Digital Technology Is Making Its Mark in Cuba

Jose Goitia for The New York Times

The director Carlos Lechuga at the International Festival of New Latin American Cinema in Havana.

HAVANA — Sebastián Miló barely had enough money to put gasoline in the aged bus that ferried his crew to the set each day, let alone to pay actors a salary.

But Mr. Miló, a 33-year-old Cuban filmmaker, had a Canon 5D digital camera and a story to tell. So, during one frenetic week in May 2011, he shot “Truckdriver,” a tense 25-minute film about bullying at one of the vaunted rural boarding schools where millions of Cubans used to spend part of their high school education.

“It was something I went through myself, and so did many people I know,” said Mr. Miló, referring to incidents of bullying that dogged him at school and, later, during military service. “The subject struck a chord.”

Mr. Miló is one of hundreds of Cuban filmmakers who, armed with digital technology, are laying the foundations of an independent movie industry outside the state apparatus that has defined Cuban cinema for much of the Castro era — and still, much to the frustration of some filmmakers, controls access to the island’s movie theaters.

Around the country, Cubans are making features, shorts, documentaries and animated works, often with little more than a couple of friends and some inexpensive equipment — and little input from the state-supported Cuban Institute of Cinematic Art and Industry.

Mr. Miló, who received about $10,000 in financing from a Spanish production company, Idunnu Music and Visual Arts, said that the crew and actors worked for next to nothing. “They said they felt strongly about what the film was saying,” he said.

The global boom in digital filmmaking has rippled across Cuba over the past decade, letting filmmakers create their work beyond the oversight of state-financed institutions. Independent movies have become a new means of expression in a country where, despite freedoms and economic reforms introduced by President Raul Castro since 2006, the state still carefully controls national press, television and radio, and access to the Internet is very limited.

While there is no official tally of independent movies, they have gained prominence on the national scene. They dominate the Cuban offerings at the International Festival of New Latin American Cinema in Havana and scored a new level of commercial visibility last year with “Juan of the Dead,” a zombie movie that was released in several countries, including the United States.

“They’re bringing fresh ideas; they’re experimenting,” said Javier Ernesto Alejándrez, 21, a humanities student waiting in line last month to see the independent feature “Pablo,” shown as part of the film festival.

“There’s a lot of creativity, and they are really thinking about stuff,” said Alexandra Halkin, the director of the Americas Media Initiative, a nonprofit group that distributes and promotes Cuban film overseas. “They just need more tools and more space.”

For decades, the film institute was an important tool of the government’s program to educate Cubans and build a national narrative under the Communist system, annually producing dozens of documentaries and features and nurturing acclaimed directors, including Tomás Gutiérrez Alea (known as Titon), Humberto Solás and Fernando Pérez. The institute’s financing plummeted after the Soviet Union collapsed, and it now relies on foreign sources to produce a handful of features each year.

The explosion of independent film has yielded an uneven jumble of movies that draw on genres eschewed by the establishment — like thrillers and horror — and that offer raw depictions or biting satire about the darker side of life on the island.

Miguel Coyula, whose surreal, fragmentary feature “Memories of Overdevelopment” was shown at the Sundance Film Festival in 2010, said that while no specific trend had emerged, there was a greater willingness to tackle riskier and risqué subjects — even Fidel Castro — and document issues not covered by the official press.

Some movies offer a glimmer of a promising new generation, experts and filmmakers say, citing the experimental documentaries of Marcel Beltrán and Armando Capó, which will be included in a program at the Museum of Modern Art in February; Victor Alfonso’s humorous animated shorts about a high school nerd; Carlos Machado Quintela’s feature-length movie “The Swimming Pool,” about a group of physically disabled children and their swimming instructor; and the work of more established practitioners like Mr. Coyula and Esteban Insausti, whose work has been screened at many foreign festivals, including Cannes.

Carlos Lechuga, 29, whose debut feature film, “Melaza” (“Molasses”), tells a story of social degradation in a sugar town whose mill has been shuttered, said that independent movies were nourishing a conversation among Cubans keen to see the hard realities of their lives dealt with on screen.

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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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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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After Fiscal Deal, Tax Code May Be Most Progressive Since 1979

WASHINGTON — With 2013 bringing tax increases on the incomes of a small sliver of the richest Americans, the country’s top earners now face a heavier tax burden than at any time since Jimmy Carter was president.

The last-minute deal struck by the departing 112th Congress raised taxes on a handful of the highest-earning Americans, with about 99.3 percent of households experiencing no change in their income taxes. But the Tax Policy Center estimates that the average family in the top 1 percent will pay a federal tax rate of more than 36 percent this year, up from 28 percent in 2008. That is the highest rate since 1979, at least.

By some measures, the tax code might now be the most progressive in a generation, tax economists said, while noting that every American is paying a lower burden currently than they did then. In fact, the total federal tax rate is still vastly lower for the very rich than it was at any point in the 1940s through 1970s. It has risen from historical lows, but is still closer to those lows than where it was in the postwar decades.

