Author: Art Diamond

To Reduce the Huge Costs of Randomized Clinical Trials, Groups Are Excluded for Whom the Trials Matter Most

(p. D5) Geriatricians have complained for years that figuring out treatments for their patients becomes dramatically more difficult when older people are excluded from clinical trials and other research.

For an 83-year-old, what are the risks and benefits of a surgical procedure, drug or medical device tested primarily on those in their 50s? When a drug trial excludes those who have several diseases and take other drugs, how do the results pertain to older adults — most of whom have several diseases and take other drugs?

. . .

Critics of age exclusion had reason to celebrate in December, when the National Institutes of Health issued new policy guidelines for the research it funds.

Starting next January, grant applicants will have to explain how they intend to include people of all ages, providing acceptable justifications for any group they leave out. The agency will monitor investigators to make sure they comply.

“It’s the right starting point,” said Dr. Florence Bourgeois, a pediatrician at Harvard Medical School. (Children also wind up taking drugs tested only in adults.)

. . .

How often are old people left out of important medical research? In 2011, it looked like progress when Dr. Donna Zulman and her colleagues at the University of Michigan reviewed 109 clinical trials published in leading journals and found that just 20 percent set upper age limits for participation.

An earlier review of trials published from 1994 to 2006 had found that 39 percent shut out people over age 65.

But, as the University of Michigan team also pointed out, even without age limits, studies may bar participants who have multiple disorders or disabilities, or those with limited life expectancy or cognitive impairment. Some researchers won’t enroll nursing home residents.

Those restrictions, too, effectively push older people out of clinical trials and other studies.

Maddeningly, exclusion rates remain high even for studies of diseases particularly common at older ages. Dr. Bourgeois and her colleagues looked at clinical trials for heart disease medications, for instance — primarily blood thinners, cholesterol and blood pressure drugs.

More than half of the trials had upper age limits, usually 75 or 80, and only about 12 percent of participants were aged 75 or older. Yet nearly 40 percent of people hospitalized with heart attacks are over age 75.

For the full story see:

Paula Span. “The Clinical Trial Is Open. Older People Need Not Apply.” The New York Times (Tuesday, April 17, 2018 [sic]): D5.

(Note: ellipses added.)

(Note: the online version of the story has the date April 13, 2018 [sic], and has the title “The Clinical Trial Is Open. The Elderly Need Not Apply.”)

Some published academic articles supporting the points made in the passages quoted above are:

Bourgeois, Florence T., Liat Orenstein, Sarita Ballakur, Kenneth D. Mandl, and John P. A. Ioannidis. “Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease.” Journal of the American Geriatrics Society 65, no. 11 (Nov. 2017): 2354-61.

Bourgeois, Florence T., Srinivas Murthy, Catia Pinto, Karen L. Olson, John P.A. Ioannidis, and Kenneth D. Mandl. “Pediatric Versus Adult Drug Trials for Conditions with High Pediatric Disease Burden.” Pediatrics 130, no. 2 (Aug. 2012): 285-92.

Cruz-Jentoft, Alfonso J., Marina Carpena-Ruiz, Beatriz Montero-Errasquín, Carmen Sánchez-Castellano, and Elisabet Sánchez-García. “Exclusion of Older Adults from Ongoing Clinical Trials About Type 2 Diabetes Mellitus.” Journal of the American Geriatrics Society 61, no. 5 (May 2013): 734-38.

Lewis, Joy H., Meredith L. Kilgore, Dana P. Goldman, Edward L. Trimble, Richard Kaplan, Michael J. Montello, Michael G. Housman, and José J. Escarce. “Participation of Patients 65 Years of Age or Older in Cancer Clinical Trials.” Journal of Clinical Oncology 21, no. 7 (April 2003): 1383-89.

McGarvey, Caoimhe, Tara Coughlan, and Desmond O’Neill. “Ageism in Studies on the Management of Osteoporosis.” Journal of the American Geriatrics Society 65, no. 7 (July 2017): 1566-68.

Zulman, Donna M., Jeremy B. Sussman, Xisui Chen, Christine T. Cigolle, Caroline S. Blaum, and Rodney A. Hayward. “Examining the Evidence: A Systematic Review of the Inclusion and Analysis of Older Adults in Randomized Controlled Trials.” Journal of General Internal Medicine 26, no. 7 (July 2011): 783-90.

