If The NRA Really Believes That Their Gun Safety Programs Work, Shouldn’t They Be Willing To Prove It?

Since 1999 there has been a nearly 30% decline in accidental gun deaths, with a 50% drop in deaths for children under 19.  This is a remarkable decrease in unintentional gun mortality when you consider that during the same fifteen years, the civilian gun arsenal has probably increased by nearly 50%.  So what’s going on? Are gun owners becoming more careful with their guns?  Are gun manufacturers making guns that are more resistant to accidental discharges? Are gun safety programs working beyond anyone’s wildest dreams?

docs versus glocks              If you listen to the NRA and the NSSF, they’ll tell you that their safety programs are simply the best and most effective that they can be.  The NSSF runs a program called ChildSafe, which they claim is responsible for sending more than 36 million safety “kits” to more than 15,000 law enforcement agencies nationwide.  The kits basically consist of a little brochure and a gun lock which are then handed out free of charge by the cops to anyone who walks through the door.  The NSSF also sponsors occasional safety programs at participating retailers like BassPro, and has produced some thoroughly stupid videos telling parents how to sit around the dinner table and talk to their kids about guns.

The NRA safety program, Eddie Eagle, has been around since 1988, and its safety pamphlets and other teaching aids have “reached” 28 million schoolchildren, whatever the word ‘reached’ actually means.  I’ll tell you what it means.  It means that someone in Fairfax has mailed out 28 million pieces of paper to various schools around the United States. Maybe not just to schools; maybe to summer camps, maybe to the local VFW, maybe to this or that shooting range, maybe to who knows where. Back in 1991 a graduate nursing student looked at some gun safety programs and judged Eddie Eagle to have all the necessary content to teach good gun safety rules to kids.  There was only one little problem: the author also stated that there had never been any study which could determine whether Eddie Eagle was effective as a teaching tool.

And that’s why programs like ChildSafe and Eddie Eagle can’t be taken seriously, for the simple reason that mailing out some literature on anything doesn’t mean that anyone actually received it, or read it, or changed their behavior in any way at all.  The fact that safety brochures were being mailed to schools and gun locks were being mailed to police departments and gun mortality declined during the same years may appear to represent some kind of cause and effect, but nobody has ever conducted a study to see if these two factors are connected in any way, shape or form.  And this connection becomes even more problematic when we include non-fatal shootings over the same period of years.

When we examine non-fatal accidental shootings, the five-year average between 2001-2006 and 2009-2013 drops by a whopping 7%.  And remember how gun mortality for kids declined by 50%?  For this same age group in terms of non-fatal accidents the number has basically remained the same since 2003. Now you can’t tell me that people who shoot themselves accidentally are aiming at less lethal parts of their bodies.  What’s happening is that the same medical advances which result each year in a higher proportion of non-fatal gun assaults to fatal gun assaults is making unintentional gun injuries less lethal as well.

The NRA uses its Eddie Eagle program, among other things, to fight against doctors who want to caution patients about the risks presented by guns.  They argue that a more effective process would be for doctors to distribute Eddie Eagle brochures. I would be the first person to stand up and loudly proclaim that Eddie Eagle should be adopted by every physician once the NRA conducts a valid before-and-after analysis to determine whether the program actually works. But don’t hold your breath – you may turn blue long before the NRA responds.

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When The Ad Council Starts Talking About Gun Safety, Everybody Listens.

I listen to AM Talk Radio because the programs help me get to sleep.  But the other night as I was dozing off to the local shock jock Rush wannabe, I was jolted awake by a 30-second public service announcement about gun safety presented by the Ad Council.  Now when the Ad Council runs a PSA on gun safety, you know that gun safety has become a mainstream issue. After all, we’re not talking about just another group that says nice things about worthwhile projects.  We’re talking about the outfit which started off selling War Bonds in 1941, then created Smokey the Bear, the March of Dimes, McGruff the Crime Dog and Nancy Reagan’s Just Say No among hundreds of other public service campaigns. Wow!

