Ashlyn Blocker, the Girl Who Feels No Pain


Jeff Riedel for The New York Times


Ashlyn Blocker, who feels no pain, at home in Patterson, GA.







The girl who feels no pain was in the kitchen, stirring ramen noodles, when the spoon slipped from her hand and dropped into the pot of boiling water. It was a school night; the TV was on in the living room, and her mother was folding clothes on the couch. Without thinking, Ashlyn Blocker reached her right hand in to retrieve the spoon, then took her hand out of the water and stood looking at it under the oven light. She walked a few steps to the sink and ran cold water over all her faded white scars, then called to her mother, “I just put my fingers in!” Her mother, Tara Blocker, dropped the clothes and rushed to her daughter’s side. “Oh, my lord!” she said — after 13 years, that same old fear — and then she got some ice and gently pressed it against her daughter’s hand, relieved that the burn wasn’t worse.









Tara Blocker

When Ashlyn was 2, her mother had to wrap her hands to keep her from biting them.






“I showed her how to get another utensil and fish the spoon out,” Tara said with a weary laugh when she recounted the story to me two months later. “Another thing,” she said, “she’s starting to use flat irons for her hair, and those things get superhot.”


Tara was sitting on the couch in a T-shirt printed with the words “Camp Painless But Hopeful.” Ashlyn was curled on the living-room carpet crocheting a purse from one of the skeins of yarn she keeps piled in her room. Her 10-year-old sister, Tristen, was in the leather recliner, asleep on top of their father, John Blocker, who stretched out there after work and was slowly falling asleep, too. The house smelled of the homemade macaroni and cheese they were going to have for dinner. A South Georgia rainstorm drummed the gutters, and lightning illuminated the batting cage and the pool in the backyard.


Without lifting her eyes from the crochet hooks in her hands, Ashlyn spoke up to add one detail to her mother’s story. “I was just thinking, What did I just do?” she said.


Over six days with the Blockers, I watched Ashlyn behave like any 13-year-old girl, brushing her hair, dancing around and jumping on her bed. I also saw her run without regard for her body through the house as her parents pleaded with her to stop. And she played an intense game of air hockey with her sister, slamming the puck on the table as hard and fast as she could. When she made an egg sandwich on the skillet, she pressed her hands onto the bread as Tara had taught her, to make sure it was cool before she put it into her mouth. She can feel warmth and coolness, but not the more extreme temperatures that would cause anyone else to recoil in pain.


Tara and John weren’t completely comfortable leaving Ashlyn alone in the kitchen, but it was something they felt they had to do, a concession to her growing independence. They made a point of telling stories about how responsible she is, but every one came with a companion anecdote that was painful to hear. There was the time she burned the flesh off the palms of her hands when she was 2. John was using a pressure-washer in the driveway and left its motor running; in the moments that they took their eyes off her, Ashlyn walked over and put her hands on the muffler. When she lifted them up the skin was seared away. There was the one about the fire ants that swarmed her in the backyard, biting her over a hundred times while she looked at them and yelled: “Bugs! Bugs!” There was the time she broke her ankle and ran around on it for two days before her parents realized something was wrong. They told these stories as casually as they talked about Tristen’s softball games or their son Dereck’s golf skills, but it was clear they were still struggling after all these years with how to keep Ashlyn safe.


A couple of nights after telling me the story about putting her hand in the boiling water, Ashlyn sat in the kitchen, playing with the headband that held back her long brown hair. We had all been drawing on napkins and playing checkers and listening to Ashlyn and Tristen sing “Call Me Maybe,” when all of a sudden Tara gasped and lifted the hair away from her daughter’s ears. She was bleeding beneath it. The headband had been cutting into her skin entire time we were sitting there.



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The iEconomy: As Boom Lures App Creators, Tough Part Is Making a Living


Daniel Rosenbaum for The New York Times


Shawn and Stephanie Grimes’s efforts have cost $200,000 in lost income and savings, but their apps have earned less than $5,000 this year.







ROSEDALE, Md. — Shawn and Stephanie Grimes spent much of the last two years pursuing their dream of doing research and development for Apple, the world’s most successful corporation.




