If Public Health Researchers Want To Reduce Gun Violence, They Need To Figure Out Why It Occurs.

How and why did doctors get into the argument about gun violence?  They got into it because the World Health Organization (WHO) says that violence, defined as hurting oneself or someone else, is a threat to health. And since a health threat can be measured by the number of times that someone is treated at a medical facility for something which, left untreated, could make that person feel unwell, I guess that 125,000+ such treatments each year constitutes a threat to health.

paul             But a threat to someone’s health is not the same thing as a threat to public health. The latter is usually defined as a proactive, medical response that seeks to combine scientific evidence with public policies to protect the entire community from a health threat, be that community a small village, a neighborhood within that village, a group of families within that neighborhood, or maybe the total population of an entire nation-state. In other words, first we figure out why someone gets sick, then we figure out how the illness moves from one person to another, then we figure out what we need to do to confine the illness to as small a number as possible. If people get sick because they all drink water from the same contaminated well – clean up the well. If a deadly virus is transmitted through unprotected sex, educate everyone to engage in protected sex.

Unfortunately, it turns out that many illnesses cannot be eradicated or even controlled just by figuring out how the pathogen moves through the air from Victim A to Victim B. This is because many illnesses are caused not by a virus, but by the way we behave. Drive your car at an unsafe speed and sooner or later you’ll smack into someone else. Plug a home appliance into the wall while you’re taking a bath and – zap! – you’re on the way to the morgue. In 2016, more than 230,000 Americans died because they accidentally injured themselves or someone else; another 32 million needed some degree of medical attention because they were injured but weren’t killed.

Next to those numbers, 35,000 deaths and 90,000+ non-fatal gun injuries doesn’t seem like such a big deal, except for one little difference between how and why gun injuries occur. Because if public health researchers discover that excessive speed causes automotive accidents, we lower the speed limits; if research shows that tobacco causes cancer, we can pass laws which prevent kids from starting to smoke. But how do you make someone use a gun safely when the only reason to use a gun is to inflict injury on yourself or someone else?

Now one can argue that if you injure someone else with a gun in the process of protecting yourself from that person’s attempt to injure you, then the gun has served a positive purpose and that such behavior should not only be respected but encouraged as well. But at least 100,000 gun injuries occur each year because someone consciously used a gun to hurt themselves or someone else without the slightest self-defense rationale at all.

If public health researchers want to bring the number of intentional gun injuries down, they need to figure out why only a small percentage of people who own guns use them in a violent way, and more important, why even most people who engage in violent behavior choose not to use a gun.  Last year physicians treated more than 2 million victims who were injured because someone else wanted to hurt them real bad. But less than 5% of the attackers were armed with guns, and it’s not like the other 95% couldn’t get their hands on one.

Rand Paul is totally wrong when he says that gun injuries aren’t a concern for public health. But his argument will stand until and unless researchers figure out why some people make a deliberate choice to commit an assault with a gun. If a gun is the pathogen which leads to gun violence, why don’t we have 300 million gun injuries every year?


Mike The Gun Guy’s Greatest Hits: Five Must-Read Articles On Gun Violence

From time to time I think it’s important to alert Gun-sense Nation to publications that confirm one way or another what we all know, namely, that guns are responsible for the deaths and injuries of more than 100,000 Americans every year.  And while most of us consider gun violence to be both abhorrent and inexcusable, from time to time we encounter folks who don’t share that point of view.  And I’m not talking about card-carrying members of Gun-nut Nation who are today celebrating a jury’s decision to acquit the jerks who spent a week last year eating pizza up at the Malheur National Forest Range – I’m talking about a friend, a neighbor or a co-worker- someone who might profit from a serious discussion about gun violence prevention backed up with reference to research whose findings are incontestably true.
gvp2           So what follows is Mike the Gun Guy’s ‘greatest hits,’ i.e., what I think are recent studies on different aspects of gun violence that can and should be used to bolster the gun violence prevention point of view.  Because let’s not forget that Gun-nut Nation relies on a powerful network of pro-gun promoters who never miss an opportunity to broadcast the idea that guns in the home, on campus, in front of polling places and God knows everywhere else are the only things we can rely on to keep us protected and safe.  Think I’m indulging in a bit of hyperbole?  Take a listen to Wayne-o’s latest rant. Want to have information at your fingertips that can be used to deliver a more reasonable (and rational) point of view?  Here’s the list and you can download them all right here:

—–  Center for American Progress, America Under Fire.  This study matches gun violence data with the degree to which each state experiences gun violence and demonstrates that as gun regulations increase, gun violence goes down.  Gee, what a surprise. But what got this report on my ‘greatest hits’ list was a new approach to the definition of gun violence which aggregates ten different categories of gun violence so that different patterns can be seen in different states. DOWNLOAD

