Will The Bloomberg – Moms Merger Make A Difference?

Starbucks Touchscreen Storefronts

Starbucks Touchscreen Storefronts (Photo credit: DavidErickson)

The NRA better watch out.  There’s a new gun in town and it’s called, well, actually it doesn’t have a name but it’s a combination of two gun control groups – Mayors Against Illegal Guns and Moms Demand Action For Gun Sense which, according to their merger announcement, will “soon be stronger than any gun lobby.”  And who can argue with that claim when you put together Mike Bloomberg’s gazillions with the tireless energy of Shannon Watts and other moms, right?

The Moms claim they have more than 130,000 members and Bloomberg has enrolled more than 1,000 mayors in his club.  But who knows what those numbers really mean?  Moms also has 130,000 Likes on its Facebook page and when I went to their website it appeared that if I sent them an email with my name and address, that this made me a member.  As for Bloomberg’s membership, I took a quick look at the list for Massachusetts, my state, and guess what?  I couldn’t find a single Massachuetts Mayor who’s a Republican, but I did find Dominic Sarno, the Mayor of Springfield, where the gun homicide rate this year will probably top out at four times higher than the national average. Way to go, big Dom!

And since this new combination will soon be bigger than any gun lobby, let me tell you a little about that other lobby.  There’s been a lot of back and forth over the size of the NRA membership, with the gun organization claiming 4.5 million and various critics scaling this down to 3 million or a bit more.  I’m willing to cut both estimates in half and assume that they have somewhere above 3.5 million, even though even they admit that their recent increase was partially due to a one-year cut in dues paid by new members and it remains to be seen whether all these folks will re-enlist when they have to pay a higher price.

But the fact that Moms doesn’t have any dues not only makes me wary of their membership claims, but also raises the more important question of exactly how effective they can be.  Because it’s not very hard to use today’s social media to create the image of an organization whether something really exists or not.  The Moms group garnered lots of publicity when they showed up at Starbucks and sent a letter to Howard Schultz demanding that the company ban guns from all their stores.  But the company sidestepped the issue by issuing a statement ‘asking’ but not requiring gun owners to keep their guns outside, but even as strident (and usually stupid) a pro-gun outlet as the Washington Times covered the issue in very timid terms because it turns out that lots of gun owners didn’t want to risk the possibility that Starbucks might eventually get a little backbone and ban them permanently. After all, would anyone elevate the 2nd Amendment above that steamy latte?

Of course an advocacy organization can play an important role in any public debate regardless of its size.  But the trick is to figure out who you’re really talking to and whether or not they will listen to what you have to say.  If the Moms want to have a real impact in the argument over guns, why don’t they talk to gun owners and stop wasting their energy on convincing people who don’t need to be convinced?  And you don’t talk to gun people by throwing up a website or a Facebook page and just ‘invite’ them to post a comment or engage in a chat. Sometimes that strategy works when you’re selling a product, but it’s rank arrogance or simply stupid to confuse marketing a product with marketing an idea.

Every weekend there are dozens of gun shows all over the United States.  Each of these shows, on average, count 10,000 admissions. So do the math: if you went to one gun show every weekend, set up a booth, gave out a flyer and shot your mouth off, by the end of the year you would have talked to 500,000 gun guys (and gals.) And don’t think for one second that nobody would talk to you.  Gun folks love to talk – that’s why they go to those shows.

I’d love to walk into a gun show or some other gun-friendly place and see those Moms promoting their point of view.  Would they get an argument from gun folks? Sure.  Would the argument sometimes get nasty or offensive?  It might.  But if Moms or any other gun-control group believes they will make a difference by not going out and meeting the other side, they’re barking up the wrong tree.

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There Is A Way To Keep Guns Out Of The Wrong Hands. Let Doctors Decide.

NRA Headquarters, Fairfax Virginia USA

NRA Headquarters, Fairfax Virginia USA (Photo credit: Wikipedia)

As we approach the Newtown anniversary everyone’s going to weigh in with their thoughts about gun control, so here’s mine.  I believe the NRA is more right than wrong in questioning the motives of many of the proponents of more gun control.  They are correct when they say that just about all gun owners are responsible, law-abiding citizens who don’t need to jump through yet more legal hoops in order to buy or own guns.