But they did not actually have jobs at Apple. It was freelance work that came with nothing in the way of a regular income, health insurance or retirement plan. Instead, the Grimeses tried to prepare by willingly, even eagerly, throwing overboard just about everything they could.


They sold one of their cars, gave some possessions to relatives and sold others in a yard sale, rented out their six-bedroom house and stayed with family for a while. They even cashed in Mr. Grimes’s 401(k).


“We didn’t lose any sleep over it,” said Mr. Grimes, 32. “I’ll retire when I die.”


The couple’s chosen field is so new it did not even exist a few years ago: writing software applications for mobile devices like the iPhone or iPad. Even as unemployment remained stubbornly high and the economy struggled to emerge from the recession’s shadow, the ranks of computer software engineers, including app writers, increased nearly 8 percent in 2010 to more than a million, according to the latest available government data for that category. These software engineers now outnumber farmers and have almost caught up with lawyers.


Much as the Web set off the dot-com boom 15 years ago, apps have inspired a new class of entrepreneurs. These innovators have turned cellphones and tablets into tools for discovering, organizing and controlling the world, spawning a multibillion-dollar industry virtually overnight. The iPhone and iPad have about 700,000 apps, from Instagram to Angry Birds.


Yet with the American economy yielding few good opportunities in recent years, there is debate about how real, and lasting, the rise in app employment might be.


Despite the rumors of hordes of hip programmers starting million-dollar businesses from their kitchen tables, only a small minority of developers actually make a living by creating their own apps, according to surveys and experts. The Grimeses began their venture with high hopes, but their apps, most of them for toddlers, did not come quickly enough or sell fast enough.


And programming is not a skill that just anyone can learn. While people already employed in tech jobs have added app writing to their résumés, the profession offers few options to most unemployed, underemployed and discouraged workers.


One success story is Ethan Nicholas, who earned more than $1 million in 2009 after writing a game for the iPhone. But he says the app writing world has experienced tectonic shifts since then.


“Can someone drop everything and start writing apps? Sure,” said Mr. Nicholas, 34, who quit his job to write apps after iShoot, an artillery game, became a sensation. “Can they start writing good apps? Not often, no. I got lucky with iShoot, because back then a decent app could still be successful. But competition is fierce nowadays, and decent isn’t good enough.”


The boom in apps comes as economists are debating the changing nature of work, which technology is reshaping at an accelerating speed. The upheaval, in some ways echoing the mechanization of agriculture a century ago, began its latest turbulent phase with the migration of tech manufacturing to places like China. Now service and even white-collar jobs, like file clerks and data entry specialists or office support staff and mechanical drafters, are disappearing.


“Technology is always destroying jobs and always creating jobs, but in recent years the destruction has been happening faster than the creation,” said Erik Brynjolfsson, an economist and director of the M.I.T. Center for Digital Business.


Still, the digital transition is creating enormous wealth and opportunity. Four of the most valuable American companies — Apple, Google, Microsoft and I.B.M. — are rooted in technology. And it was Apple, more than any other company, that set off the app revolution with the iPhone and iPad. Since Apple unleashed the world’s freelance coders to build applications four years ago, it has paid them more than $6.5 billion in royalties.


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Israel Steps Up Aerial Strikes in Gaza





GAZA — Israel expanded its four-day assault on Gaza on Saturday, broadening its airstrikes from military targets to the civilian political infrastructure, leveling the headquarters here of the Hamas prime minister and striking police and security buildings.




Hamas continued to fire rockets at Israel, including a pair intended for the city of Tel Aviv. One landed harmlessly, probably at sea; the other was thwarted in midair by Israel.


In Cairo, the leaders of Hamas, Turkey and Qatar gathered to try to broker a truce. Hamas officials were in indirect contact with Israel through Egyptian intelligence intermediaries, an official of Egypt’s Muslim Brotherhood said.


The talks were reported to be deadlocked on Saturday evening, while continued attacks in Gaza and Israel, and Israeli preparations for a possible ground invasion, suggested that neither side was ready to end the fight.