After Safe Drinking Water, Vaccines Were the Second “Most Successful Medical Interventions of the 20th Century”

(p. B11) Dr. Paul D. Parkman, whose research was instrumental in identifying the virus that causes rubella and developing a vaccine that has prevented an epidemic of the disease in the United States for more than 50 years, died on May 7 [2024] at his home in Auburn, N.Y., in the Finger Lakes region. He was 91.

. . .

In 1966, Dr. Parkman, Dr. Harry M. Meyer Jr. and their collaborators at the National Institutes of Health, including Maurice R. Hilleman, disclosed that they had perfected a vaccine to prevent rubella. Dr. Parkman and Dr. Meyer assigned their patents to the N.I.H. so that the vaccines could be manufactured, distributed and administered promptly.

“I never made a nickel from those patents because we wanted them to be freely available to everybody,” he said in an oral history interview for the N.I.H. in 2005.

President Lyndon B. Johnson thanked the researchers, noting that they were among the few who could “number themselves among those who directly and measurably advance human welfare, save precious lives, and bring new hope to the world.”

Still, after Dr. Parkman retired from the government in 1990, as director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, he expressed concern about what he called the unfounded skepticism that persisted about the value of vaccines.

“With the exception of safe drinking water, vaccines have been the most successful medical interventions of the 20th century,” he wrote in 2002 in Food and Drug Administration Consumer, an agency journal.

For the full obituary see:

Sam Roberts. “Paul D. Parkman, 91, Researcher Whose Work Helped to Eliminate Rubella.” The New York Times (Friday, May 24, 2024): B11.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the obituary has the date May 21, 2024, and has the title “Dr. Paul Parkman, Who Helped to Eliminate Rubella, Dies at 91.”)

The 2002 article by Parkman mentioned above is:

Parkman, Paul D. “We Can’t Forget the Value of Vaccines.” Food and Drug Administration Consumer 36, no. 4 (July-Aug. 2002): 40.

Rex Murphy Saw We Are Governed by People Who Look Down on Us

(p. B12) Rex Murphy, a Canadian newspaper, radio and television commentator who delighted his country’s conservatives with sharp attacks on environmentalists, liberal politicians and what he called their “woke politics,” died on May 9 [2024] in Toronto. He was 77.

His death, from cancer, was announced on the front page of The National Post, the widely read daily newspaper for which he wrote a column, one of several he had over the years in Canadian papers, including The Globe and Mail in Toronto. His editor at The National Post, Kevin Libin, said Mr. Murphy died in a hospital.

. . .

Mr. Murphy’s sharp political turn to the right — from commenting for centrist outlets like the CBC and The Globe and Mail, where he had a regular column until 2010, to the right-wing views he espoused at The National Post — had its roots in his own working-class background, in the view of those who knew him.

. . .

He regularly took on what he deemed the sins of “woke” politics and “wokeism.” In a February 2023 column, he wrote: “I have finally fixed upon the definition of progressivism. It means the dismissal of everything that counts, unconcern with what makes life hard for most, and a scorn for the realities of day to day; instead shepherding to very particular political interest groups.”

In his final days there were diatribes against critics of Israel during its war with Hamas and against the liberalism of Prime Minister Justin Trudeau.

. . .

Mr. Murphy was animated, Mr. Libin said, by “the sense that we were being governed by people who looked down on us.”

. . .

Throughout his career, Mr. Murphy set great store by verbal expression. His fans and his critics agreed that his distinctive, sometimes high-flown use of English was what set him apart from his country’s other journalists. Profiles noted that he was as devoted to the works of John Milton as he was to “The Simpsons.”

For the full obituary see:

Adam Nossiter. “Rex Murphy, 77, a Pundit on the Right in Canada.” The New York Times (Friday, May 24, 2024): B12.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the obituary was updated May 23, 2024, and has the title “Rex Murphy, a Dominant Pundit on the Right in Canada, Dies at 77.”)

