The Washington Post - 22.02.2020

saturday, february 22 , 2020. the washington post eZ re A

Politics & the Nation

death-focused issue of the journal

Primates. “But we do know that

they’re constantly updating so-

cial information about each oth-

er. And their place in the social

network relates to how they use

the landscape, how they survive,

how they reproduce.”

The day after Victoria’s death,

many of the same elephants were

back. And over the next three

weeks, the researchers observed

members of five families interact-

ing with Victoria’s corpse. Some

would have known Victoria by

scent, if not sight, but many more

would have been strangers. If this

had been a wake, it would have

been well-attended.

Some elephants touched Victo-

ria’s body with their trunks, while

others tried to lift her stiffened

ears with their feet.

One obstacle to understanding

elephants’ experience — and their

reaction to death — is that the

animals’ world is inhabited by an

array of smells we can scarcely

imagine.

“This puts a big barrier be-

tween how we interpret what

they’re perceiving and interact-

ing with,” said co-author George

Wittemyer, a conservation biolo-

gist at Colorado State University

who has studied the elephants of

Kenya’s Samburu National Re-

serve for more than 20 years.

A bull named Omtata spent

eight minutes sniffing Victoria’s

body and the dirt around it. Ele-

phants continued to interact with

her body even after rangers had

removed the tusks to secure them

from poachers, and after scaven-

gers had reduced the carcass to

skin and bones. Other studies

have found that elephants show

extreme interest in skulls, jaws

and other bones from their own

species while paying little mind to

bones from cape buffaloes or gi-

raffes.

Other animals are also known

to interact with their dead. The

special issue of Primates explores

the behavior of several species,

from infanticide in chimpanzees

to avoidance and vigilance in

horses. In 2018, Ta hlequah, a Pa-

cific Northwest orca, swam carry-

ing the corpse of her dead calf for

17 days.

Because elephants are much

bigger than most animals, their

bodies take a very long time to

decompose. A dead capuchin

monkey might be eaten over-

night, and a whale’s body will

eventually float away or sink. But

an elephant skull could sit in

roughly the same place for years.

The same is true of elephant

tusks, which are important focal

points for elephants. Goldenberg

and Wittemyer documented an

elephant carrying a disarticulat-

ed tusk for more than three miles.

“They are touching each oth-

er’s tusks all the time,” s aid Gold-

BY LAURIE MCGINLEY

The Food and Drug Adminis-
tration on Friday approved the
first non-statin oral medication
for high cholesterol in almost two
decades, giving patients and doc-
tors another weapon against
heart disease, the number one
killer in the United States and
around the world.
The drug, bempedoic acid, is
the first in a new class of drugs to
treat low-density-lipoprotein
cholesterol, also called “bad” c ho-
lesterol, which causes the buildup
of fatty deposits in the arteries,
reducing blood and oxygen flow.
Cardiologists said the new
drug, which is taken as a pill once
a day, will be used primarily as an
add-on therapy for people who
are taking as high a dose of statin
medications as they can tolerate
but still have higher-than-desired
cholesterol. Studies showed that
bempedoic acid reduced choles-
terol by an average of 18 percent
in patients taking moderate- or
high-dose statins, compared with
the placebo group, said the manu-
facturer, Esperion Therapeutics
Inc.
The medicine also can be used
for patients who can tolerate only
low-dose statins or can’t take sta-
tins at all. In studies involving
those patients, it reduced LDL
cholesterol by 28 percent, the
company said.
Esperion, which is based in
Ann Arbor, Mich., said the drug’s
brand name will be Nexletol. Es-
perion also has applied to the
FDA for approval of a combina-
tion pill of bempedoic acid and
ezetimibe, a non-statin pill ap-
proved in 2002. In studies, the
combination pill reduced choles-
terol by about 38 to 44 percent,
depending on whether a person
was taking a statin and how
much, the company said. The
FDA decision is expected shortly.
Statins, which were introduced
in the 1980 s, are the premier
medicines for high cholesterol
and typically are the first drugs
prescribed along with changes in
diet and exercise. But they can
cause muscle aches and cramps,
making it hard for some people to
take the required dose, said Rob-
ert Rosenson, director of cardio-
metabolic disorders for Mount
Sinai Hospital. More than 10 per-
cent of people taking high-dose
statins had muscle pain, accord-
ing to a 2005 study.
Because bempedoic acid tar-

gets an enzyme in the liver, not in

muscles, it doesn’t cause muscle

pain, he said.

Rosenson, who wasn’t i nvolved

in the development of bempedoic

acid, said the drug reduces cho-

lesterol by a relatively modest

amount but could nevertheless be

helpful in achieving patients’

goals.

Recommended cholesterol lev-

els vary b y age and gender, but the

“optimal” l evel for LDL cholester-

ol is 100 milligrams per deciliter

or below, according to the Nation-

al Heart, Lung and Blood Insti-

tute. Experts say high-risk indi-

viduals, including those who have

had a heart attack, should aim for

below 70 mg/dl.

The FDA approved bempedoic

acid based on its cholesterol-low-

ering effect. Whether the drug

reduces the risk of heart attacks

and strokes is being studied as

part of a large outcomes trial

involving people who can’t toler-

ate statins. The trial is scheduled

to be completed in two years.