At the same time, the NRA should stop diluting the force of their argument and keep their nose out of places where it doesn’t belong.  And one place they don’t belong is challenging the right of physicians to talk to their patients about guns.  Their attempt to criminalize such efforts by physicians (‘Docs versus Glocks’) is both stupid and wrong.  And here are the reasons why.

Every day in Emergency Rooms all over the country, people wander in complaining of various degrees of mental distress.  Unless they present a “clear and present danger” to themselves or anyone else, they are free to leave and, if we follow the argument of the NRA, they can walk out into the street even if they walked into the ER with a gun.  Physicians can restrain a person in the ER who is drunk and might, if released, drive off in his car.  But unless an individual actually threatens someone with his gun, the physician who even asks the patient whether he has a gun is, according to the NRA, trampling on the guy’s 2nd Amendment rights, and should be prosecuted to the full extent of the law.

In 2004 a woman in Indianapolis called the police and reported that her 24-year old son was exhibiting dangerous signs of mental distress.  The cops found the kid in possession of multiple guns and ammunition, briefly took the guns away but within several days let the young man reclaim ownership of his guns.  Eight months later the young man, Kenneth Anderson, shot and killed his mother, a police officer, and then was shot and killed by the police.

I don’t know whether in the intervening period this troubled young man ever saw a physician or other medical professional even though he was clearly at risk.  But I do know that even if he had been seen by a physician, the NRA’s position would be that the doctor would not have been able to ask him about his guns.  The NRA is trying to have it both ways.  On the one hand, they say that the mental health system needs to be ‘fixed.’  On the other hand, they don’t want physicians to be able to close a gap in mental health treatment simply through asking appropriate questions and using common sense.

If you walk into a doctor’s office and you’re obese, the physician would be violating the Hippocratic Oath if he or she didn’t tell you to lose some weight. Not everyone who weighs too much is going to live a shortened life, but the physician isn’t violating your privacy by telling you that your weight is putting you at risk.  If someone walks into an ER or a doctor’s office and exhibits symptoms of emotional distress, anyone who would deny that gun ownership by that individual constitutes a risk, has no business engaging in a rational discussion or debate about guns.

The 2nd Amendment gives us the right to arm and protect ourselves from the bad guys in our midst.  It doesn’t give anyone the right to prevent physicians from finding out whether someone’s behavior might turn them into a bad guy whether they meant to be bad or not.

Will the 2014 Election be Red or Blue?

National_Rifle_Association

National_Rifle_Association (Photo credit: ChrisWaldeck)

This morning I received an email from Chris Cox, who spearheads the membership campaigns for the NRA.  The email referred to a recent comment by Michelle Obama at a New York fundraiser in which she asked the guests to donate to the 2014 campaign in order to push through the President’s agenda; issues which, of course, include the gun control bill that failed to pass the Senate earlier this year.  The point of Cox’s email, which also solicited a contribution, was that , “next year’s elections will decide whether you and I get to keep our freedom, or if we will lose the Second Amendment as we know it…PERIOD.”

It would be easy to dismiss Cox’s hyped-up rhetoric except that it might just be true.  And the reason I say this is that while the Colorado recall last September was a big victory for the NRA, more recent election results seem to indicate a turning of the tide.  In particular I’ll draw your attention to the close contest for Attorney General in Virginia which, although there will be a recount, will still probably end up with the election of a Democrat who ran a very explicit anti-gun campaign. Not only did he charge his opponent, State Senator Mark Obenshain, with opposing “common-sense” gun controls, he also brought such gun control heavies as Gabbie Giffords into the state to campaign on his behalf.

Virginia has been turning steadily more blue and less red but that only reflects trends that are happening elsewhere as well.  Slowly but surely the county is becoming more racially and ethnically diverse, the population is increasingly urbanized or suburbanized, the percentage of households that admit to gun ownership, according to Gallup, keeps going down.  Overwhelmingly gun owners are white, male, high school but not college educated, and located in smaller cities and towns, particularly in the South.   While people who fit this profile may vote overwhelmingly Republican, the truth is that this profile just doesn’t register majorities at the polls, particularly in ‘battleground’ states like Virginia which hold the key to electoral victory every four years.

Right now, and of course things could always change, whichever party wins two of three states – Florida, Virginia, Ohio – will control the White House in 2016.  And don’t think that the GOP is in any better shape when it comes to their majority in the House of Representatives, because even though they currently enjoy a 31-seat edge (but will lose the majority if the Democrats pick up 17 seats), in 2012 they actually lost the total popular House vote.

