What Guns To Be Safe? Get Rid Of The Guns.

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Ever since my pal Tony Scalia decided in 2008 that owning a gun is a Constitutional ‘right,’ the gun violence prevention (GVP) community has been trying to figure out a strategy that will reduce the annual gun carnage, while at the same time preserving the heritage of freedom and democracy represented by guns. So it’s become kind of a standard preamble to every gun-control argument made by every gun-control group that they ‘support’ the 2nd Amendment, as if any member of the Gun-nut Nation tribe would actually believe that someone who thinks that guns represent any kind of problem at all would ever really be in favor of the 2nd Amendment. Anyway….

kids and guns             One of the GVP strategies that tries to neatly straddle the line between being against guns and yet being for the 2nd Amendment is something called ‘safe storage,’ which means that if you do own guns, they should be kept locked or locked away at all times. Here’s the operative statement from Everytown: “Everytown’s research on unintentional child gun deaths shows that 65 percent of these shootings take place in a home or vehicle that belongs to the victim’s family, most often with guns that were legally owned but irresponsibly stored.” The Brady Campaign says that nearly 1.7 million kids live in homes with unlocked or unstored guns, and they partner with the American Public Health Association in their ASK campaign, which tells parents to make sure their kids aren’t playing in someone’s house where there are unsecured guns.

Let me make it clear that I am not suggesting or even hinting at the idea that safe storage of guns is a bad thing. Nor do I believe for a single second that someone who locks up his gun at night is now defenseless in the face of an invasion by some street ‘thug.’ But I know a bit about how guns are used and what they represent, and I’m not sure that these issues are fully understood by the GVP organizations who promote safe storage or by the public health scholars upon whose research the GVP depends.

Let’s say for the sake of argument that every single gun in America was locked or locked away every day. According to the CDC, in 2015 there were 22 unintentional gun deaths where the victim was under the age of 15. This is 4% of all unintentional gun mortality, a number which slips to 1% when we calculate all categories of gun deaths, intentional or not. The figures change somewhat but not all that much if we increase the maximum age to 19 or 21, but most states issue hunting licenses to residents beginning at age 15, so it’s pretty hard to say that older adolescents don’t understand the risks of guns.

As to whether safe-storage counseling makes any real difference in gun violence rates, the jury is still out.  An analysis in 2016 of the most comprehensive studies on the effects of safe storage showed that some programs worked, others did not. And the criteria for determining the effectiveness of these programs was comparing the use of safety devices before and after counseling occurred. In other words, we don’t have any data on whether or not rates of gun violence actually changed.
           The best and most realistic approach I know to gun safety is the Advice to Parents stated by the American Academy of Pediatrics. It goes like this: “The best way to keep your children safe from injury or death from guns is to NEVER have a gun in the home.”  As far as I’m concerned, any attempt to find some alternate, crowd-pleasing message just doesn’t work.
              I have sold more than 11,000 guns to 7,000 different people and not one of these customers bought a gun from me to take it home, lock it away and never look at it again. As Walter Mosley says, “If you walk around with a gun it will go off sooner or later.”
 

Where To Look For Gun Violence? Start With The Kids

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Last year after Sandy Hook, the American Academy of Pediatrics (AAP) and their Past President, Judith Palfrey, came in for an extended and indecorous series of attacks by the NRA and other supporters of the gun lobby.  In particular, the AAP and Dr. Palfrey were attacked for voicing the bizarre idea that guns in the home were a danger to children’s health.  And since the only way to get rid of all those guns would be to confiscate them or worse, the AAP became Public Enemy #1 in the eyes and mouths of people and organizations sworn to defend the right of all law-abiding Americans to own a gun.

