Scare Amplifies Fears That Clinton’s Work Has Taken Heavy Toll

Pool photo by Brendan Smialowski

Hillary Rodham Clinton with Field Marshal Mohamed Hussein Tantawi in Cairo in July.

WASHINGTON — When Secretary of State Hillary Rodham Clinton fractured her right elbow after slipping in a State Department garage in June 2009, she returned to work in just a few days. Her arm in a sling, she juggled speeches and a trip to India and Thailand with physical therapy, rebuilding a joint held together with wire and pins.

It was vivid evidence of Mrs. Clinton’s indomitable stamina and work ethic — as a first lady, senator, presidential candidate and, for the past four years, the most widely traveled secretary of state in American history.

But after a fall at home in December that caused a concussion, and a subsequent diagnosis of a blood clot in her head, it has taken much longer for Mrs. Clinton to bounce back. She was released from a hospital in New York on Wednesday, accompanied by her daughter, Chelsea, and her husband, former President Bill Clinton. On Thursday, she told colleagues that she hoped to be in the office next week.

Her health scare, though, has reinforced the concerns of friends and colleagues that the years of punishing work and travel have taken a heavy toll. Even among her peers at the highest levels of government, Mrs. Clinton, 65, is renowned for her grueling schedule. Over the past four years, she was on the road for 401 days and spent the equivalent of 87 full days on a plane, according to the State Department’s Web site.

In one 48-hour marathon in 2009 that her aides still talk about, she traveled from talks with Palestinian leaders in Abu Dhabi to a midnight meeting with Prime Minister Benjamin Netanyahu in Jerusalem, then boarded a plane for Morocco, staying up all night to work on other issues, before going straight to a meeting of Arab leaders the next morning.

“So many people who know her have urged me to tell her not to work so hard,” said Melanne S. Verveer, who was Mrs. Clinton’s chief of staff when she was first lady and is now the State Department’s ambassador at large for women’s issues. “Well, that’s not easy to do when you’re Hillary Clinton. She doesn’t spare herself.”

It is not just a matter of duty, Ms. Verveer and others said. Mrs. Clinton genuinely relishes the work, pursuing a brand of personal diplomacy that, she argues, requires her to travel to more places than her predecessors.

While there is no medical evidence that Mrs. Clinton’s clot was caused by her herculean work habits, her cascade of recent health problems, beginning with a stomach virus, has prompted those who know her best to say that she desperately needs a long rest. Her first order of business after leaving the State Department in the coming weeks, they say, should be to take care of herself.

Some even wonder whether this setback will — or should — temper the feverish speculation that she will make another run for the White House in 2016.

“I am amazed at the number of women who come up to me and tell me she must run for president,” said Ellen Chesler, a New York author and a friend of Mrs. Clinton’s. “But perhaps this episode will alter things a bit.”

Given Mrs. Clinton’s enduring status as a role model, Ms. Chesler said women would be watching which path she decides to take, as they plan their own transitions out of the working world.

“Do remember that women of our generation are really the first to have worked through the life cycle in large numbers,” she added. “Many seem to be approaching retirement with dread.”

For now, aides say, Mrs. Clinton’s focus is on wrapping up her work at the State Department. She would like to take part in a town hall-style meeting, thank her staff and sit for some interviews. But first she has to get clearance from her doctors, who are watching her to make sure that the blood thinners they have prescribed for her clot are working.

Speaking to a meeting of a foreign policy advisory board from her home in Chappaqua, N.Y., on Thursday, Mrs. Clinton said she was crossing her fingers and encouraging her doctors to let her return next week. “I’m trying to be a compliant patient,” she said, according to a person who was in the room. “But that does require a certain level of patience, which I’ve had to cultivate over the last three and a half weeks.”

While convalescing, Mrs. Clinton has spoken with President Obama and has held a 30-minute call with Senator John Kerry, Democrat of Massachusetts, whom Mr. Obama nominated as her successor.

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Europe Likely to Be Harder on Google Over Search

PARIS — By some accounts, the United States let Google off the hook when it found that the technology giant had not abused its dominance in the Internet search market.

Yves Logghe/Associated Press

Joaquín Almunia has vowed to restore competition to the Internet search business in Europe.