The gun-safety messages, which are hitting television and radio stations around the country (I heard the radio spot on a local Fox-affiliate station)were funded by a million-dollar grant from the Department of Justice that was awarded in 2013. The radio script has a no-nonsense voice stating that guns have to be kept away from “curious children, troubled teens, thieves, or anyone else who might misuse your gun.” The television ads are just as direct, and there are also graphics and digital ads, along with additional information on safe storage provided by the National Crime Prevention Council, another blue-ribbon advocacy group that partnered with the Ad Council to create and sponsor this campaign.

Thumbnail_adc_sgs_young_boy_with_gun_Eng_bw5.6875x10.5                A couple of years ago the National Shooting Sports Foundation, the gun industry’s lobbying group which runs the SHOT show, put together a little gun-safety video featuring the National Crime Prevention Council’s mascot, McGruff the Crime Dog, which could be sent out to school and community organizations, along with a Teacher’s Guide and a pledge for students to sign.  The pledge, of course, was the NRA’s Eddie Eagle stop – don’t touch – find an adult mantra, which has been floating around since God knows when and is still considered the gun-safety gospel by an industry which until now had the safety playing-field all to itself.

What I like about the Ad Council’s message, like the message being delivered by Melissa Joan Hart for Everytown, is not just the no-nonsense tone of the narration, but the degree to which both campaigns cut through the usual bromides about gun safety to really tell it like it is, specifically mentioning groups that are particularly vulnerable to unsafe guns, like young children and depressed teens.  And even more important, the Ad Council message is very simple: an unlocked gun is an unsafe gun.  Period.  I couldn’t have said it better myself.

Contrast this PSA with the latest effort by the NSSF to pretend that gun safety is of paramount concern.  It’s a video that runs more than 5 minutes featuring a competitive shooter, Julie Golob, who goes on and on about the “importance” of talking to your kids about guns. After several lengthy sermons about the difference between communicating with young children and teens, Julie actually mentions in 5 whole seconds that adults should set an example through “safe handling and proper storage” of their guns.  Nowhere is the word ‘lock’ mentioned, nowhere is anyone identified as being particularly vulnerable if guns are in the home.  I’m not casting aspersions at Ms. Golob for narrating a video so devoid of any reality about gun safety at all; it’s not her fault that she’s working for an organization for whom safety is secondary to selling guns.

All of a sudden the NRA and the NSSF are no longer controlling the game when it comes to discussions about gun safety; in fact they may find themselves on the sidelines while the Ad Council and other non-gun owning groups redefine how the game is played.  The gun industry’s going to have a problem trying to get everyone to walk around with a gun while trying at the same time to figure out how to keep the guns locked up or locked away.  Given the power, reach and authority of the Ad Council, this could be an interesting state of affairs.

 

The Be Smart Video On Sets A New Standard On Gun Safety.

This week a new gun safety campaign was launched by Everytown and Moms Demand Action called Be Smart, and you can usually judge the value of such efforts by the degree to which the pro-gun media weighs in on the other side.  They weighed in right away with multiple blogs and, as always, the infantile Breitbart response.  And one of the pro-gun bloggers got it right when she wrote that “allowing the anti-gun side to control the gun safety message is a big mistake.”

Until recently, the pro-gun gallery has owned the issue of gun safety, which they mostly define as keeping guns out of the ‘wrong’ hands, i.e., crooks, creeps and other undesirables who want access to guns for no other reason than to inflict harm.  The NRA has given a new hip-and-cool look to their Eddie Eagle program which has allegedly distributed millions of flyers although it’s unclear whether this effort has had any real impact at all. The NSSF gives away cable locks and has been running a public service campaign with the ATF about the danger of “straw” sales.  They also promote a competitive shooter with instructions for talking about gun safety with children, as if being a competitive shooter gives you the slightest credibility when it comes to knowing how to communicate with kids.

melissa                Don’t get me wrong.  I’m not against any of the gun industry’s safety programs.  But opposing background checks for private gun transfers makes it pretty hard to argue that you’re all that worried about criminals and other disqualified individuals getting their hands on guns. The new Be Smart campaign, on the other hand,  goes beyond the usual arguments about gun safety that you get from both sides, and this is what makes it such an interesting and potentially effective effort which the gun folks better not simply deride or ignore.

