Does ‘Training’ Make You Safer With A Gun?

Of late, everyone seems enamored of the idea that gun violence is a safety issue, and the way we deal with any safety issue involving mechanical devices is to teach people how to use the particular device in a safe way. This is what lies behind the strategy to reduce auto accidents by making sure that drivers aren’t drunk or drive too fast; it’s the same strategy when applied to cycles, motor-driven or not, by requiring everyone to wear a helmet so that when they fall off the bike they won’t crack their heads.

training             When it comes to a mechanical device known as a gun, however, what will make everyone safer is training in how to use a gun. But a recent study on gun training has discovered that upwards of 40% of the gun-owning population has not received any training at all. Which means that four out of ten individuals who might legally pick up a gun may not be picking it up in a safe way. But how do we know that the six out of ten who claim they have received safety training have really been trained at all? This gets to is the definition of ‘training,’ which in the gun industry is actually a word with no meaning at all.

If you take a look at the states which require some kind of gun training as Jennifer Mascia did for The Trace, you’ll discover that most states talk about something called an ‘eight-hour’ course. And where did the magic number ‘eight’ come from? How do we know that being trained for eight hours gives you the necessary competency to use a gun?

This is the time-period the NRA says their training course, something known as Basic Pistol, is supposed to last. The training manual does consist of eight different sections, each of which takes an hour, more or less, to complete. Now the fact that three of those eight sections have nothing whatsoever with how to use a gun – so what? In order to complete the class you have to learn all about various shooting programs sponsored by the NRA, how to sign up for a shooting competition and other essential safety topics like that.

The NRA claims to have certified more than 100,000 trainers (I happen to be one of those lucky folks) but not a single one of those trainers was required to perform any kind of competency qualification that professional certifications usually entail. I was certified as an instructor in networking IT both by Microsoft and Novell. In order to receive those certifications I not only had to pass a battery of difficult exams, I also had to demonstrate before a live group that I possessed the knowledge, aptitude and classroom presence to teach networking skills. Know what is required to become certified NRA gun trainer? Sit through an 8-hour class while another trainer drones on and on from the NRA manual and then take a multiple-choice quiz. Big deal.

I earn my living teaching the gun-safety course that is required in my state. I have taught the class to more than 8,000 men and women since mid-2012 and I normally enroll 100 – 125 students every month. My state, Massachusetts, does not require live fire but I make every student go through a live fire drill because after they see, hear and feel what happens when a handgun goes off, much of what I say about safety makes a lot more sense. The students shoot at a 9-inch target set at 18 feet. Roughly half the shots fired by every class hit somewhere outside the target area, but since Massachusetts doesn’t require live fire, people who literally can’t hit the broad side of a barn still pass the course.

According to public health research, journalists and GVP advocacy groups, the 8,000 people I have trained are now more prepared to own and carry a gun than residents of other states who receive no training at all. Oh please, give me a break.

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Despite What Some People Believe, We Need More Gun Buybacks, Not Less.

Last week my eye caught an interesting gun article in The New York Times, and it’s not like I often read articles in the NYT that are interesting (or correct, for that matter.) But this was an article about two young men who put together a very successful gun buyback in Los Angeles that collected more than 770 weapons in a one-day program last May, and have taken more than 1,100 guns out of circulation since 2013.

confiscated             The two guys behind this initiative have put together an organization, Gun By Gun, which has been operating on the West Coast but with proper care and feeding could obviously become a national thing. The whole deal is funded through crowd-sourced donations which, according to the NYT article, have collected more than $100,000. But what I really found interesting about this effort was not the amount of money donated or the number of guns taken off the streets, but rather the fact that folks who give in their guns get a Target gift card as their reward.  I’ll come back to the significance of that fact in a bit.

But meanwhile I first have to spend a bit of time discussing the manner in which our dear public health friends have viewed the question of gun buybacks, because the truth is that the narrative they have developed about buybacks misses the basic point of such programs, which means that public health gun violence researchers simply get it wrong.

Over the years there have been a number of gun buyback programs whose results have been analyzed by some of our leading public health gun researchers, including Frederick Rivara and Garen Wintemute, along with a summary published by the National Academies in 2004. These articles basically say the same thing, namely, that gun buybacks are ineffective because people turn in old or broken guns whereas the guns which are used in felonies remain in the street. And of course it’s impossible to prove any direct connection between the number of guns which are turned in and whether or not this has any effect on crime, and if you can’t make some kind of connection or what public health loves to call ‘association’ between two sets of facts, then you can’t assume that anything has happened at all.

