high found a way to get around the time-release design of the pill.
"All you needed to do was to crush it, chew it, grind it down," Meier says, "and basically the entire narcotic pain [reducing] load that was contained within the drug was released immediately, which is why it was [such a] powerful high and such an addictive drug when it was abused that way."
Meier's previous book, Pain Killer, was published in 2003. He explains that for patients, part of the danger when it comes to the long-term medical use of painkillers like OxyContin comes from the body's ability to develop a tolerance for it.
"Unlike many other types of medications where you can be prescribed a dosage and stay on that dosage for a long time," Meier says, "your body adapts to these drugs. "[Essentially], you require more of the [narcotic] to get the same ... effect. And what happens is a steady escalation in dosage, and it can keep going and going and going and going to the point where, after a year or two of treatment, you are on extremely high levels of these drugs."
That doesn't mean, however, that Meier is unilaterally opposed to these narcotics.
"There is no question that these drugs are extremely beneficial," he tells Gross. "They are valuable, vital drugs. There should be no hesitation in their use after conditions like surgery, or accidents, or cancer treatment or end-of-life use. ... [T]he question becomes: How effective are these drugs in long-term treatment of chronic pain?"
Interview Highlights
On the promotion of OxyContin for chronic pain relief
"The company that produces OxyContin — Purdue Pharma — launched ... an innovative and huge campaign to introduce drugs that had previously been used for cancer treatment into [use for the relief of] general pain. That involved training hundreds of doctors to go out and speak to their medical colleagues about the benefits of these drugs and, most importantly, the FDA allowed Purdue to make an unusual claim ... that because OxyContin was a time-release drug it would be less prone to causing addiction and less attractive to people who abuse drugs. This became part of a steady drumbeat that was sounded by not only the company, but by leading pain experts — that, in fact, with this drug we had what was really a unique new weapon to deal with an age-old problem."
On the first signs of problems with OxyContin
"The first person who sounded the alarm about this was a doctor in Boston. Her name is Jane Ballantyne, and she was the head of pain treatment at Massachusetts General. In 2003 she had accepted that these drugs were beneficial. She was a soldier in this war on pain, and as she kind of walked around Mass General, she started seeing things that caught her attention. For example, chronic pain patients who were given these drugs started improving. They would improve for a while, and suddenly their improvement would stop. Their pain would return. They would lose function, or the improvement in function they had achieved would be lost, and she began to wonder why this was going on. That led her to start studying animal tests involving these drugs, and basically began to lead her to question whether these drugs were really beneficial for patients in the long term."
On the side-effect of becoming disengaged from life
"I had a doctor who I greatly respect who said, 'We thought the great problem with these drugs is addiction. What we didn't realize [was] that the people who take them would opt out of life.' And you see it across the spectrum: One of the more startling things is in the area of workplace injuries; things like back strains are very common problems. But what folks have discovered is the more patients — workers — who are treated with these drugs for back strain, the longer and longer and longer they stay away from work. In fact, we've kind of created a legion of chronically unemployed people who are dependent on these drugs."
On widespread use of OxyContin in Appalachia
"If you look at the atlas of how drugs are prescribed in different parts of the country, there usually is a pretty straight correlation between the use of narcotic painkillers and areas where you have physical labor jobs, like mining, farming, logging — [places] where people get a lot of back problems and muscle injuries and things of that nature. In many of these areas you have doctors who are generalists; they're not specialists. So most folks are going to a general practitioner — a family doctor — and when they were told that OxyContin was a less abusable drug than drugs that had preceded it, they said, 'Great. This sounds like a good thing for my patients.' So they started prescribing it very heavily."
On the rise of pill mills
"You basically had these pain clinics [with] doctors that supposedly specialized in treating pain. These, in fact, were doctors who had no experience in treating pain. These are essentially clinics where you could walk in and the doctor would say, 'How do you feel?' 'I'm in pain. I think OxyContin would work for me.' And the doctor would write your prescription. You would pay cash for the appointment, and the cycle would start. And these ... proliferated throughout the U.S."
This is FRESH AIR. I'm Terry Gross. Prescription painkillers have become the most widely used drugs in America. My guest Barry Meier has been investigating painkillers for more than 10 years. He's a reporter for the New York Times who covers the intersection of business, medicine and public health. His new e-book, "A World of Hurt," was published today.
It's about high-dose opioid painkillers and the consequences that come with long-term use. It focuses especially on OxyContin, how it came to be prescribed for chronic pain, and what the consequences have been. It also examines how Oxy became a street drug. Meier's previous book, published in 2003, is called "Painkiller."
Barry Meier, welcome to FRESH AIR. Let's start with an overview. What is Oxy, and how does it compare to, say, morphine or Percocet or Vicodin?
BARRY MEIER: Sure. OxyContin is basically a time-release form of a narcotic called oxycodone. It's in the same class of drugs as morphine, codeine. They're basically all natural or synthetic variations of the - from the poppy seed. What made OxyContin so unique is that it was a pure version of the drug. It wasn't mixed with aspirin or acetaminophen the way it's found in other narcotic painkillers like Percocet.
And it was in a time-release form, so the drug was supposed to - you take it, and you are supposed to get pain relief for about 12 hours or so.
GROSS: But people who wanted to use it to get high found a way around that.
MEIER: Correct. All you needed to do was to crush it, chew it, grind it down, and basically the entire narcotic pain load that was contained within the drug was released immediately, which is why it was such a powerful high and such an addictive drug when it was abused that way.
GROSS: You've been writing about how medical and social attitudes toward opiate painkillers keep shifting. You write a lot about the war on pain, which started, what, in the '80s, where attitudes shifted to be more open to the long-term use of opioids in the treatment of pain. This actually started with cancer and with people who were, you know, terminally ill and sought pain relief. Let's start there.
MEIER: Sure, that's correct. I mean basically in the 1980s or '70s, drugs like morphine were not widely used in this country because of fears of addiction related to them. And as a result of that, a lot of people at their end of their lives, be it cancer sufferers or people who were dying, were denied these drugs.
And there was a lot of suffering as a result of that. In the '80s there was a realization that these drugs could be used successfully on cancer patients and terminally ill patients. And then in the mid-1990s there was really a revolution that took place. There was a study done here in New York by a pain expert who found that if I gave these same drugs to people with non-cancer pain, common pain like back pain, arthritis, facial pain, that it appeared that they also weren't getting addicted.
And that opened the door to the widespread medical use of drugs that had previously been reserved for cancer patients into the general patient population.
GROSS: Did the manufacturer of OxyContin do anything to promote the long-term use of the drug for pain patients who didn't have cancer, people with back pain and nerve damage?
MEIER: Oh, absolutely. The company that makes OxyContin, Purdue Pharma, launched what was an innovative and huge campaign to introduce drugs that had previously used for cancer treatment into general pain. That involved training hundreds of doctors to go out and speak to their medical colleagues about the benefits of these drugs.
And most importantly, the FDA allowed them to make an unusual claim, and that is that because OxyContin was a time-release drug, it would be less prone to causing addiction and less attractive to people who abuse drugs. So this became part of what was a steady drumbeat that was sounded not only by the company but by many leading pain experts, that in fact with this drug we had what was really a unique new weapon to deal with an age-old problem.
