If The Facts Don’t Support Gun-nut Nation, Why Bother With Facts?

Now that we have a President-elect who has made a virtue out of not even trying to distinguish between fact and fiction in debates about public policy, we will begin to see this confusion appear in public policy discussions about guns.  Actually, it’s not a confusion at all; rather, the door is now open for Gun-nut Nation to say anything they want to say about guns because as long as they say it, then it must be true. And if the other side says it, since they lost on November 8th, it’s false.

ccw           How long did it take for this new approach to appear?  Exactly one week following the election, with an article in National Review. The author, Andrew Branca, a self-described expert on self-defense, floats around the alt-right radio world and also teaches self-defense ‘law’ on a website which, of course, contains the usual disclaimer that none of the content ‘accurately communicates laws or court decisions,’ too bad these classes can’t be listed any longer on the Trump University curriculum.

The subject of the NR critique is an article which just appeared in a leading medical journal, JAMA – Internal Medicine, which finds a clear connection between the ‘Stand Your Ground’ law in Florida and an increase in homicide in the Gunshine State. The article looked at homicide rates and gun-homicide rates between 1999 and 2014, and found a significant increase in both trends after the SYG law was passed in 2005. This increase was particularly evident for age groups 20-35 and for males, which happen to be the two most common demographic categories for gun violence overall.

This is not the first study which links SYG laws to increases in gun violence and violence in general.  The Everytown research group found that after the law was passed, the justifiable homicide rate tripled, with most of the victims, not surprisingly, being young, Black men.  A detailed study based on Texas data showed that such laws did not deter crimes like assault, robbery or burglary, but did lead to an increase in murder and manslaughter. In other words, if you walk around armed and are not required to first back down when facing what you believe to be a criminal threat, you might end up shooting someone but you won’t be protecting yourself or your community from crime.

Which is exactly the opposite of what Gun-nut Nation claims is the reason for walking around with a gun. And you can be sure that you’ll hear this nonsense again and again next year when the NRA leads the charge to get a national, concealed-carry law on the Chief Executive’s desk. Which brings us back to Branca’s critique of the JAMA new study on the effects of the Florida STG laws; a critique based on a misuse of data that reaches colossal terms.

Branca states that the SYG study is ‘fatally flawed’ because it does not distinguish between murder on the one hand and homicide on the other and, in many cases, murder turns out to be a reasonable response by a victim to a violent crime.  And since the whole point of STG laws is to give a crime victim an opportunity to defend himself before or during the commission of a crime, of course the number of people killed would go up as all these gun-toting community defenders use their guns to protect themselves and everyone else.

.  In Florida, the average annual homicide rate increased from 600 to 840 after STG was passed. Meanwhile, according to the FBI, the number of justifiable homicides recorded throughout the entire United States averaged roughly 280 per year for the years covered by the JAMA report  Should we assume, therefore, that every, single act of justifiable homicide occurred only in the Gunshine State? And that’s the level of stupidity masquerading as informed opinion that we will now face when it comes to the public debate about guns.

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There’s A New Gun Petition Out There And It Sure Ain’t To Promote Guns.

Funny how politics makes strange bedfellows, doesn’t it? Way back when, sometime around 2007 or so, I sent a donation to moveon.org because they were running a campaign against the Iraq War, in particular the escalation of the war known as the ‘surge.’  And to explain and justify the strategy, none other than General David Petraeus was brought back from the battlefield to explain what was going on to various Congressional committees on the Hill. And the fundraising request I received from moveon.org started off by saying, “Here comes Petraeus, don’t let him betray us.”  I thought this was very funny so I sent moveon.org a few bucks.

moveonSo now it’s a different time, a different place and I got Petraeus and Mark (Gabby’s husband) Kelly coming together to form a new gun-control organization which, like all the Gun Violence Prevention groups, is trying to attract more attention to the gun violence problem in the wake of the Orlando shooting last week. And I was about to give the Petraeus-Kelly combine my award for this week’s most significant addition to the roster of organizations and activities that are promoting gun violence prevention except that another horse coming out of the moveon.org stable caught my eye instead.

What I am referring to is a petition on the moveon.org website which calls for the banning of all AR-15 guns.  And what I like about this petition is that it’s simple and direct: “We need to ban all assault weapons now, while moving quickly to enact common sense gun reform.”  The petition doesn’t call for redesigning the guns, or removing the hi-cap mags, or any other small reform like that. It says ban ‘em, period.  End of story. Throw them all away, or melt them down and turn them into useless junk.