—– Azrael and Miller, “Reducing Suicide Without Affecting Underlying Mental Health.” An authoritative study on the links between suicide and access to lethal means which shows that restricting access to firearms can reduce suicide rates in countries which have free access to guns (read: the USA.) DOWNLOAD

——  Webster, et. al., “Firearms on College Campuses.” This recent study is actually more than what the title suggests, because the authors go after bigger game, namely, the whole question of gun-free zones.  And what they argue and prove is that gun-free zones do not attract shooters, nor are gun-carrying civilians a deterrent to gun-violence events.  DOWNLOAD

——  Hemenway and Solnick, “The epidemiology of self-defense gun use.”  The notion that guns protect us from crime is a centerpiece of Gun-nut Nation’s continuing effort to make Americans believe that it should be normal, natural and indispensable for everyone to walk around with a gun.  This article demolishes that argument – period. DOWNLOAD

——  Lester Adelson, “The gun and the sanctity of human life.” Why would I include an article published in 1980 in a list of recently-published works on gun violence?  Because this is the best, most prescient and profoundly scholarly article ever published on gun violence and if you don’t read it, sorry, but your understanding of gun violence is sadly incomplete. DOWNLOAD

One caveat about my list.  There are many other articles and contributions which I could mention so if you happen to be a gun-violence researcher please don’t feel offended if your article doesn’t appear here.  We all need to educate ourselves on a continuing basis, and I am always willing to alert my readers to any and all research which deserves to see the brightest light of day.  And while you are reading any or all of these articles, don’t forget something you must do on or before November 8th.

A New Study Says That Gun Control Really Works. It Does?

The GVP community is abuzz with the recent publication of a study that is being advertised as showing that more gun-control laws equals less gun violence.  At least this is the headline in a story about the study published by Vox which states that gun control “actually works.”  Except that’s not exactly what the study says.  The scholars analyzed 130 peer-reviewed articles published between 1950 and 2014, although only 58 articles were utilized to create a scale of responses to various changes in gun laws, of which 50 of the articles were published since 2001.

The article groups those 58 studies into three, broad categories: (1). studies which examine the effects of laws covering personal behavior with firearms (e.g., CCW, castle doctrine) on homicides and gun homicides; (2). studies covering changes in firearms laws that target gun access and homicides; (3). studies on the effects of changes in firearms laws that target gun access and suicide. Grouping the studies into these three categories produces results that are, to put it mildly, somewhat mixed.

conference-program-picOn the question of the relationship between arming civilians and increasing or decreasing gun violence, the jury is exactly split.  Half the articles cited found that laws which made it easier to walk around armed resulted in drops in homicides; the same number of articles found that the extension of CCW resulted in more homicidal deaths.  It should be pointed out that a majority of articles on both sides of this issue were pro and con contributions to the John Lott ‘more guns = less crime’ thesis, including, of course, the seminal publications by Lott himself.

On the issue of whether gun-control statutes play a role in diminishing gun homicides, the studies listed appear to confirm the idea that more gun laws lead to less gun violence, at least this is what the articles appear to say.  But when I looked at the article by Rosengart, which is cited no less than three times in support of the notion that more gun laws leads to less gun violence, the author in fact concludes that, “No law was associated with a statistically significant decrease in the rates of firearm homicides or total homicides.” Another article by T. B. Marvell is summarized as showing almost an 8% reduction in gun violence, but the author in fact states that, “even with many different crime measures and regression specifications, there is scant evidence that the laws have the intended effect of reducing gun homicides.”

As for the grouping of articles purporting to show a connection between more gun laws and less gun suicides, here again the articles all appear to support the idea that CAP laws, background checks, minimum purchase age and banning of small, cheap guns lead to reductions in gun suicide from 3% to as much as 45%.  But once again I find myself drawn to the text of one of those cited articles which says, “No law was associated with a statistically significant change in firearm suicide rates.”

The authors of this study admit that “challenges in ecological design and the execution of studies limit the confidence in study findings and the conclusions that can be derived from them.” Which is a polite way of saying that their conclusions should be taken with several grains of salt. But I am not surprised that the public health scholarly landscape still has major gaps when you consider that research funding has been basically non-existent since 1998.

But let’s say for the sake of argument that the funding spigot gets turned back on and all those research gaps are filled in.  And let’s further say that when the research holes are completely filled that it turns out that more gun-control laws really do result in gun violence going down.  Do you think for one second that the NRA would accept the research as valid when it comes to gun control and begin to change its tune?