Private-Sector Experimentation Versus Washington Inertia in the Fight for Longer Life

(p. A15) Amid today’s technological wizardry, it’s easy to forget that several decades have passed since a single innovation has dramatically raised the quality of life for millions of people. Summoning a car with one’s phone is nifty, but it pales in comparison with discovering penicillin or electrifying cities. Artificial intelligence is being heralded as the next big thing, but a cluster of scientists, technologists and investors are aiming higher. In the vernacular of Silicon Valley, where many of them are based, their goal is nothing less than disrupting death, and their story is at the center of “Immortality, Inc.” by science journalist Chip Walter.

. . .

That is the backdrop to Mr. Walter’s absorbing story, which he begins with a visit to Alcor, the Arizona-based organization that says it preserves corpses at minus 124 degrees Celsius “in an attempt to maintain brain viability after the heart stops.” (Current “patients” include baseball legend Ted Williams.) While this life-extending strategy, known as “cryonics,” is often ridiculed, the individuals profiled in “Immortality, Inc.” are high-status, highly regarded figures whose initiatives can’t be easily dismissed. What links them, writes Mr. Walter, is that “they are all troublemakers at heart.” They believe that the “conventional approaches” of most medical researchers and practitioners are, “at the very least, misguided.”

. . .

While “Immortality, Inc.” is focused on aging and the efforts to defy it, the book is also a gripping chronicle of private-sector experimentation and ingenuity in the face of inertia in Washington. “As recently as five years ago,” Mr. Walter writes, “the great pashas at [the National Institutes of Health] . . . looked upon aging research as largely crackpot.” He faults the Food and Drug Administration for refusing to classify aging as a disease. As a result, clinical trials—the foundation of medical research—can’t be conducted.

For the full review, see:

Matthew Rees. “BOOKSHELF; Birthdays Without End.” The Wall Street Journal (Monday, Jan. 27, 2020 [sic]): A15.

(Note: ellipses between paragraphs, added; ellipsis within paragraph, in original.)

(Note: the online version of the review has the date Jan. 26, 2020 [sic], and has the title “BOOKSHELF; ‘Immortality, Inc.’ Review: Birthdays Without End.”)

The book under review is:

Walter, Chip. Immortality, Inc.: Renegade Science, Silicon Valley Billions, and the Quest to Live Forever. Washington, D.C.: National Geographic, 2020.

A Libertarian Case for Trump

(p. A15) If we pull the lever for Mr. Trump in . . . swing states, we may get a slightly more libertarian president . . .

Some Libertarians find Mr. Trump unacceptable on grounds of principle. True, he is no libertarian, but Mr. Biden—the wokester, the socialist, the interventionist—is much further from us on the political-economic spectrum than Mr. Trump.

Others are put off by Mr. Trump’s obnoxious behavior. He engages in name-calling. He puts ketchup on filet mignon.

Mr. Trump grew up in Queens. I’m roughly his contemporary and come from Brooklyn. I assure you that everyone in New York City is personally unbearable (except Staten Islanders). It is a geographical-genetic disposition. Ignore it. This act of his is mostly tongue-in-cheek. New Yorkers actually have contests to see who is the most insufferable. Prizes are given out.

The Libertarian Party typically attracts 1% to 3% of the electorate. But when opinion polls ask respondents if they support low taxes, free enterprise, and an end to victimless crimes, some 20% to 25% say yes. Libertarians, loosely defined in this manner, can have an effect on the coming election.

For the full commentary, see:

Walter E. Block. “Libertarians Should Vote For Trump.” The Wall Street Journal (Wednesday, May 29, 2024): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date May 28, 2024, and has the same title as the print version.)

High and Growing Financial Burden of Cancer

The story quoted below would lead many to support socialized medicine, euphemistically called a “single-payer system” where the single payer is the taxpayer. But socialized medicine is inefficient and slows innovation. The main reason that cancer therapy has grown so costly is that the new therapies are very expensive to achieve approval. That expense could be slashed if we followed Milton Friedman’s suggestion to stop mandating hyper-expensive Phase 3 randomized clinical trials. (These are the large trials mainly intended to prove efficacy, while the much smaller and cheaper Phase 1 and Phase 2 trials are mainly intended to prove safety.) I am researching Friedman’s suggestion and hope to write more on it soon.

(p. A1) The economic burden of a cancer diagnosis is getting strikingly worse in the U.S., as drug and medical costs soar and more patients live longer with the disease. About 55% of cancer drugs introduced between 2019 and 2023 cost at least $200,000 a year, according to Iqvia’s Institute for Human Data Science. And an increasing number of patients are working-age, a group more likely to report financial hardship after diagnosis compared with older adults.