Few expect the European antitrust watchdog to be as lenient.

The Federal Trade Commission ruled on Thursday that Google had not broken antitrust laws, after a 19-month inquiry into how it operated its search engine. But the European Commission, which is pursuing claims that the company rigs results to favor its own businesses, operates under a different standard.

The agreement with the American authorities, analysts and competition lawyers say, is unlikely to alter the demands of European regulators, led by the competition commissioner, Joaquín Almunia.

“We have taken note of the F.T.C. decision, but we don’t see that it has any direct implications for our investigation, for our discussions with Google, which are ongoing,” said Michael Jennings, a spokesman for the European Commission in Brussels.

Faced with nearly $4 billion in possible penalties and restrictions on its business in Europe, Google submitted proposals in July to remedy the concerns of the European Commission, which covered four areas. In its deal with the F.T.C., Google made concessions in two of those areas but was not required to do so in the rest.

A Google spokesman, Al Verney, declined to comment on the content of the company’s proposals to Mr. Almunia but said the company would “continue to work cooperatively with the European Commission.”

The Google case underscores a basic difference between the approaches to monopoly power in Europe and the United States. American antitrust regulators tend to focus on whether a company’s dominance harms consumers; the European system seeks to keep competitors in the market. Mr. Almunia has vowed to restore competition to the Internet search business in Europe.

“History shows that competition law is applied to monopoly power more stringently in the E.U. than in the U.S.,” said Jacques Lafitte, head of the competition practice at Avisa Partners, a consultancy in Brussels, who brought one of the original complaints against Google. “Whether the E.U. is right or not is a different question.”

Mr. Lafitte has some expertise in the matter. He is the former head of corporate affairs at Microsoft Europe and watched as that company did battle with regulators over its dominant computer operating system. Microsoft won a lenient settlement with the Justice Department in October 2001, he said, only to be slapped with nearly 1.6 billion euros, or $2.1 billion, in fines and penalties from the European Union from 2004 to 2008.

Google learned from Microsoft’s mistakes. It worked with authorities in both the United States and Europe to reach a deal rather than fight a desperate legal action. That approach appears to have paid off: last month, after a meeting with Eric E. Schmidt, Google’s executive chairman, Mr. Almunia said that the sides had “substantially reduced our differences.”

In its deal with the F.T.C., Google agreed to make concessions in two areas that concerned European regulators. In one, it will allow rivals to opt out of allowing Google to “scrape,” or copy, text from their sites. Google will probably offer the same concession to European authorities.

But in a second area of European concern — whether Google deliberately favors its own content in search results — the F.T.C. did not require changes.

Mr. Almunia has also demanded that Google put fewer restrictions on advertising distribution deals, an area his American counterparts did not explore.

The company will make a detailed set of proposed remedies in January. The European Commission will then allow the complainants to review them in a period of what is known as “market testing.” Antitrust lawyers say a final denouement could arrive by spring, depending on how hostile Google’s rivals are to the proposed remedies.

FairSearch, an alliance of Google rivals, accused the F.T.C. of rushing its decision. It said in a statement that closing the F.T.C. investigation “with only voluntary commitments from Google is disappointing and premature.”

The outcome in Europe may also be affected by Google’s dominance there. Google’s share of the United States search market was 67 percent in November, according to comScore, a digital analytics company, while its share in Europe was 83 percent that month.

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Plane Carrying Vittorio Missoni Lost Near Venezuela

MILAN — The Italian fashion designer Vittorio Missoni, the head of the prominent fashion house, was aboard a small plane that has disappeared off the coast of Venezuela, a company spokeswoman said on Saturday.

“The Missoni family has been informed by the Venezuelan Consulate that Vittorio Missoni and his wife are missing, but we don’t know any more,” the spokeswoman, Maddalena Aspes, said. “The authorities will resume their search for the plane in the morning.”

Italian media reported that the plane went missing on Friday morning after takeoff from the resort of Los Roques, an island off the coast of Venezuela. Also reported to have been aboard the plane with Mr. Missoni, 58, and his wife, Maurizia Castiglioni, were another couple and two Venezuelan crew members.

Mr. Missoni is the son of the founders of the family owned fashion house famous for its exuberantly colored knits, featuring bold stripes and zigzags. He owned the business with two siblings, Luca and Angela.

