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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Israeli Strike in Gaza Kills at Least 11, Including Children


Tyler Hicks/The New York Times


Residents in Gaza dug through the rubble of an apartment building hit by Israeli rockets. More Photos »







GAZA CITY — Israeli forces killed at least 11 people, including several children, in a single airstrike that destroyed a home here on Sunday, as Israel pressed its bombardment of the Gaza Strip for a fifth day, deploying warplanes and naval vessels to pummel the coastal enclave.




The airstrike, which the Israeli military said was meant to kill a Palestinian militant involved in the recent rocket attacks, was the deadliest operation to date and would no doubt weigh on negotiations for a possible cease-fire. Among the dead were five women and four small children, The Associated Press reported, citing a Palestinian health official.


Two media offices were also hit on Sunday, and Prime Minister Benjamin Netanyahu of Israel warned of a “significant” expansion in the onslaught, which has already killed over 50 people, many of them civilians.


Speaking on Sunday from Bangkok, President Obama condemned missile attacks by Palestinian fighters in Gaza and defended Israel’s right to protect itself.


“There’s no country on earth that would tolerate missiles raining down on its citizens from outside its borders,” Mr. Obama said in his first public comments since the violence broke out. “We are fully supportive of Israel’s right to defend itself.”


The president also said that efforts were under way to address Israel’s security concerns and end the violence. “We’re going to have to see what kind of progress we can make in the next 24, 36, 48 hours,” Mr. Obama said.


Even as the diplomacy intensified on Sunday, the attacks continued in Gaza and Israel.


Mr. Netanyahu made his warning as militants in Gaza aimed at least one rocket at Tel Aviv, a day after Israeli forces broadened the attack beyond military targets, bombing centers of government infrastructure in Gaza, including the four-story headquarters of the Hamas prime minister.


“We are exacting a heavy price from Hamas and the terrorist organizations, and the Israel Defense Forces are prepared for a significant expansion of the operation,” Mr. Netanyahu told his cabinet at its routine Sunday meeting, referring directly to the of thousands of reservists who have been called up and the massing of armor on the Gaza border that many analysts have interpreted as preparations for a possible invasion.


“I appreciate the rapid and impressive mobilization of the reservists who have come from all over the country and turned out for the mission at hand,” Mr. Netanyahu said. “Reservist and conscript soldiers are ready for any order they might receive.”


His remarks were reported shortly after a battery of Israel’s Iron Dome defense shield, hastily deployed near Tel Aviv on Saturday in response to the threat of longer-range rockets, intercepted at least one aimed at the city on Sunday, Israeli officials said. It was the latest of several salvos that have illustrated Hamas’s ability to extend the reach of its rocket attacks.


Since Wednesday, when the escalation of the conflict began, Iron Dome has knocked 245 rockets out of the sky, the military said Saturday, while 500 have struck Israel.


The American-financed system is designed to intercept only rockets streaking toward towns and cities and to ignore those likely to strike open ground. But on Sunday a rocket fired from Gaza plowed through the roof of an apartment building in the southern Israeli city of Ashkelon. There were no immediate reports of casualties there.


In Gaza City, the crash of explosions pierced the quiet several times throughout the early morning.


Before the latest deadly strike involving civilians on Sunday, Hamas health officials had said the Palestinian death toll had risen to 53. One of the latest victims was a 52-year-old woman whose house in the eastern part of Gaza City was bombed around lunchtime.


A few hours earlier, a Hamas militant was killed and seven people were wounded in an attack on the Beach Refugee Camp, where Ismail Haniya, the Hamas prime minister, has a home. Those killed on Sunday included three children ages 1 through 5, the health officials said.


In Israel, 3 civilians have died and 63 have been injured. Four soldiers were wounded on Saturday.


The onslaught continued despite talks in Cairo that President Mohamed Morsi of Egypt said Saturday night could soon result in a cease-fire. Mr. Netanyahu said he would consider a comprehensive cease-fire if the launchings from Gaza stopped.


The attack on Mr. Haniya’s office, one of several on government installations, came a day after he hosted his Egyptian counterpart in the same building, a sign of Hamas’s new legitimacy in a radically redrawn Arab world.