“We made the system more progressive by raising rates at the top and leaving them for everyone else,” said Roberton Williams of the Tax Policy Center, a research group based in Washington. “The offsetting issue is that the rich have gotten a lot richer.”

Indeed, over the last three decades the bulk of pretax income gains have gone to the wealthy — and the higher up on the income scale, the bigger the gains, with billionaires outpacing millionaires who outpaced the merely rich. Economists doubted that the tax increases would do much to reverse that trend.

With the recovery failing to improve incomes for millions of average Americans and the country running trillion-dollar deficits, President Obama made “tax fairness” a centerpiece of his re-election campaign. In the heated negotiations with House Speaker John A. Boehner, that translated into the White House’s insistence on tax increases for the top 2 percent of households and a continuation of tax breaks and cuts for a vast number of taxpayers.

Republicans resisted increasing tax rates and aimed for lower revenue targets, arguing that spending was the budget’s primary problem and that no American should see his or her taxes go up too much in such a sluggish economy. But ultimately they relented, and Congress cut a last-minute deal.

“A central promise of my campaign for president was to change the tax code that was too skewed towards the wealthy at the expense of working middle-class Americans,” Mr. Obama said after Congress reached an agreement.

That deal includes a host of tax increases on the rich. It raises the tax rate to 39.6 percent from 35 percent on income above $400,000 for individuals, and $450,000 for couples. The rate on dividends and capital gains for those same taxpayers was bumped up 5 percentage points, to 20 percent. Congress also reinstated limits on the amount households with more than $300,000 in income can deduct. On top of that, two new surcharges — a 3.8 percent tax on investment income and a 0.9 percent tax on regular income — hit those same wealthy households.

As a result of the taxes added in both the deal and the 2010 health care law, which came into effect this year, taxpayers with $1 million in income and up will pay on average $168,000 more in taxes. Millionaires’ share of the overall federal tax burden will climb to 23 percent from 20 percent.

The result is a tax code that squeezes hundreds of billions of dollars more from the very well off — about $600 billion more over 10 years — while leaving the tax burden on everyone else mostly as it was. And the changes come after 30 years of both Republican and Democratic administrations doing the converse: zeroing out federal income taxes for many poor working families while also reducing the tax burden for households on the higher end of the income scale.

“Back at the end of the Carter and beginning of the Reagan administrations, we had a pretty severe income-tax burden for people at a low level of income. It was actually kind of appalling,” said Alan D. Viard, a tax expert at the American Enterprise Institute, a right-of-center research group in Washington. “Policy makers in both parties realized that was bad policy and started whittling away at it” by expanding credits and tinkering with tax rates.

After those changes and the new law, comparing average tax rates for poor households and wealthy households, 2013 might be the most progressive tax code since 1979. But economists cautioned that measuring progressivity is tricky. “It’s not like there is some scientific measure of progressivity all economists agreed upon,” said Leonard E. Burman, a professor of public affairs at Syracuse University. “People look at different numerical measures and they’ve changed in different ways at different income levels.”

Mr. Viard said that over time the code had become markedly more progressive for the poor compared with the middle class. But it arguably did not become much more progressive for the rich compared with the middle class, or the very rich compared with the rich, in part because of the George W. Bush-era tax cuts on investment income.

An anesthesiologist who earns a $500,000 salary subject to payroll and income taxes might pay a higher tax rate than a hedge fund manager making $1 billion subject mostly to capital-gains taxes, for instance.

Economists are also divided on the ultimate effect of those tax increases on the wealthy to income growth and income inequality in the United States. The recession hit the incomes of the rich hard, but they have snapped back much more strongly than those for middle or low-income workers.

“I’d still rather be really rich, even if I’m getting taxed much more than a low-income person” would be, Mr. Williams of the Tax Policy Center added.

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India Ink: Lawmakers in India Charged With Crime Could Face Speedier Trials

India’s Supreme Court on Friday asked the government to consider fast-tracking trials of lawmakers who are facing criminal charges, lawyers said, after activists filed a petition demanding legislators accused of abusing women be disqualified from public office.

Six state legislators have charges of rape against them, and 36 have been charged with other crimes against women, according to a Dec. 20 report by the Association for Democratic Reforms.

The Supreme Court rejected activists’ demands that these lawmakers be suspended from their offices when charged, saying the court was not empowered to make such a decision. The activists’ demands were part of two sweeping public interest litigations reviewed by the court on Friday, filed in response to a recent gang rape in Delhi that resulted in the death of a 23-year-old woman.

The government has announced several measures in response to outrage over the gang rape in recent weeks, including faster courts, women’s hotlines and an initiative to review the country’s rape law. Civil society groups and activists, however, are demanding broader reforms.

The Supreme Court on Friday asked the government to respond to several requests, including the establishment of fast-track courts in all states to try sex offenses, the formulation of judicial norms for the payment of compensation to rape victims, the filling of vacancies in the police force, the creation of a national toll-free helpline for victims of rape and child abuse and the creation of a registry of convicted sexual offenders to be circulated among the police force.

The court rejected a demand for a reduction in security for high-profile figures like politicians and diplomats, which many say reduces the police force for other citizens, and for the investigation of crimes against women by female officers only.