GROSS: When OxyContin started entering the realm of medical use for long-term chronic pain, like back problems and nerve pain, was it controversial within the medical field?
MEIER: There was some controversy. You know, prior to that there had been other approaches to treating pain, sometimes successfully, sometimes unsuccessfully. It basically involved, you know, physical therapy, behavioral therapy. Pain is a very, very complex condition, particularly chronic pain. And what happened was that with the introduction of what seemed to be kind of a wonder drug, insurers shifted to basically paying only for drugs, much as they did when antidepressants replaced psychotherapy.
So whatever controversy there was at the point of introduction, it was kind of quickly swept aside by economic forces, and these drugs, OxyContin in particular, were very quickly and widely accepted by many, many doctors.
GROSS: You write about how pharmaceutical companies who manufacture painkillers have actually funded medical and patient pain groups. Would you describe the funding and the relationship of the pharmaceutical companies to these groups?
MEIER: Sure, these types of arrangements are found throughout medicine, where you have drug companies funding patient or advocacy groups that represent a particular disease or particular interest that they have. This in the area of use of opioids became very, very well-funded with the launch of OxyContin and continued for about a decade or so.
The dilemma here is that companies have legitimate commercial interests, and that is to make sure these drugs are available for patients, and that became the drumbeat to which the patient groups marched as well, and so it became very focused on changing state laws or deterring any effort that might limit the availability of these drugs to patients, rather on the issue of whether these drugs were actually beneficial to the patients who were taking them.
GROSS: What were some of the early problems that pain specialists started reporting?
MEIER: Well, the person that sort of first sounded the alarm about this was a doctor in Boston, her name is Jane Ballantyne, and she was the head of pain treatment at Massachusetts General. And in 2003, I mean she accepted that these drugs were beneficial. She was a soldier in this war on pain, and as she kind of walked around Massachusetts General, she started seeing things that caught her attention.
For example, chronic pain patients who were given these drugs started improving. They would improve for a while, and suddenly their improvement would stop. Their pain would return, they would lose function, or the improvement in function they had achieved would be lost, and she began to wonder why this was going on.
And that led her to start studying animal tests involved in these drugs and basically began to lead her to question whether these drugs were really beneficial for many patients in the long term.
GROSS: And what some doctors started finding, you write, is that patients would become tolerant of the drug. They would develop a tolerance and require increased doses. Does that frequently happen?
MEIER: It's a very common thing, and it's sort of part and parcel of using these drugs. Essentially, unlike many other types of medications, where you can sort of be prescribed a dosage and stay on that dosage for a long time, your body adapts to these drugs. And when your body adapts to these drugs, which is the situation called tolerance, essentially you require more of the drug to get the same killing effect.
And so what happens then is a steady escalation in dosage, and it can keep going and going and going and going and going, to the point where after a year or two of treatment, you are on extremely high levels of these drugs, and the higher level you take these drugs at, the more potential side effects that can occur.
So you had people who became addicted to it through its medical use, and increasingly we're seeing evidence that patients become dependent upon it. We're seeing consequences where people's hormonal balance is basically being affected and their production of sexual hormones is being decreased, which is leading to lethargy.
We're seeing a variety of ill effects that are being produced by the long-term medical use of these drugs as opposed to their abuse.
GROSS: And one of the side effects you write about is basically disengaging from life.
MEIER: Correct. I mean I had a doctor who I greatly respect mention to me that, you know, we thought the big problem with these drugs was addiction. What we didn't realize is that people who take them would opt out of life. And, you know, you see it across the spectrum. One of the more startling things is in the area of workplace injuries. I mean things like back strains are very common problems.
But what folks have discovered is that the more patients that - you know, workers who are treated with these drugs for back strain, the longer and longer and longer they stay away from work. In fact, we've kind of created kind of a legion of chronically unemployed people who are dependent on these drugs.
GROSS: It makes me wonder, though, maybe the people who became dependent on drugs were the people who didn't respond to other forms of therapy like physical therapy, or maybe they were in more severe pain than the other people who were able to return to work, and consequently stayed on drugs longer.
MEIER: That's possible, but we don't know that because the way our medical system is set up right now is that we really don't finance the treatment of these chronic pain conditions through alternative means. If you look at data from other countries where there is more aggressive use of alternative pain treatments, what you'll see is that in many cases people recover far more quickly from chronic pain conditions when they're given alternative forms of treatments than when they're given opioids.
GROSS: So I don't want to unnecessarily scare people about using painkillers when they come out of surgery or when they've been in a terrible accident. So would you just address that? I mean...
MEIER: Absolutely.
GROSS: I think it's good to have cautionary advice, but there's times when you really need a painkiller.
MEIER: There is no question that these drugs are extremely beneficial. They're valuable, vital drugs. And there should be no hesitation in their use after conditions like surgery or accidents or cancer treatment or end-of-life use. One does not want to turn the clock back to the limitations of these drugs in certain medical treatments.
The question becomes how effective are these drugs in the long-term treatment of chronic pain, and the dilemma that we're facing now, after an experiment that began 15 years ago, is we really don't know that answer. And what we're seeing the longer these drugs are being used are consequences from their long-term use that weren't envisioned when this experiment began.
GROSS: If you're just joining us, we're talking about pain medicine, particularly various forms of oxycodone. My guest is Barry Meier. He's a New York Times reporter who covers the intersection of business, medicine and public health. He's the author of a new New York Times e-book, which is called "A World of Hurt: Fixing Pain Medicine's Biggest Mistake." It's his second book about painkillers.
So OxyContin also has an underground history. How did it start catching on as a high?
MEIER: Well, it started catching on pretty soon after it appeared on the street. This is going back about a decade ago or so. And people that abuse drugs are very clever in finding ways of abusing whatever new drug comes onto the market, and it was quickly discovered that OxyContin could be crushed and snorted or chewed.
And it sort of became the hottest drug on the street...
GROSS: And as you explained before, the advantage of crushing it is that it was a time-release capsule, and if you crushed it, all of the opiate would be released at once. So you'd get...
MEIER: Correct.
GROSS: ...a bigger hit at one time.
MEIER: Absolutely. I mean you got a huge hit at one time. And you know, to people who had never tried it before, it was extraordinarily dangerous as well, because that big hit could actually kill you from an overdose. So people in areas like Appalachia and Maine, where there was a large-scale use of painkillers for work-related problems, et cetera, started catching on to that there was this really great new drug on the street if this is the way I'd like to get high.
And it kind of ran like wildfire. It really started catching on in 1999, and by 2001 it was all over much of the Eastern United States and then spread across the country.
GROSS: So one of the first places it caught on was in Appalachia because of work-related pain problems? Is that what you're saying?
MEIER: There was - you know, if you look at sort of the atlas, if you will, of how drugs are prescribed around the country, what types of drugs are prescribed in different parts of the country, there usually is a pretty straight correlation between the use of narcotic painkillers in areas where you have physical labor, jobs like mining, farming, logging, where people get a lot of back problems and muscle injuries and things of that nature.
And it also - in many of these areas you have doctors who are generalists, you know, they're not specialists. So most folks are going to a general practitioner, a family doctor, and when they were told that OxyContin was a less abusable drug than drugs that had preceded it, they said great, this sounds like a good thing for my patients. So they, you know, they started prescribing it very heavily.
