Will Banning The Ammo Ban The Guns? Rush Thinks So.

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You know that something’s up in the gun business when Rush Limbaugh starts talking about gun control.  And what he was talking about today was the decision by the ATF to create a new standard for exempting certain kinds of so-called ‘armor-piercing’ bullets from the ban that Congress placed on such ammo in 1986.  The law was designed to prevent civilians from buying or carrying ammo whose bullets could penetrate body armor worn by police, but manufacturing exemptions were routinely granted if the ATF determined that the ammo was going to be used for ‘sporting purposes,’ which usually meant that it would be used in rifles, as opposed to handguns whose use usually served no hunting or sporting purposes at all.

The announcement by the ATF was picked up by Rush not because he cares a wit about guns, but because he could then go into a riff about how the ‘regime’ was once again using Executive actions to promote liberal policies which Congress would never pass.  By the time I turned off Rush off turned on my computer, the web was crawling with denunciations of the latest threat to 2nd Amendment rights, with the NRA calling the plan a “disaster” and the blogs following suit.  Because what the ATF is proposing is a ban on the manufacture of the 5.56×45 round, which just happens to be a cartridge designed for the AR-15.  Get rid of the ammo, get rid of the gun, right?

assault                The ATF might have left this whole issue alone were it not for the decision by gun makers to begin manufacturing handguns chambered for 5.56×45.  And this decision was based on the fact that AR-15 rifles, which had been a major part of the upswing in gun sales after the election of the Kenyan in 2008, can be turned into handguns by simply substituting a barrel of shorter length.  And since the determination of what constitutes a ‘sporting’ cartridge is based on whether it is designed primarily for rifle as opposed to handgun use, now that civilians can start walking around with AR-15 handguns, the exemptions for sporting use of the ammunition no longer hold.

What the ATF is now proposing are exemptions for this ammunition based on a much narrower definition of the kinds of guns for which such ammo would be used.  Basically, ammo manufacturers will be able to make and sell this cartridge only if it is loaded in a rimfire round (which is much less dangerous) or used in a single-shot handgun which, by definition, is rarely found in the hands of the bad guys committing all those crimes with guns.  Which doesn’t mean that AR-15 shooters won’t have anything to load into their guns, ipso facto they might as well throw the guns away.  What it does mean, however, is that the gun industry will finally have to fess up to the fact that AR-15 rifles, marketing campaigns notwithstanding, aren’t really sporting guns at all.

The AR-15 sold in the United States can actually take two rounds:  the 5.56×45 NATO cartridge with a 62-grain bullet, and the .223 Remington cartridge, normally loaded with a 55-grain shell. The difference, as you might suspect, is that the 5.56×45 penetrates more deeply, is significantly more lethal, and when loaded into a 5.56×45 chamber, tends to be a bit more accurate than the 223. The 5.56×45 was adopted by the military because of its lethality, and it’s a stretch to think of it as a ‘sporting’ round.

The gun industry is challenging the ATF ruling not because it will mean the end of ‘black’ guns, but because they want to have it both ways.  On the one hand they want to promote AR-15s as the newest style of sporting guns for hunting or just plain fun.  On the other hand, they also want to promote these weapons as the latest and greatest ‘tools’ for personal defense.  Either way, I guarantee you that the net result of Limbaugh’s rant will be a disappearance of all AR-15 ammo within the next couple of days.

 

 

What Can Doctors Do To Reduce Gun Violence? Tell Us What Only They Know.

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Next week’s issue of the New England Journal of Medicine will contain an editorial, “Guns, Society and Medicine,” written by the Journal’s former editor, Jerome Kassirer.  This editorial follows hard on the heels of another editorial, “Preventing Firearm Injury and Death” which just appeared in the Annals of Internal Medicine.  The good news about these statements is that they appear to reflect a growing consensus in the medical community that physicians should play a more active role in the debate about guns.  The bad news, it seems to me, is that the manner in which physicians appear to be lining up to engage in the debate may actually diminish the value of what they have to say.