“We have asked for many systemic changes,” said Promilla Shankar, one of the petitioners and a former government officer who worked in India’s administrative services. “What is needed is a complete overhaul of the judicial and governance system.”

India’s top court has already given directions on many of the changes activists are demanding. In November, while considering a case on “Eve-teasing,” a term used in South Asia to mean sexual harassment, the court directed the government to deploy female police officers in all busy public places, held the managers of places like educational institutions, worship houses and movie theaters responsible for preventing sexual abuse, and required operators of public vehicles to report cases of harassment to the police.

In Ms. Shankar’s petition, the Supreme Court was asked to suspend “tainted” police officers, government officials and members of Parliament and legislative assemblies who are facing rape or murder charges. The petition also demanded that the trials of these high-profile suspects be expedited, and if they are found guilty, they should be dismissed.

In India, a lawmaker convicted by a lower court can keep his position by appealing the decision in a higher court. These cases often continue for years, if not decades.

“Lawmakers should be people of a certain character and caliber,” Ms. Shankar said. “What can the people expect if their representatives have criminal cases pending against them?”

Activists have also objected to political parties who field candidates with criminal charges pending. In the 2009 general elections, six candidates, from various parties, had been charged with rape, and in the last five years, political parties have nominated 27 candidates with rape charges against them, according to the report by the Association for Democratic Reforms, a nonprofit that works for electoral reforms.

These cases represent a “minuscule number” of actual crimes, said Anil Bairwal, the organization’s national coordinator, as a large number of such crimes are not reported, and politicians are able to use their considerable influence to prevent prosecution.

In an effort to “name and shame” the accused politicians, the report includes their names and political parties and details the charges against them.

“These are the people in whose hands the people have given the country, so to speak,” said Mr. Bairwal. “This is not a small matter.”

Petitions filed by the Association for Democratic Reforms over a decade ago resulted in an order that requires candidates to declare their financial, educational and criminal background, but only those who have been convicted of a crime are disqualified from running for office. A separate petition to disallow candidates who are facing criminal charges has been pending in the courts since 2005.

“A much simpler solution is to put pressure on political parties not to have candidates who have criminal charges,” said Jagdeep Chhokar, one of the founders of the Association for Democratic Reforms. “But that is not happening in this country because of the obstinacy or shamelessness of the political parties.”

Public anger poured out in Assam this week against a Congress politician, Bikram Singh Brahma, who was accused of raping a married woman. Television footage showed a bare-chested man being beaten by a group of women shortly before his arrest. Mr. Brahma was subsequently suspended from his party.

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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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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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U.S. Economy Adds 155,000 Jobs; Jobless Rate Is 7.8%

American employers added 155,000 jobs in December, about apace with job growth over the last year, the Labor Department reported on Friday.

Source: Bureau of Labor Statistics

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.”

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.

But Congress’s last-minute deal to raise taxes earlier this week 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” said Mr. Ryding. “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 2 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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Depardieu, in Tax Fight, Gets Russian Citizenship

MOSCOW (AP) — Gerard Depardieu, the French actor who has waged a battle against a proposed super-tax on millionaires in his native country, has been granted Russian citizenship.

A brief announcement on the Kremlin website on Thursday revealed that President Vladimir Putin signed the citizenship grant following an application from the actor.

The former Oscar nominee and star of the movie "Green Card" has been vocal in his opposition to French President Francois Hollande's plans to raise the tax on earned income above €1 million ($1.33 million) to 75 percent from the current high of 41 percent. Russia has a flat 13-percent tax rate.

"I have never killed anyone, I don't think I've been unworthy, I've paid €145 million in taxes over 45 years," Depardieu wrote in an open letter in mid-December to Prime Minister Jean-Marc Ayrault, who had called the actor "pathetic."

"I will neither complain nor brag, but I refuse to be called 'pathetic,'" the 64-year-old actor wrote in his response.

A representative for the former Oscar nominee declined to say whether he had accepted the Russian offer, and refused all comment. Thursday was a holiday in Russia and officials from the Federal Tax Service and Federal Migration Service could not be reached for comment on whether the decision would require Depardieu to have a residence in Russia.

Depardieu said in his letter to Ayrault that he would surrender his passport and French social security card. In October, the mayor of a small Belgian border town announced that Depardieu had bought a house and set up legal residence there, a move that was slammed by the newly-elected Socialist government.

Najat Vallaud-Belkacem, the French government spokeswoman, didn't comment directly on Depardieu's tax fight, but drew a clear distinction between people who have personal or professional reasons to live abroad, and "French citizens who proclaim loudly and clearly that they they're exiling themselves for fiscal reasons."

She said Putin's offer "is an exclusive prerogative of the Russian chief of state."

Depardieu has had increasingly high-profile ties with Russia. Last October he visited the capital of Chechnya, Grozny, to celebrate the birthday of Chechen President Ramzan Kadyrov. And in 2011, he was in Russia's Arkhangelsk region to play the lead role in the film "Rasputin."

"You have to understand that Depardieu is a star in Russia," Vladimir Fedorovski, a Russian writer living in France, told the network Europe 1 on Thursday. "There are crowds around Depardieu. He's a symbol of France. He's a huge ambassador of French culture."