Given those numbers, I don’t think that Chris Cox is being at all extreme when he says that gun owners could lose their 2nd-Amendment “rights.”  Of course this assumes that any change in current gun regulations, even something as feeble as Manchin-Toomey, represents an erosion of the right to bear arms.  The NRA would like everyone to believe that gun ownership is as mainstream and traditionally American as apple pie.  But what’s really mainstream is the notion that everyone has the right to vote.  And right now, the votes don’t seem to be adding up for the NRA.

 

 

Want To Do Something About Gun Violence? Take A Look At Seattle.

King County Sheriff's Office (Washington)

King County Sheriff’s Office (Washington) (Photo credit: Wikipedia)

A rather remarkable document was published this week, remarkable because it undercuts much of the current nonsense that comes from the NRA and its supporters about the link between guns and deaths or injuries suffered by children.  The report wasn’t issued by the CDC or any other federal government agency whose research has long been derided by the NRA as being useless because it’s “anti-gun.”  Rather, it’s a report issued by the Public health Department of Seattle and King County, areas not particularly known for their anti-gun or DC-elitist sentiment.

The report covers the years 1999 to 2012, during which time 68 children were killed by firearms and another 125 admitted to hospitals with gun injuries.  The sober comment that introduces the report and these numbers are: “Every one of these deaths and injuries was preventable.”  Why?  Because according to the report’s authors, more than two-thirds of all homicides involved either people who were related or people who knew each other and, in the case of suicides, more than three-quarters of the victims used guns that were owned by a member of the victim’s family.  In other words, child gun violence in King County, WA, is like child gun violence everywhere else: a personalized form of anger that has roots in social or familial relationships.

King County’s gun-owning population, according to the study, contributes to the level of gun violence simply because too many guns aren’t unloaded and/or locked away in too many homes. More than one in five gun owners stored their guns loaded and nearly one in five left them unlocked.  The result is that the risk of a completed suicide among children under the age of 18 is more than 9 times higher in such gun-owning environments, and even in homes where guns were locked away, 16% of the successful children who used a gun knew how to unlock and get their hands on the weapon they then used.

The good news in all this is that King County isn’t waiting for the Federal Government to pass another law on gun control.  In fact, the County has enrolled gun dealers all over the area in a program called LOK-IT-UP, in which consumers can purchase gun safety safety devices at discounts of ten or fifteen percent. As I mentioned in my previous post, more and more local communities are beginning to develop their own public health programs to deal with gun violence in positive and meaningful ways.  They aren’t taking guns away from law-abiding gun owners, they don’t demonize anyone for owning a gun.  They are responsible and meaningful approaches to a problem that won’t go away no matter how much we argue about 2nd Amendment rights.

As the one-year anniversary of Sandy Hook approaches, let’s hope that the program in King County becomes a national trend.

Want To Get Rid Of Guns? Go Where The Bad Guns Are

Federally-supported gun violence intervention ...

Federally-supported gun violence intervention program (Photo credit: Wikipedia)

When it comes to gun control, Congress still seems confused about whether more regulation equals better regulation.  I don’t think it necessarily does.  Particularly when a law is passed that only will make a difference if it is rigorously enforced at the level of the neighborhood and the street. And anyone who thinks that guns aren’t a neighborhood and street-level issue doesn’t know much about neighborhoods or guns, for that matter.  Which is why I wasn’t terribly concerned when Manchin-Toomey went down to defeat, because I knew that it would force people who are trying to do something about gun violence to stop looking to Uncle Sam for a quick solution that probably wouldn’t change things at all.

One organization that really seems to understand gun violence where the violence actually occurs is the Center for Crime Prevention and Control, located at John Jay College of Criminal Justice in New York City.  The Director of the Center, David Kennedy, has been a researcher, policy expert and program director for more than thirty years, and prior to coming to John Jay, he directed the Safe Guns project in Boston which created a successful model for dealing with gun violence by uniting law enforcement, social service agencies and community groups.

By moving to New York, Kennedy has been able to take his experiences and widen his vision beyond one city to embrace the country as a whole.  The Center offers planning and technical assistance to help cities and towns build safer communities, and is currently engaged in ongoing projects in Chicago, Detroit, Newark, the State of Connecticut, and several Native American reservations.  The Center recently received a million-dollar grant from the Bureau of Justice Assistance to “develop and sustain its highly-successful crime-reduction strategies” which, BJA noted,  are in “high demand” from communities that want to implement such programs.