Jodi Rudoren and Fares Akram reported from Gaza City. Reporting was contributed by Isabel Kershner, Carol Sutherland and Iritz Pazner Garshowitz from Jerusalem; Tyler Hicks from Gaza, Peter Baker from Bangkok, Alan Cowell from London, Michael Schwirtz from New York and David D. Kirkpatrick and Mayy El Sheikh from Cairo.



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Drug Shortages Are Becoming Persistent in U.S.


Paul Davis, the chief of a rural ambulance squad in southern Ohio, was down to his last vial of morphine earlier this fall when a woman with a broken leg needed a ride to the hospital.


The trip was 30 minutes, and the patient was in pain. But because of a nationwide shortage, his morphine supply had dwindled from four doses to just one, presenting Mr. Davis with a stark quandary. Should he treat the woman, who was clearly suffering? Or should he save it for a patient who might need it more?


In the end, he opted not to give her the morphine, a decision that haunts him still. “I just feel like I’m not doing my job,” said Mr. Davis, who is chief of the rescue squad in Vernon, Ohio. He has since refilled his supply. “I shouldn’t have to make those kinds of decisions.”


From rural ambulance squads to prestigious hospitals, health care workers are struggling to keep vital medicines in stock because of a drug shortage crisis that is proving to be stubbornly difficult to fix. Rationing is just one example of the extraordinary lengths being taken to address the shortage, which health care workers say has ceased to be a temporary emergency and is now a fact of life. In desperation, they are resorting to treating patients with less effective alternative medicines and using expired drugs. The Cleveland Clinic has hired a pharmacist whose only job is to track down hard-to-find drugs.


Caused largely by an array of manufacturing problems, the shortage has prompted Congressional hearings, a presidential order and pledges by generic drug makers to communicate better with federal regulators.


The problem peaked in 2011, when a record 251 drugs were declared in short supply. This year, slightly more than 100 were placed on the list, and workers say the battle to keep pharmacy shelves stocked continues unabated. The list of hard-to-find medicines ranges from basic drugs like the heart medicine nitroglycerin to a lidocaine injection, which is used to numb tissue before surgery.


A deadly meningitis outbreak caused by contamination at a large drug producer could worsen the situation, federal officials have warned. The Food and Drug Administration said that shortages of six drugs — medicines used during surgery and to treat conditions like congestive heart failure — could get worse after a big compounding pharmacy closed over concerns about drug safety. The pharmacy, Ameridose, shares some management with the New England Compounding Center, which is at the center of a meningitis outbreak that has claimed 33 lives.


“When you can’t treat basic things — cardiac arrest, pain management, seizures — you’re in trouble,” said Dr. Carol Cunningham, the state medical director for the Ohio Department of Public Safety’s emergency services division. “When you only have five tools in your toolbox and three of them are gone, what do you do?”


Dr. Margaret A. Hamburg, the F.D.A. commissioner, said in an interview this week that she was “guardedly optimistic” that the shortage crisis was abating. “I think there’s been an enormous amount of progress,” she said. “We’re seeing real change in the number of shortages that we’re able to recognize early.” More than 150 new shortages have been prevented this year, according to the agency.


But Erin Fox, who tracks supply levels for a broader range of drugs at the University of Utah, said once a drug became scarce, it tended to stay scarce. The university’s Drug Information Service was actively tracking 282 hard-to-find products by the end of the third quarter of this year, a record.


“The shortages we have aren’t going away — they’re not resolving,” she said. “But the good news is we’re not piling more shortages on top.”


In 2011, prompted by emotional pleas by cancer patients and others who said the drug shortage was threatening lives, President Obama issued an executive order requiring drug makers to notify the F.D.A. when a shortage appeared imminent. The agency also loosened some restrictions on importing drugs, and sped up approvals by other manufacturers to make certain medicines.


A law passed this summer contains several provisions aimed at improving the situation, including expediting approval of new generic medicines and requiring the agency’s enforcement unit to better coordinate with its drug-shortage officials before it takes action against a manufacturer.


Ralph G. Neas, the chief executive of the Generic Pharmaceutical Association, said fixing the drug shortage was complex and would take time, but was a top priority. “One shortage is one shortage too many,” he said. “One patient not getting a critical drug is one patient too many.”


Federal drug officials trace much of the drug shortage crisis to delays at plants that make sterile injectable drugs, which account for about 80 percent of the scarce medicines. Nearly a third of the industry’s manufacturing capacity is not running because of plant closings or shutdowns to fix serious quality issues. Other shortages have been caused by supply disruptions of the raw ingredients used to make the drugs, or by manufacturers exiting the market.