Though France's highest court struck down the two-year tax on Dec. 29, the government has promised to resubmit the law in a slightly different form soon. On Wednesday it estimated that the court decision to overturn the tax would cost it €210 million in 2013.

In an interview published Sunday, Depardieu told the Sunday Parisien that the court decision made no difference.

France's debt burden is around 90 percent of national income — not far off levels that have caused problems elsewhere in the 17-country eurozone.

Depardieu has made more than 150 films, among them the 1991 comedy "Green Card" about a man who enters into a marriage of convenience in order to get U.S. residency. Most famously, Depardieu was nominated for an Academy Award for his role as Cyrano de Bergerac in the 1990 film by the same name.

The Kremlin statement gave no information on why Putin made the citizenship grant, but the Russian president expressed sympathy with the actor in December, days after Depardieu reportedly said he was considering Russian citizenship.

"As we say, artists are easily offended and therefore I understand the feelings of Mr. Depardieu," Putin said.

Although France and Russia disagree sharply about how to resolve the civil war in Syria, the two countries have strong commercial relations. In 2011, Russia signed a contract worth more than €1 billion ($1.33 billion) Friday to buy two French warships — the largest military deal between a NATO country and Moscow.

Depardieu is well known in Russia, where he appears in an ad for Sovietsky Bank's credit card and is prominently featured on the bank's home page.

Depardieu is not the only high-profile Frenchman to object to the super-tax. Bernard Arnault — chief of the luxury goods and fashion giant LVMH and worth an estimated $41 billion — has also said he would leave for Belgium.

France's Civil Code says one must have another nationality in order to give up French citizenship because it is forbidden to be stateless. Thursday's decision by the Kremlin appears to fulfill that requirement.

____

Hinnant contributed from Paris. Silvie Corbet also contributed from Paris.

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New York Comptroller Sues Qualcomm for Data on Political Giving

The New York State comptroller, attempting to force greater public disclosure of corporate political spending, sued Qualcomm on Wednesday, demanding to view internal records of political expenditures by the company, one of the country’s largest makers of computer chips for mobile devices.

The suit by the comptroller, Thomas P. DiNapoli, was a novel and potentially significant tactic in the running battle over corporate political spending in the post-Citizens United era, after a 2010 Supreme Court ruling that opened the door to unlimited political spending by corporations and unions.

Qualcomm’s founder, the billionaire Irwin Jacobs, and some of the company’s top executives, are major donors to the Democratic Party: Mr. Jacobs contributed at least $2.3 million to three Democratic super PACs including one dedicated to re-electing President Obama, last year.

Mr. DiNapoli, a Democrat, is also seeking to determine whether Qualcomm made corporate contributions to tax-exempt groups and trade associations that are not required to disclose their donors. Such groups poured hundreds of millions of dollars into the 2012 election, including money from large corporations seeking to avoid negative publicity or customer outcries.

It is not clear whether Qualcomm has contributed to tax-exempt groups. The company did not reply to requests for comment about the suit. Mr. DiNapoli is asserting the right to access Qualcomm’s spending records as the sole trustee of the New York State pension fund, which is a major shareholder in Qualcomm and one of the largest public institutional investors in the country. He maintains that the contributions could pose financial risks for shareholders.

Qualcomm is based in California but registered in Delaware, where state law gives shareholders the right under some circumstances to inspect a company’s books.

Mr. DiNapoli filed the lawsuit in a state court in Delaware after Qualcomm rebuffed requests by the New York pension fund and other institutional investors to disclose its political spending. If successful, Mr. DiNapoli could establish a precedent giving shareholders the right to inspect contribution records.

“We’ve done the petitions and the letter-writing,” Mr. DiNapoli said in an interview. “We’ve done shareholder resolutions. Rather than continue to be rebuffed, we’re taking this new approach.”

Mr. DiNapoli’s suit is one of a wave of actions by pension funds and other institutional investors attempting to limit or force disclosure of corporate political spending in the wake of the Citizens United ruling. More than 100 shareholder resolutions concerning corporate political contributions were filed last year, according to Institutional Shareholder Services, which tracks proxy actions.

“We believe that shareholders have a right to know how money is being spent in the political arena,” said Amy Borrus, deputy director of the Council of Institutional Investors, an association of pension funds, endowments and foundations. “Boards need to step up to the plate and ensure that political checks that a company writes enhance, not erode, shareholder value.”

Many of the new efforts to force disclosure of contributions are emerging in New York, where some of the nation’s biggest corporations and charities do business, giving state and local elected officials — the leverage to pursue political spending that has national implications.

The New York State attorney general, Eric T. Schneiderman, has spent several months investigating political spending by politically active tax-exempt groups that raise money in New York; last month, he issued a regulation that will force many of them to disclose their donors. Bill de Blasio, the New York City public advocate, who is a trustee of the city’s pension fund, has secured pledges from a number of large businesses that they will not spend money on political campaigns.