There are two things about the Center’s approach that I find exceptional.  The first, as I mentioned earlier, is the focus on prevention not through legislation, but with hands-on, street-level programs that actually work.  And the reason they work is that the Center combines theory with practice through diligent research into the effectiveness of what they are doing and an awareness that not two situations, two neighborhoods, two cities, are exactly alike.  This was proven, for example, in the different approaches to gun violence in New York and Boston; the latter created a tapestry of law enforcement, social service and community groups to deal with the problem while the former sent ‘stop-and-frisk’ police teams into high-crime zones.  Both programs worked at first but results tailed off earlier in Boston, then later in New York.   The Center’s success in its more recent programs shows that they learned from both.

It’s great to see efforts like David Kennedy’s Center for Crime Prevention and Control getting some nice, big funding support from the folks in DC.  But why doesn’t the NRA kick in some dough as well?  After all, the NRA keeps reminding us that they represent law-abiding gun owners who believe that 2nd Amendment guarantees should not stand in the way of getting criminal guns off the street.  Which is exactly what Kennedy and his colleagues are all about.  Want to build a real alliance between gun owners and non-gun owners over the issue of gun control?  Here’s the place to start.

What Does That NRA Small-Arms Treaty Really Say?

Case O' Guns

Case O’ Guns (Photo credit: Gregory Wild-Smith)

Last month the Obama Administration joined 114 other countries and signed the UN Arms Trade Treaty, immediately setting off howls of protests by the NRA and its Congressional supporters insisting that this was just another example of the Administration’s desire to disarm America and take away all our guns.  According to Senator Bob Corker (R-Tenn.) the treaty undermines the 2nd Amendment guarantees of gun ownership because, among other provisions, it requires importers to identify end-users for whom small arms have been bought.

I have read every word of the treaty, it’s not a terribly lengthy document, and I think it would be worthwhile if I spend one post explaining what the treaty actually says.  Not that I’m assuming that anything I say will change anyone’s mind about the treaty, or the 2nd Amendment or anything else related to guns. But in all the hysteria that has been drummed up about this document by the NRA and its allies and friends, I have never seen the treaty text itself.  So here goes.

The treaty begins with a preamble that “reaffirms the sovereign right of any State to regulate and control conventional arms exclusively within its territory, pursuant to its own legal or constitutional system.”  This statement isn’t buried in some footnote; it’s found at the very beginning of the treaty itself.   Correct me if I’m wrong, but doesn’t this mean that our government, and not the United Nations, gets to figure out how guns will be handled within the United States?

But what about the question of end users, because here’s where the NRA believes there lurks an attempt to create not just a national, but an international registry of all guns.  I quote again from the treaty text: “Each State Party shall maintain national records, pursuant to its national laws and regulations, of its issuance of export authorizations or its actual exports of the conventional arms….”  Now note what it says about imports: ” Each State Party is encouraged to include in those records: the quantity, value, model/type, authorized international transfers of conventional arms actually transferred, details of exporting State(s), importing State(s), transit and trans-shipment State(s), and end users, as appropriate.”

This is in fact no different than what U.S. exporters and importers must now do to comply with State Department and ATF regulations on export and import of small arms.  But the operative word here is encouraged; not required, just encouraged.  Signatories to this treaty are not bound by any requirements to either compile lists of import end-users (which we compile already) or deliver such lists to any international body.  The only required record-keeping involves the destination of exports, and correct me if I’m wrong, but only American citizens possess 2nd Amendment guarantees.

The NRA, the Washington Times, and all the other pro-gun stalwarts who make a living by ginning up the fears of gun owners every time that someone says anything even remotely connected to gun control might do us all a favor and stop concocting arguments out of whole cloth.  I know, I know, Obama’s a liberal which means he hates guns and he’ll do anything to  take them away.  But maybe it’s time to stop worrying about Obama and start thinking about how to convince rational and reasonable people that responsible gun ownership is the American way.

The real enemy of gun owners isn’t Washington and isn’t the UN.  The real enemy is any discussion in which facts and logic give way to noise and a lack of common sense.  I don’t need the NRA or Mayor Bloomberg to tell me about guns.  I can read as well as the next person and figure out what’s really going on. So can you.

 

 

 

Think Doctors Shouldn’t Ask Patients About Guns? Think Again.