I would never challenge my friends in the public health community when it comes to understanding or using data about guns or gun violence and I would certainly never even hint at the idea that public health research on gun violence shouldn’t be continued and, if anything, increased in scope and size. But by casting the academic discussion about the value of gun buyback programs in terms of being able to measure results, and public health researchers simply can’t detach themselves from their never-ending commitment to measuring whatever they look at, the discussion about the importance and value of buybacks is pushed in the wrong direction and is simply never discussed or understood.

The real value of gun buybacks, the reason that such programs need to be expanded into every community which suffers from any degree of gun violence, is that when a buyback program occurs, it gets everyone in the community thinking about guns. And the thoughts have nothing to do with whether guns are a good thing to have around, the thoughts are about the importance and necessity of getting rid of guns.

Gun-nut Nation has done a very effective job of convincing lots of Americans that they would be safer if their home contained a gun. They have done such a good job that they are maybe less than 2 Senate votes away from a new law that would allow everyone to wander throughout the entire United States carrying a gun.

A buyback program is the most effective way of telling a community that guns won’t make them safer and that guns should be turned in. If my friends in the public health community have come up with a better messaging about gun violence, please share it with me.

 

Thank you Margaret Ayres.

The NRA Goes After Mike Bloomberg Over Soft Drinks.

Anyone who says that guns aren’t a threat to public health is either consciously lying or doesn’t understand what the words ‘public health’ actually mean. And what those two words mean is anything which might be a community-wide health threat and could be monitored or regulated by public authorities. Which is why the self-appointed as well as paid representatives of Gun-nut Nation have been proclaiming that guns shouldn’t be considered as anything having to do with public health, because the whole point of their strategy is to eliminate all government regulation of guns.

bloomberg              Except now the pro-gun narrative seems to be going beyond a concern about regulating guns to an attack on regulating anything else having to do with threats to health. And what I am referring to is a commentary on the NRA-ILA website which attacks Mike Bloomberg not just for funding an effort in New Mexico to expand NICS background checks, but also for pushing an attempt in Santa Fe, NM, to impose a 2-cent per ounce ‘soda tax’ on sugar-filled beverages, an effort which, along with the background check initiative, ultimately failed.

Now why would the NRA link background checks for gun transfers to whether consumers should pay more for caloric drinks?  Well, for one thing, any time they can dump on Bloomberg they’ll give it try, if only to remind Gun-nut Nation that even with Adolph Trump in the White House, there still are threats to the 2nd Amendment lurking around. But I think there’s something even more insidious going on when the NRA equates the ‘freedom’ to drink high-caloric soda with the ‘freedom’ to own a gun.  Which is exactly what the NRA-ILA statement says: “And make no mistake: he’s just as focused on coming for your guns as he is on coming for your Dr. Pepper.”

Remember a guy named Ronald Reagan?  It was during his Presidency that we first stuck warnings on packs of cigarettes. And then what happened is that we started passing additional taxes on cigarettes to discourage people from starting or continuing to smoke. And we did it because smoking is a serious risk to health.  Which also happens to be true when we talk about high-caloric drinks.  Every day, at least 5 percent of all adults add 567 calories to their food intake by drinking soda and juice with sugar; one in four adults adds at least 200 calories to their daily food intake with sugary drinks. Right now we spend nearly 200 billion a year treating the health conditions caused by obesity and the complications from obesity are probably responsible each year for 300,000 deaths.  We also probably lose 480,000 Americans to smoking every year, but that number has been going down while the obesity number keeps going up.

The amount of money spent by Bloomberg on anti-smoking campaigns around the world has gone above one billion bucks.  When it comes to personal freedom, you don’t hear the NRA or anyone else saying that Bloomberg’s attempt to get more stringent anti-smoking laws is a threat. But that’s because as loony as the NRA’s messaging has become, nobody would take Wayne-o or Chris Cox seriously if they told the membership to demonstrate their support of the 2nd Amendment by buying a pack of cigarettes and enjoying a smoke. But public opinion hasn’t yet come to a consensus on how sugary drinks contribute to the epidemic of excess weight, so the NRA can pretend that regulating soft drinks, like regulating guns, is another example of government overreach into an area of personal choice which should be left alone.