This campaign to create a cordon sanitaire between pediatricians and the American family had already been elevated to a level far beyond nasty rhetoric when the State of Florida decided to criminalize physicians, mostly pediatricians, who had the audacity to ask their patients about guns. The law was first passed in 2011, was overturned at the District level in 2012, and recently reinstated by the 11th Circuit, and now is probably on its way to the Supreme Court.

docs versus glocks               The attempt to keep physicians out of the gun debate can only be understood if we look at the issue creating the argument in the first place.  Which goes like this.  Each year roughly 100,000 Americans are killed or injured by guns, which is 4% of violence-related injuries and deaths that occur each year.  Of this total, roughly 20,000 are gun suicides and the remaining 80,000 are either homicides or aggravated assaults.

Both sides in the gun debate agree that the way to deal with the suicide problem is to “fix the mental health system,” whatever that means.  On the other hand, both sides also agree that people who use guns to consciously hurt others have committed a crime. Tap the average gun owner on the shoulder and ask what to do with people who commit a gun crime and he’ll probably say, “Lock ‘em up and throw away the key,” or words to that effect.  Tap the average non-gun owner on the shoulder, ask the same question and you’ll probably get, ”We have too many guns,” or words to that effect. Guns don’t kill people, people kill people says the NRA; hence, control the people.  Guns kill a lot more people than if we didn’t have guns, says the Violence Policy Center; hence, control the guns.  That’s where the gun argument begins and ends.

Both of these arguments obscure the reality of the problems they seek to correct.  Increasing the severity of punishments assumes that one can stick the perpetrators in one category and the victims in another, when in fact most violent crime, in particular gun homicides, usually occurs because both the perpetrator and the victim are contributors to the criminal act.  As for getting rid of the guns by registering transactions, what do you do about the more than one million guns that are reported stolen or lost each year and are overwhelmingly the guns that show up in cases of murder and aggravated assault?

In a brilliant study Marvin Wolfgang found that 6% of all juvenile offenders committed more than half of all juvenile crimes.  And guess what happened when they became adults?  The chronic juvenile offenders became the chronic adult criminals and committed the most violent crimes. Wolfgang looked  at juveniles over the age of ten. What’s missing in the debate about guns and violent crime in is what Wolfgang did not incorporate into his work, namely, whether or not interventions occurred with kids who became chronic offenders before their delinquent behavior took place.  And where could such interventions have happened?  During consultations with pediatricians who are trained to look for anti-social behavior during pre-school years.

Pushing pediatricians out of the orbit of caregiving for children means eliminating contact with a professional committed to reducing harm that puts a child’s health at risk.  Anyone who wants to put their 2nd Amendment ‘rights’ ahead of their child’s health better hope they have lots of luck.

Think Doctors Shouldn’t Ask Patients About Guns? Think Again.

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English: A roadside sign at Santa Clara Valley...

English: A roadside sign at Santa Clara Valley Medical Center in San Jose. This sign is an example of how the U.S. state of California requires all hospitals with emergency rooms to include text like “Comprehensive Emergency Medical Service” and “Physician On Duty.” (Photo credit: Wikipedia)

There’s been a lot of talk in and out of gun circles about the attempt by Florida to criminalize physicians who ask patients whether or not they own guns.  The law, passed in 2011, was  overturned in Federal Court but now is headed for another hearing in the 11th Circuit.  At issue is whether physicians can inquire about the ownership of guns, even if no clear threat to health is perceived. Supporters of the law insist that because most physicians are anti-gun, what they are really trying to do is disarm law-abiding Americans.  To quote the NRA-sycophant Dr. Timothy Wheeler:  “doctors are following a hidden agenda laid out for them years ago by the American Academy of Pediatrics — an agenda that would take guns away from Floridians.”

But the question is not whether physicians are following some hidden agenda.  The real question is whether they are following federal law.  And the law I am referring to is the law that covers all hospitals and physicians delivering medical services covered by Medicaid and Medicare, which in the case of hospitals basically covers every hospital treatment facility in the United States.  This law is regulated by an agency known as the CMS, whose treatment manuals define medical care.  And here is what the CMS has to say about what a physician must do when a patient walks into an Emergency Department and requests care: “In such a case, the hospital has incurred an obligation to provide an appropriate medical screening examination (MSE) for the individual and stabilizing treatment or an appropriate transfer. The purpose of the MSE is to determine whether or not an emergency medical condition exits.”