The centerpiece of the program is a video narrated by Melissa Joan Hart, which for no other reason than she votes Republican makes it difficult for the pro-gun chorus to simply brand her as another liberal, gun-grabbing, Hollywood star.  But aside from the image, what we get are serious comments about issues the gun industry would rather you and I forget.  For example, there’s a very sober message about teen suicide and how much easier it is to commit suicide with a gun. For another, Melissa actually uses the phrase ‘risk factors’ when talking about gun-owning families where there is evidence of mental illness or substance abuse.  The most important comment, however, is when she notes that “kids are naturally curious,” and that a gun is therefore a risk unless it is locked up “one hundred percent of the time.”

I’m really happy to see these issues injected into the gun safety debate and let me break it to you gently:  Melissa’s being perfunctory when she mentions her concern about the 1.7 million kids living in homes where guns are loaded and unlocked.  It’s children living in every home where there is a gun who are at risk, because sooner or later every one of those guns will be left around. If you haven’t figured it out yet, let me break it to you gently:  We are human. We are careless. We forget.

The industry’s approach to gun safety is that they want it both ways.  People should own guns to defend themselves, but the reason guns are touted as the best defense against crime is because of their lethality and nothing else.  Sooner or later, if you are a gun-owner who believes that owning a gun makes you safe, that gun is going to be left out, unsecured and unlocked, which poses a risk to the kids.

I have a suggestion for trigger-heads who  get nervous giving up space in the gun-safety debate to folks who aren’t particularly enamored of guns.  Start talking about gun safety in a realistic way. Stop pretending that guns aren’t a risk just because we “always” lock them up or lock them away.  There’s still only one way to guarantee that you can’t have an accident with a gun.

 

Want To Teach Kids Gun Safety? The NSSF’s New Video Doesn’t.

Ever since Sandy Hook, the gun industry has decided that safety is its middle name.  And chief among the proponents of this new strategy is the National Shooting Sports Foundation, which has taken upon itself the mission of pushing gun safety messages to kids who aren’t yet old enough to own or purchase guns, but it’s never too early to start cultivating the next generation of consumers.  You’ll pardon me for sounding just a tad sarcastic in this commentary, but this new-found concern about safety issues is interesting, given the fact that gun design hasn’t really changed in the last 125 years.  In other words, guns are as lethal and dangerous now as when the invention of smokeless-powder cartridges in the 1880s allowed gun makers to design small arms that could fire multiple rounds without having to be reloaded after every shot.

But what’s interesting about the new attention to safety being paid by the gun industry is that the notion that guns might be potentially dangerous no matter how they are used is a concept that is remarkably absent from the NSSF’s safety campaign, even though the campaign’s name, Project Childsafe, does beg the question of what exactly are we trying to keep the children safe from?

lock2                To the credit of the gun manufacturers, you may have to read the fine print, but they don’t beat around the bush when it comes to telling a gun owner the truth about the product he just bought.  For example, the instructional manual issued by Smith & Wesson for its old warhorse, the Model 10, K-frame revolver, states that “this firearm is classified as a dangerous weapon.”  The manual that accompanies Ruger’s Mini-14 rifle is even more explicit, stating in big, bold red letters – FIREARMS ARE DANGEREOUS WEAPONS – a warning that has not deterred me from owning three of them.

The risk posed by a gun, however, seems to be lost on the folks who produce safety videos for the NSSF.  The most recent is a bouncy, joyful message from a veteran, competitive shooter, hunter and mom named Julie Golob, whose family shares a love of the heritage, outdoors and the shooting sports; in other words, all the right credentials to be considered an expert on how to communicate with children on any subject, let alone safety and guns.  The video goes on to showcase a few cutesy testimonials from what is now the standard racial and gender inclusive group of kids, who relate how their parents did or didn’t talk to them about guns.  At which point Julie reappears and chants the usual refrain borrowed from the NRA’s phony safety program, Eddie Eagle, about not touching the gun – leaving the area – telling an adult, which is then followed by a new lyric for the older kids involving telling them never to touch a gun unless being supervised by an adult, never point a gun at anyone and always assume that every gun is loaded.