GROSS: When Oxy started to catch on on the street, what kind of pill mills grew up around that new craving for it?
MEIER: Basically an industry. You basically had these pain clinics open up, doctors that supposedly specialize in treating pain. These in fact were doctors who had no experience in treating pain and were probably the wrong person to go to see if you actually had pain.
But they were essentially clinics where you could walk in and the doctor would say to you, How do you feel? Well, I'm in pain and I think OxyContin would work for me. And the doctor would write you a prescription, you would pay cash for the appointment, and the cycle would start.
And these literally proliferated throughout the United States. I mean, they started in places where Oxy abuse first started. But more recently you would go to states like Florida and there would be literally hundreds of these pain clinics that would draw drug abusers from around the country.
GROSS: Why Florida?
MEIER: Florida's kind of interesting because Florida's one of the states where Oxycontin abuse did start early. But there's also a unique - or there was until very recently a unique aspect to Florida law, which allowed doctors to not only prescribe a drug but dispense a drug as well. So if you went to your doctor and your doctor said to you, you needed X drug, and you said fine, normally you would take it to a drugstore. In this case the doctor would say to you, you need X drug and as a matter of fact I can sell it to you, or you can go to the office next door to my office and buy it there. So it became very financially rewarding for these doctors to set up clinics in Florida and attract people from all over the Eastern Seaboard.
GROSS: The street use of Oxy has led to overdoses. Can you give us a sense of what the scope is?
MEIER: It's enormous. I mean the current statistic is that about 16,000 people a year die of overdoses involving prescription narcotics.
GROSS: But this is the street use of it.
MEIER: Right. The presumption is that the vast majority of overdoses involve the abuse of the drug. There may be a small fraction of those that involve people who become medically addicted to the drugs who then go on to abuse them. You know, it's a huge problem. I mean the number of people dying from these drugs is second only to the number of people that die in car accidents.
And what's been startling to me over time is seeing this number grow. I mean, you asked me before about what was most sort of - what I've seen over the years. And what I've seen is the number of people dying of overdoses quadrupling between 2003 and today, and that's a staggering increase.
GROSS: What approach has the Drug Enforcement Agency and other law enforcement groups taken to trying to crack down on the street use of Oxy?
MEIER: The DEA has arrested hundreds of doctors who worked in pain clinics. It's prosecuted many of these doctors. I mean some of these doctors are criminals. The folks that run these clinics do it for money. But many of the doctors that work there are well-meaning; they're, you know, often retired doctors; they're doctors looking for added income.
You know, the problem is, is that many of the doctors that work in these clinics don't understand how to treat pain, they don't understand how to recognize symptoms of abuse, and they unfortunately become facilitators of this entire system.
GROSS: This is FRESH AIR. I'm Terry Gross back with Barry Meier, author of a new e-book about opioid painkillers called "A World of Hurt." Meier is a New York Times reporter who covers the intersection of business, medicine and public health. He's also the author of the 2003 book "Painkiller." Earlier, he was telling us how OxyContin became a street drug. One reason was that the original time-released version - approved by the FDA in 1995 - could easily be crushed and that would release the entire narcotic payload at once so the user could get a big hit and get high.
OxyContin changed its formula to prevent smashing from releasing the full dose at one time. So what's the state of OxyContin now in terms of its, you know, capacity to be a good, quick high like the previous version?
MEIER: OxyContin right now is probably not a good high. When you try to smash it now, it turns it kind of into this gummy goo. So it can't be easily injected or abused in the way that it was abused prior to the reformulation. Even going back a number of years ago, doctors, because of the uproar over OxyContin abuse, started shying away from it. They'd moved on, then, to drugs like methadone. And methadone, while it's most popularly known as an addiction treatment, is also a widely used painkiller. So people abusing the drug, let's say OxyContin, would then go on to methadone. Or doctors would start prescribing sort of the generic oxycodone tablets and people abusing drugs would go on to that. So you kind of had this game of leapfrog between doctors and people seeking out drugs to abuse.
GROSS: Painkillers are not just recommended by pain specialists, other doctors can recommend them too. It's very easy to get addicted to drugs. When you overuse them it's difficult to wean yourself from those drugs. Do you think the doctors who prescribe pain medicines are necessarily trained in how to wean patients off of those medicines?
MEIER: Well, I think that's absolutely true, but it's - to expand beyond that just a little bit, that doctors who prescribe these drugs are not really that well-trained, and in many cases, not trained at all in pain treatment. So basically you have patients who are coming into these offices with extremely complex conditions. And, you know, chronic pain can be part physical, it can evolve or begin as a psychological or emotional problem, and they're very complex patients to treat, and most general practitioners, family doctors, don't have the time, training, skill or interest in treating these patients, which is often the reason why they prescribe them a drug.
You know, one of the big dilemmas that's spun out over this past decade has been the lack of people who can specialize in pain treatment, who know this area. And I think that's an area that is extremely important for both the medical industry and the medical profession and society to come to grips with - that is making sure that there is a cadre of well-trained, knowledgeable doctors that can properly treat these patients.
GROSS: You've been writing about pain medication for over 10 years. You wrote a book about the subject back in 2003, so you seen this whole story evolve. You've been reporting on it as it's evolved. What are some of the biggest surprises you've witnessed?
MEIER: I would say the biggest surprise that I've witnessed is, you know, back in 2003, when "Painkiller" came out, the prevailing medical thought and my thought was that there was a line of demarcation - a bright line - between the benefits of these drugs for patients and their abuse on the street. So one of the big realizations for me is that that bright line is certainly not very bright and in fact may be a mirage.
GROSS: What changed your mind?
MEIER: Basically, the scientific evidence that's been coming out, the experience of patients. Because back when I wrote the book, the use of these drugs for chronic pain was a fairly new phenomenon. There wasn't really a lot of data that had been gathered about their effectiveness. And now that this experiment's been going on for more than a decade, there is increasing evidence that for, while these drugs are very beneficial for some patients, they are, in fact, not beneficial at all for many patients.
GROSS: You mean they won't even help the pain at all?
MEIER: Well, they will help the pain for a period of time until you get to that point of tolerance and then you'll need more, and unfortunately for some patients, their ability to function will start to decline as the amount of medication they take increases. So that's the dilemma.
GROSS: You know, you have forces from both ends of the spectrum. I mean, there has for a long time been resistance to the use of morphine from people who are just like anti-drug for moral reasons and are afraid like any use of morphine is going to be addictive - even if like you're dying of cancer, you have like two weeks to live, you know, there was this fear, oh no, you can't let the patient get addicted. What's the problem? They're dying. They're not even going to be around in two weeks, so why is addiction a problem? And then on the other end, you know, you write about how there's people who are saying well, let's not worry about addiction because it's going to solve the pain problem. And I guess, what's the controversy in the field now?
MEIER: Well, I mean the issue that you brought up is a very important one and sort of central to this. John Hockenberry put it very well when he said, when he wrote an essay one time, when you try to balance the damage caused by pain against the damage caused by drug abuse, nobody wins. And that's absolutely right. How do you balance these two things against each other? How do you give pain patients relief and avoid these drugs kind of spilling over into the street and causing abuse? And I think that whole issue is perhaps being in the process of being reframed from the standpoint of, you know, if we really just focus on what is the best way of treating pain, then we kind of address the second issue, because maybe we need to put more patients into other ways of treating pain than simply doling out drugs and dealing with, you know, alternative pain treatments and things of that nature.