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U.S. Continues to Add Jobs at Slow Pace, Report Shows

Despite their concerns about looming tax increases and government spending cuts, American employers added 155,000 jobs in December, about apace with job growth over the last year, the Labor Department reported on Friday.

The biggest gains were in health care, food services, construction and manufacturing, and the government sector showed modest job losses, the report said. The unemployment rate was 7.8 percent, the same as in November, whose rate was revised up from 7.7 percent.

“It’s not a home-run report by any stretch, but it’s constructive,” said John Ryding, chief economist at RDQ Economics. “It’s another month of fairly stable, solid, moderate job creation.”

Over the course of 2012, the country added 1.8 million jobs, despite continued job losses in the government sector and anxiety related to the presidential election and scheduled tax increases and spending cuts. 

Economists are unsure of what the rest of the year holds for the American job market, but most are forecasting more of the same: hiring fast enough to stay just ahead of population growth, but still too slow to make a sizable dent in the 12.2-million-person backlog of unemployed workers.

A number of encouraging trends in the economy suggest that businesses have good reason to speed up hiring, including the housing recovery, looser credit for small businesses, a rebound in China and pent-up demand for new autos. Friday’s report also showed slightly faster wage growth and longer working hours in December, both of which bode well for hiring.

But Congress’s last-minute deal earlier this week to raise taxes will offset some of these sources of growth, since higher taxes trim how much money consumers have available to spend each week.

“Job creation might firm a little bit, but it’s still looking nothing like the typical recovery year we’ve had in deep recessions in the past,” Mr. Ryding said. “There’s nothing in the deal to do that and nothing in this latest jobs report to suggest that. We’re a long way short of the 300,000 job growth that we need."

The fiscal compromise also renewed for a year the federal government’s emergency unemployment benefits program. That allows workers to continue receiving unemployment benefits for up to 73 weeks, depending on the unemployment rate in the state where they live, and acts as a stimulus to the American economy because unemployment benefits are spent almost immediately.

The extension has proved to be a tremendous relief to the two million workers who would have otherwise abruptly lost their benefits this week.

“We woke up on Wednesday morning and saw the news and just said, ‘thank God, thank God, thank God,’ and then went out and went food shopping because we knew we had money coming in,” said Gina Shadis, 56, of Newton, N.J.

Both she and her husband, Stephen, were laid off within the last 14 months from jobs they had held for more than a decade: she from a quality assurance manager position at an environmental testing lab, and he as foreman and senior master technician at an auto dealership. They are now each receiving $548 per week in federal jobless benefits, or about a quarter of their pay at their most recent jobs.

“It has just been such a traumatic time,” she said. “You know you wake up in the morning with shoulders tense and head aching because you didn’t sleep the night before from worrying.”

While Congress’s deal on New Year’s Day brought clarity to tax and unemployment benefits policies, lawmakers have still not settled their disputes about federal spending cuts and the debt ceiling. Economists worry that the lingering uncertainty over these issues could discourage businesses from investing in more workers or equipment.

“We may be seeing the calm before the storm right now,” said Ian Shepherdson, chief economist at Pantheon Macroeconomic Advisors, noting that a recent survey from the National Federation of Independent Business found that alarmingly few small companies plan to hire in the coming months. “Small businesses are wringing their hands in horror at what’s going on in Washington.”

In the meantime, more than six million workers have exhausted their unemployment benefits altogether since the recession began in December 2007, according to the National Employment Law Project, a labor advocacy group.

Millions of workers are sitting on the sidelines and so are not counted in the total tally of unemployed. Some are merely waiting for the job market to improve, and others are trying to invest in skills to appeal to employers who are already hiring.  

“I have a few prospects who say they want me to work for them when I graduate,” said Jordan Douglas, a 24-year-old single mother in Pampa, Tex., who is enrolled in a special program that allows her to receive jobless benefits while attending school full time to become a registered nurse. She gets $792 in benefits every two weeks, a little less than half of what she earned in an administrative position at the nursing home that laid her off last year.

She calculates that her federal jobless benefits will run out the very last week of nursing school.

“This had to have been a sign from God that I had to do this since it all worked out so well,” she said.