The statement in the Annals, signed off by eight medical professional organizations (AAP, ACEP, ACP, etc.) calls for vigorous support of the following measures: universal background checks, elimination of physician “gag” laws, restrictions on the sale of assault rifles and high-capacity feeding devices, additional research, improved mental health services and avoidance of stigmatization through non-specific reporting laws.  These measures were adopted by the eight medical societies after the American Bar Association confirmed that they did not conflict with 2nd-Amendment rights.

conference program pic                In his NEJM editorial, Jerome Kassirer voices his support for these same measures but notes that gun-safety advocates appear to be losing the battle due primarily to the “reality that gun-control advocates are ’outgunned’  by the NRA.”  It should be noted, inter alia, that in the twelve months following Sandy Hook, dues received by the NRA jumped more than 60% from $108 million in 2012 to $175 million in 2013, an increase due to the ability of the organization to sell the idea that the public outcry over what happened in Newtown would result in all guns being taken away.

I have been listening to gun-safety advocates bemoan the political power and financial muscle of the NRA for more than twenty years while, at the same time, researchers continue to publish articles which rightly demonstrate that the losses from gun ownership outweigh the gains.  There simply is no question that scholars like Hemenway, Cook, Webster and so many others have produced a body of literature about gun risk that cannot be honestly challenged by the other side.  But the other side isn’t interested in participating in a scholarly debate.  The other side is interested in selling guns.  And as long as guns are legal commerce, why shouldn’t it be up to the individual consumer to decide whether gun ownership represents a risk?

The answer to that question, and the role that I believe physicians should play in the gun debate can be found in a substantive piece of research that was also published this week in the Annals.  This work covered the medical histories of everyone discharged in 2006-2007 from an ER in Washington State and found that the patients who were admitted for a gun injury, particularly if they had a previous gun or violence-related arrest, had a significantly higher chance of coming either back to the ER with another injury or winding up in the morgue.  The research plan focused primarily on more than 9,000 patients who were treated for violent injuries, of whom 680 were in the ER because they were injured with guns.

What seems to be missing from the recommendations to reduce gun violence proposed by the medical associations and echoed by Dr. Kassirer is the fact that in the Seattle study, each of those 680 patients represented at least one direct, face-to-face contact with a clinician who had to deal with the medical risk of guns.  Thanks to data mining, we know a lot about the demographic profiles of these patients, but only the physician who treated them was in a position to ask and possibly learn what happened, why it happened, and whether it would happen again.  The answers to those questions and how those answers could shape policy, is a contribution to the gun debate that only doctors can make.

Is Gun Violence A Recurring Disease? A New Study Says ‘Yes.’

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What are the odds that someone who is discharged from a hospital after treatment for a gunshot injury will return to the hospital with another serious injury or will be arrested for committing a serious crime?  For the first time a study attempts to answer that question based on enough data to discuss how the medical community should respond to people who seek medical help after being assaulted with a gun.  The Annals of Internal Medicine contains a study of more than 9,000 patients who were admitted to hospitals in Washington State with violent injuries in 2006-2007 and were then followed through December, 2011 or to their next subsequent hospitalization, arrest, or death, or whichever came first.  The findings about this group were then compared to 68,000 patients who were discharged during the same two-year period but had been treated for non-violent injury, along with a comparison to 180,000 patients comprising the general population.

conference program pic                Before we compare the long-term experiences of all three groups, let’s look at the composition of the violent injury group itself.  Of all patients treated between 2006 and 2007 for violent injury, roughly 7.5% were admitted for injuries involving guns, or what the researchers refer to as firearm-related hospitalizations or FRH.  But the FRH number was actually 21% of all assaults, since 65% of all serious injuries were self-inflicted (accidents and the like.)  The ratio of one out of five assaults in which a gun was used is no different from what the FBI reports across the nation as a whole.

Patients admitted in 2006-2007 for gun injuries were also typical of this population in general, with nearly 75% being less than 40 years old, and 85% being male.  Racial data was not available for this study, but interestingly, one-third of all victims of gun violence in Washington State paid their hospital bills with private insurance, whereas the Urban Institute recently calculated that less than 5% of all hospital admissions for gun-related violence were covered by private plans.

Here’s the bottom line.  A patient who was treated and discharged for a gun injury in 2006 and 2007 had a significantly higher chance of then being killed with a gun or being arrested for some kind of violent assault.  A history of criminality prior to the hospitalization increased the likelihood of post-discharge victimization or criminal behavior even further.  The point is that a medical encounter for the treatment of gun violence does not just represent a challenge to respond to the injuries caused by the specific gun-related event.  It is also a harbinger of further medical challenges to come and should be understood and responded to in the context of an ongoing and continuous medical risk.

