Take A Look At Some Interesting Public Health Research About Gun Violence.

               I like it when public health research on gun violence gets in the way of Gun Nation’s continued effort to pretend that the only thing which stands between America and Armageddon is a good guy with a gun.  So I think it’s important now and again to highlight some recent gun violence scholarship, even though by including a handful of important articles I am forced to omit others that are of equal importance to the field.  Feel free to download any of the articles mentioned here.

               Article #1.  “Lethal means access and assessment among suicidal emergency department patients” is a study of more than 1,300 emergency patients across the country who either reported suicide thoughts or actually attempted suicide in the week prior to their ED visit, of whom 11% reported having at least one, if not more than one gun in their home. Of the gun-owning suicidal patients, 22% considered using a gun as their chosen suicidal method, with only medication scoring higher among this group as the preferred way to bring their lives to an end.  Among the emergency population that did not own guns, only 6% reported thoughts about using a gun to end their lives.  Pills have a 5% success rate for suicide, with guns the death rate is 90%. Get it?

               Article #2. “Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration” is a comparison of the frequency of hospitalization for victims of gun violence when compared with the population that is hospitalized for an injury not involving guns.  The study looked at patient outcomes for more than 9,000 violent injuries and 68,000 non-violent injuries, of whom 680 were classified as FRH or firearm-related hospitalizations.  And what was learned from this study, which was the first to look comprehensively at medical histories of patients shot with guns? “Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization

or crime perpetration.” Gee, what a surprise.

               Article #3.  “Long-term mortality of patients surviving firearm violence” deals with the degree to which being injured by a gun increases the possibility of early death.  What makes this study significant is that the researchers compared five-year outcomes following hospital discharge of 516 patients who sustained gun wounds, 992 vehicle accident injuries and 695 assaults where no gun was involved. What they found was that five-year, post-discharge mortality rates were significantly higher among gun assault victims and other assault victims as opposed to patients who were injured in accidents involving cars.  But while the 5-year mortality rates for gun and non-gun assaults were similar, a greater proportion of the victims of gun assaults died within one year of their initial hospital release.  Most of these early gun-injury deaths were – you guessed it – gun homicides.  In other words, if someone leaves the hospital after getting shot, they have some unfinished business which usually ends up with them getting shot again.

               Article #4.  “Social networks and the risk of gunshot injury” goes beyond the usual epidemiological data that drives public health research and looks at group behaviors which influence gun violence on a community-wide scale.  For this article the researchers studied two inner-city Boston neighborhoods with high rates of violent crime and utilized data from the Boston PD Field Intelligence Observation unit to construct the social networks linking the population which was most likely to be criminally involved with guns.  What they found was that using standard demographic categories (income, race) to define a population as high-risk for gun violence was not as important as understanding how individuals were situated in social networks where gun violence frequently occurred.

               Four studies, each of which fills important gaps in our knowledge about violence caused by guns. Four studies, which if it were up to Gun Nation would never be funded, would never see the light of day. Four studies, which whether we are talking about suicide, homicide, assault or combinations of all three, remind us again that you don’t protect anyone from anything by walking around with a gun.

                

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How Violent Is Gun Violence? More Than You Think.

One of the continuing debates within the GVP community is how to define ‘gun violence.’  On the one hand there are the obvious categories: homicide, assault and robbery with a gun.  Then there is suicide with a gun, which results in death but is certainly a different sort of violence than what happens when a gun is used in a criminal act. And of course we also differentiate between intentional, as opposed to unintentional acts of gun violence; indeed, the latter may not actually be gun violence, even though someone still ends up being injured by a gun.

conference-program-pic              Incidentally, outside the GVP, gun violence doesn’t exist.  As far as I know, the NRA and the NSSF have never used the term ‘gun violence’ in anything they have ever said about guns. The various pro-gun noisemakers (Emily Miller, Dana Loesch, every Republican Presidential candidate, et. al.) prattle on about violent ‘thugs’ who use guns, but it’s people who kill people, remember?  It’s got nothing to do with the gun.  Now back to reality.

Adding up all the categories above, the national gun violence toll in 2013 was 117,894.  At least this is the number published by the CDC. By the agency’s own admission, this number is understated.  Why?  Because when we count nonfatal injuries, any kind of injury, we are estimating the actual number based on reporting from a ‘representative’ group of emergency medical facilities, and sometimes the estimations are close to reality and sometimes they are not. So the death toll is close to accurate but the injury numbers may or may not be exact.  And this is a serious gap in what we know about gun violence because gun injuries are more likely to be significantly more serious than any other type of injury, unless you fall out of a fifth-story window and somehow manage to survive.

My friends at the Gun Violence Archive, by the way, have gun morality numbers which match up pretty close to the CDC.  In 2014 the CDC found 12,265 gun deaths from every type of shooting except suicides.  The GVA number for 2014 was 12,585.  Obviously, the GVA calculation for non-fatal gun injuries is far below the number recorded by the CDC, because most shootings that don’t result in a death aren’t newsworthy enough to get media mention, which is the basic source of information used by the GVA.