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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.


Read More..

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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Shortcuts: The Meaning in a Drawer Full of Old Family Snapshots


Eric Thayer/Reuters


A resident found photos as she sifted the debris of a house destroyed by Hurricane Sandy in Union Beach, N.J.







I WASN’T going to write about Hurricane Sandy. I was going to write about the changing nature of photographs and our relationship to them in this digital age.








Doug Mills/The New York Times

Picture-taking is now mainly digital, making prints of photos uncommon.






But as I began my research, I came across a Facebook page where lost photos from the storm were posted. Called “Union Beach — Photos and Misplaced Items,” the page shows photos of newborns and birthday parties, weddings and family gatherings.


Starting the morning after the storm devastated her community of Union Beach, N.J., Jeanette Van Houten and her niece have collected over a thousand photos and some photo albums. She is making it her mission to scan and post to Facebook as many as possible, including those turned into the fire department, police station and borough hall.


In addition, she was handed a drawerful of over a thousand family photos that must have been wrenched from a dresser.


About 60 photos have been claimed so far, and some professionals have offered to restore damaged photos free.


“These photos were passed down through families and they survived Sandy, even if the structures they were in didn’t,” Ms. Van Houten said. “They tell our story.”


With the Facebook page, Ms. Van Houten uses newer technology to help people reconnect with their old-fashioned snapshots. And seeing the photographs of mundane scenes and milestones on Facebook, along with the grateful comments from people who got back a bit of their lives, reminded me of both the fragility and strength of photos and their continuing importance in our lives. Judith Dupré, author of “Monuments: America’s History in Art and Memory” (Random House, 2007), and other books, teaches a class at her local library in Mamaroneck, N.Y., called “Stories from My Life,” for older residents. They use photos and stories to write about their lives.


“They bring in a basketful of photos,” Ms. Dupré said. “Each one of these photos contains a story — they’re like a key that opens the door to a life.”


And a printed photo “is a different species than a digital photo,” she said. “I don’t think anyone’s figured out the place of digital photos in terms of memory keeping.”


When an elderly aunt of hers died and left behind lots of photographs, Ms. Dupré said the family took them to the memorial service.


“We had a table and people could select and take what they wanted,” she said. “It was a very moving part of the memorial.”


Of course, even prints can lose their meaning and poignancy through the generations.


And in some cases, as with Hurricane Sandy, photos may be safer in cyberspace than in an album on a bookshelf — as long as you remember to upload them to a site like Flickr, Shutterfly, Snapfish or countless other photo sites available. (And make sure you know how long a site will keep your photos. Some, for example, require you to show some activity at least once a year.) That way, if you lose your hard drive, you don’t lose your photos.


But Ms. Dupré said she worried that photos that existed only online somewhere might die with the photographer.


“I don’t even know what my parents have in terms of digital photography,” she said. She said she put the password to her photos safely away with her will and other documents, so her children can access them.


Now I’m not trying to say that the old-fashioned way is the only way. Photography has constantly evolved. The Brownie camera, first sold by Kodak for $1 in 1900, radicalized photography by making it available to just about everyone.


But, and I know this largely a generational thing, I can’t help but wonder about the ubiquity of the cellphone photo. As Ms. Dupré said, “The infinite number of digital photos that can be taken has devalued the single image and made one-of-a-kind prints that much more precious.”


E-mail: shortcuts@nytimes.com



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Israel Sticks to Tough Approach in Conflict With Hamas





TEL AVIV — With rockets landing on the outskirts of Tel Aviv and Jerusalem on Friday and the Egyptian prime minister making a solidarity visit to Gaza, the accelerating conflict between Israel and Hamas — reminiscent in many ways of so many previous battles — has the makings of a new kind of Israeli-Palestinian face-off.




The combination of longer-range and far deadlier rockets in the hands of more radicalized Palestinians, the arrival in Gaza and Sinai from North Africa of other militants pressuring Hamas to fight more, and the growing tide of anti-Israel fury in a region where authoritarian rulers have been replaced by Islamists means that Israel is engaging in this conflict with a different set of challenges.


The Middle East of 2012 is not what it was in late 2008, the last time Israel mounted a military invasion to reduce the rocket threat from Gaza. Many analysts and diplomats outside Israel say the country today needs a different approach to Hamas and the Palestinians based more on acknowledging historic grievances and shifting alliances.