Oh, by the way, Julie doesn’t forget to mention that guns should be locked or locked away. As she puts it, parents have to set a “talk the talk and walk the walk” example.  The video runs 5 minutes, 37 seconds, and the entire comment about safe storage, which is the only way to keep guns away from kids no matter how many times you tell them not to touch a firearm, consumes a total of 8 seconds.  In other words, the only valid statement about gun safety in this entire message takes up 2% of the message.

As I said at the beginning of this commentary, you’ll have to excuse me from sounding a bit sarcastic.  But when the organization which represents the gun industry in every legislative and public discussion about gun safety can produce a public service announcement that is, to put it bluntly, an exercise in cheap hucksterism, then when it comes to safety the gun industry is inviting itself not to be taken very seriously.

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We Don’t Need Better Laws On Gun Safety. We’ve Got The NRA.

            Shannon Watts wrote a column for Huffington Post promoting more effective laws to hold parents accountable when their children get their hands on guns. She points out that child access prevention (CAP) laws make a real difference in unintentional gun injuries in which the victims are kids, but that the NRA has chosen to oppose such laws because CAP might “infringe on gun owners’ rights to effectively protect their homes.”

eagle            What Shannon didn’t mention is that the NRA goes a lot further than just fighting CAP laws. They also promote themselves as America’s gun-safety organization through their Eddie Eagle program which they claim to have introduced to more than 26 million children in schools throughout all 50 states. The program materials consist of instructional brochures, DVDs, student workbooks and the like, all designed to “keep America’s young children safe.”

The gun industry and the NRA touts their commitment to gun safety because unintentional gun injuries have steadily declined over the past twenty years.  The NSSF cites data from the National Safety Council which shows that deaths of children from accidental shootings has dropped by more than 70% since 1993, with all unintentional gun mortality for both children and adults now standing at an all-time low. What better proof could there be about the effectiveness of the NRA’s Eddie Eagle program or other safety programs conducted by the NSSF?  All the more reason why comprehensive CAP laws would just make it more difficult for gun owners to protect themselves, their families and their homes, right?

Duhhh, there’s only one little problem.  The NRA and the gun lobby in general can’t ever seem to understand that causation and causality are two very different things.  The fact that unintentional gun injuries have declined over the same period that the NRA claims to have introduced its Eddie Eagle gun safety program to millions of school kids doesn’t mean that one has anything to do with the other, even if they occurred at the same time.

The NRA has never validated its claims about the effectiveness of Eddie Eagle through an objective, third-party source.  And while the NRA Eddie Eagle website contains what at first glance appears to be an impressive list of individuals who comprise the program “task force,” if you examine the list closely you soon discover that while it includes teachers, school administrators, NRA staff and a few cops, there isn’t a single individual connected to the program in any way who has ever attempted to study the impact or value of the program at all.

Public health researchers have convincingly demonstrated that efforts to change the behavior of children by discussing issues in group settings yields little, if any positive results.  The most effective way to modify the behavior of children is on a one-to-one basis, and if the teaching is widened to a group setting, the target group should be very small.  The fact that the NRA has never conducted any study to test the before-and-after results of distributing their safety literature either in classrooms or in community groups makes it impossible to accept their self-congratulatory statements about teaching gun safety to kids.

I’m not saying the Eddie Eagle program doesn’t work.  I’m saying that to use a totally non-validated safety program as an excuse for opposing CAP laws is shabby at best, harmful and unsafe at worst. The real reason that unintentional gun injuries have declined over the past twenty years is because gun makers have phased in more safety engineering (e.g., floating firing pins) and states now require additional safety features such as loaded chamber indicators and minimum trigger-pull weights. But neither factor invalidates Shannon’s call for more comprehensive CAP laws.  If the NRA was really serious about representing all those responsible gun owners, they would welcome laws that require guns to be locked or locked away.

