Think That Suicide Isn’t Gun Violence? Think Again.

The bad news is that suicides overall are up, the good news is that gun suicides as a percentage of all suicides is down. Well, kinda down.  Fifteen years ago, the CDC counted 29,199 suicides of all types across America; the per-100K rate was 10.48.  In 2014, the overall number was 42,773; the rate had climbed 23 percent to 12.93.  Ouch!  That’s not good.  Gun suicides, on the other hand, claimed 16,599 lives in 1999 for a 100-K rate of 5.96; in 2014 gun suicides were 21,334 resulting in a 100-K rate of 6.34.  So the gun suicide rate only increased by 6 percent.  I guess Gun Nation is doing something right, right?

Actually, wrong. Want the latest and greatest from Gun Nation about suicide and guns?  Take a look at the new, online safety program developed by the NSSF.  It’s a glossy website that gives a roadmap for ‘responsible’ gun ownership based on safe storage, training, communication and all the other things that you should do to be a ‘responsible gun owner.’  The website includes a nice list of safe storage options ‘to fit your lifestyle and home circumstances,’ ranging from a trigger lock to a full-size gun safe, all of which should be used to ‘prevent accidents.’

But what if you don’t want to lock the gun away because you might need to use it to shoot a You-Know-Who breaking down the front door?  After all, isn’t concealed or open carry also a lifestyle?  You betcha, considering that for the last twenty years the gun industry and its media sycophants have been promoting how much safer you’ll be if you own a gun.

But will you be safer?  To my utter astonishment, the NSSF’s safety brochure actually contains a statement about gun risk which is true: “Keeping a firearm to defend your family makes no sense if that same firearm puts family members or visitors to your home at risk.”  What kind of risk? The risk that is never mentioned by the NSSF or anyone else who promotes gun ownership, namely, risk that someone might end their own life with a gun. The NSSF gets about as close to this untouchable issue as they can by noting that gun safety is particularly necessary if “loved ones experience a difficult time.”  Well, at least Gun Nation has found a pleasant euphemism for depression; i.e., a ‘difficult time.’

But let’s drop the euphemism and look at reality: “States with higher levels of household gun ownership had higher rates of firearm suicide and overall suicide.  This relationship held for both genders and all age groups.  It remained true after accounting for poverty, urbanization and unemployment.” The link between gun ownership and suicide is particularly evident among teens, according to researchers at Harvard’s School of Public Health, and the fastest-growing age-group prone to suicides are teens. Since 2007, the overall rate of gun suicide has increased by 12%, the gun suicide rate among teens is up by 42%.

Why is Gun Nation so reluctant to mention the word suicide when they talk about gun safety?  Because it’s an unbroken rule among the gun-nut fraternity/sorority that the only people whose lives are lost from the misuse of guns are law-abiding citizens who didn’t use a gun to defend themselves against the You-Know-Who’s.  Think I’m overstating things?  Just listen to Wayne-o or home-school queen Dana Loesch repeat this nonsense in the videos they produce for the NRA.

Don’t think that suicide isn’t gun violence?  Think again.  Here’s how violence is defined by the Oxford English Dictionary: “Behavior involving physical force intended to hurt, damage, or kill someone or something.” Notice it doesn’t say ‘someone else,’ because that’s a crime called aggravated assault.

Violence means damage and there’s nothing out there that can damage someone as effectively or quickly as a gun, particularly when you don’t even have to aim.  As far as I’m concerned, at least when it comes to suicide, maybe the GVP community should just drop the ‘V.’

 

 

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How Do You Convince People That Guns Are A Risk? Maybe By Not Talking About Guns.

conference program pic           In the face of more than 100,000 serious injuries and deaths every year, it’s pretty difficult to accept the idea that gun violence isn’t a public health issue, yet promoters and defenders of gun ownership continue to insist otherwise.  And while it would be easy to assume that such warped thinking is the product of infantile and/or uninformed minds, medical and public health communities have been spectacularly unsuccessful trying to convince Americans that guns constitute a risk to health.  In fact, both Gallup and Pew polls indicate that a majority think that guns protect us from crime, even while the same majority also support expanded background checks.

In light of the divergence between public health research findings on the one hand, and public opinion in the other, I am beginning to think that perhaps the problem lies not in the power and messaging of Gun Nation, but reflects the possibility that perhaps public health research should stop focusing so much energy on the public aspects of gun violence and spend more time thinking about the health aspects of the problem, in particular, the issue of why people own and use guns.

Because there would be no gun violence if a certain number of people each year didn’t misbehave with their guns.  And the issue of behavior is never far removed from the manner in which the medical profession deals with disease. The mortality numbers for serious illnesses would be much different if we changed behaviors like smoking, excess eating and drinking which cause heart disease and cancer which leads to medical distress.