Mr. DiNapoli’s suit, filed in Delaware Chancery Court, is known as a books-and-records demand. While such demands are typically used to try to prove mismanagement, waste, or wrongdoing by corporate executives or board members, the comptroller’s complaint asserts that political spending creates financial risk for companies and that shareholders should be entitled to be able to evaluate those risks.

“It really gets to the heart of the question of transparency,” Mr. DiNapoli said. “How is a corporation spending money in the political process and how does that impact shareholder value? The first step in evaluating that from a shareholder perspective is to find out where the money is being spent.”

Harvey Pitt, who was chairman of the Securities and Exchange Commission under President George W. Bush, said he believed that Mr. DiNapoli’s suit was consistent with the purpose of the Delaware law that permits such records demands.

“I don’t want to predict where the Delaware court will come out, but where you have a very large shareholder and something related directly to corporate governance, it seems to me a pretty compelling circumstance” under the state law, Mr. Pitt said.

Qualcomm scores relatively low on the CPA-Zicklin Index, a ranking of corporations’ policies on political transparency, which was created by the Center for Political Accountability, a nonprofit watchdog organization. The company spent about $4.7 million on lobbying last year and its employees and executives made at least $456,799 in contributions to candidates and parties last year.

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The New Old Age Blog: On the Way to Hospice, Surprising Hurdles

I’ve often wondered why more families don’t call hospice when a loved one has a terminal disease — and why people who do call wait so long, often until death is just days away.

Even though more than 40 percent of American deaths now involve hospice care, many families still are trying to shoulder the burden on their own rather than turning to a proven source of help and knowledge. I’ve surmised that the reason is families’ or patients’ unwillingness to acknowledge the prospect of death, or physicians’ inability to say the h-word and refer dying patients to hospice care.

But maybe there’s another reason. A study in the journal Health Affairs recently pointed out that hospices themselves may be turning away patients because of certain restrictive enrollment policies. It’s possible, too, that physicians who know of these policies aren’t referring patients whom the doctors fear wouldn’t qualify.

Surprisingly, this randomized national survey of almost 600 hospice programs represents the first broad inquiry into enrollment practices, though it’s been nearly 30 years since hospice became a Medicare benefit.

Nearly 80 percent of hospice programs, the study found, reported having at least one policy that could restrict access. “It represents a barrier to people who want hospice care but can’t receive it,” said lead author Melissa Aldridge Carlson, a geriatrics and palliative care researcher at the Mount Sinai School of Medicine.

What kind of barriers are we talking about? More than 60 percent of hospices won’t accept a patient on chemotherapy, and more than half won’t take someone relying on intravenous nutrition. Many won’t enroll patients receiving palliative radiation or blood transfusions; a few say no to tube feeding.

This made more sense a couple of decades ago, when Medicare developed the regulations requiring patients to forgo curative treatments when they entered hospice. Hospice patients must have a terminal disease, likely to cause death within six months, so such treatments were presumed futile.

But medicine evolves. Now, Dr. Aldridge Carlson pointed out, the distinction between curative and palliative treatments has grown blurry. “It’s increasingly an artificial dichotomy,” she said. “That’s not the reality for most patients today with end-stage disease.”

Chemotherapy, for instance, is often used to shrink tumors that cause pain; radiation can prevent nausea and vomiting for patients with bowel obstructions. Though neither will cure a terminal cancer, as palliative treatments they can improve quality of life. Blood transfusions can help anemic cancer patients feel better, too, at least for a while.

Why, then, would hospices not accept dying people using these treatments? First, these are expensive to provide. The national average Medicare reimbursement for hospice care is just $140 a day, the study notes, and it’s not adjusted to reflect the cost of more complicated regimens. Besides, hospices worry about running afoul of Medicare regulations and being denied even that inadequate reimbursement.

This probably explains why the researchers found that smaller hospices were more likely than large ones to say no to patients receiving such treatments. “If you’re a small hospice caring for someone with many medical issues and the reimbursement doesn’t even cover the care – and then Medicare comes to take it back – that’s a big hit,” Dr. Aldridge Carlson said. Larger organizations with more patients and bigger budgets can better absorb the costs.

One bright note, though, is that almost 30 percent of the hospices studied offer some kind of open access enrollment without insisting on those prohibitions. Much more common in nonprofit hospices (a pity, because the real growth is in for-profit ones), open access usually means enrolling people who don’t yet meet the Medicare criteria, then converting them to Medicare patients as they become eligible.

At Gilchrist Hospice Care in Baltimore, for instance, patients still using chemotherapy, radiation, transfusions and several other treatments can enter what it calls “expanded care,” sometimes also known as “concurrent care.” (At Gilchrist, however, such patients still must meet the six-month hospice eligibility requirement.)

“If you say, ‘You can’t get blood transfusions any more,’ people say, ‘Why would I go with your program?’” said Regina Bodnar, Gilchrist’s clinical director. The hospice’s concurrent program “is not so either/or.”

People who enter hospice care with palliative treatments usually decide to forgo them anyway when they become less effective or more burdensome, Ms. Bodnar said, but “this allows people to make the transition over time.” As the largest hospice program in Maryland, a nonprofit with generous donors, Gilchrist can afford this more flexible, but expensive, approach.