 

 

 

Another Gun Violence Expert Tells Physicians How To Do Their Jobs

While editorial opinion seemed to be running against the recent 11th-District ruling that reinstated Florida’s gag law, there were some notable exceptions, chief among them being an op-ed that appeared in the Pensacola News Journal written by Marion Hammer.  As a career NRA lobbyist, this lady has a long and courageous history fighting for the rights of gun owners in the Gunshine state, as well as for standing up for the oppressed in general, having been responsible not only for Florida’s concealed-carry law but also as the architect of Florida’s Stand Your Ground law, the first of its kind in the U.S.

          Marion Hammer

Marion Hammer

Hammer begins her diatribe by reminding readers that the real agenda of physicians is to rid the country of guns, and she lifts anti-gun statements from the AAP website to support her case.  She then goes on to remind physicians that if they “genuinely wish to offer safety information [they] can simply hand out firearms safety and safe storage brochures to all patients. Interrogating parents and children about what they own or have in the home is not only an intrusion but is a violation of privacy rights.”

Now I know that the press is very sensitive to anything that even remotely smacks of censorship, hence, if someone wants to express their opinions the editorial policy usually means that the writer can say more or less anything they damn well want to say.  But if Hammer thinks she’s presenting anything other than a total fiction about the role and responsibilities of the physician in counseling patients, then either her own physician never went to medical school, or she simply doesn’t have the faintest idea about what physicians actually do.  Her statement that doctors are violating privacy by inquiring about items in the home is a mind-boggling distortion of the doctor-patient relationship and I only hope that she has the good sense to avail herself of medical care that’s a little more aware of the requirements of the Hippocratic Oath than she seems to be.

In a way I can’t blame her for promoting a vision of medical care that’s so at odds with the reality of doctor-patient relationships, because there’s even a physician out there named Robert Young, who basically said the same thing in an op-ed piece published by the Sarasota Herald-Tribune. Like Hammer, Dr. Young also believes that physicians should limit their concern about gun ownership to handing out gun safety brochures developed by the NRA, whose gun-safety program for children, Eddie Eagle, has never been shown to have any positive safety results at all.

I’m not surprised that Ms. Hammer would follow Dr. Young’s lead in advocating the distribution of gun safety materials to patients.  After all, she’s a lobbyist for the NRA and all their training courses emphasize safe use of guns.  On the other hand, the NRA avoids the issue of safe gun storage like the plague, because the last thing they would endorse are mandatory laws requiring gun owners to lock away their guns.   After all, if guns are locked away to keep them from the kids, how will the “good guys” with the guns stop the “bad guys” with the guns?

Physicians need to ask patients if they lock away their guns for the same reason they ask patients whether their children are constrained while sitting in the car.  Unlocked guns are a health risk just like unlocked seat belts, and if Marion Hammer wants to dispute the studies which link gun ownership to higher levels of child mortality and morbidity, she’s also has the Constitutional right to promote the idea that the moon is made out of cheese.

 

 

 

 

Why Should Doctors Talk To Patients About Guns? Let The NRA Do It.

When the 11th Circuit re-instated the Florida gag law on physicians talking to patients about guns I knew that sooner or later we would hear from Timothy Wheeler and his gun-promoting group which believes that 19,000 gun suicides, 11,000 gun homicides and 50,000 (or more) intentional gun injuries each year shouldn’t concern physicians at all.  Wheeler is the doctor who began promoting the idea that doctors who inquire about gun ownership are their patients’ worst enemies, and his organization is rolled out by the pro-gun lobby whenever they need additional ammunition to keep America from adopting a common-sense approach to the issue of gun violence.