Bempedoic acid also can be

used with another class of heart

drugs, called PCSK9 inhibitors,

which are injectable medications

launched in 2015. They can re-

duce LDL cholesterol sharply

when combined with a statin. But

they initially cost about $14,000 a

year, causing insurers to balk.

Since then, prices have fallen

sharply, but uptake remains slow.

While the drugs “are highly effec-

tive, there are a lot of hassles with

prior authorization and they of-

ten get denied,” s aid Christie Bal-

lantyne, a cardiologist at Baylor

College of Medicine who ran the

late-stage clinical trial for bempe-

doic acid.

Ballantyne said that bempedo-

ic acid, along with the possible

new combination with ezetimibe,

will give doctors and patients

more ways to attack high choles-

terol — an approach that has

worked to treat high blood pres-

sure. “For blood pressure, we tend

to use lots and lots of combina-

tions, often in the same tablet,

and have been pretty successful,”

he said.

The FDA approved the drug for

patients with heart disease who

need to reduce their cholesterol

as well as for those who with an

inherited condition that causes

high cholesterol levels. But doc-

tors said they expected the drug

to be prescribed more broadly —

though that will depend partly on

the price and insurers’ reactions.

Esperion officials did not an-

nounce a price on Friday but

previously indicated it would be

about $10 a day, which would

make the drug less expensive

than the PCSK9 inhibitors but

more costly than statins, which

are available in cheap generic

versions.

[email protected]

Non-statin cholesterol drug approved

BY JASON BITTEL

In Kenya, there’s a spot on the
banks of the Ewaso Ng’iro River
where elephants like to congre-
gate. Ta ll acacia trees provide
shade for naps, and doum palms
supply date-like fruits that the
animals scarf up by the trunk-full.
It w as in this place that Victoria, a
55-year-old matriarch well-
known to scientists, drew her last
breaths in June 2013.
But that was not the end of
Victoria’s story.
Several elephants huddled
around the body, recalled ecolo-
gist Shifra Goldenberg, who was
observing the animals with col-
leagues that day. She noticed that
Malasso, a 14-year-old bull, was
one of the last to leave. Victoria
was his mother.
Later, when Goldenberg and
other researchers examined Vic-
toria’s body, they found two fresh
cuts in her cheek and at t he top of
her mouth. Both seemed to have
occurred after death. “We think
possibly [Malasso] tried to lift
her, because he has these long
tusks,” said Goldenberg, who
works at t he Smithsonian Conser-
vation Biology Institute.
Another elephant to linger was
a 10-year-old named Noor. She
was Victoria’s youngest daughter,
and when she finally plodded
away, the temporal glands on
each side of her head were
streaming liquid: a reaction
linked to stress, fear and aggres-
sion.
The researchers’ observations
of what happened in the days and
weeks after Victoria died — some
of the first to document how wild
elephants respond to loss — are
described in a new review paper
that examines more than 30 re-
ports.
When an elephant falls, the
loss is acknowledged and investi-
gated by other elephants, even
those unrelated to the deceased.
Death means something to ele-
phants, in other words — possibly
something emotional.
“We don’t know what’s going
on in their heads,” said Golden-
berg, a co-author of the paper,
which was published in a special,

enberg, who is also a research

fellow with San Diego Zoo Glob-

al’s Institute for Conservation Re-

search. “A nd they tend to show

disproportionate interest in tusks

relative to other bones.”

Joyce Poole, who contributed

observations reviewed in the new

paper, doesn’t shy away from at-

tributing emotion to what she has

witnessed. In an interview, she

recalled watching a female

named Polly die before her eyes in

Kenya.

“She just sort of tipped over,

spun around on a tusk, and fell.

Her legs kind of went up in the air,

and boom, that was it,” s aid Poole,

scientific director for the conser-

vation and education nonprofit

ElephantVoices.

The first elephants to find her

body were a trio of young, unre-

lated males. They spent upward

of an hour trying to lift Polly and

pulling on her tail and tusks

before eventually mounting her,

said Poole. That night, rangers

removed Polly’s tusks.

Poole said she returned the

next day to check on the body and

was amazed to again find three

elephants loitering around Polly,

including one that had been there

the day before.

“They were just standing over

her body where her face had been

hacked out, where her tusks had

been. And they were touching her

bloody face,” Poole said.

Another time, also in Kenya,

Poole watched as a female named

To nie tried again and again to get

her stillborn calf to stand. “She

stood over that calf and protected

it from hyenas and from jackals

for a couple of days,” s he said.

For Wittemyer, the loss of Vic-

toria — an elephant he followed

for decades — came with a kind of

unexpected joy. Victoria had led a

long, rich life.

“Certainly, it’s sad. But this is

what we would hope for, that

elephants can live out their lives

and die peacefully, in an area

where they’re not being hunted,”

Wittemyer said. “We got to watch

her die naturally, in a beautiful

part of the park, with her family

around her.”

[email protected]

When a wild elephant dies, that’s not the end of the story

Wolfgang kaehler/lightrocket/getty images

A baby African elephant stands between the legs of its mother in Namibia. A new review paper that describes how wild elephants respond

to loss documents how the death is acknowledged and investigated by other elephants, even those unrelated to the deceased.

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