Nearly 60% of working-age cancer survivors report facing some financial difficulty. Many patients struggle to afford care and end up taking on debt, with some getting payday loans or running up credit cards. Cancer alone accounts for some 40% of medical campaigns seeking financial help on GoFundMe, research shows.

. . .

(p. A2) Among common diseases, cancer creates a uniquely difficult financial strain known as financial toxicity. Treatments with expensive medicines start immediately and come with a string of nonmedical costs. Chemotherapy and other treatments can leave patients too weak to work for weeks or months. This can result in a twofold blow, with patients losing income and their employer-sponsored health insurance.

. . .

The problem starts with costs for medical care and cancer drugs that have either risen above the rate of inflation or have high starting prices. Common cancer drugs have list prices that go well into the six figures: Imbruvica, which treats leukemia, has a list price of more than $213,000 for a full year. The average Medicare patient taking it paid $5,247 out-of-pocket in 2022, federal data show. AbbVie, one of the drug’s co-marketers, declined to comment.

. . .

Many insurers have shifted rising healthcare costs to patients. Some employer-backed plans require patients to pay a percentage of a drug’s cost, which can add up to thousands of dollars. One report found a 15% increase in out-of-pocket costs for privately insured, working-age cancer patients from 2009 to 2016. Patients also foot the bill for transportation, lodging, child care and parking.

. . .

People with cancer are at higher risk of ending up late on credit-card payments, mortgage payments, and experiencing other financial challenges than noncancer patients, according to research co-written by Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Center in Seattle.

Other research shows that patients with more out-of-pocket costs are more likely to delay starting their medications or stop taking them. Ramsey and his co-authors also found that cancer patients who file for bankruptcy had an 80% higher risk of dying than cancer patients who didn’t file.

“There actually was a pretty big detriment for survival,” he said.

For the full story, see:

Brianna Abbott and Peter Loftus. “Cancer Costs Destroy Finances: ‘It Broke Me’.” The Wall Street Journal (Wednesday, May 29, 2024): A1-A2.

(Note: ellipses added.)

(Note: the online version of the story has the date May 28, 2024, and has the title “Cancer Is Capsizing Americans’ Finances. ‘I Was Losing Everything.’.”)

One of the relevant papers co-authored by Ramsey and mentioned above is:

Ramsey, Scott D., Aasthaa Bansal, Catherine R. Fedorenko, David K. Blough, Karen A. Overstreet, Veena Shankaran, and Polly Newcomb. “Financial Insolvency as a Risk Factor for Early Mortality among Patients with Cancer.” Journal of Clinical Oncology 34, no. 9 (March 2016): 980-86.

Bdelloids Frozen for 24,000 Years Return to Life and Reproduce

(p. D2) Bdelloids can . . . come back to life after tens of thousands of years in deep freeze, according to a study published Monday [June 7, 2021] in the journal Current Biology. Bdelloids are one of a handful of teensy creatures, including tardigrades, that are known to survive incredibly inhospitable conditions.

. . .

For the study, scientists collected samples by drilling about 11 feet below the surface of permafrost in northeastern Siberia. They discovered living bdelloid rotifers locked in the ancient permafrost, whose average temperature hovers around 14 degrees Fahrenheit.

. . .

Radiocarbon-dating revealed the bdelloids were 24,000 years old. They then bounced back and were still capable of reproducing once thawed.

For the full story see:

Marion Renault. “The Deepest Sleeper: It Makes Rip Van Winkle Look Like an Amateur.” The New York Times (Tuesday, June 15, 2021 [sic]): D2.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date June 7, 2021 [sic], and has the title “This Tiny Creature Survived 24,000 Years Frozen in Siberian Permafrost.” Where the versions differ, in the passages quoted above I follow the online version.)

The study mentioned above is:

Shmakova, Lyubov, Stas Malavin, Nataliia Iakovenko, Tatiana Vishnivetskaya, Daniel Shain, Michael Plewka, and Elizaveta Rivkina. “A Living Bdelloid Rotifer from 24,000-Year-Old Arctic Permafrost.” Current Biology 31, no. 11 (June 7, 2021): R712-R713.