GROSS: Barry Meier, thank you so much for talking with us.
MEIER: Thank you, Terry. It was a real pleasure.
GROSS: Barry Meier's new e-book, "A World of Hurt," was published today.
Coming up, John Powers tells us about the Cannes Film Festival, the film that won the top prize, the films he liked best and the one that got the most boos.
This is FRESH AIR.
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Inside delivery - Inside delivery includes delivery to the nearest dry threshold. This service is to the main floor only, without any stairs, or a garage. If the package or crate does not fit through the door, then there will be extra charges for breaking down the delivery. The delivery will not be brought up to any other floors but the main floor without incurring additional charges. A delivery appointment will be included.
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BFF-400S144 Specifications:
Overall Dimensions: 59.61"W x 29.61"D x 28.11"H
Weight: 44 lbs
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BTOD 400 Series Desk Features:
- Thermally fused laminate finish and impact resistant edges for long-lasting quality
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Iran selects 16 sites suitable for nuclear plants
- Iran%3A 20 plants needed to meet electricity demand
- Sites chosen based on immunity to quakes%2C air strikes
- State TV%3A new uranium resources were found
TEHRAN, Iran (AP) — Iran has selected 16 locations as suitable for new nuclear power plants it intends to build to boost its energy production over the next 15 years, authorities said on Saturday.
The Islamic republic says it needs 20 large-scale plants to meet its growing electricity needs over the next one-and-a-half decades. It currently operates a 1,000-megawat nuclear power plant at Bushehr, a coastal town on the Persian Gulf, and is planning to build a 360-megawatt nuclear power plant in the southwestern town of Darkhovin.
"The whole country has been studied in the past years," said Vice President Fereidoun Abbasi, who also heads Iran's atomic energy organization. "Adequate locations, on the basis of global parameters, were probed and 16 locations at various parts of the country were identified," he said in comments published by the semiofficial ISNA news agency.
A statement released by his organization said the sites were chosen in part for their resistance to earthquakes and military air strikes.
"Geologic, demographic, topographic, seismic, meteorological and hydrologic criteria as well as access to power transmission lines ... were given into consideration," it said.
Separately, state TV said the country has discovered new uranium resources in what it characterized as a "big discovery." As U.N. sanctions ban Iran from importing any nuclear material, it has focused on developing domestic uranium reserves.
The U.S. and some of its allies fear that Iran could ultimately be able to develop a nuclear weapon. Iran has denied the charges, saying its nuclear program is geared merely toward peaceful purposes such as generating electricity and producing nuclear medical radioisotopes for medical use — not atomic bombs.
Iran also has a considerable stock of yellowcake uranium, a lightly processed substance it acquired from South Africa in the 1970s under the former U.S.-backed shah's original nuclear program. It also has unspecified quantities of yellowcake obtained from China before U.N. sanctions came into effect.


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Dental Care
Even though dogs and cats don't get cavities, there are other types of dental disease that owners need to be aware of. Periodontal, or gum disease, is the number one illness found in both dogs and cats.
What You Need To Know About Dental Care For Your Pet
Dental disease can cause serious problems for your pet, ranging from gum inflammation and tooth loss to infection and even organ damage.
Up to 80% of dogs and 70% of cats that don't receive proper dental care will develop signs of dental disease by the age of three.
Dental disease can be easily prevented by following your veterinarian's advice regarding dental examinations, home care, and dental cleanings.
What is Periodontal Disease?
Periodontal disease is an infection caused by the bacteria found in dental plaque. It often begins with discoloration on the teeth. Without regular dental cleanings, this plaque builds up and turns into tartar. Tartar can dig into the gums, where bacteria can become trapped and cause infections. If left unchecked, periodontal disease can lead to serious pain, infection, and tooth loss. The infection can also result in bacteria entering the bloodstream and damaging other organs or body systems in your pet. It can also complicate other underlying diseases, such as diabetes or chronic sinusitis.
The Dangers of Periodontal Disease
Without proper dental care, your pet will most likely suffer from bad breath, inflamed gums, and missing, loose, or broken teeth- as well as the pain and discomfort that accompanies these symptoms.
Dental disease can also lead to systemic health problems in dogs and cats. The good news, however, is that dental disease is easily prevented by regular dental examinations, home care, and dental cleanings.
- Bad breath
- Visible tartar on the teeth
- Swelling under the eyes
- Loose or missing teeth
- Difficulty eating
- Discharge from the nose
- Drooling or excessive salivation
- Pawing at the teeth or mouth
- Discoloration or staining of the teeth
- Red, irritated, swollen, or bleeding gums
- Weight loss or loss of appetite
- Lethargy and loss of vitality
While the damage caused by periodontal disease is sometimes irreversible, it can be halted with antibiotics and regular cleaning. The wisest solution is to stop the disease before it starts.
Annual Cleanings & Home Care
Beginning at age one, your pet should have an annual dental examination and cleaning performed by your veterinarian. A thorough cleaning removes plaque and tartar both above and below the gum line. This proactive treatment is aimed at maintaining the natural oral defenses so that periodontal disease and other dental problems have a harder time becoming established. A good home care program can tremendously extend the positive effects of the professional cleaning.
The best form of oral home care is daily brushing with a soft toothbrush. There is no better way of removing the disease-causing dental plaque. Your veterinarian can show you how to do it, and provide special brushes, toothpastes, and oral gels specifically made for pets. We can also tell you about special treats that help control dental plaque.
Dry food is generally better than canned for tooth health. However, you'll get the best results with specially formulated foods that have been proven effective in combating plaque and tartar buildup. Ask your veterinarian for recommendations.
Dental Health FAQ
What should I do about broken teeth?
Broken teeth can be extremely painful for pets and can lead to chronic infection, abscess formation, and loss of secondary teeth. Immediate treatment is vital. Performing a root canal will save what's left of the broken tooth and prevent it from becoming infected a second time. Where root canal is not an option, the tooth should be extracted.
I'm not sure I can afford dental cleanings every year.
While dental cleanings may seem like an added expense, they're actually a very cost effective investment in your pet's health. Caught early, dental problems are easy to treat. Neglected, they can turn into serious, costly, and painful problems.
Does my pet need to be anesthetized during cleanings?
Yes. Unlike with human patients, we can't explain to your pet what's happening and why. For that reason, we need to anesthetize pets in order to access the entire mouth and gums and perform the necessary work thoroughly and safely. Your veterinarian will recommend pre-anesthetic testing to make sure there are no hidden health problems that could affect your pet's ability to undergo the procedure.


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The Middle East and North Africa: Political Succession and Regime Stability
Description: This report discusses the political future of various countries in the Middle East-North Africa (MENA) region. A change in the leadership in these countries could significantly affect their policies toward the United States and their willingness to cooperate with the United States in achieving the stability needed to advance U.S. interests in this important region.
Date: August 29, 2003
Creator: Thayer, Amy E. & Prados, Alfred B.