Wheeler’s organization, for which his claim of having thousands of members has never been verified in any way whatsoever, has just launched a small campaign to support the Florida gag law, at the same time that a coalition of medical associations and advocacy groups are going back to the 11th Circuit to ask the entire court, en banc, to overturn the recent ruling.  Which is exactly why Wheeler and his buddies in the gun-blogging community are trying to tilt public opinion the other way.

docs versus glocks                In the interests of full disclosure, I should state that I am married to an attending pediatrician, and am also a member and certified gun trainer for the NRA.  I have no issue with private ownership of guns but I take personally these indecorous attacks on physicians who are required to speak with patients about any matter which they feel might pose a medical risk, particularly involving something as potentially lethal as a gun.  The shabby attempt by physicians like Wheeler to pretend that guns do not constitute a health risk reminds me of the pathetic charades conducted back in the 1950’s by a few physicians and scientists who publicly disavowed any link between smoking and cancer.

Of course Wheeler and his cronies, in this case a psychiatrist named Robert Young, don’t want their audience to believe that they are against safe use and storage of guns.  After all, everyone’s in favor of safe gun use these days,  just ask the NRA and they’ll tout their gun safety program, aka Eddie Eagle which has “reached more than 26 million children in all 50 states.”  The same website that contains this information about Eddie Eagle also states that the NRA is “not affiliated with any firearm or ammunition manufacturers,” which is, simply put, a lie.  But Dr. Young seems oblivious to the requirement in his own medical profession to base clinical decisions and strategies on evidence-based information, since he advises his medical colleagues to use the Eddie Eagle handouts in contacts with patients who might or might not own guns.

I saved the best part for last.  Although Dr. Young believes in educating children in safe behavior around guns, he also wants to make sure that the safety of children is balanced out by the requirements for self defense.  And I quote:  “Even the sound practice of storing guns and ammunition in separate, locked places isn’t always right if they are intended to be used for emergency protection.”

This guy’s a physician?  This guy took the Hippocratic Oath which requires him to counsel patients about risks to their health?  There is not one single piece of credible research which shows that keeping a loaded, unlocked gun around the house creates protection from crime that outweighs the risks of injury or death from the existence of that gun.

People like Robert Young and Timothy Wheeler find media outlets for their destructive ideas because we really are committed to the idea of hearing “both sides” in the public policy debate.  But I don’t think that there are two sides when it comes to discussing a health issue which claims 80,000 or more victims each year.  Unless, of course, you’d rather believe that mortality and morbidity at those levels has nothing to do with health at all.

When Is A Homicide Always A Homicide? Try Using A Gun.

One area in which behavior that results in serious medical conditions has remained largely outside the purview of public health regulation and research concerns injuries caused by accidents with guns.  Most gun injuries that result in deaths aren’t accidents.  They were caused by people who consciously decided to use a gun on themselves or someone else.  Together. suicides and homicides account for 98% of annual gun deaths; accidental or unintentional deaths account for only 2% of the total.  At least this is what the numbers look like that are published by the CDC.  In 2010, the last year for which we have complete numbers, gun suicides were 19,392, gun homicides were 11,078 and unintentional gun deaths were 606; the last number, as Ralph Cramden used to say on The Honeymooners, a mere “bag of shells.”

But now we have a very different argument being made by Michael Luo and Mike McIntire of the New York Times, who believe that the way in which coroners and other public health officials treat and report fatal gun injuries seriously undercounts the number of accidental gun deaths that occur each year.  In their article, published last September, the reporters dug into specific, coroner-level gun death reports in four different states and discovered that as many as half of the gun mortalities that were reported as homicides were, in fact, unintentional or accidental, a finding which if true for the entire country, would make a substantial difference in the ratio of homicides to accidents and might undercut a major argument on gun safety promoted by the gun industry and the NRA.