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Scant Proof Is Found to Back Up Claims by Energy Drinks

Energy drinks are the fastest-growing part of the beverage industry, with sales in the United States reaching more than $10 billion in 2012 — more than Americans spent on iced tea or sports beverages like Gatorade.

Their rising popularity represents a generational shift in what people drink, and reflects a successful campaign to convince consumers, particularly teenagers, that the drinks provide a mental and physical edge.

The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers.

“If you had a cup of coffee you are going to affect metabolism in the same way,” said Dr. Robert W. Pettitt, an associate professor at Minnesota State University in Mankato, who has studied the drinks.

Energy drink companies have promoted their products not as caffeine-fueled concoctions but as specially engineered blends that provide something more. For example, producers claim that “Red Bull gives you wings,” that Rockstar Energy is “scientifically formulated” and Monster Energy is a “killer energy brew.” Representative Edward J. Markey of Massachusetts, a Democrat, has asked the government to investigate the industry’s marketing claims.

Promoting a message beyond caffeine has enabled the beverage makers to charge premium prices. A 16-ounce energy drink that sells for $2.99 a can contains about the same amount of caffeine as a tablet of NoDoz that costs 30 cents. Even Starbucks coffee is cheap by comparison; a 12-ounce cup that costs $1.85 has even more caffeine.

As with earlier elixirs, a dearth of evidence underlies such claims. Only a few human studies of energy drinks or the ingredients in them have been performed and they point to a similar conclusion, researchers say — that the beverages are mainly about caffeine.

Caffeine is called the world’s most widely used drug. A stimulant, it increases alertness, awareness and, if taken at the right time, improves athletic performance, studies show. Energy drink users feel its kick faster because the beverages are typically swallowed quickly or are sold as concentrates.

“These are caffeine delivery systems,” said Dr. Roland Griffiths, a researcher at Johns Hopkins University who has studied energy drinks. “They don’t want to say this is equivalent to a NoDoz because that is not a very sexy sales message.”

A scientist at the University of Wisconsin became puzzled as he researched an ingredient used in energy drinks like Red Bull, 5-Hour Energy and Monster Energy. The researcher, Dr. Craig A. Goodman, could not find any trials in humans of the additive, a substance with the tongue-twisting name of glucuronolactone that is related to glucose, a sugar. But Dr. Goodman, who had studied other energy drink ingredients, eventually found two 40-year-old studies from Japan that had examined it.

In the experiments, scientists injected large doses of the substance into laboratory rats. Afterward, the rats swam better. “I have no idea what it does in energy drinks,” Dr. Goodman said.

Energy drink manufacturers say it is their proprietary formulas, rather than specific ingredients, that provide users with physical and mental benefits. But that has not prevented them from implying otherwise.

Consider the case of taurine, an additive used in most energy products.

On its Web site, the producer of Red Bull, for example, states that “more than 2,500 reports have been published about taurine and its physiological effects,” including acting as a “detoxifying agent.” In addition, that company, Red Bull of Austria, points to a 2009 safety study by a European regulatory group that gave it a clean bill of health.

But Red Bull’s Web site does not mention reports by that same group, the European Food Safety Authority, which concluded that claims about the benefits in energy drinks lacked scientific support. Based on those findings, the European Commission has refused to approve claims that taurine helps maintain mental function and heart health and reduces muscle fatigue.

Taurine, an amino acidlike substance that got its name because it was first found in the bile of bulls, does play a role in bodily functions, and recent research suggests it might help prevent heart attacks in women with high cholesterol. However, most people get more than adequate amounts from foods like meat, experts said. And researchers added that those with heart problems who may need supplements would find far better sources than energy drinks.

Hiroko Tabuchi contributed reporting from Tokyo and Poypiti Amatatham from Bangkok.

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Scant Proof Is Found to Back Up Claims by Energy Drinks

Energy drinks are the fastest-growing part of the beverage industry, with sales in the United States reaching more than $10 billion in 2012 — more than Americans spent on iced tea or sports beverages like Gatorade.

Their rising popularity represents a generational shift in what people drink, and reflects a successful campaign to convince consumers, particularly teenagers, that the drinks provide a mental and physical edge.

The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers.