Item Type: Refine your search to only Report


text:
Polk County, Missouri - Townships Map
View Google Maps with Polk County, Missouri Township Boundaries. Find township by address. Check if an address is in town limits and see a township limits map.
See a township boundaries map on Google Maps • Find township by
address • Answer what township is this address in
Quickly answer 'What township is this address in' and 'What township do I live in' anywhere in the U.S.
To find township by address, type the address into the Search places box above the map.
Quick Tips for using this Civil Townships map tool
Type any place or address in the "Search places" box above the map*
OR: Zoom into your place of interest on the map
Township boundary lines will draw on the map, and the township name, state name, country name and latitude/longitude for your chosen location will appear at the top of the map**
- Check the "Show township labels" checkbox in the lower left corner of the map to see the names of the townships on the map
- Optionally, check the "Show US city limits" checkbox in the lower left corner of the map to see
City Limits overlaid on the map
- Click the ◉ button in the upper right corner of the map to use your current location. Click the ◉ button again to automatically update your location every 1, 5 or 10 minutes (Monthly Contributors also get an option to update every several seconds). †
- Subscribe to receive notification of tool updates and usage tips
* You can also type in GPS coordinates in decimal degrees into the Search places box. For example, type -105.25,
40 for Boulder, Colorado.
** All information is reported based on the location of the blue dot on the map; to move the blue dot, click the map
† The "Locate" button will be more accurate on smartphones and other devices containing a GPS; desktop browsers typically show an approximate location
FAQs for Polk County, Missouri - Townships Map
How do you see Google Maps with township boundaries? Just follow the quick steps above and you will see the township boundary lines displayed on a fully-interactive Google Map.
Do things such as:
– Find township for an address
– Help determine which township or local sales tax may apply for a given location
– Find out what township are these GPS coordinates located in (see * above)?
– plus any of a number of other topics where knowing townships may be important, such as real estate, sales, education, field research, business and more
Coverage Notes
- Civil townships includes the boundaries of Civil townships, also called township limits,
town lines, or township borders. New England, New York and Wisconsin typically refer to townships as towns, and
Michigan uses charter townships.
Townships with the following US Census Bureau minor civil division class codes are shown:
– T1: Governmentally active minor civil division (MCD) that is not coextensive with an incorporated place (this is often a township)
– T9: An inactive county subdivision
– Z1: A nonfunctioning county subdivision
– Z2: A county subdivision that is coextensive with an American Indian, Alaska Native, or Native Hawaiian area and legally is independent of any other county subdivision
– Z3: A county subdivision defined as an unorganized territory
- "Show US city limits" draws all incorporated cities and towns in the United States and its territories and possessions
- "Show county lines" in Counties in all 50 states plus Puerto Rico, US Virgin Islands, Guam, Northern Mariana Islands and American Samoa
Civil Township boundaries depicted include the following types of townships for each state
|American Samoa
|township, precinct
|township, unorganized territory
|township, unorganized territory
|gore, plantation, reservation, town, unorganized territory
|township, unorganized territory
|precinct, township
|New Hampshire
|grant, location, purchase, town, township
|New Jersey
|New York
|borough, reservation, town, unorganized territory
|Northern Mariana Islands
|North Carolina
|township, unorganized territory
|North Dakota
|township, unorganized territory
|Puerto Rico
|barrio, barrio-pueblo
|Rhode Island
|South Dakota
|township, unorganized territory
|gore, grant, town
|West Virginia
Other Notes
- The Search places box uses a standard Google Maps geocoding engine, therefore you can type street addresses, road names, points of interest, and GPS coordinates (see * above) to see what township that location is part of
- Many of the map layers from which this information is extracted are very large, so it may take several seconds for all of the map layers to finish drawing
- Because the map layers are large, boundaries will not be shown if you are zoomed out too far
- Note that typing an address will zoom in the map very close, whereas typing a city or township by itself will show you a map with a wider view
- Disclaimer: While the number of decimals in the latitude and longitude displayed for the map marker may imply a positional accuracy of within a few feet, note that Google Maps and the source data may not be that accurate. Accordingly, this tool should not be used for legal nor surveying purposes or anything beyond entertainment value.
Sources– US: Census Bureau
Help improve this tool. Please comment.
Listing of all U.S. County Maps showing Civil Townships and Township Boundaries


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Propeller, RH, Sq, 12" Dia, 1 1/8" Bore
The 3 bladed stainless square pitch impeller is the staple impeller for many mixing processes due to its efficiency and durability. Mixer Direct's propellers are solid 316L for maximum corrosion resistance in most environments. Being right handed, they will pump in a upward direction when rotating clockwise. This can be ideal for some products with high settling rate or sensitive to air impartation. Almost every process industry utilizes this product in some capacity, from chemical and coatings, to pharmaceutical and construction.
Have a Question?
- Item Number PRPR12112
- Bore Size 1.125 in
- Impeller Attachment Set Screw
- Impeller Diameter 12 in
- Impeller Material 316SS
- Impeller Type Propeller


text:
Three-time All-Star Oswalt officially retires
Righty spent most of 13-year career with Astros; also pitched for Phils, Rangers, Rox
HOUSTON -- The crowning achievement in Roy Oswalt's terrific career with the Astros came in Game 6 of the 2005 National League Championship Series, when he pitched Houston past the Cardinals in St. Louis and into the World Series for the first time.
Oswalt and the Astros were on top of the baseball world, and the soft-spoken right-hander from Weir, Miss., was named the Most Valuable Player of the NLCS, earning him a tractor promised to him by then-owner Drayton McLane.
Only a couple of weeks after Lance Berkman announced his retirement, Oswalt followed his longtime teammate into the sunset Tuesday by saying he was hanging up his spikes. He played 10 of his 13 seasons with the Astros, going 163-102 with a 3.36 ERA.
"Last year I had a down year, as far as I got hurt six games into it and sat there for two months and didn't really get to do what I wanted to do," he said. "I decided this offseason that it's time to try to start something else. My girls are growing up, and I'm trying to be around home a little more."
Oswalt, 36, and Berkman both plan to sign one-day contracts and retire with the Astros. Owner Jim Crane said Monday the team had chose a date to honor one of the best pitchers and best hitters in franchise history, but no date has been released.
"Lance and I were teammates for 10 years in Houston," Oswalt said. "He's a tremendous guy, and getting to retire with Lance, a good quality guy and the type of person he is, just adds that much more. We talked about it one time a couple of years back, about signing one-day contracts and trying to retire with the Astros. We made a lot of friends and had a lot of memories together."
Oswalt was drafted by the Astros in the 23rd round of the 1996 First-Year Player Draft and made an unlikely rise through the system. He made his Major League debut in 2001, going 14-3 with a 2.73 ERA in 28 games (20 starts). That began an eight-year run where he was one of the best pitchers in baseball.
A three-time All-Star, Oswalt won 20 games in back-to-back seasons, helping the Astros reach the NLCS in '04 and World Series in '05. He finished third in the Cy Young voting in '04 and fourth in '05 and '06.
His 143 wins with the Astros are second in franchise history behind Joe Niekro's 144.
With the Astros floundering in '10, Oswalt requested a trade and was dealt to the Phillies at the Trade Deadline. He won nine games for the Phillies in '11 and four for the Rangers in '12 before going 0-6 with an 8.63 ERA in nine games with the Rockies a year ago.