Why is there such a discrepancy in how gun deaths occur as opposed to how they are reported?  Because in many states and localities, any shooting of one person by another, regardless of age, is considered a homicide.  Or sometimes the same office will rule one accidental shooting as a homicide and the next one as an accident.  Luo and McIntire give examples of both, including a “homicide” in Texas where a 9-month-old was killed when his two-year-old brother opened a dresser drawer next to the crib, pulled out a gun and banged away.  Now I can’t imagine that even in Texas they could figure out how to execute a two-year-old for murder, but I also suspect that the parents weren’t charged with neglect, or abuse, or anything else.  Texas, along with a majority of other states, has no law requiring that guns be locked or locked away in the home, remember?

childsafeOf course if you listen to the NRA touting it’s Eddie Eagle program or the NSSF promoting its ChildSafe safety kits, you would think that the entire decline in unintentional gun injuries was due to them.  And in fact there has been a decline in accidental gun deaths over the last decade, from 726 in 2000 to 606 in 2010 (although the rate of gun injuries over the same period has gone up.)  But the question that emerges from Luo and McIntire’s reportage is whether the morbidity data that the gun industry uses to  pat itself on the back for its safety initiatives really tells us whether gun owners are being safe, or whether coroners and other medical workers are just playing fast and loose with different definitions of how gun accidents really occur?

These issues might be resolved and we could finally understand the true degree to which Americans suffer from unwise use of guns if politicians like Rand Paul would stop pandering to the NRA faithful and withdraw their cynical opposition to guns and public health.  I don’t blame the NRA for trying to hold the line against physicians or anyone else who might seek to limit or regulate the market for guns.  After all, they represent the gun industry, and when was the last time that any industry came out in favor of government controls? But it’s nothing short of disgraceful when a politician who also happens to be a licensed physician could pretend that public health should play no role in how Americans use their guns.  Note:  I didn’t say that public health should make the rules.  But public health should be able to explain gun accidents when there are no rules at all.

The NRA Has Found a New Physician Friend

eagleRecently the medical news service Medscape published a video editorial about gun safety by Art Caplan, who runs the Division of Ethics at NYU’s Langone School of Medicine. The editorial content was hardly unique or different from similar statements that have been made by virtually every major medical society, namely, that the existence of several hundred million guns constitutes a health risk that cannot simply be ignored because of a 2nd-Amendment right to own a gun.

Caplan’s editorial has just been challenged on Medscape by Dr. Gregory Hood, an internist from Kentucky, who’s a rising star in the medical establishment, having just been named Governor of the Kentucky Chapter of the American College of Physicians.  Incidentally, the ACP  stated that “physicians need to be able to have frank discussions with their patients and parents of patients about firearm safety issues and risks to help them safeguard their families from accidents,” in a letter sent to the U.S. Senate during the debate over a new gun law following Sandy Hook.

While there appears to be a consensus among Dr. Hood’s colleagues about medical risks from guns, he evidently doesn’t share their concern.  This is particularly true given the fact that ” there will always be the inevitable threat of acts of violence and terrorism, whether by guns, fists, or other measures,” against which, according to Doctor Hood, “we must acknowledge the inherent right of law-abiding citizens to take reasonable precautions against such threats.”  The issue isn’t hundreds of published, peer-reviewed articles that show a link between access to guns, safely stored or not, and medical risk.  The real problem is allowing the good, law-abiding citizen the right to protect himself from terrorism with a gun.

What really seems to bother Dr. Hood is his belief, probably true, that most physicians have little first-hand knowledge about firearms and therefore risk violating best practices by counseling patients about an issue for which they cannot be considered to have much objective knowledge.  But that’s not a problem because medical professionals can always turn for guidance to the real experts on gun safety, namely the NRA.  According to Dr. Hood, the NRA’s Eddie Eagle program has “instructed” more than 25 million children in gun safety since 1988, and the program’s signature phrase, “STOP. Don’t Touch. Leave the Area. Tell an Adult” shouldn’t be bandied about by well-meaning researchers like Art Caplan and various medical professionals who aren’t skilled in the ways and means of guns.

If it were the case that Dr. Hood was just a flack for the NRA I could forgive his flight into fantasy about the NRA’s commitment to gun safety and let it go at that.  But Gregory Hood has an impeccable educational background, he’s obviously trusted and respected by patients and peers, his voice and opinions carry some weight inside and outside his profession.  So I’m going to take his comments very seriously and reply to them in a direct and serious way.