“As long as the crime of dispossession and refugeehood that was committed against the Palestinian people in 1947-48 is not redressed through a peaceful and just negotiation that satisfies the legitimate rights of both sides, we will continue to see enhancements in both the determination and the capabilities of Palestinian fighters — as has been the case since the 1930s, in fact,” Rami G. Khouri, a professor at the American University of Beirut, wrote in an online column. “Only stupid or ideologically maniacal Zionists fail to come to terms with this fact.”


But the government in Israel and the vast majority of its people have drawn a very different conclusion. Their dangerous neighborhood is growing still more dangerous, they agree. That means not concessions, but being tougher in pursuit of deterrence, and abandoning illusions that a Jewish state will ever be broadly accepted here.


“There is a theory, which I believe, that Hamas doesn’t want a peaceful solution and only wants to keep the conflict going forever until somehow in their dream they will have all of Israel,” Eitan Ben Eliyahu, a former leader of the Israeli Air Force, said in a telephone briefing. “There is a good chance we will go into Gaza on the ground again.”


What is striking in listening to the Israelis discuss their predicament is how similar the debate sounds to so many previous ones, despite the changed geopolitical circumstances. In most minds here, the changes do not demand a new strategy, simply a redoubled old one.


The operative metaphor is often described as “cutting the grass,” meaning a task that must be performed regularly and has no end. There is no solution to security challenges, officials here say, only delays and deterrence. That is why the idea of one day attacking Iranian nuclear facilities, even though such an attack would set the nuclear program back only two years, is widely discussed as a reasonable option. That is why frequent raids in the West Bank and surveillance flights over Lebanon never stop.


And that is why this week’s operation in Gaza is widely viewed as having been inevitable, another painful but necessary maintenance operation that, officials here say, will doubtless not be the last.


There are also those who believe that the regional upheavals are improving Israel’s ability to carry out deterrence. One retired general who remains close to the military and who spoke on the condition of anonymity said that with Syria torn apart by civil war, Hezbollah in Lebanon discredited because of its support for the Syrian government, and Egypt so weakened economically, Israel should not worry about anything but protecting its civilians.


“Should we let our civilians be bombed because the Arab world is in trouble?” he asked.


So much was happening elsewhere in the region — the Egyptian and Libyan revolutions, the Syrian civil war, dramatic changes in Yemen and elections in Tunisia — that a few rockets a day that sent tens of thousands of Israeli civilians into bomb shelters drew little attention. But in the Israeli view, the necessity of a Gaza operation has been growing steadily throughout the Arab Spring turmoil.


In 2009, after the Israeli invasion pushed Hamas back and killed about 1,400 people in Gaza, 200 rockets hit Israel. The same was true in 2010. But last year the number rose to 600, and before this week the number this year was 700, according to the Israeli military. The problem went beyond rockets to mines planted near the border aimed at Israeli military jeeps and the digging of explosive-filled tunnels.


“In 2008 we managed to minimize rocket fire from Gaza significantly,” said Lt. Col. Avital Leibovich, a military spokeswoman. “We started that year with 100 rockets a week and ended it with two a week. We were able to give people in our south two to three years. But the grass has grown, and other things have as well. Different jihadist ideologies have found their way into Gaza, including quite a few terrorist organizations. More weapons have come in, including the Fajr-5, which is Iranian made and can hit Tel Aviv. That puts nearly our entire population in range. So we reached a point where we cannot act with restraint any longer.”


Gazans see events in a very different light. The problem, they say, comes from Israel: Israeli drones fill the Gazan skies, Israeli gunboats strafe their waters, Palestinian militants are shot at from the air, and the Gaza border areas are declared off limits by Israel with the risk of death from Israeli gunfire.


But there is little dissent in Israel about the Gaza policy. This week leaders of the leftist opposition praised the assassination of Ahmed al-Jabari, the Hamas military commander, on Wednesday. He is viewed here as the equivalent of Osama bin Laden. The operation could go on for many days before there is any real dissent.


The question here, nonetheless, is whether the changed regional circumstances will make it harder to “cut the grass” in Gaza this time and get out. A former top official who was actively involved in the last Gaza war and who spoke on the condition of anonymity said it looked to him as if Hamas would not back down as easily this time.