"When I first got to the big leagues, my goal was to play 10 years and win 100 games at least," he said. "I got to do that and then some. It's one of the greatest things ever to experience is Major League Baseball. As a kid growing up, there's a lot of kids that want to play in the big leagues and only a few of us get the chance to do it.
"I was blessed and fortunate enough to catch some breaks here and there, and when guys went down, I got to move up a little faster than other guys. Being able to perform with the athletes they have in the big leagues is tremendous. The proudest thing about the whole experience is I did it with natural talent, and that sits with me really well."
His crowning achievement came on Oct. 19, 2005, when he started and held the Cardinals to three hits and one run in seven innings to clinch the NL pennant in the final game at the old Busch Stadium. The win lifted the Astros, who only two days earlier were stunned by a ninth-inning, game-winning homer by Albert Pujols in Houston, into the World Series for the first time.
"I think pitching in the playoffs to get us into the World Series in Game 6 against St. Louis kind of made the whole career there," Oswalt said. "To get a team to the World Series that had never been, for a city that really supported us. When I came up, we were drawing 40,000 people almost every night in Houston and letting them experience a World Series was great. We came up short, but getting there for the first time was one of my greatest moments in baseball."
As for what's next for Oswalt, he plans to assist his agent, Bob Garber. He also recently got his pilot's license.
"I'm going to try to go farther than that and try to fly jets and stuff," Oswalt said. "I'm helping my agent out some. We're signing kids out of college, so that ought to be good. Since I've been through the Minor Leagues and the big leagues and stuff, I can tell them what to expect coming through."


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Maybe it's unique to my FreeTDS configuration, but if I don't call mssql_free_statement() after every stored procedure (i.e. mssql_init, mssql_bind, mssql_execute, mssql_fetch_array), all subsequent stored procedures on the same database connection will fail.
I only mention it because this man-page deprecates the use of mssql_free_statement(), saying it's only there for run-time memory concerns. At least in my case, it's also a crucial step in the process of running a stored procedure. If anyone else has problems running multiple stored procedures on the same connection, I hope this helps them out.


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Four Failures of Deliberating Groups – Abstract
Posted by The Situationist Staff on June 12, 2008
Cass Sunstein and Reid Hastie have posted their new paper, "Four Failures of Deliberating Groups" on SSRN. Here's the abstract.
* * *
Many groups make their decisions through some process of deliberation, usually with the belief that deliberation will improve judgments and predictions. But deliberating groups often fail, in the sense that they make judgments that are false or that fail to take advantage of the information that their members have. There are four such failures. (1) Sometimes the predeliberation errors of group members are amplified, not merely propagated, as a result of deliberation. (2) Groups may fall victim to cascade effects, as the judgments of initial speakers or actors are followed by their successors, who do not disclose what they know. Nondisclosure, on the part of those successors, may be a product of either informational or reputational cascades. (3) As a result of group polarization, groups often end up in a more extreme position in line with their predeliberation tendencies. Sometimes group polarization leads in desirable directions, but there is no assurance to this effect. (4) In deliberating groups, shared information often dominates or crowds out unshared information, ensuring that groups do not learn what their members know. All four errors can be explained by reference to informational signals, reputational pressure, or both. A disturbing result is that many deliberating groups do not improve on, and sometimes do worse than, the predeliberation judgments of their average or median member.
One Response to "Four Failures of Deliberating Groups – Abstract"
August 6, 2008 at 2:46 pm
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More from Lightronics
Category: Lighting:Control:DMX Devices
Search for this product on our new online store https://musiccitycanada.com
Music City Canada is the new home of PA Shop, London Guitars, London Percussion, PA Shop AV Solutions, and Charterhouse Studios. We hope you enjoy this new shopping experience. Visit our new website by clicking here.


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We're Alexandra, Ted, Jonatan and Kajsa, the creators of this site. Since 2017, our mission is to create a collection of the best spa hotels in Miami. Spa hotels with wonderful massages, treatments, pools, saunas and more. We also guide you to the greatest places nearby, like coffeeshops, restaurants or museums.
Alexandra Bocheliuk
Content Manager & Hotel Researcher
Ted Valentin
Entrepreneur & spa hotel expert.
Jonatan Heyman
Developer, designer & avid traveler.
Kajsa Karstorp
Hotel Researcher
You can contact us by sending an e-mail to firstname.lastname@example.com


text: Contact Linda Rains-Russell Use this form to contact various staff, administrators and officials of the City of Waco. Voice concerns, make comments, let your voice be heard. For a complete list of city departments and phone numbers, please see the City Staff Directory.To report a street light outage, you will need to contact Oncor. For all other requests please use the form below. Name: Address: City: State: Zip: Phone: E-Mail: Image Upload (optional): File types accepted: JPEG, PNG, GIF. Maximum file size 6MB. Message:


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Today's News: Our Take - The Bachelor's Chris Harrison: We've Never Had Anybody Get to Second Base on Night 1!
Ten months after America watched Sean Lowe propose to Catherine Giudici on The Bachelor's Season 17 finale, the ABC series is back with its first ever Latino star Juan Pablo Galavis.
On Monday's premiere, we were reintroduced to the single dad who left early on during Desiree Hartsock's season of The Bachelorette. Within the first 15 minutes of the episode, fans not only got to see how devoted he is to his 4-year-old daughter Camila, but were also reminded of just how sexy the former professional soccer player is.
6 things to know about Juan Pablo and the season premiere of The Bachelor
But the episode wasn't without its usual tears and awkward moments. While one woman, Lauren H., wound up being Night 1's emotional wreck, another mistakenly stepped forward to accept a rose when she wasn't in fact receiving one.
As always, host Chris Harrison is back for our weekly chat and gave his rundown of the Season 18 premiere.
Going into the season, how were you feeling about Juan Pablo as a choice for The Bachelor?
Chris Harrison: I was hesitant in that culturally it's a very different show with him. He's also very family-oriented and his daughter is very important to him so I was worried he wouldn't give in to the fantasy ofThe Bachelor. You really have to let go and give in to the process and I still don't know if he fully did. He also didn't know about the show - he didn't watch - so a part of me was relieved that it was fresh to do it with someone who didn't know what was coming next, but at the same time for someone who doesn't know what's coming he had a hard time embracing it.
Who stood out to you on Night 1?
Harrison: The ones who stood out to me were the ones I saw him notice the most.For some reason, he was really taken more by Lauren, the piano player, than anybody else. It wasn't that big of a stunt, but he continues to talk about it. So again she really made an impression on him even though I didn't think [her introduction] was that great. Nikkicame out and did the pediatric nurse thing and I'm pretty sure he felt her up. She put his hand on her boob, but I think she meant to put it on her heart so that was the smoothest move by far and we've never had anybody get to second base on Night 1. Clare doing the whole pregnancy trick was like taking Lindsay's wedding dress [from Sean's season] and going two more steps, but he found it endearing and liked it.Lucy came out as the free spirit with no shoes and you can definitely see they might be oil and water.
Check out our winter TV premiere calendar
Sharleen almost didn't accept the first impression rose! What was that about?
