Physicians Need To Be Engaged In Preventing Gun Violence Right From The Start.

In 1969 I was a caseworker for the Cook County Welfare Department, working out of the West Madison office near Garfield Park in Chicago’s West Side.  The neighborhood, then and now, was considered one of the city’s more troubled areas characterized by high levels of crime and low levels of economic opportunity; not quite as bad as some other Chicago neighborhoods but not a place where I would ever feel comfortable or at home.  And when I recently looked at the Chicago Tribune’s crime map, it hardly came as a surprise that East Garfield was still a place where getting shot or shot at is a regular feature of life in that part of town.

Actually, Chicago is right now enjoying a slight respite from the gun violence of the past few years with 2015 shootings running about 20% lower than in 2014.  I’m not sure, however, that the word ‘enjoying’ actually fits what happened this past weekend because so far during the holiday there have been 9 killed and 32 others wounded by gunfire and Memorial Day celebration still has one more day to go. Is it actually possible that a city of 2.7 million could end up with 50 shooting victims in just 3 days?  Last year, New York with twice as many people experienced 10 shootings over the holiday weekend and the media called it a “shooting spree.”  When it comes to gun violence, Chicago is hardly the “Second City,” that’s for sure.

conference program pic                 Of course the crime numbers on Chicago’s West Side are appreciably different from where Barack and Michelle live in the South Side neighborhood known as Hyde Park.  This area surrounding the University of Chicago and counting about the same number of residents as east Garfield recorded only 6 violent crimes in the past month.  I suspect that crime in Hyde Park will drop even further in 2017 when the President comes home to live full-time surrounded by a phalanx of Secret Service agents complete with dogs, anti-crime patrols, choppers, the whole Presidential security bit.

In addition to the Obamas, Hyde Park is also home to the Chicago Crime Lab, a research and think-tank at the University supported by a who’s who of America’s glitterati foundations and various government funding sources.  The Lab has published significant research on gun violence, much of the work conducted by Philip Cook and Jens Ludwig and one of their reports, Gun Violence Among School-Age Youth in Chicago, stands out as a model for public health research of this kind. The report deserves to be read in its entirety, but my self-imposed space limitation requires me to focus on only one major theme, namely, the fact that youth who engage in gun violence can usually be spotted at a very young age.

The report argues that children start to exhibit behavior that pushed them to get their hands on guns by the time they reach middle school years; i.e., the eighth grade.  This report was published in 2009 but America’s foremost criminologist, Marvin Wolfgang, basically made the same argument in his remarkable book, Delinquency in a Birth Cohort, published in 1972. Wolfgang didn’t tie delinquency to gun violence per se, but you don’t have to be a rocket scientist to assume the connection between repeated delinquency, serial criminality and access to guns.

If, as Cook and Ludwig argue, behavior predictive of gun violence begins to appear at a young age, their call for interventions by school authorities and community programs lacks one vital piece.  Every young child in cities like Chicago is examined by a physician at least once each year.  And who better than physicians are trained to diagnose youth behavior that might create risk? When it comes to children’s health, we need to think of gun violence not just as a socio-economic phenomenon, but as a medical condition whose diagnosis and treatment should be handled by the same medical professionals who make sure that kids are immunized against measles, mumps and the flu.




Where To Look For Gun Violence? Start With The Kids

Last year after Sandy Hook, the American Academy of Pediatrics (AAP) and their Past President, Judith Palfrey, came in for an extended and indecorous series of attacks by the NRA and other supporters of the gun lobby.  In particular, the AAP and Dr. Palfrey were attacked for voicing the bizarre idea that guns in the home were a danger to children’s health.  And since the only way to get rid of all those guns would be to confiscate them or worse, the AAP became Public Enemy #1 in the eyes and mouths of people and organizations sworn to defend the right of all law-abiding Americans to own a gun.

This campaign to create a cordon sanitaire between pediatricians and the American family had already been elevated to a level far beyond nasty rhetoric when the State of Florida decided to criminalize physicians, mostly pediatricians, who had the audacity to ask their patients about guns. The law was first passed in 2011, was overturned at the District level in 2012, and recently reinstated by the 11th Circuit, and now is probably on its way to the Supreme Court.

docs versus glocks               The attempt to keep physicians out of the gun debate can only be understood if we look at the issue creating the argument in the first place.  Which goes like this.  Each year roughly 100,000 Americans are killed or injured by guns, which is 4% of violence-related injuries and deaths that occur each year.  Of this total, roughly 20,000 are gun suicides and the remaining 80,000 are either homicides or aggravated assaults.

Both sides in the gun debate agree that the way to deal with the suicide problem is to “fix the mental health system,” whatever that means.  On the other hand, both sides also agree that people who use guns to consciously hurt others have committed a crime. Tap the average gun owner on the shoulder and ask what to do with people who commit a gun crime and he’ll probably say, “Lock ‘em up and throw away the key,” or words to that effect.  Tap the average non-gun owner on the shoulder, ask the same question and you’ll probably get, ”We have too many guns,” or words to that effect. Guns don’t kill people, people kill people says the NRA; hence, control the people.  Guns kill a lot more people than if we didn’t have guns, says the Violence Policy Center; hence, control the guns.  That’s where the gun argument begins and ends.

Both of these arguments obscure the reality of the problems they seek to correct.  Increasing the severity of punishments assumes that one can stick the perpetrators in one category and the victims in another, when in fact most violent crime, in particular gun homicides, usually occurs because both the perpetrator and the victim are contributors to the criminal act.  As for getting rid of the guns by registering transactions, what do you do about the more than one million guns that are reported stolen or lost each year and are overwhelmingly the guns that show up in cases of murder and aggravated assault?

In a brilliant study Marvin Wolfgang found that 6% of all juvenile offenders committed more than half of all juvenile crimes.  And guess what happened when they became adults?  The chronic juvenile offenders became the chronic adult criminals and committed the most violent crimes. Wolfgang looked  at juveniles over the age of ten. What’s missing in the debate about guns and violent crime in is what Wolfgang did not incorporate into his work, namely, whether or not interventions occurred with kids who became chronic offenders before their delinquent behavior took place.  And where could such interventions have happened?  During consultations with pediatricians who are trained to look for anti-social behavior during pre-school years.

Pushing pediatricians out of the orbit of caregiving for children means eliminating contact with a professional committed to reducing harm that puts a child’s health at risk.  Anyone who wants to put their 2nd Amendment ‘rights’ ahead of their child’s health better hope they have lots of luck.