The air raid that struck the office of the Hamas prime minister, Ismael Haniyeh, came about 4 a.m., reducing the four-story building where weekly cabinet meetings were held to a huge pile of rubble.


Three Palestinian flags that used to hang over the entryway were draped across the dusty mess, with datebooks and personnel records scattered about. Mr. Haniyeh’s gray-bearded face beamed from a page  of a Hamas booklet promoting “the government’s achievements despite the obstacles.”


A security official, who asked to be identified only as Abu el Abed, took one of the fallen flags and replanted it upright. “We will rebuild this place as we have rebuilt others,” he said. “Every structure that is demolished or destroyed is a big loss, but the blood of anybody wounded is more important than any structure. This place will be rebuilt and the occupation will go and we will stay.”


Mark Regev, a spokesman for Prime Minister Benjamin Netanyahu of Israel, said government buildings had been targeted because Hamas “makes no distinction between its terrorist military machine and the government structure.”


“We have seen Hamas consistently using so-called civilian facilities for the purposes of hiding their terrorist military machine, including weapons,” Mr. Regev said.


The Israeli military said that it had struck more than 200 targets overnight, including underground rocket launchers and smuggling tunnels in Rafah, on the Gaza-Egypt border. The military also said that it struck the police and homeland security headquarters of Hamas, as well as the house of a Hamas commander, Ahmed Randor.


Hamas’s military wing, the Qassam Brigades, claimed responsibility for firing an Iranian-made rocket at Tel Aviv.


Israel appeared to be keeping up the pressure on military targets as well.


Hamas said seven of its members were killed Saturday morning in two separate attacks — four in Rafah, and three in the Al Maghazi refugee camp, in the middle of the Gaza Strip. The deadliest airstrikes today were reported in the southern town of Rafah, which borders Egypt, where six people, including four Hamas fighters, were killed in separate raids.


Israeli F16 airplanes hit a house for a commander of the Qassam Brigades in southeast Gaza City, but the house was empty at the time, Hamas officials said. The Israeli military also released video of what it said was an attack Saturday on the house of the Hamas northern brigade commander, Ahmed Randor, and said that it showed the secondary explosions that took place because of ammunition stored under the commander’s house.


The Palestinian Health Ministry in Gaza said that 40 Palestinians had been killed in the fighting so far, and more than 385 people wounded. Three Israelis have been killed.


This latest battle between Israel and Hamas, the Islamist militant group that controls Gaza, began Wednesday, when Israel launched airstrikes on Gaza in retaliation for a surge of rocket attacks in recent months from Gaza. The assault has drawn comparisons to Israel’s invasion of Gaza in late 2008, but so far Israeli ground forces have not entered Gaza.


Last week, Israel shifted infantry brigades, authorized the calling up of 75,000 reservists and blocked roads near Gaza, indicating an invasion of the coastal territory was possible.


The region’s political landscape has also shifted since the war four years ago, with Hamas gaining crucial allies in Egypt, Turkey and Qatar, as well as longer-range, apparently Iranian-made, missiles.


Israel’s Iron Dome missile defense system appears to have successfully intercepted many of the rockets from Gaza. After an attack on Tel Aviv last week, Israel deployed an Iron Dome anti-missile battery near the city, which became operational on Saturday.


The missiles intercepted one of the Hamas rockets on Saturday evening in the sky above the city, Israeli authorities and witnesses said.


In Cairo, a senior official of the Muslim Brotherhood confirmed that President Morsi was working furiously to secure a cease-fire but insisted that the Israeli side of the talks remained the “sticking point.” The official did not identify a specific issue.


While the regional leaders met in various combinations around Cairo, foreign ministers of members of the Arab League met in an emergency closed door meeting to discuss responses to the situation, Egypt’s Foreign Ministry said.


President Obama, who has asked President Mohamed Morsi of Egypt to try to mediate the crisis, called Prime Minister Recep Tayyip Erdogan of Turkey on Friday to press for a solution, the White House said. Mr. Erdogan was among the regional leaders meeting in Cairo.