Here’s how the NRA sums it up: “we’ll happily join the residents of Santa Fe in toasting liberty with the soft drink of their choice, whatever its sugar content might be.” And on the way back from the Mini-Mart, why not stop off at your local gun shop and pick up some ammo or even another gun? After all, you can still strap on your Glock even if you can’t fit into your pants.

 

Doctors For Responsible Gun Ownership Show How Irresponsible They Really Are.

Yesterday the medical quacks who run a website called Doctors for Responsible Gun Ownership (DRGO) decided to demonize physicians who regard gun ownership as a health risk by descending to the lowest, possible level of pandering to the lowest, intellectual denominator – a style promoted successfully by our soon-to-be President which now serves as the rhetorical burnishing for the thoughts of every jerk, dope and creep climbing out from underneath their rock to bask in the light of the Age of Trump.

docs versus glocks             What I am referring to is a scurrilous attack on an up-and-coming public health researcher, Bindu Kalesan, whose group continues to publish articles on guns and gun violence that really pisses Gun-nut Nation off.  And the reason their work attracts such negative attention from the Jerks and Dopes Brigade is because Dr. Kalesan and her colleagues make no secret of the fact that they are not enamored of guns.  Kalesan even comes down out of the Ivory Tower to serve as the Vice President of a neat GVP organization which attempts to “assist in the funding required to promote mental and emotional healing” of gun victims, something which the medical quacks who slither around the DRGO website know and care absolutely nothing about.

What got the so-called physicians who spearhead the Jerks and Dopes Brigade so hot and bothered was an article published in a peer-reviewed medical research journal that correlated school shootings with such factors as handgun background checks, state-level mental health expenditures, education funding and gun-ownership rates, among others. By the way, the DRGO claims that this is the first of a series of articles that will be produced by the DRGO Publication Review team which consists of ‘medical scientists and statisticians,’ although none of these august individuals is actually identified by name.

And to show you DRGO’s commitment to medicine and science, the first thing that caught my eye was their finding of a major error in Kalesan’s piece, namely, that she neglected to mention a school shooting which occurred in Boston on April 18, 2013.  Now if you want to characterize this event as a ‘school shooting’ you are either delusional or dumb, or both.  Because this happened to have been a shooting of a campus cop at MIT by the two Tsarnaev brothers (the Marathon Bombers) who were trying to evade a citywide manhunt and might have been stopped by the cop after their pictures were broadcast all over the place by the FBI. If this purposeful misuse of evidence constitutes what the DRGO feels represents the work of statisticians and scientists on their behalf, then there’s really no sense in taking them seriously at all.

But the misrepresentation of evidence is not the lowest degree to which this bunch of fools can sink; in fact, they go one step further (or perhaps I should say ‘lower’) in their attempt to guttersnipe at Kalesan’s work and name.  Because they also turn their attention to the journal in which this article was published – Injury Prevention – and note that the editorial staff is “dominated by foreigners unfamiliar with and likely hostile to America’s constitutional right to keep and bear arms.”  Note the use of the word ‘foreigners,’ and it’s not by accident that this comment is placed in an attack on a researcher who, by dint of her name, might also be part of the horde that’s coming over here to destroy everything about America that’s good and right.

This is what I meant above when I talked about how disgustingly low the DRGO creeps have sunk.  It’s not bad enough that they use their so-called medical credentials to spread absolute falsehoods about the non-risk from guns.  What they are now beginning to do is resort to the same, malicious and dangerous racism and hatreds which infected the Presidential campaign.  In the process they not only demonize evidence-based research upon which all medical knowledge and practice depends, but show themselves to be nothing more than crude hucksters for the gun industry hiding behind medical degrees.

Want To Help Reduce Gun Violence? Support The Children’s Firearm Safety Alliance.

A new gun violence prevention organization has just popped up and their goals are worthy of mention here and elsewhere.  The organization is called the Children’s Firearm Safety Alliance (CFSA) representing a coalition of physicians, law enforcement, prosecutors, lawmakers and gun violence prevention (GVP) advocates, and its goal is to reduce gun violence committed by or against kids.

cfsa          You may recall that back in 2011, Granny Hammer got a bunch of her ass-backward Florida legislators to pass a bill that basically made it a felony for physicians to counsel patients about guns.  The case is still awaiting a final appellate decision and there are several other dumb states that have enacted similar ‘gag’ laws.  Until Docs vs. Glocks was enacted, the medical community had been fairly reticent to speak out about gun violence beyond the obvious policy pronouncements about the dangers of guns.  But one thing that always seems to happen when it comes to any kind of public policy – push hard in one direction and someone will push back.  Which is exactly what has happened when it comes to physicians and guns.