English: A roadside sign at Santa Clara Valley...

English: A roadside sign at Santa Clara Valley Medical Center in San Jose. This sign is an example of how the U.S. state of California requires all hospitals with emergency rooms to include text like “Comprehensive Emergency Medical Service” and “Physician On Duty.” (Photo credit: Wikipedia)

There’s been a lot of talk in and out of gun circles about the attempt by Florida to criminalize physicians who ask patients whether or not they own guns.  The law, passed in 2011, was  overturned in Federal Court but now is headed for another hearing in the 11th Circuit.  At issue is whether physicians can inquire about the ownership of guns, even if no clear threat to health is perceived. Supporters of the law insist that because most physicians are anti-gun, what they are really trying to do is disarm law-abiding Americans.  To quote the NRA-sycophant Dr. Timothy Wheeler:  “doctors are following a hidden agenda laid out for them years ago by the American Academy of Pediatrics — an agenda that would take guns away from Floridians.”

But the question is not whether physicians are following some hidden agenda.  The real question is whether they are following federal law.  And the law I am referring to is the law that covers all hospitals and physicians delivering medical services covered by Medicaid and Medicare, which in the case of hospitals basically covers every hospital treatment facility in the United States.  This law is regulated by an agency known as the CMS, whose treatment manuals define medical care.  And here is what the CMS has to say about what a physician must do when a patient walks into an Emergency Department and requests care: “In such a case, the hospital has incurred an obligation to provide an appropriate medical screening examination (MSE) for the individual and stabilizing treatment or an appropriate transfer. The purpose of the MSE is to determine whether or not an emergency medical condition exits.”

Notice that I say “walked” into the emergency room.  Obviously if someone is wheeled into the emergency room bleeding from a gunshot wound, the attending physicians don’t have to figure out whether an emergency medical condition exists.  But most people who visit emergency departments don’t present such obvious symptoms of distress.  Rather, they show up because they “don’t feel good,” or have a pain here or a pain there.  Many are suffering from mental distress, others have been victims of domestic violence that, if left untreated, might get much worse.

How many of these patients are caught in a vortex of physical or mental deterioration that could wind up in a gun being shot off?  According to Megan Ranney, an emergency room physician in Providence, patients who are treated for gun wounds have a one-in-five chance of returning with another gunshot wound within five years. Wouldn’t there be a good possibility that many of these patients would re-appear in an emergency room in the intervening period and shouldn’t an attending physician need to know whether that individual had access to a gun?

Let me quote a little further from the CMS: “Individuals coming to the emergency department must be provided an MSE appropriate to the individuals’ presenting signs and symptoms, as well as the capability and capacity of the hospital. Depending on the individual’s presenting signs and symptoms, an appropriate MSE can involve a wide spectrum of actions….” So what should a doctor do when a patient says that he or she feels “depressed” or “upset,” or reports some other sign of mental distress.  Should the attending physician ignore all the data that indicates a clear correlation between household gun ownership and successful suicide attempts?

It’s time to set aside all the nonsense about how physicians have some kind of secret agenda to take away the guns.  Let’s remember that it was the CDC’s announcement in a 1981 morbidity report regarding deaths from an “unknown” lung infection that eventually led to treatments for AIDS.  If the NRA wants to pretend that 31,000 annual deaths and 75,000 injuries don’t constitute a health issue that’s fine.  But I’ll close this post with a quote from the novelist Walter Mosely: “If you carry a gun, it’s bound to go off sooner or later.”  Physicians need to figure out if the gun is going to go off, and when it does, what to do about it. That’s not a secret agenda, that’s the law.

 

 

 

 

Coming Up: The Next SCOTUS Gun Case

NRA Headquarters, Fairfax Virginia USA

NRA Headquarters, Fairfax Virginia USA (Photo credit: Wikipedia)

You may recall that in the debate over a new gun bill earlier this year, the major issue was whether to expand the FBI background check system to cover private sales. Proponents of expanded checks (Bloomberg, et. al.) argued that background checks helped prevent “straw sales,” thus keeping guns out of the wrong hands; opponents of the measure (NRA) said that there was no reason to further restrict law-abiding citizens from exercising their constitutional rights to own guns.