The fact is that the NRA has absolutely no idea whether a single child has ever been “instructed” in gun safety either in school or at home.  Hood’s figure of 25 million children comes from the NRA, it has never been validated by an independent source, and it is based on the number of Eddie Eagle pamphlets that the NRA claims it has mailed out over the last twenty-five years. That’s not instructing anyone in anything, and Hood should be embarrassed for pretending that this “program” does anything more than promote the NRA.

I really wish that guys like Greg Hood would stop hiding behind their cloak of professional integrity and admit, once and for all, that their primary interest is in protecting the access of their patients to guns.  I have no quarrel with that position, incidentally, because if you haven’t figured it out by now, I’m a gun owner myself.  But if we are ever going to have a serious and honest debate about whether guns are a public health risk then everyone has to come clean.  At this point Dr. Hood needs to be a little more candid about the reasons for his concerns about guns.

What Do We Do About Gun Violence?

At least two-thirds of the perpetrators who commit gun homicides are males under the age of 30.  What else do these shooters have in common?  They live in neighborhoods with overall high crime rates and low family income, they had previous contact with their victim, all facts that are well known. But there’s another commonality these shooters share which, as far as I can tell, isn’t mentioned in the discussions about gun violence and crime.

The commonality has to do with certain neurological and developmental factors shared by males under the age of 30.  It turns out that the part of the brain that controls processing of information about impulse, desire, goals, self-interest, rules and risk develops latest and probably isn’t fully formed until the mid-20’s or later.  And while adolescents and young adults both perceive and balance ‘good’ versus ‘bad’ as well as older adults, they tend to let peer pressures rather than expected outcomes guide their behavior when they have to choose between risks and rewards.

Now take this neurological-behavioral profile of males between ages 15 to 30 and stick a gun in their hands. The brain research clearly demonstrates that kids and young adults walking around with guns understand the risks involved. Whether it’s the NSSF’s new Project ChildSafe, the NRA’s Eddie Eagle or the community-specific gun safety programs that have expanded since Sandy Hook, nobody’s telling the kids something they don’t already know.

So what can we do to mitigate what President Obama calls this ‘epidemic’ of gun violence when the population most at risk consciously chooses to ignore the risk?  I think the simplest answer would be to look at what communities have done to protect themselves from other kinds of epidemics that threatened public health in the past.  And the most effective method has been to quarantine, or isolate the area or population where the threat is most extreme.  It worked in 14th-century Italy, according to Boccaccio in The Decameron.  Why wouldn’t it work now?

Last month the city of Springfield, Mass., recorded its 12th gun homicide.  If the killing rate continues, the city might hit 15 shooting fatalities this year, a number it actually surpassed  in 2010.  This gives the city a homicide rate of 10.2 per 100,000 residents, nearly three times the national rate.  But the city’s overall rate hides the fact that virtually all the violence takes place in two specific neighborhoods bounded on the north by Interstate 291 and on the south by State Route 83.  There two neighborhoods contain less than 40,000 residents which means that the homicide rates here are 40 per 100,000, more than 10 times the national rate.  This isn’t an epidemic?

2010 springfield homicide

                                                                                             2013 springfield homicides

Springfield Homicides 2010                                                                                                                                                    Springfield Homicides 2013

In 2010, not a single victim was older than 35 and 5 were not yet 20, the average age of all victims was 22.  This year there have been three older victims (+35 y/o) but otherwise the 2010 average age remains about the same in 2013.  If I had room to show the data for 2011 and 2012, the map would be the same.  Why can’t this area be designated a quarantine zone?  Following the designation, the police would behave like public health workers and conduct a residence-by-residence contact with everyone in the quarantine zone.  Ask every resident if they have seen any guns, ask permission to conduct a premise search, create a “watch list” of persons or residences that appear to be particularly high risk.  There’s no Constitutional issues here, you’re not kicking down any doors.  But you are telling people that there is one thing that must be done to curb the epidemic: the epidemic known as violence is carried by a virus known as guns and they must be eliminated in order to reduce the risk.