Could it be the future of hospice? That would require Medicare to make some changes in eligibility and reimbursement practices — a shift that might bolster Medicare’s solvency, too.

“Hospice saves money because it keeps people out of the hospital,” Dr. Aldridge Carlson said. Even more expensive outpatient treatments, like palliative radiation, are less costly than days spent in intensive care. Adjusting policies to allow more patients into hospice might bring costs down.

But as important, it could make the call to hospice a slightly less terrifying prospect and provide more families with the help they need at the end of life. “We need to take down the barriers to hospice care,” Ms. Bodnar said, “and this is one way to do it.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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The New Old Age Blog: On the Way to Hospice, Surprising Hurdles

I’ve often wondered why more families don’t call hospice when a loved one has a terminal disease — and why people who do call wait so long, often until death is just days away.

Even though more than 40 percent of American deaths now involve hospice care, many families still are trying to shoulder the burden on their own rather than turning to a proven source of help and knowledge. I’ve surmised that the reason is families’ or patients’ unwillingness to acknowledge the prospect of death, or physicians’ inability to say the h-word and refer dying patients to hospice care.

But maybe there’s another reason. A study in the journal Health Affairs recently pointed out that hospices themselves may be turning away patients because of certain restrictive enrollment policies. It’s possible, too, that physicians who know of these policies aren’t referring patients whom the doctors fear wouldn’t qualify.

Surprisingly, this randomized national survey of almost 600 hospice programs represents the first broad inquiry into enrollment practices, though it’s been nearly 30 years since hospice became a Medicare benefit.

Nearly 80 percent of hospice programs, the study found, reported having at least one policy that could restrict access. “It represents a barrier to people who want hospice care but can’t receive it,” said lead author Melissa Aldridge Carlson, a geriatrics and palliative care researcher at the Mount Sinai School of Medicine.

What kind of barriers are we talking about? More than 60 percent of hospices won’t accept a patient on chemotherapy, and more than half won’t take someone relying on intravenous nutrition. Many won’t enroll patients receiving palliative radiation or blood transfusions; a few say no to tube feeding.

This made more sense a couple of decades ago, when Medicare developed the regulations requiring patients to forgo curative treatments when they entered hospice. Hospice patients must have a terminal disease, likely to cause death within six months, so such treatments were presumed futile.

But medicine evolves. Now, Dr. Aldridge Carlson pointed out, the distinction between curative and palliative treatments has grown blurry. “It’s increasingly an artificial dichotomy,” she said. “That’s not the reality for most patients today with end-stage disease.”

Chemotherapy, for instance, is often used to shrink tumors that cause pain; radiation can prevent nausea and vomiting for patients with bowel obstructions. Though neither will cure a terminal cancer, as palliative treatments they can improve quality of life. Blood transfusions can help anemic cancer patients feel better, too, at least for a while.

Why, then, would hospices not accept dying people using these treatments? First, these are expensive to provide. The national average Medicare reimbursement for hospice care is just $140 a day, the study notes, and it’s not adjusted to reflect the cost of more complicated regimens. Besides, hospices worry about running afoul of Medicare regulations and being denied even that inadequate reimbursement.

This probably explains why the researchers found that smaller hospices were more likely than large ones to say no to patients receiving such treatments. “If you’re a small hospice caring for someone with many medical issues and the reimbursement doesn’t even cover the care – and then Medicare comes to take it back – that’s a big hit,” Dr. Aldridge Carlson said. Larger organizations with more patients and bigger budgets can better absorb the costs.

One bright note, though, is that almost 30 percent of the hospices studied offer some kind of open access enrollment without insisting on those prohibitions. Much more common in nonprofit hospices (a pity, because the real growth is in for-profit ones), open access usually means enrolling people who don’t yet meet the Medicare criteria, then converting them to Medicare patients as they become eligible.

At Gilchrist Hospice Care in Baltimore, for instance, patients still using chemotherapy, radiation, transfusions and several other treatments can enter what it calls “expanded care,” sometimes also known as “concurrent care.” (At Gilchrist, however, such patients still must meet the six-month hospice eligibility requirement.)

“If you say, ‘You can’t get blood transfusions any more,’ people say, ‘Why would I go with your program?’” said Regina Bodnar, Gilchrist’s clinical director. The hospice’s concurrent program “is not so either/or.”

People who enter hospice care with palliative treatments usually decide to forgo them anyway when they become less effective or more burdensome, Ms. Bodnar said, but “this allows people to make the transition over time.” As the largest hospice program in Maryland, a nonprofit with generous donors, Gilchrist can afford this more flexible, but expensive, approach.

Could it be the future of hospice? That would require Medicare to make some changes in eligibility and reimbursement practices — a shift that might bolster Medicare’s solvency, too.

“Hospice saves money because it keeps people out of the hospital,” Dr. Aldridge Carlson said. Even more expensive outpatient treatments, like palliative radiation, are less costly than days spent in intensive care. Adjusting policies to allow more patients into hospice might bring costs down.