Now the Supreme Court has decided to hear a straw sales case concerning a transaction that took place in Virginia where a former state trooper, Bruce Abramski, was convicted of committing a straw sale purchase because he bought a gun for his uncle but stated on the background check form (ATF Form 4473) that the gun was for himself. Abramski argued that there was nothing illegal about the sale because his uncle was, in fact, legally able to buy a gun. Therefore, since the intent of the statute and the background check was to keep guns from getting into the wrong hands, the defendant’s transfer of the gun to his uncle didn’t violate the law at all.

Abramski is represented by the NRA, whose attorneys discovered a split at the federal appellate level over how to handle straw sales. Several circuits have upheld the government’s contention that making a false statement on the 4473 is, in and of itself, a violation of the law, regardless of the intention or additional facts in the case. But the Fifth Circuit held in US vs. Polk, that purchasing a gun for someone else, as long as the latter individual also qualified to own a gun, was completely permissible within the statute that applies to the 4473. The SCOTUS has agreed to hear the case and resolve the apparent dispute between the different appellate courts.

Who was this guy Polk whose conviction for lying on a 4473 Form was overturned by the 5th Circuit? It turns out that Polk didn’t actually purchase the gun or guns in question; the real straw purchase was committed by a guy named Davidson who was acting on instructions from Polk. And the reason that Polk instructed Davidson to buy more than 40 guns for him, along with plastic explosives, grenades, a light tank anti-weapons system and a machine gun was that he allegedly represented an organization called ‘Constitutional America’ that was planning a rebellion to restore America to its “common-law roots.” Polk was finally arrested, charged and convicted of soliciting various crimes of violence, along with “aiding and abetting” a straw purchase even though he didn’t actually fill out the 4473.

The NRA wants SCOTUS to exonerate the Virginia state trooper who lied on the 4473, using as precedent a wacko in Texas who got somebody else to lie on his behalf. It would be nice if Mother Theresa was the defendant every time an attorney wanted a conviction overturned, but a guy who wants to blow up IRS offices and assassinate judges and police officers all over the country deserves just as much consideration if the law was used improperly to get a conviction in his case. On the other hand, it seems to me that the NRA is really scraping the bottom of the barrel by trying to assert a constitutional right to gun ownership because everyone involved in the transaction is legally entitled to own a gun. The 4473, with all its shortcomings, doesn’t give the purchaser the right to decide for himself whether the gun will eventually wind up in law-abiding hands.

Abramski could have avoided the entire problem by having his Virginia dealer send the gun directly to his uncle’s dealer in Pennsylvania; licensed dealers do this all the time. If the SCOTUS decides this case in favor of Abramski and the NRA, we might as well get rid of the background check system all together. But isn’t that what the NRA wants?

Thanks To The Government, We Finally Have Some Good Numbers About Gun Violence

Coalition to Stop Gun Violence

Coalition to Stop Gun Violence (Photo credit: Wikipedia)

One of the major issues in dealing with gun violence is that the data seems to fly all over the map.  And if you don’t have reliable data then it’s pretty tough to develop a solid strategy for dealing with the problem. Of course you can always deal with this by saying that there is no problem.  But let’s leave the loonies to talk (or yell) among themselves.  For the rest of us, who believe that we try to make evidence-based decisions, if there ain’t good evidence there ain’t a decision.But this may have changed this week with the release by the American Public Health Association of a report that analyzes firearm injuries from 2003 to 2010, using national data from the Agency for Healthcare Research and Quality, which is a branch of HHS. The study aggregated data from virtually every hospital in the United States, or at least every hospital that is connected to the government through HHS-administered programs like Medicare, Medicaid, Veterans, etc.  In other words, virtually every hospital. And the injury data, drawn from hospital admissions, was coded to pick up just about every type of primary or secondary diagnosis that could have been the result of a gun injury.  The bottom line is this: If this data ain’t complete, there ain’t no complete.

One caveat before I talk about the actual findings:  the data on hospitalizations seriously undercounts the actual level of gun violence because it does not cover ER visits, but only hospital admissions. We can assume that most people who came to the ER with a gunshot wound probably ended up staying in the hospital, but the Department of Justice data on gun violence, which comes from the FBI (which comes from state and local law enforcement) doesn’t break gun injuries out of the much larger category of gun violence, which means any criminal incident in which a gun was involved,whether someone was shot or not.  And of course the hospital data completely undercounts homicides, because even though slightly less than ten percent of hospital admissions resulted in death during the admission period, we can assume that almost all homicides and certainly all suicides were taken not to a hospital or an ER, but to the morgue.