“They will not stop until enough Israelis are killed or injured to create a sense of equality or balance,” he said. “If a rocket falls in the middle of Tel Aviv, that will be a major success. But this government will go back at them hard. I don’t see this ending in the next day or two.”


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Wealth Matters: Advisers Caution Against Hasty Decisions in Advance of Tax Changes





WITH all the ominous talk of tax increases and a “fiscal cliff” if President Obama and Congressional leaders can’t agree on a plan to avert automatic tax increases on Dec. 31, some investors may be tempted to act soon to take advantage of the current tax rates.




But financial advisers say that in their rush to do something this year, investors may end up with regrets.


“Any time you make a decision purely for tax reasons, it has a way of coming back and biting you,” said Mag Black-Scott, chief executive of Beverly Hills Wealth Management. “Could you be at a 43 percent tax on dividends instead of 15 percent? The straight answer is yes, of course you could. But what if that doesn’t happen? What if they increase just slightly?”


Various proposals are on the table, but the taxes the wealthy say they worry most about are an increase in the capital gains rate to 20 percent from 15 percent, which would affect investments like stocks and second homes; an increase in the 15 percent tax on dividends; and a limitation on deductions, which would effectively increase the tax bill. For the truly wealthy, there is also the question of what will happen to estate and gift taxes.


In addition, the health care law sets a 3.8 percent Medicare tax on investment income for individuals with more than $200,000 in annual income (and couples with more than $250,000). Taking taxes on capital gains as an example, Ms. Black-Scott, who started her career at Morgan Stanley in the late 1970s, said people needed to remember that the rates were 28 percent when Ronald Reagan was president. “If they go from 15 to 20 percent, is it really that bad?” she asked. “You need to say, ‘Do I like the stock?’ If you do, why would you get rid of it?”


Here is a look at some of the top areas where short-term decisions based solely on taxes could end up hindering long-term investment goals.


APPRECIATED STOCK Many people have large holdings in a single stock, often the result of working for a company for many years. And the stock may have appreciated significantly over that time. But if they are selling now solely for tax reasons, advisers say they shouldn’t. The stock may continue to do well and more than compensate for increased capital gains.


But there is an upside to an increase in the capital gains rate: wealthier clients may finally be pushed to diversify their holdings. “If you have 75 percent of your wealth in one stock, then it’s a really appropriate time to think about this,” said Timothy R. Lee, managing director of Monument Wealth Management. If the increased tax rate “is a motivating factor for some people, O.K. Letting go of that control and the pride that goes with it is a really difficult decision.”


Selling stock now may also make sense when it is in the form of stock options set to expire early next year. “Do you want to take the risk the price will drop in January?” asked Melissa Labant, director of the tax team at the American Institute of Certified Public Accountants. “What if we have a fiscal cliff or a change in the markets? If you’re comfortable, do it now.”


Some investors may also fear that higher taxes will drive all stocks down. Patrick S. Boyle, investment strategist at Bessemer Trust, said there was no historical link between tax increases and stock market performance.


In the most recent three tax increases, he says, “the market has actually gone up in the six months before and after.” He added: “It’s not that tax rates aren’t important. They are. It’s just that there are so many other things going on that are more important than tax policy.”


MUNICIPAL BONDS Bonds sold to finance state and local government projects are tax-free now and will be tax-free next year. That is no reason to load up on them.


Tax-free municipal bonds have always been attractive to people in higher-income tax brackets. Now, advisers fear that individuals just above the $200,000 threshold, people who say they do not feel wealthy but will probably be paying higher taxes on their income and investments, will try to offset that increase by moving more of their investments into municipal bonds.


Beth Gamel, a certified public accountant and executive vice president at Pillar Financial Advisers, imagined a case where people in higher tax brackets, thinking they were acting rationally, sold stocks this year to take advantage of the lower capital gains rates and then, to avoid higher taxes next year, put all or some of that money into municipal bonds. Maybe they outsmart the tax man, but they do so at risk to their retirement.


“It will be very difficult for them to reach their long-term goals,” she said, “because the yield on muni bonds is lower than stocks over time.”


Or as Will Braman, chief investment officer of Ballentine Partners, said of this trade-off: “It’s not about minimizing the taxes but maximizing the after-tax returns.”


He suggested that people use their deductions to reduce what is owed from taxable securities.


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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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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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