The Muslim Brotherhood, Egypt’s powerful Islamist group, called for Mr. Morsi to expel Israel’s ambassador and freeze relations with Israel. Mr. Morsi, a former Brotherhood leader, had already recalled Egypt’s ambassador to Israel.


In Gaza City, Ghazi Hamad, the deputy foreign minister of Hamas, said Israel’s shift in strategy, attacking Hamas government buildings, would not significantly change the dynamic of the current fighting.


“Israel has the capacity to destroy all buildings in Gaza, all homes,” he said. “They destroyed our government buildings before many times, but we rebuild again. It’s a long struggle, a long story. It will not stop today or tomorrow.”


Jodi Rudoren reported from Gaza, and Isabel Kershner from Jerusalem. Reporting was contributed by Fares Akram and Tyler Hicks from Gaza City, and Mayy El Sheikh and David D. Kirkpatrick from Cairo.



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You for Sale: Your Online Attention, Bought in an Instant by Advertisers


Monica Almeida/The New York Times


Frank Addante, 36, chief executive of the Rubicon Project, says that 97 percent of American Internet users encounter its electronic ad sales system every month. And most aren’t even aware of it.







YOU can be sold in seconds.






Beverly Orr

“Online consumers are being bought and sold like chattel,” says Jeffrey Chester, executive director of the Center for Digital Democracy.






No, wait: make that milliseconds.


The odds are that access to you — or at least the online you — is being bought and sold in less than the blink of an eye. On the Web, powerful algorithms are sizing you up, based on myriad data points: what you Google, the sites you visit, the ads you click. Then, in real time, the chance to show you an ad is auctioned to the highest bidder.


Not that you’d know it. These days in the hyperkinetic world of digital advertising, all of this happens automatically, and imperceptibly, to most consumers.


Ever wonder why that same ad for a car or a couch keeps popping up on your screen? Nearly always, the answer is real-time bidding, an electronic trading system that sells ad space on the Web pages people visit at the very moment they are visiting them. Think of these systems as a sort of Nasdaq stock market, only trading in audiences for online ads. Millions of bids flood in every second. And those bids — essentially what your eyeballs are worth to advertisers — could determine whether you see an ad for, say, a new Lexus or a used Ford, for sneakers or a popcorn maker.


One big player in this space is the Rubicon Project. Never heard of it? Consider this: Rubicon, based in Los Angeles, has actually eclipsed Google in one crucial area — the percentage of Internet users in the United States reached by display ads sold through its platform, according to comScore, a digital analytics company.


Rubicon is among a handful of technology companies that have quietly developed automated ad sales systems for Web site operators. The bidders are marketers seeking to identify their best prospects and pitch them before they move to the next Web page. It is a form of high-frequency trading — that souped-up business of algorithm-loving Wall Streeters. But in this case, the prize is the attention of ordinary people. And it all depends on data-mining to instantly evaluate the audiences available to see those online display ads, the ones that appear on Web sites next to or around content.


In industry parlance, each digital ad space is an impression. The value of an impression depends on several factors, like the size of the ad, the type of person who is available to see it and that person’s location.


“The first impression seen by a high-value person on the opening page of a major newspaper first thing in the morning has a different value than a user from China who is 12 and has been on the Web all day long playing games,” says Frank Addante, the founder and chief executive of Rubicon.


Yet for most of us, real-time bidding is invisible. About 97 percent of American Internet users interact with Rubicon’s system every month, Mr. Addante says, and most of them aren’t aware of it.


That worries some federal regulators and consumer advocates, who say that such electronic trading systems could unfairly stratify consumers, covertly offering better pricing to certain people while relegating others to inferior treatment. A computer-generated class system is one risk, they say, of an ad-driven Internet powered by surveillance.


“As you profile more and more people, you’ll start to segregate people into ‘the people you can get money out of’ and ‘the people you can’t get money out of,’ ” says Dan Auerbach, a staff technologist at the Electronic Frontier Foundation, a digital civil rights group in San Francisco, who formerly worked in digital ad data-mining. “That is one of the dangers we should be worried about.”


