They Don’t Have Many Gun Accidents In Tennessee But Lots Of People Keep Getting Shot.

Earlier this year a big hue and cry broke out in Tennessee when the State Health Department issued a report which put the number of accidental shooting deaths for 2014 at the stratospheric level of 105.  This was not only four times higher than the number of unintentional gunshot deaths for any previous year, but accounted for nearly 20% of reported accidental shooting mortality in the United States.

safe-tennessee           There’s an organization in Tennessee called Safe Tennessee Project which is ‘dedicated to addressing the epidemic of gun-related injuries and gun violence’ through tracking the rate of shootings, and advocating the standard Gun-sense Nation strategies for reducing gun violence like expanded background checks, strengthening CAP and domestic violence laws, temporary gun removal from persons considered to be threats by family members – the usual nine yards. The group was rightfully alarmed when the 2014 number for accidental gun deaths was made public and their statement lamenting these shootings bounced around various media outlets here and there.

Oops! – one little problem.  Even though Safe Tennessee checked the validity of the data with the Health Department before going public, it turned out that the report was wrong. Two weeks or so after the initial reports about the 105 accidental gun deaths appeared, the State Health Department sent out an advisory which adjusted the 2014 number from 105 down to just five. This was not only the lowest annual total that Tennessee had ever recorded, but was far and away the lowest state-level number for any of the 20 states that sent their unintentional gun-death number to the CDC for 2014.

So what do you think happened?  What happened is what always happens whenever data which is used by Gun-sense Nation to promote its agenda is changed, namely, that Gun-nut Nation immediately told all its members that, once again, the gun grabbers were lying about gun violence in order to justify taking away all the guns.  The NRA called it just another example of how Gun-sense Nation uses ‘suspect data to push their political agenda,’ and of course we all know what the goal of that agenda happens to be.

As usual, the real issue that drives the debate about gun violence was lost in the mea culpa’s and tua culpa’s which followed from what was nothing more than a silly mistake made by some hapless employee at the Tennessee Department of Health. The CDC creates data based on reports that follow a procedure known as ICD-10, developed and administered by the World Health Organization, which allows physicians throughout the entire world to keep track of medical diagnoses in a uniform and comprehensive way. In the case of injuries, they are divided between intentional versus unintentional events, so as to make it easier for public health and law enforcement to ascertain the extent to which the incidence of any particular type of injury is going up or going down.

Although I can understand why we need to differentiate car accidents as unintentional injuries versus aggravated assaults where intentionality is clearly the cause, I have never felt comfortable in dividing gun injuries into these distinct categories for the simple reason that, as opposed to responding to damages from vehicle crashes by designing safer cars, there is no way to make guns ‘safer’ as long as someone points a gun at themselves or someone else and goes – bang!  Because if you haven’t figured this one out yet, let me break it to you gently: guns are designed for one purpose and one purpose only – to propel a solid piece of lead at high speed from me to you.

Tennessee may have a very ‘low’ accidental gun-death rate, but the rate of all gun deaths is 50% higher than the national rate.  Which doesn’t make the efforts of Safe Tennessee in any way irrelevant to health and welfare in the Volunteer State.  To the contrary, they have important work to do, Health Department data screw-ups or not.

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Should Doctors Stop Talking About Gun Violence Because Medical Errors Cause More Deaths? No.

Gun Nation is abuzz with the publication of an article in the British Medical Journal which finds an alarmingly high rate of U.S. hospital deaths due to medical errors.  Now why would the pro-gun noise machine care one way or the other about an article in a medical journal?  Because it’s been an article of faith amongst the gun faithful that physicians should stop wasting their time talking about gun violence when the number of people killed each year by firearms is just a fraction of the number who die due to medical mistakes.  And since the BMJ article states that medical errors account for anywhere between 200,000 and 400,000 avoidable deaths each year, and annual gun homicides only count around 11,000, why can’t doctors take care of really ill patients properly before they start making so much fuss about guns?

docs versus glocks           Marion Hammer, former NRA President who spearheaded Docs versus Glocks in Florida, says that docs should “do no harm” and keep their political opinions out of the examining room.  And in pushing for the gag law, Hammer distributed a document that listed ‘medical misadventures’ as three times more likely to result in deaths than accidental shootings.  Other sources, like media that promote natural healing, paint an even grimmer picture, with one expose claiming that guns kill 31,940 Americans each year (homicide/suicide/accidents) but the medical system accounts for783,936 deaths! By the way, this particular website also published a story that said the San Bernardino shooting had all the “signs” of a staged government operation, and this story rolled out more than 31,000 times.  Hmmmmm.

The problem is that the British Medical Journal isn’t an adjunct of the Area 51 gang, so when they publish something about morbidity from medical errors, it needs to be taken seriously, particularly if what they say ends up being injected one way or another into the gun violence debate.  Now let me make it clear that I’m not a physician and I have no medical training of any kind.  But I know how to read the King’s English and I can figure out whether data in a peer-reviewed journal aligns with the facts and conclusions on which the article is based.  In the case of the BMJ, I not only read the article detailing mortality rates from medical errors in U.S. hospitals, I also closely read the articles on which the BMJ article was based. Let’s start first with the BMJ.

In 2013, 611,000 Americans died from heart disease, 585,000 died from cancer and 251,000 died from medical error, this last being the third most common cause of death.  Since the medical profession doesn’t actually have specific medical errors as coded events in the ICD-10 coding system used almost universally as the primary indicator of health, the figure noted above is a best-guess estimate based on specific studies of in-patient outcomes throughout the U.S. The most comprehensive study from Medicare records, gave the total mortality for doctor errors as slightly more than 195,000 per year from 2000 through 2002, of which 75% of all deaths were attributed to something known as ‘failure to rescue,’ which means a diagnostic error leading to improper (or no) treatment, leading to the patient’s death.

But failure to rescue in a clinical context may have little, if anything to do with decisions made by physicians themselves. Many such deaths are attributable to mistakes in managing patient information, particularly for elderly patients who tend to suffer from multiple conditions requiring intensive and complicated care. A necessary treatment is omitted or delayed, vital signs begin to decompose, the patient is dying but his physician may be far removed from the scene.

To compare the ‘responsibility’ of physicians for patient deaths to the ‘responsibility’ of a gun owner who lets his gun get into the wrong hands, is to make a comparison with no basis in fact. But since when did Gun Nation respond to the issue of gun violence with any facts at all?