“If you had a cup of coffee you are going to affect metabolism in the same way,” said Dr. Robert W. Pettitt, an associate professor at Minnesota State University in Mankato, who has studied the drinks.

Energy drink companies have promoted their products not as caffeine-fueled concoctions but as specially engineered blends that provide something more. For example, producers claim that “Red Bull gives you wings,” that Rockstar Energy is “scientifically formulated” and Monster Energy is a “killer energy brew.” Representative Edward J. Markey of Massachusetts, a Democrat, has asked the government to investigate the industry’s marketing claims.

Promoting a message beyond caffeine has enabled the beverage makers to charge premium prices. A 16-ounce energy drink that sells for $2.99 a can contains about the same amount of caffeine as a tablet of NoDoz that costs 30 cents. Even Starbucks coffee is cheap by comparison; a 12-ounce cup that costs $1.85 has even more caffeine.

As with earlier elixirs, a dearth of evidence underlies such claims. Only a few human studies of energy drinks or the ingredients in them have been performed and they point to a similar conclusion, researchers say — that the beverages are mainly about caffeine.

Caffeine is called the world’s most widely used drug. A stimulant, it increases alertness, awareness and, if taken at the right time, improves athletic performance, studies show. Energy drink users feel its kick faster because the beverages are typically swallowed quickly or are sold as concentrates.

“These are caffeine delivery systems,” said Dr. Roland Griffiths, a researcher at Johns Hopkins University who has studied energy drinks. “They don’t want to say this is equivalent to a NoDoz because that is not a very sexy sales message.”

A scientist at the University of Wisconsin became puzzled as he researched an ingredient used in energy drinks like Red Bull, 5-Hour Energy and Monster Energy. The researcher, Dr. Craig A. Goodman, could not find any trials in humans of the additive, a substance with the tongue-twisting name of glucuronolactone that is related to glucose, a sugar. But Dr. Goodman, who had studied other energy drink ingredients, eventually found two 40-year-old studies from Japan that had examined it.

In the experiments, scientists injected large doses of the substance into laboratory rats. Afterward, the rats swam better. “I have no idea what it does in energy drinks,” Dr. Goodman said.

Energy drink manufacturers say it is their proprietary formulas, rather than specific ingredients, that provide users with physical and mental benefits. But that has not prevented them from implying otherwise.

Consider the case of taurine, an additive used in most energy products.

On its Web site, the producer of Red Bull, for example, states that “more than 2,500 reports have been published about taurine and its physiological effects,” including acting as a “detoxifying agent.” In addition, that company, Red Bull of Austria, points to a 2009 safety study by a European regulatory group that gave it a clean bill of health.

But Red Bull’s Web site does not mention reports by that same group, the European Food Safety Authority, which concluded that claims about the benefits in energy drinks lacked scientific support. Based on those findings, the European Commission has refused to approve claims that taurine helps maintain mental function and heart health and reduces muscle fatigue.

Taurine, an amino acidlike substance that got its name because it was first found in the bile of bulls, does play a role in bodily functions, and recent research suggests it might help prevent heart attacks in women with high cholesterol. However, most people get more than adequate amounts from foods like meat, experts said. And researchers added that those with heart problems who may need supplements would find far better sources than energy drinks.

Hiroko Tabuchi contributed reporting from Tokyo and Poypiti Amatatham from Bangkok.

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Google’s Lawyers Work Behind the Scenes to Carry the Day

SAN FRANCISCO — For 19 months, Google pressed its case with antitrust regulators investigating the company. Working relentlessly behind the scenes, executives made frequent flights to Washington, laying out their legal arguments and shrewdly applying lessons learned from Microsoft’s bruising antitrust battle in the 1990s.

After regulators had pored over nine million documents, listened to complaints from disgruntled competitors and took sworn testimony from Google executives, the government concluded that the law was on Google’s side. At the end of the day, they said, consumers had been largely unharmed.

That is why one of the biggest antitrust investigations of an American company in years ended with a slap on the wrist Thursday, when the Federal Trade Commission closed its investigation of Google’s search practices without bringing a complaint. Google voluntarily made two minor concessions.

“The way they managed to escape it is through a barrage of not only political officials but also academics aligned against doing very much in this particular case,” said Herbert Hovenkamp, a professor of antitrust law at the University of Iowa who has worked as a paid adviser to Google in the past. “The first sign of a bad antitrust case is lack of consumer harm, and there just was not any consumer harm emerging in this very long investigation.”