Of course, ad agencies and brands can tailor ads to Web users without real-time bidding. They can also buy ads without aiming them at narrow audience groups. But for marketers, the marriage of ad- and audience-buying is one of the benefits of real-time bidding.


Not so long ago, they simply bought ad spaces based on a site’s general demographics and then showed every visitor the same ad, a practice called “spray and pray.” Now marketers can aim just at their ideal customers — like football fans who earn more than $100,000 a year, or mothers in Denver in the market for an S.U.V. — showing them tailored ads at the exact moment they are available on a specific Web page.


“We are not buying content as a proxy for audience,” says Paul Alfieri, the vice president for marketing at Turn, a data management company and automated buy-side platform for marketers based in Redwood City, Calif. “We are just buying who the audience is.”


Still, for many consumer advocates, real-time bidding resembles nothing so much as a cattle auction.


“Online consumers are being bought and sold like chattel,” says Jeffrey Chester, the executive director of the Center for Digital Democracy, a consumer group in Washington that has filed a complaint about real-time bidding with the Federal Trade Commission. “It’s dehumanizing.”


FRANK ADDANTE is 36 years old and given to wearing black shirts with a white Rubicon logo on the front. Rubicon is the fifth company he has started or helped to found.


In 1996, in his dorm room at the Illinois Institute of Technology, he developed and introduced a search engine. He later helped found L90, a digital ad technology company that went public and was later acquired by DoubleClick. His fourth enterprise, StrongMail Systems, provides e-mail delivery infrastructure to large companies.


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Well: Meatless Main Dishes for a Holiday Table

Most vegetarian diners are happy to fill their plates with delicious sides and salads, but if you want to make them feel special, consider one of these main course vegetarian dishes from Martha Rose Shulman. All of them are inspired by Greek cooking, which has a rich tradition of vegetarian meals.

I know that Greek food is not exactly what comes to mind when you hear the word “Thanksgiving,” yet why not consider this cuisine if you’re searching for a meatless main dish that will please a crowd? It’s certainly a better idea, in my mind, than Tofurky and all of the other overprocessed attempts at making a vegan turkey. If you want to serve something that will be somewhat reminiscent of a turkey, make the stuffed acorn squashes in this week’s selection, and once they’re out of the oven, stick some feathers in the “rump,” as I did for the first vegetarian Thanksgiving I ever cooked: I stuffed and baked a huge crookneck squash, then decorated it with turkey feathers. The filling wasn’t nearly as good as the one you’ll get this week, but the creation was fun.

Here are five new vegetarian recipes for your Thanksgiving table — or any time.

Giant Beans With Spinach, Tomatoes and Feta: This delicious, dill-infused dish is inspired by a northern Greek recipe from Diane Kochilas’s wonderful new cookbook, “The Country Cooking of Greece.”


Northern Greek Mushroom and Onion Pie: Meaty portobello mushrooms make this a very substantial dish.


Roasted Eggplant and Chickpeas With Cinnamon-Tinged Tomato Sauce and Feta: This fragrant and comforting dish can easily be modified for vegans.


Coiled Greek Winter Squash Pie: The extra time this beautiful vegetable pie takes to assemble is worth it for a holiday dinner.


Baked Acorn Squash Stuffed With Wild Rice and Kale Risotto: Serve one squash to each person at your Thanksgiving meal: They’ll be like miniature vegetarian (or vegan) turkeys.


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Well: Meatless Main Dishes for a Holiday Table

Most vegetarian diners are happy to fill their plates with delicious sides and salads, but if you want to make them feel special, consider one of these main course vegetarian dishes from Martha Rose Shulman. All of them are inspired by Greek cooking, which has a rich tradition of vegetarian meals.

I know that Greek food is not exactly what comes to mind when you hear the word “Thanksgiving,” yet why not consider this cuisine if you’re searching for a meatless main dish that will please a crowd? It’s certainly a better idea, in my mind, than Tofurky and all of the other overprocessed attempts at making a vegan turkey. If you want to serve something that will be somewhat reminiscent of a turkey, make the stuffed acorn squashes in this week’s selection, and once they’re out of the oven, stick some feathers in the “rump,” as I did for the first vegetarian Thanksgiving I ever cooked: I stuffed and baked a huge crookneck squash, then decorated it with turkey feathers. The filling wasn’t nearly as good as the one you’ll get this week, but the creation was fun.