Physicians Are Neither Trained Nor Paid to Express the “Medical Heresy” that Good Health Depends on Good Nutrition

(p. A17) Amazingly, medical schools in the United States focus very little on nutrition. The topic, according to one study, gets less than 1% of the classroom time that aspiring physicians are required to sit through over four years—even though the foods and beverages people ingest are far and away, in America, the biggest drivers of disease.

Because of the knowledge gap, doctors routinely miss opportunities to counsel their patients on the connection between nutrition and health—thus allowing bad eating habits to keep doing major damage. This failure is one of many indictments that Robert Lustig, a physician, brings against America’s medical-nutritional establishment in “Metabolical,” a wide-ranging polemic that covers the misdeeds of food and beverage companies and the misinformation that, in his view, contributes to the undermining of health.

. . .

Dr. Lustig’s real complaint is with “ultra-processed” products, which account for 58% of Americans’ calorie intake. Such products—candy, crackers, deli meat, frozen pizzas, fruit juices—are increasingly found not just in supermarkets and restaurants but virtually everywhere: movie theaters, hardware stores, gas stations, even health clubs. They’re typically mass produced, have a long shelf life and offer low nutritional quality.

How low? Dr. Lustig characterizes these products as “poison” more than two dozen times. To validate the claim, he describes in detail how the dominant features of such foods—high in sugar but also teeming with nitrates and refined carbohydrates—lead to cancer and other chronic diseases like diabetes and heart disease. Roughly 60% of Americans are afflicted with such diseases today (up from 30% in 1980). Relatedly, unhealthy eating has contributed to the decline in U.S. life expectancy in recent years.

That doctors don’t do more to steer their patients away from such hazards is only part of Dr. Lustig’s attack on the medical profession. He believes that, on the whole, doctors are “parochial,” taking their cues mostly from other doctors and thus succumbing to herd thinking. He worries that too many elements in their professional world—research, clinical meetings, webinars—are underwritten by Big Pharma and that the little nutrition science they know is compromised by studies that are sponsored by food companies. He says that doctors “don’t listen” to their patients and prefer to reach for the “quickest and easiest form of treatment,” whether it works or not, in part because insurance companies have limited the length of patient visits. “Talking about lifestyle changes takes time that we don’t have—because that’s how we’ve been trained and how we get paid.”

. . .

Dr. Lustig says that his book is “both my act of contrition to you, the public, and my act of medical disobedience to the medical establishment.” He hints that he could write such a book only after retiring from clinical practice—at the University of California, San Francisco (where he is an emeritus professor)—because “no ivory tower academic bastion would want to take credit for the ‘medical heresy’ that you’ll find sandwiched within these pages.”

For the full review, see:

Matthew Rees. “BOOKSHELF; Is It Something I Ate?” The Wall Street Journal (Monday, May 10, 2021 [sic]): A17.

(Note: ellipses added.)

(Note: the online version of the review has the date May 9, 2021 [sic], and has the title “BOOKSHELF; ‘Metabolical’ Review: Is It Something I Ate?”)

The book under review is:

Lustig, Robert H. Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine. New York: Harper, 2021.

After This Virus Infects This Fungus, It Transforms the Fungus from Killer to Probiotic

(p. D2) Some 400 species of plants are thought to be susceptible to the pathogen, including soybeans, which fell in droves to the fungus in 2009, costing farmers $560 million. The fungus also goes dormant in soil for years, seeding new infections that can raze entire fields of crops.

Dr. Jiang has spent 10 years hot on Sclerotinia’s trail in the hopes of bringing the blight to heel. He and his colleagues now think they’ve found an answer: a treatment that doesn’t just stop the fungus from killing, but transforms it into a probiotic that can boost plant growth and enhance resilience to future disease. They reported their findings Tuesday in the journal Molecular Plant.

For the full story see:

Katherine J. Wu. “If it Goes Viral: Turning a Scourge Into a Farmer’s Friend.” The New York Times (Tuesday, October 6, 2020 [sic]): D2.

(Note: the online version of the story has the date Sept. 29, 2020 [sic], and has the title “Infected by a Virus, a Killer Fungus Turns Into a Friend.” Where the versions differ, the passages quoted above follow the more detailed online version.)