Harrison: That was easily the first time someone has thought twice about the first impression rose and I'm glad we showed it the way it happened. I think with the show you have to realize he's not the catch for everybody and not everyone is captivated, so I'm glad we showed Sharleen go, "I'm not seeing fireworks." So I'm glad she admitted it because it's normal. She ended up accepting it because it was way too early to say no. I think that was her dilemma: Why would I go home now because maybe I'll like this guy? She's not the first person or the last to deal with that issue.
Poor Kylie thought Juan Pablo called her name during the rose ceremony.
Harrison: It was horrible. It was late and he has an accent and he whispers, so he whispers "Kat" who is standing right behind Kylie and he looks right at Kylie, so she starts stepping forward and he's like, "Kat." She was mortified. The only thing that made it worse was the fact that she didn't get a rose. So not only did she step out and get embarrassed, but she was sent home.
Any last thoughts thinking about the season ahead?
Harrison: I think it'll be a hard season to pick the women he's attracted to because it's an interesting mix and it's hard to put a finger on his type. I'm really excited to see how people take him and everything that goes on because there was this initial infatuation with him, but there's more to life than a cute accent and good abs and therein lies what we're about to see this season.
What did you think of premiere? The Bachelor airs on Mondays at 8/7c on ABC.
View original The Bachelor's Chris Harrison: We've Never Had Anybody Get to Second Base on Night 1! at TVGuide.com


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Hole makes 1,400-pound pumpkin ineligible for Alaska fair
KENAI, Alaska – J.D. Megchelsen holds the record for giant pumpkins in Alaska, and the Nikiski gardener knew he had a candidate this year to beat the record of 1,287 pounds set in 2011.
But when a boom truck gently lifted the behemoth on Monday with rigging and a sling, the big pumpkin revealed a big disappointment: a thumb-size hole that will make it ineligible for the competition at the Alaska State Fair in Palmer.
"It's not going to count," Megchelsen told the Peninsula Clarion. "It's a bummer, but it's the rules."
Entries must be free of rot, chemical residue and serious soft spots. They can't have holes or cracks that reach the pumpkin cavity.
A scale on the crane indicated the big pumpkin weighed 1,500 pounds, but Megchelsen estimates the state competition scale would have registered closer to 1,420 pounds.
"It's just killing him," said Pam Elkins, Megchelsen's sister-in-law. "He eats, sleeps and dreams pumpkins. All he does is pumpkins."
Megchelsen began to pursue the record in 2002. He set the record in 2004 with a 700-pounder. A year later, he grew a 942-pound pumpkin, and in 2006 he grew the first Alaska pumpkin to exceed 1,000 pounds. The current record followed in 2011.
Two years ago, Megchelsen said, he had a disqualifying hole in another of his giants. It might have surpassed the record if it had kept growing, he said.
His 2013 pumpkin probably grew too fast when it opened a hole in a "rib valley," he said. During the height of a growth spurt in the warmest part of the summer, Megchelsen said, he was feeding the pumpkin up to 300 gallons of water a day.
The hole likely opened the first week of August when the fruit hit its peak growth spurt of 41 pounds in 24 hours. That happened two days in a row, he said.
When the pumpkin was hand-pollinated June 5, it was the size of a cherry tomato.
Megchelsen still plans to take his pumpkin to Palmer for weigh-in day. He's not likely to leave it there on display, he said.


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It's a righteous time to be a music lover. It's been a few years since radio, tune-conscious friends or hit-and-miss music store exploration were the only methods to feed your music addiction. And forget about peer-to-peer software that, while it seemed like a good idea at the time, only infested your music library (and computer) with malware.
While smartphone apps are nice, how much nicer is it to safely download apps onto your tablet? According to Rosetta, a consulting-centered interactive agency, in the first three to six months of tablet ownership, people spend 32 percent of their time listening to music.
This honeymoon is particularly sweet because the bigger, brighter, crisper screen lends itself to a more awe-inspiring and multi-meteoric music experience. Developers have taken user cues and created music apps – like the following five – that thrill, educate, inspire and entertain.
PowerAMP (free)
Having access to your entire music collection is worthless without a music player. This Android app gets high marks for its "robust equalizer" and presets. It also offers an engaging, visual-centric way to browse your library. It's easy to "scrub" a song and fans are pretty crazy about the widget. (And isn't all about the widget?)
Hitlantis (free)
Tired of the same played-out genres in your archive? Music discovery apps make an obscure garage band in the Ukraine your favorite new find. This iPad and Android app is candy for the eyes as well as ears and uses a floating gaggle of color-coded bubbles to help you navigate artists you never knew existed. The bubbles reveal the genre and you can toggle and get lost in a brand new sound experience. It also has a radio feature.
SoundHound (free)
If you can't for the life of you name that annoying ear-worm of a song in your head, this cool music app will help. Just hum, sing, speak, record, type or tap and not only will it tell you what the song is, but it will also provide artist bios and links to videos and an online store. Before you hit that purchase button, however, be mindful of malware and make sure you're in protected territory.
SampleWiz ($9.99)
If you'd rather make music than archive it in nifty folders, SampleWiz for iPad may be the app that makes your foot tap. It offers three sampling modes: classic, granular and modern, and it's pretty darn easy to record samples (or multisamples) with the built-in mic. You can share your files with others, and you can also choose from a collection of synth sounds from Jordan Rudess, former keyboardist for Dream Theater.
Musixmatch (free)
If you're more of a sentimental, karaoke-loving music lover, this app will satisfy your desire to not only learn the synced lyrics you're listening to (in any language), but it will also share and talk about them with others. No longer do you have to wonder what an emo artist is mumbling. Now you can explicate his motives and conspire with someone across the globe.
As an aside, if you're a composer, artist or musicologist, check out this super comprehensive listing of music geek apps, including theory, notation, production categories and more.
Finally, while you're grooving to new genres like goth-hip-hop-funk-metal, be sure to mobilize your security efforts and protect your extensive collection of beats.


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Yoshida: It's not too late to save Nokia
Keywords:Smartphones? Android? Windows? Symbian? feature phones?
It's just too painful to watch these two handset giants – through their dominance in the only market with meaningful growth for semiconductors – shut out practically every chip company who designs modems and apps processors, except for Qualcomm and Samsung.
I suspect I'm not alone in this feeling.
Don't get me wrong. I'm not here calling for a Nokia bailout. Nokia's where it is today through Nokia's own doing.
Looking back, Nokia's management screwed up royally on three fronts: 1) clinging to Symbian for too long; 2) losing the battle in China; and 3) not choosing Android as an operating system for the company's smartphones.
Many pundits pin Nokia's failure on the company having been too slow to accept the emergence of smartphones. They believe Nokia's lack of presence in smartphones has triggered its downfall.
I disagree.
Missed opportunities
Nokia's grip on the feature phone market had begun sliding way before smartphones became mainstream. While spending a lot of engineering resources perfecting a variety of feature phones for the global market, Nokia unfortunately missed the cues for two key opportunities.
One was the advent of the dual SIM mobile phone, designed to hold two SIM cards. It took Nokia almost a decade before fully embracing this trend. Dual-SIM operation essentially enables mobile phone users to use two services without carrying two phones. Using multiple SIM cards allows a user to take advantage of different pricing plans for calls and text messages to certain destinations, as well as mobile data usage.