Notice that I say “walked” into the emergency room.  Obviously if someone is wheeled into the emergency room bleeding from a gunshot wound, the attending physicians don’t have to figure out whether an emergency medical condition exists.  But most people who visit emergency departments don’t present such obvious symptoms of distress.  Rather, they show up because they “don’t feel good,” or have a pain here or a pain there.  Many are suffering from mental distress, others have been victims of domestic violence that, if left untreated, might get much worse.

How many of these patients are caught in a vortex of physical or mental deterioration that could wind up in a gun being shot off?  According to Megan Ranney, an emergency room physician in Providence, patients who are treated for gun wounds have a one-in-five chance of returning with another gunshot wound within five years. Wouldn’t there be a good possibility that many of these patients would re-appear in an emergency room in the intervening period and shouldn’t an attending physician need to know whether that individual had access to a gun?

Let me quote a little further from the CMS: “Individuals coming to the emergency department must be provided an MSE appropriate to the individuals’ presenting signs and symptoms, as well as the capability and capacity of the hospital. Depending on the individual’s presenting signs and symptoms, an appropriate MSE can involve a wide spectrum of actions….” So what should a doctor do when a patient says that he or she feels “depressed” or “upset,” or reports some other sign of mental distress.  Should the attending physician ignore all the data that indicates a clear correlation between household gun ownership and successful suicide attempts?

It’s time to set aside all the nonsense about how physicians have some kind of secret agenda to take away the guns.  Let’s remember that it was the CDC’s announcement in a 1981 morbidity report regarding deaths from an “unknown” lung infection that eventually led to treatments for AIDS.  If the NRA wants to pretend that 31,000 annual deaths and 75,000 injuries don’t constitute a health issue that’s fine.  But I’ll close this post with a quote from the novelist Walter Mosely: “If you carry a gun, it’s bound to go off sooner or later.”  Physicians need to figure out if the gun is going to go off, and when it does, what to do about it. That’s not a secret agenda, that’s the law.

 

 

 

 

Should Physicians Advocate for More Gun Control? Of Course They Should

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A remarkable article on gun safety advocacy by physicians has recently been published in the Annals of Internal Medicine.  Written by three public health specialists, it calls for physicians and other health care professionals to be more aggressive in advocating measures to cut gun violence.  What’s remarkable about the article is not what it says, but the fact that it has been published at all.  Because despite the overwhelming evidence that the existence of several hundred million guns is coincident with the highest levels of gun violence of any advanced country, physicians of late have been reluctant to play the role of advocates in the gun violence debate.

The self-imposed constraint on gun safety advocacy goes back to the firestorm that was ignited by physicians who were one of many groups that called for stricter gun controls, if not some degree of outright abolition of guns, during the public debates that led up to the passage of the assault weapons ban and Brady laws in 1993-94.  In retaliation, the NRA launched a successful campaign to defund the CDC from sponsoring gun research, and continues its barrage of nonsensical claims about the inherent value of guns to protect us from crime and violence.  Worse, many of these so-called “studies” are the handiwork of individuals who use their alleged medical credentials to promote social and political agendas that go far beyond any rational discussion about guns or anything else.

One of the latest salvos is the handiwork of an Arizona internist, Jane Orient, who recently published a survey of gun control research in the Journal of American Physicians and Surgeons, an organization which can best be described as “libertarianism meets medicine.”  Now don’t get me wrong.  Physicians have as much right to organize and advocate for any political position as anyone else.  They also have the right to publicly criticize any and all government policies that affect their work as physicians.  But there is a difference between using your status as a medical professional to challenge medical procedures or policies, as opposed to promoting a political agenda based on unproven claims masquerading as medical research.

