Back in February, representatives from 44 ‘major’ medical organizations came to Chicago to hold a ‘summit meeting’ on gun violence. Four years previously, eight of these same organizations published a ‘Call to Action’ on the same topic. Obviously, the medical community’s concern about how to deal with what they refer to as a ‘public health’ issue resulting in 125,000 or more fatal and non-fatal injuries every year has reached a fever pitch.
FolIowing the February conference, the group published a Magna Carta to define what physicians and public health specialists need to do about guns. Having now read this entire epistle, along with most of the 80 research papers on which it is largely based, I happen to believe that this approach is taking the medical community down the wrong path. While the programmatic and research efforts recommended by the summit participants may help some of them burnish their CV’s or perhaps get them interviewed on the Ambulance Driver or one of the other medical blogs, I don’t believe that any of the recommendations contained in this document will result in a substantive decline in gun violence at all.
The paper begins by offering a very novel revision of what its authors believe to be the basic reason why gun deaths, as opposed to deaths from traffic deaths, heart disease, cancer and HIV haven’t declined, which is because gun injuries have been treated not as a medical but as a political problem. Many of the earlier medical efforts were “mired in a debate about personal liberty and the Second Amendment to the U.S. Constitution.” Instead of this dead-end strategy, the Summit wants “research agendas to understand and address root causes of violence,” an approach which “mirrors the public health model that has been so effective in improving outcomes in traffic-related injury.”
Over the next several weeks, I am going to devote a number of columns to the specific research agendas and programs advocated by this Summit. I am going to make a point of sending those columns, as well as this column, to the authors of this document asking them to reply. What is unique about gun-violence research, as opposed to research in other medical fields, is the remarkable paucity of public discussion and debate within the research community itself. This document, for example, references 80 peer-reviewed articles but I do not believe that the findings or the data of any one of those articles was ever challenged in print. Are we all so completely correct in our work?
Unfortunately, understanding and addressing the ‘root causes’ of violence is simply not the same thing as understanding and addressing the root causes of gun violence, a distinction which the authors of this piece don’t acknowledge or attempt to explain. On a yearly basis, somewhere around two million individuals suffer violent attacks. A significant number (i.e., most) of these victims exhibit the same socio-economic status, family backgrounds and personal histories as the less than 5 percent whose injuries are caused by guns. So the issue here isn’t violence per se; it’s a very specific type of violence that needs to be understood on its own terms.
A bigger problem involves the belief that the public health model for understanding and responding to automobile injuries can be just as effective when the model applies to guns. This is wishful thinking to the nth degree. It simply flies in the face of reality because cars aren’t designed to do the one and only thing which guns are designed to do, namely, to kill yourself or somebody else. If your car smashes into someone and they die, you weren’t driving the way you’re supposed to drive. If you pull out your Glock and blow the guy’s head off, the gun is being used exactly the way it’s supposed to be used.
How do you design a valid research agenda about a threat to public health when the threat is so poorly defined? I’ll continue this next week while I await any replies from the authors of this piece.