But as important, it could make the call to hospice a slightly less terrifying prospect and provide more families with the help they need at the end of life. “We need to take down the barriers to hospice care,” Ms. Bodnar said, “and this is one way to do it.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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DealBook: Hormel to Buy Skippy Peanut Butter

The Hormel Foods Corporation said on Thursday that it had agreed to buy the Skippy peanut butter business from Unilever for $700 million.

Unilever, the British-Dutch food and consumer products giant, announced in October that it was considering selling Skippy, the No. 2 peanut butter brand in the United States, behind J.M. Smucker’s Jif. Skippy has annual sales of roughly $370 million, with $100 million of that coming from outside the United States. It is the leading peanut butter brand in China.

It is the biggest acquisition by Hormel, known primarily for its fresh, cured, smoked and frozen meats. Nonfrozen grocery products account for 14 percent of its annual revenue, according to Thomson Reuters data. Its brands include Chi-Chi’s, Dinty Moore, El Torito and perhaps its best known, Spam.

The last big purchase by Hormel, based in Austin, Minn., was its $334 million acquisition of the Turkey Store Company in 2001, according to Standard & Poor’s Capital IQ data. The company said it expected that the Skippy acquisition would add 13 to 17 cents to earnings per share in its 2014 fiscal year.

The acquisition includes Unilever’s Skippy production plants in Little Rock, Ark., and in Weifang, China, Unilever said in a statement.

Jeffrey M. Ettinger, chief executive of Hormel, said in a statement: “The acquisition of the Skippy peanut butter business represents a significant opportunity for Hormel Foods. It allows us to grow our branded presence in the center of the store with a nonmeat protein product and it reinforces our balanced portfolio.”

Unilever has a huge portfolio of food and household goods brands, including Ben & Jerry’s ice cream, Dove soap and Lipton and PG Tips teas. It has shed brands in North America and Europe to focus on faster-growing emerging markets, which now account for more than half the conglomerate’s sales.

Barclays is advising Hormel Foods.

Lazard and the law firm of Cravath, Swaine & Moore advised Unilever.

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IHT Rendezvous: Hoping to End Decades-long Kurdish Conflict, Turkey Calls on Archenemy

LONDON — Turkish intelligence agents have been making the short hop from Istanbul across the Sea of Marmara to the prison Island of Imrali in recent weeks for talks with a jailed Kurdish separatist leader who was once Turkey’s most wanted man.

Abdullah Ocalan, founder of the Kurdistan Workers’ Party, the P.K.K., has been languishing on Imrali since he was captured in Nairobi, Kenya in 1999 while on the run. He is serving a life term after a death sentence was commuted.

Now the Turkish government wants his help to end a resurgent war with P.K.K. rebels that has claimed around 900 lives in the last year and a half.

Recep Tayyip Erdogan, the Turkish prime minister, revealed the dialog last week when he told state-run TRT television, “I cannot hold such meetings myself as a politician but the state has agents and they do.”

In an acknowledgement that the latest escalation in a three-decade battle against the Kurdish insurgents was probably unwinnable, Yalcin Akdogan, a senior adviser to Mr. Erdogan, said this week that the talks were aimed at persuading the P.K.K. to disarm.

“The government supports any dialog to this end that could result in a halt to violence,” Mr. Akdogan said in a television interview. “You cannot get results and abolish an organization only with armed struggle.”

The strategy of seeking a deal with the P.K.K. has implications for Turkey’s policy in neighboring Syria, where Kurdish militants linked to the organization have taken over territory vacated by retreating government forces.

Turkey “fears that an autonomous Kurdish region in Syria would become a haven for Kurdish militants to carry out cross-border attacks in the Kurdish areas in southeastern Turkey,” my colleague Tim Arango wrote recently in a report from the border region.

Tensions over Syria and the Kurdish issue have also led to a souring of Turkey’s relations with Iran and the Iraqi government in Baghdad, as Ankara struggled to cope with the aftermath of the so-called Arab Spring.

There is a question mark over how much authority the jailed Mr. Ocalan has over the P.K.K. leadership, which is based in the Qandil mountains in the Kurdish region of northern Iraq. “He remains a figure of symbolic importance,” Mr. Akdogan said of the P.K.K. founder. “But we still have to wait and see how Qandil will react.”

Mr. Ocalan’s capture in 1999 was a cause of national celebration among Turks after the worst years of a war that has cost 40,000 lives, including those of Turkish and Kurdish civilians. The P.K.K. is regarded as a terrorist organization by, among others, the United States and the European Union.

However, the Turkish authorities have not shrunk from dealing with Mr. Ocalan in the past to intervene in Kurdish matters.

In November, he saved the authorities from an escalating crisis that threatened to worsen tensions with the Kurds by calling on hundreds of his imprisoned supporters to halt a two-month hunger strike. The protesters had been demanding an end to Mr. Ocalan’s isolation and improved rights for Turkey’s Kurdish minority, which makes up 20 percent of its population.

Andrew Finkel wrote in the IHT’s Global Views opinion section that the intervention signaled the resumption of Mr. Ocalan’s career.

