TUESDAY, MARCH 30, 2010

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The World A15

Bomb went off steps away from top security agency

by Greg Miller and Peter Finn

The twin suicide bombings

that killed at least 38 people in Moscow’s crowded subway sys- tem on Monday included an at- tack on a station just steps away from the headquarters of Russia’s premier security service. The strike shortly before 8 a.m.

at the Lubyanka station — named for the forbidding building that houses Russia’s Federal Security Service (FSB), the successor to the KGB — is part of a wave of sui- cide assaults that target spy ser- vices engaged in violent confron- tations with militant Islamist groups. Monday’s attack in central

Moscow appeared designed to maximize the chance that Rus- sian intelligence officials would be among the commuters caught in the carnage. If so, the assault would extend a string of losses for intelligence services, which are more accustomed to carrying out lethal operations than to be- ing attacked themselves. A December bombing killed seven CIA employees and con-

tractors near the Afghan city of Khost, the deputy chief of Af- ghanistan’s intelligence service was assassinated in September, and a series of suicide strikes killed dozens of Pakistani opera- tives at facilities used by the country’s Inter-Services Intelli- gence (ISI) agency in cities from Peshawar to Lahore. A U.S. intelligence official said

that spy services have become priority targets for militant groups, since spies are at the fore- front of counterterrorist cam- paigns. “While every counterterror

conflict is different, the fact that the enemy wears no uniform and relies on stealth means that intel- ligence officers will be playing key roles,” said the official, who spoke on the condition of ano- nymity because he was not au- thorized to speak on the record. “The more effective they are, the more likely they are to be targets.” The sophistication in a spree of recent attacks on spy services suggests that militant groups are also becoming more skilled at stalking their pursuers. Abdullah Laghmani, the No. 2 in the Af- ghan intelligence service, was

killed last year by a suicide bomb- er who caught the deputy spy chief as he was leaving a mosque. In some cases, militants have become adept at using methods that have long been the preserve of espionage agencies. The bomb- ing of the CIA base in Khost was carried out by an al-Qaeda dou- ble agent who convinced CIA op- eratives that he was their asset, and lured officials to their deaths by promising to inform them of the whereabouts of top al-Qaeda leaders in Pakistan. Monday’s attacks in Moscow were aimed at a more vulnerable target: a subway system used by millions of commuters every day. It was carried out by female sui- cide bombers who penetrated se- curity systems that were strengthened several years ago after a previous wave of strikes. A second, less powerful blast at

the Park Kultury station on Mon- day killed 12 people, but Lu- byanka appears to have been the main target. It was the site of the first explosion, and at least 23 people were killed there. Security experts said Lubyanka was se- lected almost certainly because the name serves as such a potent

symbol of Soviet and Russian se- curity services. “The choice of that station is a

strategic one,” said Sarah Men- delson, a fellow at the Center for Strategic and International Stud- ies, and co-author of the report “Violence in the North Caucasus: 2009, A Bloody Year.” “They were trying to get people who work at Lubyanka on their way to work.” Alexander Bortnikov, director of the FSB, Russia’s domestic se- curity service, said those respon- sible for the bombings have links to insurgencies in the North Cau- casus, a largely Muslim region of Russia that has been plagued by violence. The number of suicide bombings in the North Caucasus nearly quadrupled in 2009, ac- cording to the CSIS report, with most of the attacks directed at po- lice and security services in the Russian republic of Chechnya. The FSB has been heavily in- volved in counterterrorism op- erations in the Caucasus, battling what appear to be coalescing in- surgencies in the republics of Da- gestan and Ingushetia, as well as Chechnya. Rebels increasingly are adopting the tactics and lan- guage of militant Islamists.