There is simply no valid proof to the continuous claims made by NRA-leaning researchers that a positive correlation exists between private ownership of guns and decreases in crime rates.  The best the pro-gun crowd can offer are studies that show a decline in gun violence coincident with an increase in concealed-carry licensing.  But what do they say when a jurisdiction like New York City sees a significant drop in violent crime while, at the same time, refusing to relax its stringent gun control laws at all?  The silence is deafening.  The truth is that Dr. Orient and her followers are opposed to gun control because they are opposed to all government regulations, not just as they might apply to guns, but as they apply to environment, financial activities and, of course, the practice of medicine itself.

On the other hand, when serious research on gun violence is done by serious medical and public health researchers, they need to put as much time and energy into publicizing the results as they spend in doing the research itself.  Sending a press release to the gun control lobby, like the Brady Campaign or The Coalition to Stop Gun Violence does nothing to mitigate the pro-gun advocacy work of Jane Orient and her like-minded friends.  But if the American Academy of Pediatrics decided it wanted to tell the world about a new study on school bullying, I guarantee they would send something to every PTA.  I’m really glad that a few voices are finally speaking up for the necessity of more physician advocacy about guns.  Like I said yesterday, I just want a fair fight, and for that to take place, the medical community has to get back into the fray.

Ever Hear About The NSSF? Not If You Don’t Own A Gun

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The biggest problem in dealing with the issue of gun violence is that the two sides don’t have the foggiest idea of what the other side is talking about.  The gun control people talk one language, the anti-gun control crowd speaks in a different tongue.  They talk to different audiences, they talk about different issues, they might as well be on different planets.  Want the latest example?  It comes from the gun control side.

 

The current issue of Atlantic Monthly magazine contains an article entitled, “The Gun Lobbying Group You Don’t Hear About” and it goes on to detail the activities of the National Shooting Sports Foundation, whose national office, ironically, is located right down the road from the Sandy Hook Elementary School in Newtown, CT.

 

The article details the extent to which the NSSF, which represents manufacturers, gun wholesalers and retailers, has of late stepped up its lobbying and PR efforts to match the influence and expenditures of the National Rifle Association.  In fact, the author makes the point that the NSSF’s role in the gun debate has of late become more important because people within the industry have begun to question the role and value of the NRA.

 

I’m not saying that the NSSF is a household word when it comes to pro or con discussions about guns.   And if you’re not a gun owner, or haven’t been to the annual gun trade show (aka the SHOT show) run by the NSSF in Las Vegas, there’s no reason that you should be aware of the organization’s existence or activities.  Furthermore, the NSSF’s President, Steve Sanetti, is a quiet, corporate guy who avoids the media spotlight about as diligently as Wayne LaPierre tries to attract it.

 

For all those reasons, you could argue that an article introducing the NSSF to the readership of a magazine like The Atlantic is a worthwhile exercise in investigative journalism.  There’s only one problem.  The NSSF has of late begun to promote several public campaigns that are not only a break with past industry strategies for defending themselves against the anti-gun crowd, but are designed to put the gun industry in the forefront of the debate about the issue that makes them most vulnerable, namely, the issue of gun safety.

 

Historically, the gun industry’s response to concerns about gun violence, as promoted by the NRA, was to argue that everyone would be safer if they had or were protected by a gun.  Remember Wayne LaPierre’s call for armed guards in schools following the massacre at Sandy Hook?  As a counterpoint, take a look at the new NSSF website promoting its ChildSafe campaign.  It’s direct, it’s clever and it calls for every gun owner to take a pledge to lock up or lack away all their guns – the American Academy of Pediatrics would be proud.

 

Mike Bloomberg campaigned hard for expanded background checks to eliminate or curtail “straw sales.”  For years the NSSF has sent literature and display posters to all its gun dealer members (myself included) promoting its “Don’t Lie For The Other Guy” campaign.  Now they are taking this message directly to the public with full-size, highway billboards that are being mounted in inner-city neighborhoods throughout the United States.

 

Don’t get me wrong.  The NSSF’s newly-found concern about safety and responsibility isn’t without its faults.  The distribution of gun locks, as The Atlantic article points out, was a PR sham.  And their attempt to convince us that military-style rifles are nothing more than the twenty-first century version of the traditional hunting rifle is a joke.  But when was the last time that Michael Bloomberg put up a roadside billboard that reminded people that straw sales were against the law?