Which brings me to the point of this commentary, namely, the fact that by focusing on gun deaths, as opposed to overall injuries, the main issue of gun violence is obscured, if not altogether lost.  The gun violence issue is driven by homicides, particularly when a mass shooting occurs.  But in terms of how many people are seriously affected by shootings, gun mortality is the tip of the iceberg, and we need to understand the totality of the problem if we are going to map mitigating strategies that will really work.

There’s a neighborhood in Brooklyn called Bedford-Stuyvesant, a.k.a., ‘Bed-Stuy, Do or Die.’ Like many Brooklyn neighborhoods, it’s beginning to experience a degree of gentrification, but the area around Fulton and Atlantic Avenues is still the Wild West.  So far this year the neighborhood has experienced 2 murders, which if the carnage continues, the yearly homicide rate per 100,000 will top 20.  But the total number of shooting victims is now 6, which will yield an annual gun violence rate of 60; further down Atlantic Avenue in East New York the GV rate could top 140 by end of year.

Numbers like this don’t describe an ‘epidemic’ of gun violence.  Frankly, I don’t know whether we have invented terminology which accurately describes this state of affairs. But there are neighborhoods all over the United States which experience gun violence at levels equal or above to what goes on in Bed-Stuy; higher even than the violence experienced in Honduras or the Ivory Coast. I’m not even sure that a word like ‘violence’ describes what is really going on.

 

 

 

 

We Know That Guns Are A Risk. But Does Anyone Really Care?

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.

Want To End Gun Violence? Stop Settling Arguments With Guns.

As soon as the word got around last week that a middle-aged, white man shot three young Muslim-Americans in Chapel Hill, the net exploded with the usual speculation about whether it was a hate crime, an attack on the Muslim religion, a civil rights assault, and so forth and so on. While the police haven’t yet ruled out the possibility of religious or ethnic bigotry, the preliminary indication is that the gunfire erupted during a dispute over a parking a car.  Three young, lovely human beings are dead because nobody could figure out how to find an empty parking space in a wide-open suburban parking zone.

Last year, a highly-decorated, retired police officer walked into a matinee showing of a movie in a suburb of Tampa and found himself sitting behind a young man who was texting messages to his daughter before the movie began.  An argument over whether the younger man should continue texting erupted, one thing led to another, the retired cop pulled out a gun and that was that.  At the time that these two gentlemen decided that staying put was more important than one of them moving to another location and thus avoiding any problem altogether, the theater audience filled less than 30 seats.

If you haven’t figured out the parallel between these two utterly senseless shootings, let me tell you what it is: nobody knows how to back down.  In each situation a man was legally armed, no doubt walking around with a weapon to protect himself against crime.  Of course the armed guys weren’t going to back down.  Why should they?  They had guns.  As for the victims, they weren’t about to walk away either.  After all, who were they to back down from a dispute in which they no doubt were in the right?

For all the talk about why the good guys need guns to protect everyone from the bad guys, the  truth is that more than 90% of the 31,000 gun homicides that occur each year are the result of someone’s inability to back down.  It’s what we call a lack of anger management, and if your anger gets out of control, being able to put your hands on a gun won’t result in protecting yourself against crime or against anything else, including anger directed at yourself.  It will probably result in you or someone else being seriously injured or seriously dead.

violence                According to the FBI, less than 15% of homicides each year occur during the commission of a serious crime; i.e., robbery, larceny, burglary or rape.  On the other hand, at least 4 out of 5 homicides grow out of arguments, and these arguments involve people who know each other.  And we aren’t talking about casual acquaintances – we’re talking about people who knew each other on a continuous basis and had been arguing and fighting over a period of time.  The personal connection between shooter and victim in domestic disputes accounts for virtually every single killing in which the victim is a female (who are 15% of all murder victims each year) and accounts for 100% of all suicide victims who, by definition, have allowed their anger at themselves or others to get out of control.

It’s important to remember that even when we are dealing with violence as a criminal offense, more than 1 million violent crimes were reported to the police in 2013, of which only 1% involved homicides using a gun. And the fact that someone has a propensity to behave violently doesn’t ipso facto mean that they would ever express this anger by using a gun. But there is no other form of personal behavior that is as dangerous and costly as pulling a trigger at yourself or someone else.  And I don’t think we will get very far just by trying to identify the most violent among us and then figuring out how to keep guns out of their hands.  Wouldn’t it be much easier to just get rid of the guns?

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If The NRA Didn’t Exist, The Gun Control Crowd Would Have To Invent It

Today I received an email from the Violence Policy Center, a DC-based advocacy group that often partners with Brady and Bloomberg to push back against the legislative and legal initiatives of the NRA.  Like every organizational email I receive from both sides, the VPC wants dough.  But this particular message caught my eye because of what it said about the NRA’s upcoming Indianapolis show.

The VPC is upset not just in general about the NRA’s impending celebration of gun ownership, but in particular because the show is being held this year in a city that has an alarmingly high murder rate, many of these homicides, according to the VPC, committed with guns.  Here’s a quote from the email:  “Wayne LaPierre, Ted Nugent, and the rest of the NRA leadership will be in Indianapolis later this month for the NRA’s annual meeting which begins on April 25. We don’t expect they will mention the fact that Indianapolis has a murder rate higher than Chicago’s and that most of those killings are committed with guns.”