The F.T.C. had put serious effort into its investigation of Google. Jon Leibowitz, the agency’s chairman, has long advocated for the commission to flex its muscle as an enforcer of antitrust laws, and the commission had hired high-powered consultants, including Beth A. Wilkinson, an experienced litigator, and Richard J. Gilbert, a well-known economist.

Still, Mr. Leibowitz said during a news conference announcing the result of the inquiry, the evidence showed that Google “doesn’t violate American antitrust laws.”

“The conclusion is clear: Google’s services are good for users and good for competition,” David Drummond, Google’s chief legal officer, wrote in a company blog post.

The main thrust of the investigation was into how Google’s search results had changed since it expanded into new search verticals, like local business listings and comparison shopping. A search for pizza or jeans, for instance, now shows results with photos and maps from Google’s own local business service and its shopping product more prominently than links to other Web sites, which has enraged competing sites.

But while the F.T.C. said that Google’s actions might have hurt individual competitors, over all it found that the search engine helped consumers, as evidenced by Google users’ clicking on the products that Google highlighted and competing search engines’ adopting similar approaches.

Google outlined these kinds of arguments to regulators in many meetings over the last two years, as it has intensified its courtship of Washington, with Google executives at the highest levels, as well as lawyers, lobbyists and engineers appearing in the capital.

One of the arguments they made, according to people briefed on the discussions, was that technology is such a fast-moving industry that regulatory burdens would hinder its evolution. Google makes about 500 changes to its search algorithm each year, so results look different now than they did even six months ago.

The definition of competition in the tech industry is also different and constantly changing, Google argued.

For instance, just recently Amazon and Apple, which used to be in different businesses than Google, have become its competitors. Google’s share of the search market has stayed at about two-thirds even though competing search engines are “just a click away,” as the company repeatedly argued. That would become the company’s mantra to demonstrate that it was not abusing its market power.

Claire Cain Miller reported from San Francisco, and Nick Wingfield from Seattle.

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The Lede: Video of Pakistani Schoolgirl Malala Yousafzai Walking Out of Hospital

Video of Malala Yousafzai, a young Pakistani activist, leaving Queen Elizabeth Hospital in Birmingham, England, on Thursday. The images were released without sound.

Malala Yousafzai, the 15-year-old Pakistani schoolgirl who survived an assassination attempt by Taliban militants, was discharged from Queen Elizabeth Hospital in Birmingham, England, on Thursday.

Ms. Yousafzai “is well enough to be treated by the hospital as an outpatient for the next few weeks,” the hospital said in a statement. “She is still due to be readmitted in late January or early February to undergo cranial reconstructive surgery as part of her long-term recovery, and in the meantime she will visit the hospital regularly to attend clinical appointments.”

The complete text of the statement was posted on the hospital’s Web site, along with video of the girl walking out of her hospital room under her own power.

Dr. David Rosser, the hospital’s medical director said: “Malala is a strong young woman and has worked hard with the people caring for her to make excellent progress in her recovery.”

Ms. Yousafzai became an outspoken advocate for the education for girls in Pakistan at the age of 11, when the BBC’s Urdu-language service published her “Diary of a Pakistani Schoolgirl.” The blog chronicled life under Taliban rule, after her home in the Swat Valley was overrun by the Islamist militants in 2009. (Later that year, the girl and her father were featured in a documentary by my colleague Adam Ellick.)

She was shot in the head by a militant in October and airlifted to England for treatment the same month.

Her father, Ziauddin, has been appointed to a three-year term as Pakistan’s education attaché in Birmingham, ITV News reported on Wednesday.

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Biogen Gives Up on Drug for Lou Gehrig’s Disease

A closely watched experimental drug to treat Lou Gehrig’s disease failed to work in a late-stage clinical trial, the drug’s developer, Biogen Idec, said Thursday. The company said it would discontinue further work on the drug.

Biogen said that the drug was not effective in either slowing the loss of muscular function or prolonging the lives of people with the disease, formally known as amyotrophic lateral sclerosis, or A.L.S.

There were also no signs that the drug, dexpramipexole, worked in any subgroup of patients, Biogen said.