Doku Umarov, an insurgent leader who has called for an Is- lamic emirate in the Caucasus, warned recently that he would strike at Russian cities, where he said the fighting in distant and impoverished Muslim-majority republics barely registers with the public. “Blood will no longer be limited to our cities and towns,” Umarov said in an inter- view with an extremist Web site. “The war is coming to their cit- ies.” The FSB is routinely involved

in raids, arrests and interroga- tions in the Caucasus. Human rights groups have charged that Russia’s campaigns in the region have also been marked by the tor- ture, disappearances or targeted killings of suspected terrorists — tactics that have deeply alienated the general population and bred extremism. Russian officials have not yet said whether any FSB personnel were killed in Monday’s attack. Targeted agencies have tended to respond with promises of re- newed vigor. The CIA has stepped up drone strikes in the remote corner of Pakistan where the Khost bombing is thought to

have been planned. Even so, the bombings have

taken a significant toll. Among the CIA operatives killed in Khost was a longtime agency veteran who served as base chief and was one of the CIA’s leading experts on al-Qaeda and other terrorist groups. In Pakistan, officials said that a string of bombings has forced the ISI to put operations on hold while it repairs buildings, assesses security breakdowns and finds officers to replace those who died. At least 74 ISI operatives were killed over the past year in at- tacks that included the car bomb- ing of an ISI facility in Lahore, a suicide strike at the agency’s main base in Peshawar and a fol- low-on attack that damaged an agency building in Multan. Each was “a very significant setback,” said a Pakistani military official. Intelligence operations “are a very specialized task in which only certain people can fit in.”

millergreg@washpost.comfinnp@washpost.com

Special correspondent Natasha Abbakumova in Moscow contributed to this report.

Obama is turning his attention from global audience to foreign leaders

obama from A1

Lee H. Hamilton (D-Ind.), who chaired the House Foreign Affairs Committee and is now president of the Woodrow Wilson Interna- tional Center for Scholars. The change from a year ago is

stark. In his widely broadcast ad- dress in Cairo last June, Obama called Israeli settlements in the occupied territories “illegiti- mate.” By contrast, he met last week at the White House with Is- raeli Prime Minister Binyamin Netanyahu for two hours, urging him privately to freeze Jewish set- tlement construction. A year ago, Obama was in

France, where he held one of his first foreign town hall forums, be- fore hundreds of exuberant citi- zens. On Tuesday night, he and first lady Michelle Obama will have a private dinner for French

President Nicolas Sarkozy and his wife, Carla Bruni — the first such dinner with a visiting head of state of his presidency.

And in April 2009, Obama called for a world free of nuclear weapons before thousands of cheering Czechs gathered in a Prague square. Next month, he will host more than 40 heads of state in Washington for a meeting on securing nuclear materials. It will be the first time, White House officials say, that a U.S. president has held a single-issue summit with so many foreign leaders. Bush put enormous stock in personal chemistry and cultivat- ed a jocular informality with many world leaders, once calling out to then-British Prime Min- ister Tony Blair at an interna- tional forum by just his last name. He rode horses with fellow cowboy-boot-clad President Vi-

cente Fox of Mexico and, as a fare- well gift, he gave the Elvis-loving Japanese Prime Minister Junichi- ro Koizumi a personal tour of Graceland. Most famously, Bush said after his first meeting with then-Russian President Vladimir Putin that he was “able to get a sense of his soul,” a statement that haunted him as Putin grew in- creasingly authoritarian. But Bush’s policies, rooted in his “global war on terrorism,” proved highly unpopular in much of the world. He left office with few friends among the leaders he had reached out to for years. “Obama is not the sort of guy who looks for a best buddy, and that’s very different than Bush,” said a European diplomat, who spoke on the condition of ano- nymity to speak candidly about perceptions of U.S. leaders abroad. “Sometimes being too

personal is not a good thing. You can make mistakes.”