Given the caveats above, the findings of this report still require serious thought and consideration.  First and most important is the fact that of the more than 250,000 gun injuries between 2003 and 2010, more than 30% were classified as self-inflicted wounds.  Of late the NRA has been patting itself on the back because the number of firearm deaths that are ruled as accidents is quite low, so low that accidental gun deaths don’t even make it to the list of major accident deaths published by the CDC.  But gun injuries are very serious, the report gives convincing evidence that the costs of gun injury hospitalizations averages $75,000, which means that we are spending an awful lot of money, nearly one billion dollars every year, on taking care of people who didn’t even know how to handle a gun.

The other significant finding from a public health point of view is that more than one-third of gun injury patients had no medical insurance. But this should not surprise, given the fact that 40% of the hospitalizations involved males between the ages of 18-30, which is exactly the age bracket occupied by people who usually make the conscious decision not to carry medical insurance at all. So not only do we face a serious use of medical resources for gun injuries, a third of which could be prevented by simply locking up, locking away or unloading the guns, but we also face a significant impact on public health budgets, since so many of these patients are uninsured.

It seems to me that enough data has now been produced to move the discussion beyond the debate over whether gun violence represents a health issue at all.  And if anyone reading this blog truly believes that physicians and other health professionals should refrain from talking about guns in terms of health, then they’re reading the wrong blog.  Over the next several weeks I’m going to be making some suggestions about how the medical community might try to deal with gun violence at the level where it really counts – the contact with patients before they become a statistic in the next report.

 

 

Dick Metcalf Speaks Up About Gun Control And The NRA Stays Silent

One of the most esteemed and long-time gun supporters, Dick Metcalf, recently came out with an article that supports the bizarre idea that people who walk around with guns should have training before they do so.  What makes Metcalf’s comments so significant is that his essay appeared in the December issue of Guns and Ammo magazine, the most widely-circulated commercial firearms magazine in the world.  Metcalf has been writing for G&A for decades and he was instrumental in advising Senator Jim McClure and Congressman Harold Volkmer on the drafting of the McClure-Volkmer Act, which corrected some of the abuses of the 1968 law that created federal regulation of retail and interstate gun sales.

Metcalf makes the argument, similar to an argument that you have seen in my posts, that the 2nd Amendment does not prohibit the government from regulating firearms, a point underscored by Scalia in the majority decision – District of Columbia Versus Heller – that affirmed the 2nd Amendment right to own a gun for self defense.  Scalia put it this way: “Nothing in our opinion should cast doubt on well-established laws…that regulate the legal commerce in firearms.”

photograph of the justices, cropped to show Ju...

photograph of the justices, cropped to show Justice Scalia (Photo credit: Wikipedia)

Ever since Heller, the NRA and its supporters have been going all out to justify the spread of concealed-carry laws based on the notion that the 2nd Amendment covers any sort of firearm use for self-protection in the home or anywhere else.  In fact, last week the SCOTUS refused to hear, without comment, a Maryland case in which the concealed-carry statute gives police the authority to grant concealed privileges only if an applicant can prove need.  There are a number of other concealed-carry laws that are currently moving through the courts and it’s not clear when or if the SCOTUS will decide to clarify the Heller decision with reference to concealed carry.  But if they do rule that concealed-carry laws are not an unquestioned extension of the 2nd Amendment right to own a gun, then a very major part of the NRA’s strategy to extend gun ownership goes right down the drain.

What Metcalf argues is no different from what many of us have been saying, namely, that if you want the privilege of walking around with a gun you should be required to take serious training in using it properly. There are very few states that require any special training for concealed carry permits; in my home state – Massachusetts – you don’t even need to shoot a gun one time in order to qualify for a concealed carry license.

Metcalf’s comments are attracting the usual screams and yells from the “take it from my cold, dead hands” crowd but the NRA, which usually jumps up and down when someone tries to put any limitations on gun ownership, has been quiet on this one.  And the reason that the NRA doesn’t want to go after Metcalf is: 1) he’s been a very important link between the NRA and pro-gun members of Congress; and 2) the NRA would prefer not to get into a public argument over whether gun owners who want to carry concealed weapons need to be trained. After all, the NRA has been obsessively promoting “safety” and “responsibility” since Newtown.  Why remind people that they have also been promoting an extension of unrestricted concealed carry laws at the same time?