Last year eight of the most important medical associations, along with the American Bar Association, published a manifesto which declared that gun violence was a serious public health problem that required the medical community to get involved.  And many of the national and state-level organizations followed by issuing their own statements of concern, as well as supporting and sponsoring educational programs to bring the issue of gun violence to the fore.

The CFSA represents another important step towards the involvement of the medical community in efforts to reduce gun violence, because although it is a physician-led organization, its membership embraces all of the major stakeholders who have an interest in GVP. According to the CFSA website, its mission is: “To reduce senseless child unintentional deaths and injuries in every state by advancing legislation holding adult gun owners responsible and educating the public how to keep children safe if a gun is in the home.” And to that end, their intention is to advocate for stronger and more comprehensive child access prevention (CAP) laws, of which there are no laws at all in more than 20 twenty states.

Of course the response of the Gun-nut Nation noise machine to physicians getting involved in gun safety is that such activity should not be within the scope of medical activities because most doctors don’t know anything about guns.  This is the argument made by a handful of dopey doctors who run a website called Doctors for Responsible Gun Ownership, which happens to be supported by the 2nd Amendment Foundation, get my point?

But the fact is (note use of the word ‘fact’) that physicians have played a leading role in campaigns to protect children from all kinds of injuries and unintentional harm, including efforts to mandate harnesses and seat belts, safety barriers around in-ground pools, removing lead from paint and toys, and child-resistant bottle caps to guard against the ingestion of toxic substances and meds.  I don’t hear anyone stating that doctors need to get certified as automobile mechanics before they remind parents to buckle in the kids.  Nor for that matter do they need to become lifeguards in order to ask whether there’s a fence around that pool which just got installed in a patient’s backyard.  But guns?  Nobody except a licensed gunsmith should be allowed to voice an opinion about safety and guns, right?

I am pleased to be able to spread the word about the Children’s Firearm Safety Alliance and I urge you to give them your full support. Yea, yea, I know you just have to send Hillary a few more bucks this week but as regards the CFSA, you might also consider sending a donation their way.  And just in case you missed their website address up above, don’t bother to scroll up because here it is again.  Click here, check out their website and sign up for a great cause.

 

What Should Doctors Ask Patients About Guns? Everything.

You may recall that back in April, 2015, eight national medical organizations plus the American Bar Association called deaths and injuries from guns a “major public health problem in the United States,” and asked for a stronger medical response to gun violence. Now if these medical groups, representing every medical specialty, had issued a joint statement about any other medical issue that causes more than 100,000 deaths and injuries each year, the public reaction would have ranged from ‘what took you so long?’ to ‘let’s get to work and solve the problem.’  But in this instance, of course, much of the public reaction came in the form of the now-traditional response by Gun Nation, telling the tribe that this was simply another attempt by gun-grabbing, anti-gunners to take away all the guns.

docs versus glocks              When medical groups advocated in favor of seat belts, did anyone say that car safety wasn’t a medical issue because physicians didn’t, as a rule, undergo training on car repair?  The proper medical response to any problem that causes injury is both prevention and cure; prevent the injury before it happens which reduces the number of people who then show up looking for a cure.  But the gun lobby is wedded to the idea that there is no such medical condition known as ‘gun violence,’ and to degree that on a rare basis someone accidentally gets hurt using a gun, it’s a small price to pay considering that armed citizens prevent millions of crimes each year.

Having observed the ease with which Donald Trump convinces his supporters that his lies are really self-proclaimed truths, I’m not surprised that millions of Americans and certainly a majority of gun owners agree with the nonsense that the NRA and like-minded sycophants continue to spread about the benefits of owning a gun.  But physicians do not have the luxury of developing treatment guidelines for medical conditions based on what their patients might want to believe. When research indicates repeatedly that a certain type of behavior creates medical risk, then medical professionals must respond on that basis and that basis alone, regardless of what people who sell guns for a living would like their customers to believe.