And not only does the petition call on the government to ban the damn things, it also refers to these weapons by their rightful name, assault weapons, because that’s exactly what they are. And if you happen to be someone who really and truly believes that the AR-15 or the Sig MCX whatever nomenclature is used to avoid the word ‘assault’ isn’t an ‘assault rifle,’ do me a favor and go lay brick. Because it really doesn’t matter whether the first assault rifle was a gun produced for the Wehrmacht near the end of World War II, whether it fires in full-auto or semi-auto mode, whether anything other than a machine gun is covered by 2nd-Amendment rights, blah, blah, blah and blah.

The gun is lethal as hell, you can kill 60 human beings with it in less than 60 seconds without even reloading the damn thing, and if anyone thinks that such guns will protect freedom-loving Americans from the dangers of ISIS or the tyranny of another Clinton regime, then this is someone with whom a reasonable conversation about guns or anything else simply cannot take place.

And frankly, this is usually a big part of the problem whenever the Gun Violence Prevention community takes a stand.  Because they are always, despite what Gun-nut Nation says about them, so damn reasonable whenever they argue any position at all.  For example, today’s online medical bulletin JAMA contains a new study on the effects of Australia’s 1999 assault weapons ban which clearly shows that once assault rifles disappeared from the civilian arsenal in Australia, mass shootings disappeared as well.  But in an accompanying editorial, Daniel Webster, one of our foremost public health gun researchers, made sure to mention that evidence showing a direct cause-and-effect between the assault weapons ban and overall gun homicides was not so clear.

And maybe the data on assault weapons and homicides isn’t so clear. But so what?  If we accept the crazy notion that a semi-automatic gun which can kill 60 people in one minute is no different from any five-shot rifle that is used to bag a deer, then there’s no reason to be upset about Orlando at all.  Sign the petition, okay?

Want To Be Told That Guns Aren’t A Threat To Health? Publish Research Which Shows That They Are.

It didn’t take seventy-two hours following the publication of a reasoned and respectful JAMA editorial on physicians counseling patients about guns before the self-appointed NRA medical sycophant, Timothy Wheeler, issued his usual pronouncement that doctors represent the enemy when it comes to anything having to do with guns.  Actually, I blame the Hospital and Health Networks blog for letting Wheeler crawl out from underneath his proverbial rock, because the truth is that to present him as some kind of medical authority on gun violence is to grant him a level of professional credibility that he doesn’t deserve.

The JAMA editorial, co-authored by two noted gun researchers, Drs. Marion Betz and Garen Wintemute, represents a very important step forward in the discussion about doctors and guns.  It follows from a “call to action” issued in April by eight professional medical organizations (plus the American Bar Association) that urged physicians to become more engaged in the issue of gun violence,  notwithstanding the heavy-handed effort by the gun lobby to legally de-franchise medical professionals from any connection to this issue at all.

conference program pic                The NRA has been pissing and moaning about public health and clinical views on gun violence for more than twenty years, and Wheeler is often quoted whenever relevant research is published and, in time-honored fashion, the media needs a comment from the “other side.”  I wouldn’t mind if Wheeler had ever conducted any research at all to justify his views on guns, but in fact he is a polemicist pure and simple whose pro-gun opinions come right out of the NRA playbook but are delivered with heightened authority because his name is followed by the initials ‘M.D.’

His latest salvo, written in response to the JAMA editorial, asserts that, “Physicians get no training in firearm mechanics, safety, or tactics in medical school or residency. They simply are not qualified to counsel patients about firearms.”  There was a time when physicians didn’t focus on health risks like obesity and tobacco companies routinely showed doctors inhaling a Lucky Strike cigarette in their ads. When the medical community decided that enough research had been conducted to classify obesity and tobacco as risks to health, doctors learned how to counsel patients by asking questions and, based on responses, dispensing appropriate medical advice.  Wheeler has never attempted to deny the reams of medical research that shows that the risks of gun ownership far outweigh the gains. Instead, he pompously and falsely accuses physicians of using that research to promote a ‘political’ point of view.

