Two noted clinical gun researchers, ER physicians Garen Wintemute and Megan Ranney, have just published an important commentary about gun violence. The article follows from the decision of the American College of Emergency Physicians to join the seven other major medical organizations in calling for a more aggressive and comprehensive medical approach to gun violence, and the authors raise some important issues both in terms of the data on gun violence, as well as the particular challenges facing ER physicians who often face this problem on a daily basis.

The article points out that while vehicular and gun death rates were relatively stable beginning in 2000 and continuing for the next six or seven years, motor vehicle deaths then plunged again while the rate of gun mortality is beginning to creep back up.  The decline in car deaths is due to a successful public health campaign, but there has been no such campaign in the case of guns. This is even more disconcerting when one realizes that the United States is, in fact, one of the least violent countries in the OECD.  The percentage of American adults reporting being the victims of an assault is less than one third the number in Belgium, less than half of what is reported in Switzerland or Spain.

emt                What sets America apart from these other countries is that our violence is so much more deadly, and this is due to the existence of so many guns.  Only one OECD country, Israel, has a homicide rate one-third as high as ours; for the remaining OECD community our rate is ten to thirty times higher than anywhere else.  The authors tie these disparities to the enormous number of guns floating around, the U.S. counts only 5% of the world’s population but more than 40% of all guns in civilian hands.  I want to inject a cautionary note here, however, because our gun violence is overwhelmingly a function of the presence and use of handguns and, if anything, the U.S. probably has even a greater proportion of the world’s privately-owned pistols and revolvers, certainly this is the case when we confine our comparison to the rest of the OECD.

I mention the issue of handguns because the authors call for comprehensive background checks as the primary mechanism for reducing the possibility that guns will get into the wrong hands.  But I have never understood why background check advocates always promote checks both on handguns and long guns when gun violence as a criminal behavior overwhelmingly involves handguns, and while long guns are often used in suicides, it is arguably the case that long gun suicides are usually committed by the legal owner of the gun.  Given the firestorm that erupts every time an attempt is made to expand background checks, would we lose much ground by only using NICS to control the transfer of guns that cause the most harm?

My other concern is the article’s reliance on a public health approach that has worked for many other products but does not, in my view, address the central issue involved in regulating guns.  I cannot think of another consumer product whose regulation was opposed by the energized, mobilized and well-financed grass-roots effort which is the case with guns.  Of course car manufacturers fought seat belts, of course cigarette companies tried to deny that smoking made people sick, but when public policies were being debated you didn’t see the galleries packed by drivers or smokers demanding that the government stay off their backs.

Public opinion polls now show that, pace the valid research referenced by Wintemute and Ranney, a majority of Americans believe that a home containing guns is safer than a home which is gewehr-rein.  Consider such people deluded, stupid or worse, but the NRA has done a helluva job making us feel that the benefits of gun ownership outweigh the risks.  And I’m not sure the other side has a message that plays as well in Peoria or anywhere else.