New England editorial roundup

The Providence (R.I.) Journal, Nov. 29, 2013

New guidelines on the use of statins suggest that millions more Americans should be taking the popular cholesterol-lowering drugs. But for now, some caution is in order. New methods of calculating the related health risks may have gone overboard. More important, people in danger of developing heart disease or stroke may urgently need to make lifestyle changes, such as quitting smoking. Some statin users tell themselves they are protected by a magic pill, and need do nothing more.

Four years in the making, the new guidelines were developed by the American Heart Association and the American College of Cardiology. For the first time, they take strokes into account as well as heart attacks.

In some ways, the guidelines are simpler than the old process used to evaluate candidates for statins. Those expected to benefit are now divided into four groups: people who already have heart disease, or have had heart attacks or strokes; people with diabetes; people with very high levels of LDL or “bad” cholesterol (190 or above); and people over 40 with a 7.5 percent risk of having a heart attack in the next 10 years. It is in this latter category that the methods of calculating risk appear questionable.

Currently, statins are recommended for only about 15 percent of U.S. adults. The new guidelines potentially add 33 million people to the pool. Obviously, the benefits to the pharmaceutical industry would be substantial. Yet many doctors fear that patients themselves may not benefit. In addition, they could suffer from side effects such as muscle soreness and, more rarely, rashes, liver damage, Type 2 diabetes, cataracts and memory loss.

Roughly half the members of the expert panel that developed the guidelines have financial ties to cardiac-drug manufacturers; though nonprofits, the Heart Association and the College of Cardiology also receive drug-company support. That does not necessarily indicate bias, but it could in some cases.

Certainly, the panel’s guidelines are not always perfect. For a long time, statins were prescribed to reduce LDL cholesterol to a certain level. It turns out, though, that there was never enough evidence to support such specific targets. Under the new guidelines, these target levels have been dispensed with. That means many people now taking statins may not need them, and perhaps never did. Of course, perfection is difficult in matters of health advice.

Anyone on statins now, or thinking of starting, should weigh all of these considerations in consultation with their doctors. They should not be pressured into taking medicine they may not need. The new guidelines were published alongside recommendations that Americans incorporate moderate exercise and healthier eating into their daily routines. These remedies, though more challenging, have multiple benefits. Few will go wrong by embracing them.

The Day of New London, Nov. 27, 2013

The result of a nearly yearlong investigation into the circumstances surrounding the massacre of innocents at Sandy Hook Elementary School confirms the troubling reality that presented itself within days of the Dec. 14 shooting.

A deeply troubled, mentally ill young man had access to battlefield-type firearms designed to kill quickly, effectively and massively. For reasons defying explanation or investigation, he murdered his mother and then turned an elementary school into a killing field, leaving 20 first-graders and six educators dead.

Danbury State’s Attorney Stephen J. Sedensky III officially closed the investigation Monday, releasing a 44-page report summarizing the findings. There were no surprises.

Twenty-year-old shooter Adam Lanza acted alone.

Investigators could not determine a motive for the attack.

There were no earlier acts of violence by Lanza foreshadowing the events of Dec. 14.

Armed with a .223-caliber Bushmaster AR-15 semi-automatic rifle and carrying 31 pounds of ammo, Lanza killed so quickly that police had no reasonable chance to intervene. He killed himself with a handgun at 9:40 a.m., less than 5 minutes after the initial 911 call and 1 minute after the arrival of the first police.

He still had 253 rounds of ammunition on him at the time of the suicide.

The report provides further evidence of how disturbed an individual Lanza was and that the condition was long standing. A storybook he wrote as a 10-year-old fifth-grader is filled with disturbing images of armed and violent characters — including one who threatens to hurt and kill children in a classroom and another who declares, “Let’s hurt children.”

Family and educators recognized his problems. He received counseling. A doctor diagnosed Lanza with Asperger’s syndrome in 2005, according to the report. He also showed signs of acute obsessive-compulsive disorder. Once a young adult, he apparently refused medication or to take part in therapy.

In the last couple of years of his life, the behavior grew more bizarre. He spent much of his time in a Spartan bedroom, sunshine sealed out by black plastic bags taped to the windows. Lanza became obsessed with the subject of mass shootings, particularly at schools, exchanging emails on the topic and blogging about it.

In the darkened room he spent much time playing violent video games, including a game titled “School Shooting” in which the player controls a character who enters a school and shoots students.

The report provides some insight into why the killer’s mother and first victim, Nancy Lanza, indulged her disturbed son’s fascination with firearms. Guns were something through which she could still have a relationship with him. They went to shooting ranges and took a National Rifle Association safety course together. This shared interest continued to the end. Investigators found a check written by her for him to purchase a pistol.

Investigators say son and mother were communicating otherwise only through emails and texts.

Gun advocates will focus on the mental health issues, but those issues were recognized and until Dec. 14 Lanza had yet to do anything — in the eyes of the law — to suggest he was a threat to himself or others, the threshold for an order of detainment due to mental illness.

This tragedy comes down to his access to guns of mass destruction. At a scrawny 112 pounds he was not much of a physical threat. With his Bushmaster AR-15 he was a killing machine.

If anything, this report vindicates the passage of the tough new gun laws in Connecticut, broadening the definition of assault weapons that cannot be sold in the state, prohibiting the sale or purchase of high-capacity magazines like those used in the Newtown shooting, and requiring more in-depth background checks for all gun purchases.

The public will probably never know precisely why Lanza did what he did, but it knows how he was able to do it.

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