Obama, who was an Illinois

state senator just four years be- fore he was elected president, knew few world leaders upon tak- ing office. Since then, he has de- veloped mostly arm’s-length rela- tionships with fellow heads of state, including many from devel- oping countries that previous presidents largely ignored or shunned to protect U.S. relation- ships with more traditional allies. Ever since 200,000 Germans turned out for the speech he made in Berlin during the presi- dential campaign in July 2008, Obama has made sure that his visits to other nations include di- rect encounters with the people there, especially ones that view U.S. motives suspiciously. He held a “student roundtable” in Istanbul as part of his early

outreach to the Islamic world. He talked about freedom of speech and the Internet during a Q&A session with university students in Shanghai. And he addressed the “drift” in European-U.S. rela- tions during a town hall forum in Strasbourg, France. “I wouldn’t say this was a way

of going around leaders, but it had gotten to the point where it was hard for leaders to cooperate with the United States, given our standing,” said Ben Rhodes, the deputy national security adviser for strategic communications. “Every poll you look at shows a marked uptick in support for American leadership around the world. It is far easier for leaders to cooperate with us if their people want them to.”

Sterile, Preservative-Free

tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs.

CONTRAINDICATIONS

RESTASIS®

WARNING

RESTASIS®

known or suspected hypersensitivity to any of the ingredients in the formulation.

PRECAUTIONS

General: For ophthalmic use only.

Information for Patients:

The emulsion from one individual single-use vial is to be used immediately after opening for administration to one or both eyes, and the remaining contents should be discarded immediately after administration.

Do not allow the tip of the vial to touch the eye or any surface, as this may contaminate the emulsion.

RESTASIS®

tear production typically should not wear contact lenses. If contact lenses are worn, they should be removed prior to the administration of the emulsion. Lenses may be reinserted 15 minutes following administration of RESTASIS®

ophthalmic emulsion.

Carcinogenesis, Mutagenesis, and Impairment of Fertility:

Systemic carcinogenicity studies were carried out in male and female mice and rats. In the 78-week oral (diet) mouse study, at doses of 1, 4, and 16 mg/kg/day, evidence of a statistically significant trend was found for lymphocytic lymphomas in females, and the incidence of hepatocellular carcinomas in mid-dose males significantly exceeded the control value.

In the 24-month oral (diet) rat study, conducted at 0.5, 2, and 8 mg/kg/day, pancreatic islet cell adenomas significantly exceeded the control rate in the low dose level. The hepatocellular carcinomas and pancreatic islet cell adenomas were not dose related. The low doses in mice and rats are approximately 1000 and 500 times greater, respectively, than the daily human dose of one drop (28 µL) of 0.05% RESTASIS® assuming that the entire dose is absorbed.

Cyclosporine has not been found mutagenic/genotoxic in the Ames Test, the V79-HGPRT Test, the micronucleus test in mice and Chinese hamsters, the chromosome-aberration tests in Chinese hamster bone-marrow, the mouse dominant lethal assay, and the DNA-repair test in sperm from treated mice. A study analyzing sister chromatid exchange (SCE) induction by cyclosporine using human lymphocytes in vitro gave indication of a positive effect (i.e., induction of SCE).

No impairment in fertility was demonstrated in studies in male and female rats receiving oral doses of cyclosporine up to 15 mg/kg/day (approximately 15,000 times the human daily dose of 0.001 mg/kg/day) for 9 weeks (male) and 2 weeks (female) prior to mating.

Pregnancy-Teratogenic effects:

Pregnancy category C.

should not be administered while wearing contact lenses. Patients with decreased is contraindicated in patients with active ocular infections and in patients with ophthalmic emulsion has not been studied in patients with a history of herpes keratitis.

INDICATIONS AND USAGE

RESTASIS®

ophthalmic emulsion is indicated to increase tear production in patients whose entire dose is absorbed.