Other studies have also shown that violent injury is a recurring disease.  Earlier this year JAMA Pediatrics published an article which showed a clear division between two youthful populations, ages 14-24, who were treated by Emergency Departments in Flint, MI.  The groups were divided between those patients whose first visit to the ER was for violent injury, the other group came to the ER for something else.  What then happened was that a significant number of the patients who first sought medical care for injury returned to seek care for the same problem again. Not a single member of the latter population that came to the ER for something other than violent injury ever sought medical care for any kind of serious assault.

The Annals issue containing the study on violent recidivism also held an editorial in which eight of the major medical associations (ACP, AECP, AAP, ACS, etc.,) called for stronger physician commitment and endorsed a list of public health initiatives to deal with the medical risks of guns.  But I think that physicians need to do more than just support public health strategies in this regard.  What they really should do is develop effective medical strategies based on research like the articles cited above.  After all, it’s ultimately what the doctor tells the patient which makes any difference at all.

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You Can Carry A Concealed Gun In Florida But It Better Be Concealed.

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The movement to establish open carry of guns as a constitutional right, an offshoot of the Constitutional Carry movement and particularly active in Texas, took a big hit this past week in the gunshine state when the Florida 4th District Court of Appeals took up the case of Norman vs. Florida and ruled against the petitioner’s claim that denying him open carry was an abridgement of his 2nd Amendment right.  What basically happened was that a Florida resident named Dale Norman was arrested in 2013 because his handgun was seen and reported to the police as he was walking down a Fort Pierce street.  He was convicted of violating a Florida statute that prohibits open carry of handguns, his appeal was then handled by a group called Florida Carry, which appears to be a group of military veterans who evidently like to parade around showing off their guns.

In its unanimous opinion, the Court first noted that it was embarking on a voyage into the vast terra incognita of laws covering carrying guns outside the home, which was first acknowledged to exist in the 2008 Heller decision that recognized the Constitutional right of citizens to keep a gun only inside the home.  But since the SCOTUS also recognized that the 2nd-Amendment right to private gun ownership was based primarily on the use of a gun for self-defense, it wasn’t long until the issue of whether the self-defense boundaries would be extended beyond the home also came under judicial review.

open                Where jurisprudence seems to be moving is towards the recognition that concealed-carry is, indeed, a Constitutional right, but that the government can also restrict or at least regulate the issuance of CCW as long as the regulations are “reasonable and do not effectively destroy the right in practice by imposing a substantial limitation” on carrying guns outside the home.  And here is where the pedal meets the metal, so to speak, because what irks the pro-gun movement most of all, is the idea that government should be able to impose limitations of any kind on the ownership or use of guns by law-abiding folks.

Be that as it may, there doesn’t seem to be a judge anywhere in the United States who is willing to depart from the standard rationale for government regulation of firearms, namely (to quote the Florida 4th District) that “that the government has a substantial interest in regulating firearms as a matter of public safety.”  And this ‘substantial interest’ takes the form of a near-unanimous agreement by courts to apply intermediate, rather than strict scrutiny to deciding the constitutionality of laws covering ownership and use of guns.

If the pro-gun push for fewer restrictions on guns were ever to convince the country’s jurists that gun laws should be adjudicated only through the application of strict scrutiny review, then the gun-sense movement might as well pack it up and go home.  Because what strict scrutiny means is that a law can only be considered constitutional if it is narrowly tailored to achieve its result, whereas intermediate scrutiny means that the law only needs to serve accepted, general ends.  If regulating gun ownership was no longer accepted as a compelling government interest unless the government could prove that every gun law achieved some specific safety result, you could kiss gun regulations goodbye.

Which is exactly what Dale Norman and his attorneys and his supporters were hoping would happen in the 4th Florida District Court of Appeals in West Palm Beach. But it didn’t turn out that way at all.  And the reason the District Court upheld his conviction was because it found that, given Florida’s liberal issuance of concealed-carry permits, one simply couldn’t sustain the argument that Florida was in any way preventing its residents from using guns outside their homes for self-defense.  Believing that you are safer because you carry a gun is one thing, waving it around in public to scare off the bad guys is something else.

If Doctors Can Go On The Offense About Vaccinations, They Can Go On The Offense About Guns.

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Sean Palfrey is a Boston-based pediatrician who has been a long-time advocate for improving children’s welfare through aggressive public health strategies, including the use of vaccinations to protect kids from all sorts of disease.  His latest comment in this regard appeared last week in Huffington, and while you might wonder what this has to do with guns, indulge me for a few paragraphs and let me explain.

shot                The recent public spat over the efficacy of vaccinating children erupted after a measles outbreak was traced to an amusement park in Southern California, which then prompted the Republicans to try and score a few anti-immigration points by forecasting a potential catastrophe due to infections spread by unvaccinated illegal immigrants, which then led to the usual Republican pandering about why government should be getting into the vaccination game at all.  And that a physician turned Presidential  candidate used to be against vaccinations but now isn’t sure what he’s for or against, has just muddied the waters a little more.

