Want To Learn Nothing About Public health And Guns? Listen To The DRGO.

There are a couple of loud-mouth fools out there masquerading as physicians who run something called Doctors for Responsible Gun Ownership (DRGO).  Actually, what they run is a website that is sponsored by the 2nd Amendment Foundation, and these characters have been pandering to the NRA and the gun-nut audience since medical research on guns became verboten thanks to defunding of the CDC.

Their latest screed is an all-out attack on the decision by the major medical societies, along with the American Bar Association, to take a more aggressive stance on gun violence, something which has been defined as a public health issue since 1981.  And by the way, in case you’ve forgotten, the President that year happened to be a fairly-conservative guy named Reagan, not some gun-grabbing liberal like Clinton or you-know-who.

Gun violence was and is considered a public health issue for one simple reason, namely, that shootings result in the deaths and injuries of more than 100,000 human beings each year.  And it doesn’t matter whether these human beings are mostly old, White men living in small towns who impulsively stick a gun in their mouths and pull the trigger, or young, minority males who just as impulsively settle arguments with guns rather than their fists, the bottom line is that much of this damage wouldn’t occur if it wasn’t so easy to get one’s hands on a gun.

emt                I wouldn’t have any argument with the DRGO gang except for the fact that what they claim to be the mission and method of public health is so far removed from the truth.  In fact, not only do they misrepresent public health, they don’t even remotely or accurately convey what the public health community thinks about guns.  Instead, they pretend there’s no difference between the strategies promoted by advocacy groups like Brady or VPC, as opposed to peer-reviewed research conducted by experts in public health.

The fact is that gun-safety advocacy relies on public health research for many of the arguments that they promote in the public domain, but advocacy still drives public opinion, evidence-based or not.  The late Senator Daniel Patrick Moynihan once said, “We are all entitled to our own opinions, but we’re not entitled to our own facts.”  Public health research on any issue is an exercise in fact-building, how those facts are then used or not used by advocacy doesn’t invalidate the research itself. On the other hand, the pro-gun community not only eschews reliance on evidence-based research in forming and promoting their point of view, they often distort or wholly lie about the little bit of research which they claim proves what they say to be true.

And the most flagrant example of such lying is found in the attack on public health by DRGO.  Here’s the DRGO verdict on public health and guns: “Today the phrase ‘public health perspective’ as applied to gun violence only takes into account the harmful results of gunfire. It ignores the variety of reasons guns are valued. Most significantly, it ignores people using guns defensively at least 760,000 times per year (90% of the time not even needing to fire them) and the disincentive for criminality that promotes.”

Even if it were true that guns prevent 760,000 crimes each year, the idea that this transforms the 100,000 gun deaths and injuries each year into something other than a public health issue is absurd, and no physician who takes medicine seriously would advance such a stupid state of affairs.  But worse, the 760,000 figure wasn’t derived from any research at all; it was “estimated” by Gary Kleck in a Politico piece attacking critics of his research not because of what they said, but because their criticism was ‘proof’ they are part of the gun-grabbing cabal.

I’m going to send a note to DRGO that I’m willing to debate them any time, any place, on the issue of public health and guns.  They won’t agree to such a debate because they’re all about denying gun risk, not about truth.  Whatever happened to the Hippocratic Oath?





If Schools Can Teach Safe Sex, Can’t They Teach Safe Guns?

Sooner or later, probably sooner, the number of Americans who die in car crashes each year will be exceeded by the number of Americans who die because someone put a bullet into their brain, or into their chest, or into some other vital part of their anatomy and the most skilled trauma surgeon on call when they are rushed into the ER won’t be able to put them together again.  I’m not being sarcastic when I talk about the skill of the trauma surgeon, by the way; gun injuries are much more difficult to treat than any other kind of serious trauma and the costs of gun injury to the medical system are two or three times higher than the costs of any other type of injury.

auto                An interesting commentary on the auto trauma – gun trauma issue was recently posted on Huffington written by a pediatrician, Claire McCarthy, who practices at Boston Children’s Hospital.  Dr. McCarthy makes the point that the response to injuries usually involves some kind of safety laws and rules that will limit injuries and therefore reduce risk when the particular product is being used.  In this regard she cites the fact that all states have similar licensing requirements for driving, and that all states require seat belts, particularly when kids are in the car. On the other hand, she notes that licensing for gun ownership varies from state to state if it is required at all, and that when new gun laws are proposed, somehow the argument turns into a disagreement about rights, not about safety.  The way she puts it, and I love this sentence: “I can’t imagine someone framing motor vehicle safety as a personal freedom issue.”

Dear Dr. McCarthy: Let me be the first one to welcome you to the world of guns.  Because in the gun world, particularly the gun world as it has been created and nurtured by the NRA, gun safety has absolutely nothing to do with safety, it only has to do with rights.  And your innocence in this regard (obviously intended, not real) is your comment that “we get that cars are dangerous.”  Which is exactly the point.  For the folks who live in the gun world, guns aren’t dangerous.  In fact, the whole reason for owning a gun is that it protects those of us who inhabit the gun world from things that are really dangerous like robbers, and street thugs, and terror cells which are now, according to the NRA, actively operating in every city.  What do cars protect us from?  Being late to work and getting chewed out by the boss?  Big deal.  That’s hardly a trade-off.  I’ll take the protective value of guns over cars any time.

But seriously Dr. McCarthy, your Huffington op-ed was what we would expect from someone with your background, training and experience.  It was literate, informed, rational and based on evidence-driven facts.  The only problem is that the folks who really need to be persuaded by your enlightened approach to the problem of gun violence don’t think that way at all.  The day after Christmas a young mother was shot to death in a WalMart in Idaho.  She wasn’t shot by a robber or a terrorist – she was shot by her two-year old son who reached into her pocketbook and yanked out her loaded gun.  Now what in God’s name made this poor woman actually think that she needed to defend herself in a WalMart store?  And we’re not talking about some semi-literate living in a trailer park in Tennessee.  The victim was a college graduate who worked at the U.S. Department of Energy lab and I’ll bet she made sure to buckle her kid into that safety seat before she drove off to the store.

Public health approaches to injuries – seat belts, window gates, pool fences – have worked again and again.  What we need in the case of guns is something much more fundamental.  We need education and if schools can teach safe sex and safe eating, why can’t they teach safe guns?

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.