Teratogenic effects: No evidence of teratogenicity was observed in rats or rabbits receiving oral doses of cyclosporine up to 300 mg/kg/day during organogenesis. These doses in rats and rabbits are approximately 300,000 times greater than the daily human dose of one drop (28 µL) 0.05% RESTASIS®

BID into each eye of a 60 kg person (0.001 mg/kg/day), assuming that the

Non-Teratogenic effects: Adverse effects were seen in reproduction studies in rats and rabbits only at dose levels toxic to dams. At toxic doses (rats at 30 mg/kg/day and rabbits at 100 mg/kg/day), cyclosporine oral solution, USP, was embryo- and fetotoxic as indicated by increased pre- and postnatal mortality and reduced fetal weight together with related skeletal retardations. These doses are 30,000 and 100,000 times greater, respectively than the daily human dose of one-drop (28 µL) of 0.05% RESTASIS®

that the entire dose is absorbed. No evidence of embryofetal toxicity was observed in rats or rabbits receiving cyclosporine at oral doses up to 17 mg/kg/day or 30 mg/kg/day, respectively, during organogenesis. These doses in rats and rabbits are approximately 17,000 and 30,000 times greater, respectively, than the daily human dose.

BID into each eye of a 60 kg person (0.001 mg/kg/day), assuming

Republican critics say the ap- proach has unsettled the United States’ best friends, and failed more than succeeded in promot- ing American interests on some of the most far-reaching foreign policy challenges of the day. Obama’s direct appeal to the people of China and Iran, for example, has produced little change in the attitude of their governments, showing the limits of a bottom-up approach when it comes to dealing with authoritar- ian countries. Middle East peace talks remain moribund after the administration’s

so-far-unsuc-

Offspring of rats receiving a 45 mg/kg/day oral dose of cyclosporine from Day 15 of pregnancy until Day 21 post partum, a maternally toxic level, exhibited an increase in postnatal mortality; this dose is 45,000 times greater than the daily human topical dose, 0.001 mg/kg/day, assuming that the entire dose is absorbed. No adverse events were observed at oral doses up to 15 mg/kg/day (15,000 times greater than the daily human dose).

There are no adequate and well-controlled studies of RESTASIS® RESTASIS® should be administered to a pregnant woman only if clearly needed. in pregnant women.

Nursing Mothers:

Cyclosporine is known to be excreted in human milk following systemic administration but excretion in human milk after topical treatment has not been investigated. Although blood concentrations are undetectable after topical administration of RESTASIS® caution should be exercised when RESTASIS®

is administered to a nursing woman.

Pediatric Use:

The safety and efficacy of RESTASIS® pediatric patients below the age of 16.

BID into each eye of a 60 kg person (0.001 mg/kg/day), ophthalmic emulsion have not been established in

Geriatric Use:

No overall difference in safety or effectiveness has been observed between elderly and younger patients.

ADVERSE REACTIONS

The most common adverse event following the use of RESTASIS®

Rx Only

Based on package insert 71876US1OU Revised January 2008 ©2010 Allergan, Inc.

marks owned by Allergan, Inc. APC44MN09 US PAT 4,649,047; 4,839,342; 5,474,979.

Irvine, CA 92612, U.S.A.

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RESTASIS® Rebate Terms and Conditions: To receive a rebate for the amount of your prescription co-pay (up to $20), enclose this certificate and the ORIGINAL pharmacy receipt in an envelope and mail to Allergan RESTASIS® Ophthalmic Emulsion $20 Rebate Program, P.O. Box 6513, West Caldwell, NJ 07007. Please allow 8 weeks for receipt of rebate check. Receipts prior to March 1, 2010 will not be accepted. One rebate per consumer. Duplicates will not be accepted. See rebate certificate for expiration date. Eligibility: Offer not valid for prescriptions reimbursed or paid under Medicare, Medicaid, or any similar federal or state healthcare program including any state medical or pharmaceutical assistance programs. Void in the following state(s) if any third-party payer reimburses you or pays for any part of the prescription price: Massachusetts. Offer void where prohibited by law, taxed, or restricted. Amount of rebate not to exceed $20 or co-pay, whichever is less. This certificate may not be reproduced and must accompany your request for a rebate. Offer good only for one prescription of RESTASIS® Ophthalmic Emulsion and only in the USA and Puerto Rico. Allergan, Inc. reserves the right to rescind, revoke, and amend this offer without notice. You are responsible for reporting receipt of a rebate to any private insurer that pays for, or reimburses you, for any part of the prescription filled, using this certificate.