For a moment, let’s put all that nonsense behind us and focus on what Sean Palfrey really says.  The point he’s making about vaccinations is they protect the human species against diseases for which there is no cure once the infection occurs.  In this respect, vaccines become the cure for certain diseases through prevention, whereas we usually think of being cured as what doctors do to us after we get sick. We wouldn’t need government-mandated vaccinations if everyone shared Sean Palfrey’s belief about the positive effects of this proactive response to medical risk. But prevention of disease is simply too important to be left to everybody’s individual choice.

One disease which continues to escape government-mandated controls is something called gun violence, which kills more than 30,000 Americans each year.  And if the NRA and other pro-gun folks want to continue to debase this discussion by claiming that these deaths have nothing to do with guns, that’s fine.  But notice that I’m not casting blame on anyone for these gun deaths; I’m not saying that people with guns are good or bad.  I’m simply saying that, at the end of the day, if someone puts a loaded gun to their own head or to someone else’s head and pulls the trigger, I guarantee you that someone will be dead.  And death from anything other than natural causes is a medical issue and if it is not brought under control, it constitutes a medical risk.

A recent study confirms what I have long suspected, namely, that most people who visit doctors really don’t care, nor are they insulted or angered when the physician asks them whether they own guns.  And while the study was based on a small sample of patients, it was conducted in Texas, where opposition to more restrictive gun laws ranges from fierce to worse. The fact is that nobody ever committed an act of gun violence, no matter how it’s defined, without first getting hold of a gun.  And since, by definition, none of the 31,000 Americans who will die from gunshots this year will die a natural death, physicians need to adopt, in the words of Sean Palfrey, the strongest possible defense in order to go on the offense regarding the medical risks of guns.

If a gun-owning patient believes that anything said by a doctor about guns is out of bounds, he’s not required to accept the doctor’s advice.  And God knows there are plenty of us walking around, sicut me, refusing to follow medical advice about our smoking, our drinking, our guns  or our weight.  But the government’s inability to go on the offense about gun violence has absolutely nothing to do with any evidence-based knowledge that having guns around reduces medical risk.  And until a credible, evidence-based argument proving that guns reduce harm is produced by the pro-gun side, physicians should continue to ask patients to immunize themselves against gun violence by getting rid of the guns.

 

 

Do Campus Guns Prevent Campus Rape? They Do And They Don’t.

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Now that the gun lobby has succeeded in getting all 50 states to issue some form of concealed-carry license, the next battle which they want to fight is over gun-free zones.  And while states have passed laws liberalizing the possession of concealed weapons in establishments serving liquor, houses of worship and other locations traditionally considered pistole verboten, the locations where pro-gun heat is being turned up are the nation’s college campuses which tend, by and large, to have fairly restrictive policies on students and faculty walking around with guns.

Currently only a handful of states have fairly liberal gun policies in effect, seventeen states forbid guns altogether and the remainder leave it up to individual school option, but in most such places a no-gun policy tends to be the rule.  You would think, incidentally, that states with blanket prohibitions against guns would be located in the Northeast and other parts of the country that both lean liberal and don’t have high percentages of residents who own guns.  In fact, more than half of the strongest, no-guns-on-campus states are located in the South, where gun laws in general tend to be the least strict.  Even Florida, known as the “gunshine” state, forbids guns on all college campuses; ditto Georgia which last year opened up all sorts of public locations to concealed carry of guns.

rape                The campaign to allow guns on campus recently hit the national news when state legislators in Florida and Nevada introduced pro-gun campus bills and linked the necessity for ending gun-free college zones to what continues to be a complicated and hot-button issue; namely, the question of campus rape. The sponsor of the Nevada bill, Michele Fiore (R-Las Vegas) may have stuck her foot a little too far into her mouth when she referred to the “hot little girls on campus” who needed to protect themselves, and in case you’re still wondering, her reference to heat had nothing to do with staying outside in the sun.