Mr. Ocalan is now reportedly demanding direct contact with the P.K.K.’s leadership and improved prison conditions as the price for his cooperation in persuading the militants to lay down their arms.

Some observers have cast doubt on the government’s strategy of dealing with Mr. Ocalan while failing to carry out reforms in favor of the country’s Kurdish minority.

David Rohde wrote in a Rendezvous article at the weekend that more than 10,000 Kurds were imprisoned in Turkey on various terrorism charges.

According to Hugh Pope, project director of the International Crisis Group in Turkey, the government of Mr. Erdogan is putting the cart before the horse. “They need to find a Kurdish settlement first before cutting a deal with the P.K.K.,” he told Rendezvous from Istanbul.

That would include instituting promised reforms that would give equality to Turkey’s Kurdish citizens, including the right to a Kurdish-language education.

“The P.K.K. wants to do a deal and obviously Ocalan is desperate to get out of jail,” Mr. Pope said. “He may be an essential ingredient but he’s not the magic key.”

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Tech Giants, Learning the Ways of Washington, Brace for More Scrutiny

Mario Tama/Getty Images

Nadine Wolf demonstrated against online piracy legislation a year ago in New York. The measures were defeated.

SAN FRANCISCO — Silicon Valley lobbied hard in Washington in 2012, and despite some friction with regulators, fared fairly well. In 2013, though, government scrutiny is likely to grow. And with this scrutiny will come even greater efforts by the tech industry to press its case in the nation’s capital and overseas.

In 2012, among other victories, the industry staved off calls for federal consumer privacy legislation and successfully pushed for a revamp of an obscure law that had placed strict privacy protections on Americans’ video rental records. It also helped achieve a stalemate on a proposed global effort to let Web users limit behavioral tracking online, using Do Not Track browser settings.

But this year is likely to put that issue in the spotlight again, and bring intense negotiations between industry and consumer rights groups over whether and how to allow consumers to limit tracking.

Congress is likely to revisit online security legislation — meant to safeguard critical infrastructure from attack — that failed last year. And a looming question for Web giants will be who takes the reins of the Federal Trade Commission, the industry’s main regulator, this year. David C. Vladeck, the director of the commission’s Bureau of Consumer Protection, has resigned, and there have been suggestions that its chairman, Jon Leibowitz, would step down.

The agency is investigating Google over possible antitrust violations and will subject Facebook to audits of its privacy policy for the next 20 years. Its next steps could serve as a bellwether of how aggressively the commission will take on Web companies in the second Obama administration.

“Now that the election is over, Silicon Valley companies each are thinking through their strategy for the second Obama administration,” said Peter Swire, a law professor at Ohio State University and a former White House privacy official. “The F.T.C. will have a new Democratic chairman. A priority for tech companies will be to discern the new chair’s own priorities.”

In early 2012, an unusual burst of lobbying by tech companies helped defeat antipiracy bills, which had been backed by the entertainment industry. Silicon Valley giants like Facebook and Google feared that the bills would force them to police the Internet.

At the end of the year, Silicon Valley also got its way when the Obama administration stood up against a proposed global treaty that would have given government authorities greater control over the Web.

The key to the industry’s successes in 2012 was simple: it expanded its footprint in Washington just as Washington began to pay closer attention to how technology companies affect consumers. “Privacy and security became top-tier important policy issues in Washington in 2012,” said David A. Hoffman, director of security policy and global privacy officer at Intel.

“Industry has realized it is important to be engaged,” he continued, “to make sure government stakeholders are fully informed and educated about the role that new technology plays and to make sure any action taken doesn’t unnecessarily burden the innovation economy while still protecting individual trust in new technology.”

At the end of 2012, tech companies were on track to have spent record amounts on lobbying for the year. In the first three quarters, they spent close to $100 million, which meant that they were likely to surpass the $127 million they spent on lobbying in 2011, according to an analysis by the Center for Responsive Politics, a Washington-based nonpartisan group that tracks corporate spending. Even the venture capital firm Andreessen Horowitz hired a lobbyist in Washington: Adrian Fenty, a former mayor of the city.

Technology executives and investors also made generous contributions in the 2012 presidential race, luring both President Obama and Mitt Romney to Northern California for fund-raisers and nudging them to speak out on issues like immigration overhaul and lower tax rates.

In a blog post in November, the center said Silicon Valley’s lobbying expenditures have ballooned in recent years, even as spending by other industries has fallen.

Facebook more than doubled its lobbying outlay in the year, reporting close to $2.6 million through the third quarter of 2012. Google spent more than any other company in the industry, doling out more than $13 million in the same period and more than double its nearest competitor, Microsoft, which spent just over $5.6 million in the same period.

Among Google’s advocates on Capitol Hill is a former Republican congresswoman, Susan Molinari, who heads Google’s office in Washington.

Google has particular reason to be engaged. It faces a wide-reaching antitrust investigation by the Federal Trade Commission, just as Microsoft did a decade ago. At issue is whether Google’s search engine results favor Google products over its rivals’.

Although the agency was ready to settle that case before the holidays, without harsh remedies, late last month it shelved the inquiry and put stronger penalties back in play. A resolution is expected in January.

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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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