Here are five new vegetarian recipes for your Thanksgiving table — or any time.

Giant Beans With Spinach, Tomatoes and Feta: This delicious, dill-infused dish is inspired by a northern Greek recipe from Diane Kochilas’s wonderful new cookbook, “The Country Cooking of Greece.”


Northern Greek Mushroom and Onion Pie: Meaty portobello mushrooms make this a very substantial dish.


Roasted Eggplant and Chickpeas With Cinnamon-Tinged Tomato Sauce and Feta: This fragrant and comforting dish can easily be modified for vegans.


Coiled Greek Winter Squash Pie: The extra time this beautiful vegetable pie takes to assemble is worth it for a holiday dinner.


Baked Acorn Squash Stuffed With Wild Rice and Kale Risotto: Serve one squash to each person at your Thanksgiving meal: They’ll be like miniature vegetarian (or vegan) turkeys.


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Tensions Escalate in Gaza Conflict



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If I Hire You, What’s Your 100-Day Plan?



John Duffy of 3C Interactive says he asks job candidates to describe what their first months on the job would be like, partly to “learn what their expectations are, and where they think we’re at.”



Find the best job in the New York metro area and beyond.










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10 Universities to Form Semester Online Consortium





Starting next fall, 10 prominent universities, including Duke, the University of North Carolina at Chapel Hill and Northwestern, will form a consortium called Semester Online, offering about 30 online courses to both their students — for whom the classes will be covered by their regular tuition — and to students elsewhere who would have to apply and be accepted and pay tuition of more than $4,000 a course.




Semester Online will be operated through the educational platform 2U, formerly known as 2tor, and will simulate many aspects of a classroom: Students will be able to raise their hands virtually, break into smaller discussion groups and arrange and hold online study sessions.


The virtual classroom is a cross between a Google+ hangout and the opening sequence of “The Brady Bunch,” where each student has his or her own square, the equivalent of a classroom chair. However, with Semester Online courses, there is no sneaking in late and unnoticed, and there is no back row.


Unlike the increasingly popular massive open online courses, or MOOCs, free classes offered by universities like Harvard, M.I.T. and Stanford, Semester Online classes will be small — and will offer credit.


“Now we can provide students with a course that mirrors our classroom experience,” says Edward S. Macias, provost and executive vice chancellor for academic affairs at Washington University in St. Louis, one of the participants.


“It’s going to be the most rigorous, live, for-credit online experience ever,” said Chip Paucek, a founder of 2U.


For many of the participating schools, which include Brandeis, Emory, Notre Dame, the University of Rochester, Vanderbilt and Wake Forest, Semester Online offerings will be their first undergraduate for-credit online courses, and the first to offer credit to students from outside the universities.


One draw for the colleges is the expansion in their course catalogs.


“No university can deliver the full range of courses that both might be interesting and useful and enlightening to our students,” said Peter Lange, the provost of Duke. “Imagine if you don’t have a person who works on the Sahel region in Africa, but another school does.”


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Well: Learning That Odd Is Normal

A few months ago, I was at home reading a review copy of “Oddly Normal” by my colleague John Schwartz. The book begins with the suicide attempt of John’s then 13-year-old son, Joe, who had recently told his classmates he was gay. It goes on to explain how Joe’s parents struggled with a school system that didn’t always understand their son, and how Joe eventually found the path to self acceptance.

But my plan to read the book was interrupted when my 8th-grade daughter, intrigued by the title, pulled it out of my hands and read the first few pages. She was captivated and decided to read all of it for her next school book report.

Later she wrote about how moved she was by Joe’s story and how she wished she could “give him a hug and tell him that it would all turn out O.K.” The book, she wrote, “is full of life lessons that are extremely important for every young person to understand…. Being an individual is amazing, and no one should hide their true personality. Eventually, Joe learned to be the person he wanted to be, and he realized that everyone is a little odd and different.”