“As a physician who has treated people with A.L.S., I hoped with all my heart for a different outcome,'’ Dr. Douglas Kerr, director of neurodegeneration clinical research at Biogen, said in a statement.

A.L.S., which attacks the nerves that control muscles, causes gradual paralysis and typically results in death within a few years of diagnosis. There are about 30,000 Americans with the disease.

There is only one drug approved to treat it, Rilutek, made by Sanofi, which doctors say has only modest effectiveness. Many other drugs have failed in clinical trials, in part because scientists do not understand the cause of A.L.S. and therefore do not know how to treat it.

While expectations had not been that high that dexpramipexole would succeed in its phase 3 trial, they were higher than for many previous A.L.S. drugs, given what some doctors viewed as strong results in a smaller, phase 2 trial.

“I’m more excited about this compound than any compound I’ve ever tested in A.L.S.,'’ Dr. Robert Miller, director of A.L.S. research at the California Pacific Medical Center in San Francisco, said in April on a call with investors hosted by Deutsche Bank. Patients getting the highest dose had an almost a 50 percent slower decline in muscular function than those receiving a placebo.

Biogen had licensed dexpramipexole from Knopp Biosciences, a privately held company in Pittsburgh. Biogen’s trial included 943 patients in 11 countries. The main measurement of success was a composite that took into account both deaths from the disease and the decline of functionality. Patients in the trial were allowed to take Rilutek.

Dr. Jeffrey D. Rothstein, director of the Brain Science Institute at Johns Hopkins University School of Medicine, said the results were disappointing but not surprising.

“We really, really need a new drug,'’ Dr. Rothstein, who was not involved in the phase 3 trial, said by e-mail. He said he thought the phase 2 results for dexpramipexole had been only “marginal,'’ so he was not surprised the latest trial did not succeed.

The reaction on Wall Street was somewhat muted because of the modest expectations for the trial to succeed. Biogen’s shares were down about 4 percent.

“We (and most of the Street) had characterized this trial as a high risk trial,'’ Mark Schoenebaum, an analyst at ISI Group, wrote in a research note Thursday.

Other companies are also developing drugs to treat A.L.S. Neuraltus Pharmaceuticals, a privately held company in Palo Alto, Calif., is preparing to enter the final stage of clinical trials for NP001.

The company announced in late October that its phase 2 trial, which involving 136 patients, failed to show a statistically significant benefit compared to a placebo. But the company said that 27 percent of patients getting the high dose of NP001 had no progression of their disease for six months, two and a half times as many as in the placebo group.

Cytokinetics, of South San Francisco, Calif., is in mid-stage testing of a compound, tirasemtiv, which might make muscles respond more forcefully to nerve signals.

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Hillary Clinton Is Discharged From Hospital After Blood Clot

Hillary Rodham Clinton, whose globe-trotting tour as secretary of state was abruptly halted last month by a series of health problems, was discharged from a New York hospital on Wednesday evening after several days of treatment for a blood clot in a vein in her head.

The news of her release was the first welcome sign in a troubling month that grounded Mrs. Clinton — preventing her from answering questions in Congress about the State Department’s handling of the lethal attack on an American mission in Libya or being present when President Obama announced Senator John Kerry as his choice for her successor when she steps down as secretary of state.

“Her medical team advised her that she is making good progress on all fronts, and they are confident she will make a full recovery,” Philippe Reines, a senior adviser to Mrs. Clinton, said in a statement.

Mrs. Clinton, 65, was admitted to NewYork-Presbyterian/Columbia hospital on Sunday after a scan discovered the blood clot. The scan was part of her follow-up care for a concussion she sustained more than two weeks earlier, when she fainted and fell, striking her head. According to the State Department, the fainting was caused by dehydration, brought on by a stomach virus. The concussion was diagnosed on Dec. 13, though the fall had occurred earlier that week.

The clot was potentially serious, blocking a vein that drains blood from the brain. Untreated, such blockages can lead to brain hemorrhages or strokes. Treatment consists mainly of blood thinners to keep the clot from enlarging and to prevent more clots from forming, and plenty of fluids to prevent dehydration, which is a major risk factor for blood clots.