The article in Molecular Plant mentioned above is:

Zhang, Hongxiang, Jiatao Xie, Yanping Fu, Jiasen Cheng, Zheng Qu, Zhenzhen Zhao, Shufen Cheng, Tao Chen, Bo Li, Qianqian Wang, Xinqiang Liu, Binnian Tian, David B. Collinge, and Daohong Jiang. “A 2-Kb Mycovirus Converts a Pathogenic Fungus into a Beneficial Endophyte for Brassica Protection and Yield Enhancement.” Molecular Plant 13, no. 10 (2020): 1420-33.

Species Shifting Their Range Due to Climate Change May Have Enabled the “Playing Around With Resources” That Invented Farming

(p. D6) In the 1990s, archaeologists largely concluded that farming in the Fertile Crescent began in Jordan and Israel, a region known as the southern Levant. “The model was that everything started there, and then everything spread out from there, including maybe the people,” said Melinda A. Zeder, a senior research scientist at the Smithsonian National Museum of Natural History.

But in recent years, Dr. Zeder and other archaeologists have overturned that consensus. Their research suggests that people were inventing farming at several sites in the Fertile Crescent at roughly the same time. In the Zagros Mountains of Iran, for example, Dr. Zeder and her colleagues have found evidence of the gradual domestication of wild goats over many centuries around 10,000 years ago.

People may have been cultivating plants earlier than believed, too.

In the 1980s, Dani Nadel, then at Hebrew University, and his colleagues excavated a 23,000-year-old site on the shores of the Sea of Galilee known as Ohalo II. It consisted of half a dozen brush huts. Last year, Dr. Nadel co-authored a study showing that one of the huts contained 150,000 charred seeds and fruits, including many types, such as almonds, grapes and olives, that would later become crops. A stone blade found at Ohalo II seemed to have been used as a sickle to harvest cereals. A stone slab was used to grind the seeds. It seems clear the inhabitants were cultivating wild plants long before farming was thought to have begun.

“We got fixated on the very few things we just happened to see preserved in the archaeological record, and we got this false impression that this was an abrupt change,” Dr. Zeder said. “Now we really understand there was this long period where they’re playing around with resources.”

Many scientists have suggested that humans turned to agriculture under duress. Perhaps the climate of the Near East grew harsh, or perhaps the hunter-gatherer population outstripped the supply of wild foods.

But “playing around with resources” is not the sort of thing people do in times of desperation. Instead, Dr. Zeder argues, agriculture came about as climatic changes shifted the ranges of some wild species of plants and animals into the Near East.

Many different groups began experimenting with ways of producing extra food, which eventually enabled them to start a new way of life: settling down in more stable social groups.

For the full story see:

Carl Zimmer. “The First Farmers.” The New York Times (Tuesday, October 18, 2016 [sic]): D1 & D6.

(Note: the online version of the story has the date Oct. 17, 2016 [sic], and has the title “How the First Farmers Changed History.”)

The 2015 study co-authored by Dani Nadel and mentioned above is:

Snir, Ainit, Dani Nadel, Iris Groman-Yaroslavski, Yoel Melamed, Marcelo Sternberg, Ofer Bar-Yosef, and Ehud Weiss. “The Origin of Cultivation and Proto-Weeds, Long before Neolithic Farming.” PLOS ONE 10, no. 7 (July 22, 2015): e0131422.

Common Ritualistic Human Sacrifice Detract from the Myth of the Past as Golden Age

(p. D2) One thing that’s definitely gotten better over time: not as much ritualistic human sacrifice.

. . .

The authors list some run-of-the-mill techniques for human sacrifice, but others they mention are more, let’s say, specific: being crushed under a newly built canoe, or being rolled off the roof of a house and then decapitated.

For the full story see:

Tatiana Schlossberg. “Hierarchies: A Grisly Social Order.” The New York Times (Tuesday, April 5, 2016 [sic]): D2.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 4, 2016 [sic], and has the title “Why Some Societies Practiced Ritual Human Sacrifice.” Where the versions differ, in the passages quoted above I follow the more detailed account in the online version.)

The article quoted above references the following academic article:

Watts, Joseph, Oliver Sheehan, Quentin D. Atkinson, Joseph Bulbulia, and Russell D. Gray. “Ritual Human Sacrifice Promoted and Sustained the Evolution of Stratified Societies.” Nature 532, no. 7598 (April 4, 2016): 228-31.