Which is why the new article by Garen Wintemute is so important because what he and his research associates are trying to do is develop a practical method to communicate concerns about gun risk to patients who might be predisposed to reject or be skeptical about what their physician tells them about guns.  Their initial article, published last August, discussed the need for physicians to acquire a higher level of ‘cultural competence’ in order to communicate effectively with gun-owning patients; in particular calling on gun-owning physicians to provide leadership in developing messaging that gun-owning patients would more likely understand.

But adopting a respectful and supportive toward a patient with a different cultural outlook is one thing; knowing what has to be communicated from a clinical perspective is something else.  And Wintemute’s group has now taken that step by publishing a new article that seeks to define what physicians should say and/or do if they believe that a patient’s access to guns creates a medical risk.  Aligning proper responses to different levels of medical risk is standard procedure for nearly all public health issues, particularly those issues, like gun violence, that have been listed as public health concerns for more than twenty years.  But thanks to the ban on CDC gun violence research and the continuous anti-medical drumbeat of the NRA, creating proper medical messaging for gun violence has been tantamount to finding yourself in deep water without a paddle or even a canoe.

The medical profession needs to ignore the NRA and self-aggrandizing politicians who cynically use their opposition to the concept of gun violence as a medical risk to inflame their base.  After all, Galileo spent the last nine years of his life under arrest, but when we drop a solid object, it still falls straight down.

 

Take A Look At Some Interesting Public Health Research About Gun Violence.

               I like it when public health research on gun violence gets in the way of Gun Nation’s continued effort to pretend that the only thing which stands between America and Armageddon is a good guy with a gun.  So I think it’s important now and again to highlight some recent gun violence scholarship, even though by including a handful of important articles I am forced to omit others that are of equal importance to the field.  Feel free to download any of the articles mentioned here.

               Article #1.  “Lethal means access and assessment among suicidal emergency department patients” is a study of more than 1,300 emergency patients across the country who either reported suicide thoughts or actually attempted suicide in the week prior to their ED visit, of whom 11% reported having at least one, if not more than one gun in their home. Of the gun-owning suicidal patients, 22% considered using a gun as their chosen suicidal method, with only medication scoring higher among this group as the preferred way to bring their lives to an end.  Among the emergency population that did not own guns, only 6% reported thoughts about using a gun to end their lives.  Pills have a 5% success rate for suicide, with guns the death rate is 90%. Get it?

               Article #2. “Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration” is a comparison of the frequency of hospitalization for victims of gun violence when compared with the population that is hospitalized for an injury not involving guns.  The study looked at patient outcomes for more than 9,000 violent injuries and 68,000 non-violent injuries, of whom 680 were classified as FRH or firearm-related hospitalizations.  And what was learned from this study, which was the first to look comprehensively at medical histories of patients shot with guns? “Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization

or crime perpetration.” Gee, what a surprise.

               Article #3.  “Long-term mortality of patients surviving firearm violence” deals with the degree to which being injured by a gun increases the possibility of early death.  What makes this study significant is that the researchers compared five-year outcomes following hospital discharge of 516 patients who sustained gun wounds, 992 vehicle accident injuries and 695 assaults where no gun was involved. What they found was that five-year, post-discharge mortality rates were significantly higher among gun assault victims and other assault victims as opposed to patients who were injured in accidents involving cars.  But while the 5-year mortality rates for gun and non-gun assaults were similar, a greater proportion of the victims of gun assaults died within one year of their initial hospital release.  Most of these early gun-injury deaths were – you guessed it – gun homicides.  In other words, if someone leaves the hospital after getting shot, they have some unfinished business which usually ends up with them getting shot again.

               Article #4.  “Social networks and the risk of gunshot injury” goes beyond the usual epidemiological data that drives public health research and looks at group behaviors which influence gun violence on a community-wide scale.  For this article the researchers studied two inner-city Boston neighborhoods with high rates of violent crime and utilized data from the Boston PD Field Intelligence Observation unit to construct the social networks linking the population which was most likely to be criminally involved with guns.  What they found was that using standard demographic categories (income, race) to define a population as high-risk for gun violence was not as important as understanding how individuals were situated in social networks where gun violence frequently occurred.

               Four studies, each of which fills important gaps in our knowledge about violence caused by guns. Four studies, which if it were up to Gun Nation would never be funded, would never see the light of day. Four studies, which whether we are talking about suicide, homicide, assault or combinations of all three, remind us again that you don’t protect anyone from anything by walking around with a gun.