Photographed leaving the hospital, Mrs. Clinton and her husband, former President Bill Clinton, and their daughter, Chelsea, appeared elated. In a Twitter post on Wednesday, Chelsea Clinton said, “Grateful my Mom discharged from the hospital & is heading home. Even more grateful her medical team confident she’ll make a full recovery.”

Dr. David J. Langer, a brain surgeon and associate professor at Hofstra North Shore-LIJ School of Medicine, said that Mrs. Clinton would need close monitoring in the next days, weeks and months to make sure her doses of blood thinners are correct and that the clot is not growing. Dr. Langer is not involved in her care.

Mrs. Clinton’s illness cuts short what would have been a victory lap for her at the State Department. With only a few weeks before the end of President Obama’s first term — the time frame she set for her own departure — she will be able to do little more than say goodbye to her troops.

But she will, at least theoretically, be able to testify before the Senate and House about the attack on the American mission in Benghazi, Libya, which killed four Americans, including Ambassador J. Christopher Stevens. She was not able to appear at a hearing in December because of her illness. Republicans, who have sharply criticized the Obama administration’s handling of the attack and its aftermath, had demanded that she appear to explain the department’s role, though in recent days they have modulated their request.

Mrs. Clinton’s blood clot formed in a large vein along the side of her head, behind her right ear, between the brain and the skull. The vein, called the right transverse sinus, has a matching vessel on the left side. These veins drain blood from the brain; blockages can cause strokes or brain hemorrhages. But if only one transverse sinus is blocked, the vein on other side can usually handle the extra flow.

In one sense, Mrs. Clinton was lucky: a clot higher in this drainage system, in a vessel with no partner to take the overflow, would have been far more dangerous, according to Dr. Geoffrey T. Manley, the vice chairman of neurological surgery at the University of California, San Francisco. He is not involved in her care.

The fact that Mrs. Clinton had a blood clot in the past — in her leg, in 1998 — suggests that she may have a tendency to form clots, and may need blood-thinners long-term or even for the rest of her life, Dr. Manley said.

One major risk to people who take blood thinners is that the drugs increase bleeding, so blows to the head from falls or other accidents — like the fall that caused Mrs. Clinton’s concussion — become more dangerous, and more likely to cause a brain hemorrhage. Even so, the medication should not interfere with Mrs. Clinton’s career, Dr. Manley said.

“There are lots of people running around on anticoagulants today,” he said. “I don’t see any way it would have any long-term consequences.”

He also said there was no reason to think that this type of clot would recur; he said he had treated many patients for the same condition and had never seen one come back with it again.

Dr. Langer said the vein blocked by the clot might or might not reopen. Sometimes, he said, the clot persists and the body covers it with tissue that closes or narrows the blood vessel. As long as the vein on the other side of the head is open, there is no problem for the patient.

One thing that is unclear, and that may never be known for sure, is what caused Mrs. Clinton’s blood clot. Around the second week in December, she reportedly contracted a stomach virus that caused vomiting and dehydration, passed out, fell and struck her head. A concussion was diagnosed several days after the fall, on Dec. 13, and the public was told Sunday that she had a blood clot, though its location was not revealed until the next day.

She had several risk factors for clots, including dehydration and her previous history of a clot. In addition, women are more prone than men to this type of clot, particularly when dehydrated. The fall may also have been a factor, though it is not clear whether her head injury was serious enough to have caused a blood clot. The type of clot she had is far more likely to be associated with a skull fracture than with a concussion, several experts said.

Did overwork — frequent overseas trips, perpetual jet lag, high-pressure meetings — make her ill? Mrs. Clinton has kept up a punishing schedule since she declared her candidacy for president in 2007. Having logged more than 950,000 miles and visited 112 countries, she is one of the most-traveled secretaries of state in history. She has put on weight and in recent times appeared fatigued. But the same could be said of plenty of people who do not develop clots in their heads.

“You cannot tell me that her hard work resulted in this,” Dr. Langer said. “I can’t imagine that you could make that judgment.”

In theory, Dr. Manley said, exhaustion can weaken the immune system temporarily, and lower a person’s resistance to infections like the stomach virus that apparently started Mrs. Clinton’s problems. But in his opinion, the most important contributing factor to her blood clot was probably the head injury from her fall.

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