While “Oddly Normal” has been discussed as a great book for parents, I think teenagers will relate to Joe’s struggles and learn a lot from his honesty. You can meet Joe in a new video, in which he talks about himself, his father’s book and life as a gay teen. To learn more about the book, read the recent New York Times Sunday book review “Something to Tell You.”

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Change Rattles Leading Health-Funding Agency





Major changes erupted at one of the world’s leading health-funding agencies Thursday as it hired a new director, dismissed the inspector general who had clashed with a previous director and announced a new approach to making grants.







Alex Wong/Getty Images

Dr. Mark Dybul, who led the President's Emergency Plan for AIDS Relief, in 2007.








Dr. Mark Dybul, the Bush administration’s global AIDS czar who was abruptly dismissed when President Obama took office, was named the new executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.


Dr. Dybul, who was selected over candidates from Canada, Britain and France, was backed by the United States, which donates about a third of the fund’s budget, and by Bill Gates, who helped the fund through a cash crisis earlier this year.


He is respected by many AIDS activists in the United States, though there is some lingering controversy about his time in the Bush administration related to abstinence policies and anti-prostitution pledges imposed by conservative lawmakers as well as concerning strict licensing requirements for generic drugs.


The fund, which is based in Geneva and has given away more than $20 billion since its founding in 2002, has been in crisis for more than a year. Some donors shied away after widely publicized corruption scandals, while others, notably Mr. Gates, said the scandals were exaggerated and increased donations.


Its last executive director, Dr. Michel Kazatchkine, quit in January after the day-to-day management duties of his job were given to a Brazilian banker, Gabriel Jaramillo, who was charged with cutting expenses.


By some accounts, 40 percent of the employees soon left, although Seth Faison, a fund spokesman, said the total number of employees declined by only 8 percent. The fund also dismissed its inspector general, John Parsons, on Thursday, citing unsatisfactory work.


Mr. Parsons and Dr. Kazatchkine had privately clashed. Mr. Parsons’s teams aggressively pursued theft and fraud, and found it in Mali, Mauritania and elsewhere. But the total amount stolen — $10 million to $20 million — was relatively small, and aides to Dr. Kazatchkine said the fund cut off those countries and sought to retrieve the money. The aides claimed that Mr. Parsons, who reported only to the board, went to news outlets and left the impression that the fund was covering up rampant theft.


The fuss scared off some donor countries that were already looking for excuses to cut back on foreign aid because of the global economic crisis.


Mr. Parsons did not return messages left for him Thursday.


Dr. Dybul’s appointment was welcomed by the United Nations AIDS program, the Bill and Melinda Gates Foundation, the Elizabeth Glaser Pediatric AIDS Foundation, Malaria No More and Results.org, an anti-poverty lobbying group. By contrast, Jamie Love, an American advocate for cheaper AIDS drugs who works in Washington and Geneva, said he expected Dr. Dybul “to protect drug companies.”


The fund also announced a new application process, which it said would be faster and focus more on the hardest-hit countries rather than all 150 that received some help in the past.


In an interview, Dr. Dybul said he felt the fund was “on a strong forward trajectory” after changes were put in place in the last year by Mr. Jaramillo, and now would focus on “hard-nosed implementation of value for money.”


Both the President’s Emergency Plan for AIDS Relief and the fund spend billions, but in different ways.


The fund supports projects proposed by national health ministers and then hires local auditors to make sure the money is not wasted or stolen. Pepfar usually gives grants to American nonprofit groups or medical schools and lets them form partnerships with hospitals or charities in the affected countries.


The conventional wisdom is that the Global Fund’s model is more likely to win the cooperation of government officials but more vulnerable to corruption — and also spends less on salaries and travel for American overseers.


Dr. Kazatchkine said he did not expect Dr. Dybul to “Pepfarize” the Global Fund.


“I hope that, after a year of turbulence, the fund finds the serenity needed to move forward again,” he said.


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