What kind of advice does Wheeler feel is appropriate for doctors to share with patients about guns?  You can find the answers in a book he published, Keeping Your Family Safe.  Most of the book is devoted to a warmed-over version of NRA training materials that describe how guns work, how they should be cleaned and how they should be stored.  Wheeler, incidentally, has absolutely no professional credentials in any of these areas, nor in self-defense laws and self-defense tactics, both of which are covered at length in this book.

I have absolutely no issue with anyone pushing guns as a means of self-defense; what offends me is the notion that guns represent the only or even the most effective way to respond to a possible or actual criminal event.  It’s not true, and there is no evidence-based research that proves it to be the case.  In fact, the latest research demonstrates that using a gun for self-protection is not only a rare event, but is no more effective than other protective actions, such as running away or calling 911.

After medicine took the lead in anti-smoking campaigns, the end result was that one out of two adults who smoked dropped to one out of five. Imagine what would happen to the gun industry if gun ownership followed a similar trend. If Wheeler wants to save the gun industry, he should stop pretending to be a medical expert and do what he does best, which is to figure out ways to sell guns.

What Do Doctors Need To Tell Patients About Guns? That Guns Are Lethal No Matter How Safe You Are.

This week the online version of JAMA contained an important editorial by two noted gun violence researchers.  Their editorial followed from a February “call to action” issued by the eight leading professional medical organizations promoting the idea of greater physician engagement in dealing with gun violence, notwithstanding the attempts by the NRA to legally de-legitimize the ability of doctors to talk to patients about guns.

The authors of the editorial, Drs. Marion Betz and Garen Wintemute, believe that physicians need to develop what they refer to as better ‘cultural competencies’ in order to overcome the alleged suspicions that gun owners harbor about medical professionals who try to talk about their ownership and/or use of guns.  I say ‘alleged’ because I have yet to see a single, bone-fide survey that actually quantifies the anti-physician attitudes the NRA has worked so hard to stir up. The fact that a group of red-meat Florida legislators say “yip’ every time that the NRA lobbyist Granny Hammer says ‘yap,’ doesn’t prove anything at all about how the average gun owner would feel if his doctor initiated a conversation about guns.

jama                Betz&Wintemute present no data on the attitudes of gun-owning patients but there are surveys of physicians which indicate that the majority of medical professionals don’t know enough about guns to feel comfortable raising the issue of gun violence within the context of clinical care.  And the authors are certainly correct in calling for the medical community to find ways to remedy their lack of communication skills. But with all due respect to the very important research conducted by Betz&Wintemute over the years, I am still not convinced that a growth of cultural competence in the area of gun violence should primarily focus, as they suggest, on counseling about the safe use and storage of guns.

In 2013, as the authors note, 117,894 men and women were killed or wounded with guns. But less than 15% of these injuries were considered accidents, or what the CDC calls unintentional events. Now don’t get me wrong: 17,369 accidental shootings is a serious health issue in and of itself.  And anything that can be done to lessen the impact of these events on the victims, their families and the medical system which has to respond to the problem should certainly be put into effect.  But what makes gun violence such a disturbing social and medical phenomenon is the fact that each year at least 100,000 among us make the conscious, often impulsive decision to pick up a gun and use it to shoot ourselves or someone else.  Last year the CDC called 24,000 Ebola cases in Central Africa an “epidemic.”  What do you call 100,000 cases of gun violence in the U.S. every year?  A day at the beach?

If the medical community is going to take a more dynamic approach to gun violence, I think that increasing communication skills regarding safe storage and gun safety is putting the cart before the horse.  Betz&Wintemute are correct in suggesting that effective counseling has to reflect the individualized nature of every clinical interaction, but the real problem that physicians face is not learning how to tell a gun-owning patient to lock up or lock away the guns; it’s learning how to identify patients who are prone to engage in gun violence, regardless of how they store their guns.

Adam Lanza’s mother dragged him from one shrink to another.  At no time did a medical professional ask why her home was virtually littered with guns.  Elliott Rodger, who shot 17 people in Isla Vista, California, had been seeing therapists since he was eight years old.  Not a single medical society has yet to adopt clinical guidelines to help physicians identify at-risk patients before they pull out a gun. Doctors are hardly the only group who can give advice on safe storage of guns.  But what only they can do is identify and treat risks to health.  And anyone who believes that a gun doesn’t represent a health risk doesn’t know much about either one.