The medical response to behavior which leads to gun morbidity, however, seems to largely put the cart before the horse. Doctors are being advised to counsel patients on safe gun storage, as if gun violence will be ‘cured’ by locking the guns up or locking them away.  I’m not against safe storage, but less than 4% of gun injuries occur because a child grabbed an unlocked, loaded gun.  The overwhelming amount of gun violence, for which the medical costs alone are estimated to be at least $50 billion each year, takes place because someone made the conscious decision to use their gun to injure either themselves or someone else.  And that decision is rarely going to bear on whether the gun is locked away.

Last year a public health research team conducted a survey of 4,000 adults of whom one-third reported owning guns.  Half of the gun-owning group also reported that they engaged in social activities involving guns with either family members or friends. Which meant that for these folks the ownership of guns goes far beyond believing that guns make them safe.

To people for whom gun ownership is how they create their social milieu, guns represent honesty, patriotism, family and other cultural artifacts which form a basis for self-expression and communication between family members and friends. So when such folks perceive a threat to their ownership of guns, this perception quickly becomes a threat to their self-identity as well.  Which means that trying to prove that guns are a risk will only push such individuals to harden their resistance against losing their guns.

“If individuals adopt one position or another because of what guns mean instead of what guns do, then empirical data are unlikely to have much effect on the gun debate.”  To me, this statement by Don Braman and Dan Kahan neatly sums up much of what has characterized the gun debate over the last several decades.

Please don’t misunderstand – I’m not opposed to empirical research. But it’s one thing to argue the case for gun risk by citing data which shows that gun injuries increase in homes where there are more guns; it’s another thing to convince individual gun owners that such a finding might apply to any of them. Want to counsel a patient about whether his guns represent medical risk?  You’ll have to figure out how to do it using language which isn’t perceived as a threat.

Docs Versus Glocks And The Docs Now Get A Helping Hand.

Last week a California Congressman, Michael Honda, introduced a bill that, if enacted, would end what has been the nefarious and disturbing strategy adopted by the pro-gun gang to push medicine out of the gun violence debate.  This strategy has three basic dimensions: (1). To define the 100,000 mortalities/morbidities from guns as something other than a public health issue; (2). to prevent public health research into gun violence by defunding relevant research budgets of the CDC; (3). to criminalize and/or otherwise prevent physicians from talking to patients about access to guns.

Don’t think for a second that it’s only a bunch of yahoos and red-neck gun nuts who believe that 100,000 deaths and injuries committed with guns doesn’t constitute a problem for public health.  Last year we were treated to the spectacle of a U.S. Senator who happens to be a physician, if only a self-certified one, blocking the appointment of the Surgeon General because Vivek Murthy had actually stated that guns were a public health threat.  It should be added, incidentally, that this self-same jerk (not Murthy, obviously) claims that if he is elected President, he’ll uphold the “entire Bill of Rights, but specifically our right to bear arms.”  So I guess he’ll support the other nine Amendments but only in general terms.

docs versus glocks                The defunding of CDC research into gun violence was payback by the NRA for the Brady Bill and the ten-year assault weapons ban that were passed by Congress just before the Democrats lost their majorities in both the House and the Senate in the Republican landslide of 1994.  The spending cutoff didn’t end gun research per se, because private foundations and other sources jumped in and provided much-needed support.  But what the research ban accomplished was to send a signal to the medical community, both clinicians and researchers, that gun violence was simply not considered an issue of public concern.  Which made it that much more difficult to advance legislative responses to deaths and injuries from guns.

There are now three states which have passed laws copying more or less the Florida statute that criminalizes the behavior of doctors who talk to patients about guns.  This law, known as Docs Vs. Glocks, is still being kicked around in the Federal courts, but if it is ever declared completely and totally Constitutional, the law will no doubt appear in other gun-rich states as well.  The Florida law, of course, allows clinicians to talk to patients about guns if the physician decides that the patient represents a “clear danger” to himself or someone else.  Of course the only way that a physician can make such a determination about access to guns or access to any life-threatening situation is by having the widest possible latitude to discuss, in privacy, anything that goes on.  But try and explain this to the legislators in the Gunshine State who cynically cast a quick and easy vote reminding their constituents that protecting their 2nd-Amendment rights is more important than protecting their health.

Congressman Honda’s bill seeks to remedy this entire state of affairs.  Called the “Gun Violence Research Act, “ the bill specifically re-inserts language into the Public Health Service Act calling for research into ”the causes, mechanisms, prevention, diagnosis, and treatment of injuries, including with respect to gun violence;”  it also authorizes funding of this research through 2020; and most important, it prevents prohibiting a physician or other health provider from asking a patient about guns.

All the bill’s co-sponsors are Democrats, which shouldn’t surprise. But the good news is that we now have an explicit legislative remedy that can be used against the gun gang’s shabby and dangerous efforts to silence medicine about the health risks of guns.  Don’t get me wrong.  We accept many risks in everyday life and if someone wants to accept gun risk for whatever reason, they can do as they please.  But the role of the physician is to reduce harm, and guns are harmful, no matter what anyone says.

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