Nokia's close relationship with mobile carriers, however, blurred Nokia's vision. It stayed off the dual SIM bandwagon out of misplaced loyalty to large operators, who preferred customers to use one network exclusively.
"Symbian in China" was another missed opportunity for Nokia. Before Android took the world by storm, there was reportedly a groundswell of demand for Symbian-based phones among handset vendors in China. But the decision by Symbian (and by Nokia) to make Symbian an open source operating system was too little, too late.
By the time Chinese OEMs could have embraced Symbian, there wasn't enough engineering talent left at Symbian to make serious inroads into the China's smartphone ecosystem. Meanwhile, what's left of Symbian was later acquired by Accenture.
Unpopular decision
Then, Nokia made the unpopular decision of going with Microsoft for its smartphone strategy.
Nokia's sin, however, wasn't in partnering with Microsoft. Rather, it was its stubbornness in not acknowledging the rising tide of Android.
Although industry observers understood Microsoft's powerful influence on Nokia (Stephen Elop who replaced Nokia's previous CEO, Olli-Pekka Kallasvuo, in 2010 came from Microsoft), they could not comprehend how Nokia could possibly ignore Android. It seemed almost a willful act by Nokia's management to miss Android's unmistakable momentum so completely.
One engineering executive working for a leading mobile chip company said, "I just don't understand why Nokia couldn't develop Android phones—even in parallel with Microsoft's Windows phones."
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Anyone operating a server on any scale should want a digital certificate to encrypt data between clients and services, whether for personal, office, or public use. That's a broad statement, but it holds true no matter how you slice it.
With so many people accessing networks over WiFi or other untrusted networks for an increasing number of different kinds of services—calendars, contacts, Webmail, email, and so on—encryption is a must, whether via a VPN or by securing services one by one. While I recommend VPNs, they aren't always the practical, affordable, or correct solution. For remote email access, SSL/TLS is simpler and more straightforward, and you don't have to compromise on protection in the process.
There can be something technically imposing about getting and installing a digital certificate, even though it has a high utility value, so I'm here to make it easier by breaking it down into steps that someone without encryption and command-line knowledge should be able to work with.
I'll start with an explanation of how digital certificates create encrypted sessions. Then I'll describe how to get a free certificate from StartCom as a simple case, before giving a few examples of how to install your certificates.
Secret handshakes
A digital certificate comes in the form of server-side TLS certificate. TLS stands for transport layer security, and in common use it's a method of combining the advantages of public-key cryptography, external third-party (out-of-band) validation, and per-session encryption.
(TLS is the modern name for SSL, the preceding standard. This method is sometimes called SSL/TLS to signal to people who know the older name that it's the same thing; here, let's just call it TLS.)
Public-key cryptography lets one party send information to another, hidden by a public key that can be freely distributed. The receiving party has a private key which is kept strictly secret, and which is the only component which may extract the original message from the public-key-encrypted payload.
Public keys are unwieldy for encrypting long strings of text and for fast encryption of streams of data, such as files being transferred via email or website transactions. Philip Zimmermann created PGP in 1991 as a way around this. The public key transaction is used to exchange a strong session key that's symmetric: both parties use the same key to encrypt and decrypt data. The key is passed in perfect security via the public-key transaction, making the process impenetrable to sniffers and "man in the middle" attacks.
Certificates can be generated for domain names and other data by pretty much anyone; the party generating the certificate doesn't have to be the legitimate owner of the domain or data. So, just as with PGP and the open-source GPG alternative (and SSH and many other similar methods), you need an out-of-band method to validate that party issuing the certificate is really who they say they are.
That's where certificate authorities (CAs) come in. A CA is a group that provides some validation, from cursory to extensive (in the case of Extended Validation certificates), that the party that signed up for a certificate for a given domain name is approximately that entity.
When you connect via a browser to a secure website, for instance, the browser does some handshaking with the server, receives a certificate which contains a public key and some other fielded data, and then turns to a CA to confirm that the certificate is valid.
CAs are preinstalled in browsers, client software, and operating systems, so that the CA itself is validated by the software developer or OS maker. That's where the out-of-band trust comes for the CA!
If the browser is mathematically convinced that the certificate is from a valid party for that domain, a key is exchanged, and a session is encrypted.
You can sign your own digital certificates, essentially acting as your own certificate authority, but that's a problem. Because a client and/or OS doesn't know that GlennFleishmanCA is a real authority, the client or OS has to prompt a user to accept an untrusted relationship. Depending on the process, the user may be able to trust a session or not, or to accept a CA's authority permanently.
In an organization, a self-signed cert can work because you can either tell everyone to accept the signing certificate's authority, or you can preinstall the root authority for your own CA in each person's computer. (That can be as simple as dragging a file into a system-wide key manager, clicking import and importing it, or clicking through a couple of dialog boxes.)
But instead of all that tedium and management, especially as new employees or colleagues come and go, it makes more sense to get a fully CA-validated certificate. And you can get one for free.
Start with StartSSL
StartCom's StartSSL service offers a Class 1 certificate at no cost, with fees for higher levels of identity validation (see the site's chart for comparisons). A basic Class 1 certificate doesn't validate all your details; email to a known domain contact address is the only real check. A Class 2 or 3 certificate with your identity or your organization's identity is $40 for two years. An extended validation certificate, which uses an industry standard for checking a submitter's details, is $110 for two years, and will tell a browser to show a green bar on connection.
While StartSSL is free, it isn't a clear process to those that haven't created a certificate before. Let me tell you how to walk through the site.
StartSSL uses an S/MIME personal certificate to let you log in after sign-up. This is certainly more complicated than requiring a username and a password, but it's ostensibly much more reliable because you have to have this cert, which can't be intercepted over a network or captured through keystroke monitoring. Direct access to someone's computer, likely with additional passwords, would be required to access it. (After creating the S/MIME certificate, you can use it to sign emails in programs that support S/MIME.)
(Note: Safari 4 under Mac OS X doesn't correctly interact with StartSSL's site for certificate download, validation, or menu selection. Use Firefox in Mac OS X or Firefox or Internet Explorer under Windows instead.)
- Start at the Authenticate or Sign-Up page.
- Click Sign-up.
- Fill out the Personal Enrollment details and click Continue. (StartTLS offers many imprecations against trying to falsify data here.)
- Check the email account for the address you provided in step 3, get the validation code, and enter it, clicking Continue to proceed.
- Next, StartSSL will generate the private key needed for the client certificate it provides to you for authentication. There's no good reason to choose anything but 2048 (High Grade) as the option. Click Continue.
- Click Install when the Install button appears. This should be an automatic background process. In Firefox, the certificate is installed into an internal database, from which it can be exported. (If you want to use these credentials with another browser, you can download them again from within the StartSSL website, or you can export the certificate from Firefox and drag into or import into another browser on the same or a different computer.)
- Click Finish, and you're taken to an authenticated control panel page.
This S/MIME cert is vital to using the site again, so you should back up the certificate. In Firefox, via the Advanced preference's Encryption tab, you can export a certificate by selecting View Certificates, choosing the StartCom certificate from the Your Certificates tab, and clicking Backup. After setting a mandatory password and exporting the certificate, it can be imported into other programs that read the certificate format. See answer 4 in the FAQ for Internet Explorer export.