 

 

 

Guns and Violence: Believe What You Want to Believe

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It’s about time that someone (namely: me) began debunking some of the myths that have been propagated by various NRA cronies who spring into action every time the gun control issue rears its ugly head.  The NRA has done a remarkable job (I’m being serious here) of pro-actively pushing its anti-gun control agenda whether the gun control crowd shows up or not.  Their strategy is very consistent: publicize research that “proves” guns protect people from crime, and make it easier for everyone to carry a concealed weapon.  An armed citizenry is a safe citizenry.  And an armed citizenry is exactly what the gun industry wants because it’s a guaranteed path to higher sales.

But in order to use “research” to bolster this campaign, the NRA also has to discredit the large body of evidence about the relationship of guns to violence that tells a very different story, namely, that guns not only don’t protect us from crime, but may actually result in less safety both for armed and unarmed citizens. This has been the consensus of public health professionals whose views were cited by the Clinton Administration to justify passage of the Brady Act which created the background check system in 1993.  Ever since then, public health professionals and researchers have been a particularly favorite target of the NRA, witness the recent attacks on Dr. Judith Palfrey and the American Academy of Pediatrics.

The basic public health position on gun control was stated most comprehensively in an issue of the Journal of the American Medical Association published in 1994 (April, Vol. 271, No. 16.) This editorial, endorsed by the President of every major New York City hospital and the New York Academy of Medicine called for:  expanding background checks, limiting assault rifles, taxing ammunition, restricting multi-purchases and stricter controls over dealers.  And here’s the sentence that sums it all up: “Ideally, handguns…should be banned completely, but we recognize that this strategy is not currently politically feasible.”

The NRA crowd jumped on this statement in 1994 and have been riding it ever since.  They used it to justify the de-funding of gun research by the CDC in 1997 and they continue to raise the battle cry about ‘anti-gun’ physicians, including a recent Florida law which makes it a felony for a physician to ask a patient whether there are guns in the home.  The most blatant attempt to justify the ‘armed citizen’ approach to gun ownership is a recent article by pro-gun activist and attorney Don Kates, who stated unequivocally that the National Academy of Sciences could find no evidence in a 2004 report that gun controls of any sort reduced gun violence.

Except that’s not what the NAS report actually says.  What it says is that research had not yet found any direct links between crime rates and right-to-carry gun laws.  But the report also said that there was a link between keeping guns in the home and an increased incidence of suicide,  even though pro-gun activists like Kates continue to push the idea that physicians should be prohibited from inquiring about the ownership of guns.

The conflict between pro-gun activists and public health specialists boils down to the following: both groups are advocates with very different goals.  The pro-gun activists want Americans to own more guns; the public health specialists want less violence.  And since the data on the relationship between guns and violence is somewhat ambiguous, both sides can pull what they want from the research and come up with arguments that support their point of view.

NRA (or should I say DRGO) versus AAP: Round 2

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On May 14  I published a blog criticizing the NRA ally Doctors for Responsible Gun Ownership for attacking Dr. Judith Palfrey and the American Academy of Pediatrics.  The head of DRGO, Tim Wheeler, responded with several letters  which you can read (along with my responses) in the sidebar to that blog.   In one letter, he told me that all of his articles were “painstakingly researched,” but if I found any errors he would be glad to correct them.  So here goes~~