I’m not exactly sure what the connection is between the crime rate in Indianapolis and the fact that the Indiana Convention Center no doubt worked like hell to land the NRA show.  I also suspect that the decision to hold the show in Indianapolis was made years ago and who knows whether crime in Indianapolis has since gone up or down.  But if you think for one second that anyone who’s coming to Indianapolis to visit the NRA show gives a rat’s damn about crime in Indianapolis, you’re barking up the wrong tree.

feinsteinThe crowd at the NRA show is going to look just like the NRA membership everywhere else; mostly male, White, over the age of 50 and living in rural areas or smaller towns.  The NRA show is just a big gun show and these folks will do what they always do at those shows: play with the guns, eat a few treats, stand on line for a couple of hours to get Ted Nugent’s autograph, say hello to friends, then hop in their 4×4’s and drive back home.  They won’t spend a second in the city of Indianapolis, and if while they’re at the show a couple of more inner-city residents are gunned down, they won’t know about it and they won’t care.

Meanwhile, the NRA will treat them to a good dose of double-talk as to why they are really there.  They’ll remind the visitors that guns are the best line of defense against criminals and crime. There will be endless exhortations to fight back against a federal government that is out to grab their guns.  And if they need the ultimate proof that God is on their side, they can always line up for admission to the Prayer Breakfast before entering the exhibit hall.

lapierreWant the truth? Both sides in the gun debate mobilize their followers by appealing to fear.  In the case of the NRA, it’s a fear of losing your guns, a fear of the government, a fear of crime.  For the Violence Policy Center and like-minded organizations, it’s a fear of guns.  As long as the two sides continue to appeal to their followers on the basis of fear, there’s really no chance that we will have a reasonable and responsible discussion about how to stop the killings that occur in Indianapolis and other cities and towns.

If we ever had such a debate, maybe it would turn out that we as Americans would decide that 30,000 gun deaths every year is a small price to pay for the fun of attending the NRA show.  Or maybe we would decide that the violence has to stop right now and the 2nd Amendment notwithstanding, everyone has to turn in their guns.  I don’t really care which way such a debate works out; all I know is that neither pro-gun nor anti-gun advocates are interested in kicking one off.

 

What To Do About Guns? Let’s Start With The Facts

Every time gun debate breaks out, the two sides take positions that are simply Alice in Wonderland-like in how far they are divorced from real facts. The NRA argues that the more guns are owned and carried by civilians, the safer we become.  It’s errant nonsense, and the same people who believe it and who publish “research” to prove it will also tell you that they can prove that elements in the U.S. government helped bin Laden blow up Towers One and Two. Not to be outdone in terms of flights from reality, the gun control crowd insists that banning semi-automatic rifles that look like AR-15 military weapons will have a significant impact on gun violence, despite the fact that of the 11,000+ people killed each year with guns, less than 300 deaths can be blamed on rifles of all types, let alone the so-called “assault” guns with their high-capacity mags. By the way, since the overwhelming majority of shootings occur with the discharge of only one round, I have never understood the fetish that exists among the gun control advocates to ban hi-cap mags.

crime2I agree that it’s time to get serious about gun violence but the only way I know to get serious about anything is to start with the facts.  And here is what we really and truly know:

  • Most (90%) people who use guns in criminal ways have a prior history of criminal behavior.
  • Most (80%) individuals who use guns to commit suicide had contact with a medical professional and expressed their feelings of mental distress within 30 days or less of when they killed themselves.
  • Most (70%+) of all gun homicides take place in inner-city, minority neighborhoods.

So there you have it or, as Jack Friday used to say, just the facts ma’am, just the facts.  Yea, yea, yea, I know all about the importance of gun safety, but if every single gun in the United States were locked up every single night, the overall deaths from accidental shootings would decline by a whopping 3 percent!  As for expanding background checks to be sure that guns only moved from good guys to other good guys; people who acquired a gun legally aren’t disposed to give it to a bad guy and someone who acquired a gun “off paper” isn’t about to walk into a gun shop and fill out a Form 4473.

But there are some sensible things we can do to respond to the facts stated above.  The cops could stop spending so much time issuing summonses for jaywalking or rousting young teens for hanging out on street corners and instead get in the face of every known felon and ask them if they are carrying a gun.  It seems to be working in New York, why shouldn’t it be adopted everywhere else? As for people with mental issues, the NRA should drop its cynical and stupid opposition to the right of physicians to inquire and report on gun ownership in instances where the patient displays a “clear and obvious” threat to himself or others. And what could be a more obvious threat than someone reporting thoughts of suicide who also happens to own a gun? Finally, the gun control folks need to drop their politically-correct attitude towards the individuals and groups who commit most of the felony gun violence and figure out what to do to keep guns out of their hands.  It’s just too bad if most of these people belong to certain specific, minority groups since we are always constrained to discuss or even describe things in racial terms. But the victims of these killers come from the self-same minority populations and we certainly shouldn’t be afraid to speak up in their stead.