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First MI

was ocular burning (17%).

Other events reported in1%to5%of patients included conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging, and visual disturbance (most often blurring).

cessful attempts to end Israeli set- tlement construction or to per- suade Arab governments to make even token diplomatic gestures toward the Jewish state. “Because he didn’t know any- one until recently, Obama relies on something else: his popular- ity,” said Simon Serfaty, a political scientist who holds the Zbigniew Brzezinski chair in global security at the Center for Strategic and International Studies. “His relationship is not with the president of France, for exam- ple, but with the French people,” he said. “How Sarkozy thinks is that if he likes Obama, he’ll be a little more popular himself.” But Serfaty warned that Obama

ophthalmic emulsion,

“can’t always translate popularity into an acceptance of his policies.” “He is beginning to face a crisis

of efficacy,” he said. “With Bush it was a crisis of legitimacy — the le- gitimacy of American power. Obama is facing questions of, ‘Sure people like us, but have you gotten anything done?’ ” White House officials say that,

in several key relationships, Oba- ma has worked successfully with leaders by appealing primarily to their common security and eco- nomic interests. That is true for Russian Presi- dent Dmitry Medvedev, a fellow lawyer just four years Obama’s junior. According to the Pew Global Attitudes Project, the per- centage of Russians who ex- pressed confidence in the U.S. president jumped 15 percentage points from Bush’s last year through Obama’s first. The two leaders concluded months of dif- ficult negotiations over a new strategic arms-reduction treaty

with a phone call last week. With Afghanistan at war, Oba- ma has been unable to appeal di- rectly to its people. That has made it difficult for him to use public opinion to influence Kar- zai. But making the Karzai meet- ing the centerpiece of his trip — bringing along much of his senior staff and visiting with U.S. troops only afterward — shows the im- portance Obama is placing on a relationship that he has been crit- icized for neglecting. He invited Karzai to come to Washington in May.

White House officials say Oba-

ma, viewed at times as cool and aloof, does have relationships with several leaders that go be- yond their foreign policy agendas. Over lunch in Seoul last year with South Korean President Lee Myung-bak, Obama veered from their trade and security agenda to discuss domestic issues that in- terest them both, including how to improve public education. He privately praised the pover-

ty-reduction ideas of Indian Prime Minister Manmohan Singh after their first meeting at last year’s Group of 20 summit, White House officials said. Singh later received the first state dinner of Obama’s presidency, and Obama plans to travel to India later this year. President Felipe Calderón of Mexico will receive the second state dinner, in May. The developing world outreach

paid off, Rhodes said, during the December climate change confer- ence in Copenhagen.

Obama won the support of Singh, President Jacob Zuma of South Africa and Brazilian Presi- dent Luiz Inácio Lula da Silva for an agreement he forged with Chi- nese Premier Wen Jiabao. The deal, widely criticized by environ- mentalists and some European leaders as a watered-down com- promise, would have failed with- out their backing. White House officials note that

Obama has traveled to Europe several times since taking office. He also recently established a reg- ular videoconference with Sarko- zy, British Prime Minister Gordon Brown and German Chancellor Angela Merkel. During Obama’s second presi- dential trip to France, last June, Sarkozy asked during a joint news conference, “What does friendship mean?” He listed help in closing the U.S. military prison at Guantanamo Bay, Cuba; play- ing a more active role in NATO; and confronting Iran’s nuclear program. Sarkozy has accepted two Guantanamo Bay prisoners, rejoined NATO’s military com- mand, and pledged to keep French troops in Afghanistan for as long as necessary.

“Do you think people are just waiting to see us hand in hand sit- ting here looking into one an- other’s eyes?” he said at the news conference. “Of course not.”

wilsons@washpost.com

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