  1. On May 14 Wheeler published a link to an interview he gave on the NRA Video channel in which he referred to the gun safety advice given by Dr. Judith Palfrey on CNN.COM as “dangerously wrong.”   In fact, her specific advice for keeping guns and kids safe in the same home (lock the guns up, loan and unload carefully, etc.) reads like it was lifted right out of the NRA’s Gun Safety in the Home manual, a course that many NRA instructors, myself included, have been teaching for years.
  2. On May 7, Wheeler’s blog contained several references to America’s “100 million gun owners” whose political clout would be felt at the polls.  The latest surveys indicate that 40% of all U.S. households may contain guns.  Is Wheeler saying that each of these households has 2 1/2 gun owners living under the roof?  I guess he’s assuming that for every guy in a house with a gun there must also be a gal and of course she’s just as much into guns as he is.  Fine.  That still leaves us how to figure out the identity of the half owner.
  3. The May 1 blog was about the lobbying of AAP on Capitol Hill.  His blog referenced a story from The Hill, and asserted that the AAP wanted to ban all semi-automatic weapons and refused to recognize criminology research “showing responsible gun ownership to be a net social good.”  None of these assertions can be found in the referenced story, so I guess they’re from Wheeler’s memory bank. There’s only a small problem. The AAP has only wanted to ban semi-automatic weapons that hold hi-capacity mags (which puts them well within the mainstream) and there has yet to be a single piece of academic scholarship that has definitively linked  gun ownership to crime rates, either negatively or positively.
  4. The April 29th blog was a snide description of the CDC meeting held the previous week to begin discussing research priorities if and when Congress appropriates funding to once again allow the CDC to support research into gun violence.  Perhaps Dr. Wheeler took painstaking notes about the meeting but there’s no evidence that he did any research for this blog.  He was at pains, however, to note the absence of another right-wing, pro-gun researcher named John Lott who, according to Wheeler, is the nation’s “foremost researcher of the effects of gun ownership on crime.”  So here we have one painstaking gun researcher vouching for the credentials of another one.  Except there’s one little problem, namely, that Wheeler is talking about the same John Lott whose painstaking research was discredited when it turned out that he not only faked data used for his thesis but later faked his own identity to strike back at his critics.
  5. The April 19th blog is simply an unvarnished editorial about the defeat of the Manchin-Toomey Amendment in the Senate along with the usual anti-Obama claptrap that sometimes makes me believe that people like Wheeler still think that the 2012 election didn’t take place.  Painstaking research?  There’s no research.
  6. The April 16th blog is a rehash of the May 14 blog which attacked Dr. Judith Palfrey and the American Academy of Pediatrics over their position on guns, and since Wheeler found it necessary to repeat his criticisms about the AAP, I’ll repeat my comments about him.  Either he didn’t bother to read the AAP Policy Statement on Preventing Firearm-Related Injuries, in which case he’s simply wrong.  Or he did bother to read it in which case he’s not only wrong but a liar.  And just to make it clear, when I use the word ‘liar’ I am simply asserting that someone knows something to be true and states otherwise.  If Dr. Wheeler read the AAP Policy Statement he could not have described it the way he did unless he consciously chose to misrepresent what was said.  In which case, he’s a liar. Either way, this blog does not contain any painstaking research, or any research of any kind, for that matter.
  7. The April 2nd blog is an attack on Marian Wright Edelman who, as President of the Children’s Defense Fund spoke out about gun violence after the massacre at Sandy Hook.  There’s no research here, there’s just another editorial swipe at a long-time advocate for children who doesn’t think that guns and kids are a good mix.  But I did notice one tiny bit of data that struck me as rather odd, given that it was presented by a man who describes his own research as “painstaking.”  In his attack on Dr. Edelman, our painstaking scholar Wheeler mentions that 80 million Americans own guns.  Yet his May 7th blog contains several references to the 100 million Americans who own guns.  Is he saying that 20 million more Americans became gun owners between April 2nd and May 7th?  I raise this point because Dr. Wheeler assured me in his response to my previous blog that his work was based on “painstaking” research.  So I took him at his word and began looking for examples of his painstaking efforts.  I read every word of his last seven blogs and the only, single fact that I could find that came from him rather than from someone else was the number of Americans who own guns.  Except that the number changed – in just 5 weeks it jumped by 20 million.

So much for the painstaking research of Dr. Wheeler, the NRA medicine-man who can’t tell the difference between research and editorials and probably doesn’t care.  Yes, we will be publishing some more blogs on Wheeler and the other so-called scholars who toady up for the NRA.

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