The issue of campus rape keeps bubbling back and forth between those who claim that the numbers don’t justify all the recent concern, as opposed to those who declare with equal certainty that the numbers are meaningless because young women, particularly on campuses with large residential populations, are afraid to come forward and report a rape.  Much campus sexual assaults occur during ‘animal house’-style parties, and while collage administrations are on notice to be more diligent in monitoring dangerous behavior, no educational institution wants to be considered just a party school whose lack of campus security puts students at risk.

One group that has used the campus rape issue to increase its visibility and perhaps its membership is a group called Students for Concealed Carry, which claims to have more than 40,000 members which is pretty close to the number of ‘likes’ on their Facebook page. The group gets lots of promotional help from the NRA (gee – what a surprise) and while they tend to promote their demand for campus gun rights as part of a loosely-defined libertarianism, their website motto states explicitly that guns are “an effective means of self defense.”

I really don’t know anything about sexual assault so I’ll let other experts explain the ins and outs as well as the various theories for the prevention of same.  But I do know something about guns and I also know a lot about whether guns represent, a la the SCC website, an “effective” means of defense.  And the truth is that guns do represent an effective means of defense against assaults, but they are no more effective than other methods, such as running away or calling for help. And this isn’t my opinion, it’s research published by the pro-gun criminologist Gary Kleck.  And the good news about calling for help is that a droid can’t do much damage if it falls into the wrong hands.  Can anyone say that about guns?

Thanks Sue.

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Here Comes National Concealed-Carry Again And Both Sides Are Looking Forward To The Fight.

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Once again there appears to be a well-orchestrated push in Washington for a national concealed-carry law, which is actually new wine in old bottles since it was initially introduced by Senator Larry Craig during the Clinton years. Craig was a Board member of the NRA, a position which he eventually relinquished when he was arrested in an airport men’s room for trying (he claimed) to look for his keys after they fell on the floor.  But Craig’s legacy as the NRA champion was then assumed by Sen. John Cornyn (R-TX) who has once again introduced the national CCW bill and this time believes he will get it to President Obama’s desk.  The bill failed by 3 votes in 2013 and no doubt the Bomber will veto the bill if it slides into the Oval office this time around. But maybe we’re only two years away from a Republican sitting in the White House and maybe the ol’ Wild West will finally become law of the land.

ccwThe problem for the pro-gun supporters of this legislation is that they need 7 votes which they can gain if they can pick up some votes from Democrats like Joe Manchin, who voted for the bill in 2013. The opponents of the measure are also hard at work and are aiming most of their fire at Republicans like Pat Toomey who voted for expanded background checks after Sandy Hook.  No doubt representatives of both the NRA and the Bloomberg machine are letting Senators on both sides know that they will be scoring the votes, and no doubt some Senators, regardless of their personal feelings on the issue, will be swayed by whether their vote will help or hurt them when they face the voters in 2016.

I think the argument about national CCW, while it appears to be a hot-button issue on both sides, is really much ado about very little, notwithstanding the lengthy commentary by Gail Collins in today’s New York Times. Gail makes the point that legal and training requirements for CCW vary significantly from state to state. Therefore, walking around with a bulge in your pocket which doesn’t mean you were glad to see her might require a completely different level of proficiency or legal fitness in New York than what is required in Alabama or Tennessee.  Unfortunately Gail then  goes off the deep end when she evokes the image of people “roaming the streets waving out-of-state gun permits,” but she’s right-on in assuming that this type of legislative battle can do wonders for increasing the membership rolls of the NRA.

The reason I think national CCW issue is overblown is that nobody has ever attempted to figure out whether the issuance of more concealed-carry permits means that more people are actually walking around armed.  Supporters of the bill claim that arming civilians is an important measure in the fight against violent crime.  But studies that link crime decline to increased CCW are so full of holes that anyone who really believes that armed civilians make the country safer can be excused for also believing that Martians landed in Area  51.  Opponents of the bill raise the spectre of an increase in gun homicides by people with CCW who, like the murderous dope in Chapel Hill, shot and killed three Muslim-American students with a legally-carried gun.  But the Violence Policy Center’s study of CCW-legal shootings notwithstanding, the  number of intentional, fatal gun injuries committed by someone with a concealed-carry license is still, statistically speaking, a rare event.

If nothing else, a national CCW law would require the development of a nationwide network that would allow law enforcement in one state to check the validity of CCW permits issued somewhere else.  Stop to think about it, wouldn’t such a system be akin to registering everyone with CCW, hence nothing more than another form of national gun control?  I don’t notice the Constitutional Carry gang worrying about that one at all.

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