Handgun Violence, Public Health, and the Law ( New Eng Jour Med)

[pinto]

Handgun Violence, Public Health, and the Law

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D.

Firearms were used to kill 30,143 people in the United States in 2005, the most recent year with complete data from the Centers for Disease Control and Prevention.1 A total of 17,002 of these were suicides, 12,352 homicides, and 789 accidental firearm deaths. Nearly half of these deaths occurred in people under the age of 35. When we consider that there were also nearly 70,000 nonfatal injuries from firearms, we are left with the staggering fact that 100,000 men, women, and children were killed or wounded by firearms in the span of just one year. This translates into one death from firearms every 17 minutes and one death or nonfatal injury every 5 minutes.

By any standard, this constitutes a serious public health issue that demands a response not only from law enforcement and the courts, but also from the medical community. In this issue of the Journal,2 Wintemute provides an analysis of the important public health implications of gun violence in America.

On March 18, the U.S. Supreme Court heard oral arguments in District of Columbia v. Heller,3 which questions the constitutionality of the District's 1976 statutes banning or otherwise controlling handguns. A lower federal court struck down the statutes, ruling that the Second Amendment protects an individual right to keep and bear arms. The District of Columbia then appealed to the Supreme Court. The Court's decision in this case is likely to have major impact on handgun-control laws throughout the country. As noted by Wintemute, a court decision that broadened gun rights "could weaken the framework of ordered liberty."

The Second Amendment to the U.S. Constitution states that "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed." These 27 words have been the focus of endless analysis. Do they protect an individual right to arms? Or only the collective right of a state militia? Gun-rights advocates staunchly adhere to the first interpretation, and proponents of gun control favor the second. As noted by Tushnet,4 a distinguished legal scholar, in this issue of the Journal, the language of the Second Amendment can be interpreted to provide substantial support for both points of view.

more at:

http://content.nejm.org/cgi/content/full/NEJMe0802118?query=TOC

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.

[virginia mountainman]

1. Odd...

I own MANY handguns....My neighbors ALL own many guns...

All I know is, when Democrats start talking gun control, we tend to LOSE NATIONAL ELECTIONS.

THANK GOODNESS, looks like SCOTUS may find for an individual right, all this "ban bullshit" will be over...

Need to deal with the CRIME, and NOT, an inanimate object.

[pinto]

2. New Eng Jour Med is looking at the issue as a public health issue,

with much of the public health impact of firearm fatalities in urban areas - not a political issue.

One of public health's primary functions is to track and address death and infection statistics. Their epidemiology is purposely meant to be apolitical.

[villager]

4. gun cultists refuse to look at the epidemiological aspects

or any aspect suggesting that mass proliferation of guns and ammo, with little or no controls, may not be in society's best interest

They are blind in the adoration of their fetish...

[Fire_Medic_Dave]

24. Why the nasty language?

Just because we may disagree on the best way to reduce the number of firearm injuries and deaths, doesn't mean we are cult members or have a fetish. We simply disagree and that's okay. We need to try and find common ground and make progress in areas that we can.

David

[benEzra]

11. They politicize it by lowering the ordinarily rigorous standards of review...

in order to produce the desired conclusion, because the conclusion (Guns R Bad) is foregone. The purpose of the articles is to generate momentum for restrictions, not honest weighing of the pros and cons of lawful gun ownership.

For example, consider Trask, Richards, Schwartzbach, and Kurtzke, "Massive orthopedic, vascular, and soft tissue wounds from military type assault weapons: a case report," J Trauma 1995 Mar 38(3):428-31. That article had one of the most egregious blunders I've ever seen in any peer-reviewed medical journal (ascribing magic wounding powers to low-energy 7.62x39mm caliber bullets, overstating their kinetic energy by 40%, and making the absurd claim that low-velocity AK rounds have greater velocity than high-velocity hunting rounds), yet those blunders weren't even NOTICED in peer review--because the article reinforced a certain editorial position, and therefore was not subjected to even cursory scrutiny. The widely-cited Kellerman et al studies on defensive gun use vs. criminal misuse are another egregious example.

There are a lot of systemic problems with most of the medical literature on guns, and peer review on this topic seems noticeably less rigorous than peer review on actual medical topics, with egregious procedural blunders and idiotic misunderstandings of technical issues appearing fairly regularly in the peer-reviewed medical literature. Those types of egregious blunders and biases pointed out in this article are the reason Congress yanked gun funding from the CDC back in the '90's. If you can find it on the web, the transcript of the committee hearing in which the head of the CDC was confronted over the issue of "advocacy studies" on this issue is also rather enlightening.

For an overview of the disconnect between the conclusions of peer-reviewed medical researchers on guns vs. the conclusions of peer-reviewed criminologists on guns, see the following review of the literature (a few years old, but a good read):

Kates et al, Guns and Public Health: Epidemic of Violence or Pandemic of Propaganda? (61 Tenn. L. Rev. 513-596 (1994).)

Do a keyword search of "gun-averse dyslexia" in that article, and check the journal citations for yourself.


FWIW, the public-health obsession with banning nontraditional looking civilian rifles ("assault weapons") shows just how politically driven, rather than epidemiologically driven, the issue is in public health circles:

2005 data (FBI UCR):
http://www.fbi.gov/ucr/05cius/data/table_20.html
Total murders............................14,860.....100.00%
Handguns..................................7,543......50.76%
Other weapons (non firearm, non edged)....1,954......13.15%
Edged weapons.............................1,914......12.88%
Firearms (type unknown)...................1,598......10.75%
Shotguns....................................517.......3.48%
Hands, fists, feet, etc.....................892.......6.00%
Rifles......................................442.......2.97%

2006 data (FBI UCR):
http://www.fbi.gov/ucr/cius2006/data/table_20.html
Total murders............................14,990.....100.00%
Handguns..................................7,795......52.00%
Other weapons (non firearm, non edged)....2,158......14.40%
Edged weapons.............................1,822......12.15%
Firearms (type unknown)...................1,465.......9.77%
Shotguns....................................481.......3.21%
Hands, fists, feet, etc.....................833.......5.56%
Rifles......................................436.......2.91%

And that's for all rifles combined, not just the small-caliber rifles with modern styling that they are proselytizing to ban. Rifles of any type are simply not a crime problem in the United States and never have been.

[DCKit]

12. How many of the handguns used in murders were legal...

and registered?

Making something - anything - illegal doesn't discourage, but increases it's prevalence and every imaginable crime associated with it. Illegal drugs, alcohol and the associated rise of organized crime springs to mind.

Marijuana doesn't kill people: The criminals who traffic and profit from marijuana, because of it's status as an illegal drug, kill people.

[varkam]

6. "Need to deal with the CRIME, and NOT, an inanimate object."

There were more suicides than homicides that involved firearms. I'm not sure if the presence of firearms had anything to do with any particular suicide, or not - but suffice it to say it isn't all about crime.

[benEzra]

10. The United States' suicide rate is far lower than that of most nations with strict gun controls...

suggesting that gun laws are not a significant factor in suicide rates, although they may influence method choice. But the U.S. suicide rate is lower than not only Japan's, but also Canada's, the UK's, and most of Europe's.

[jody]

3. SCOTUS cannot give a court decision that broadened gun rights. It can give a decision that

recognizes a natural, inherent, inalienable right that existed before the Constitution was ratified in 1789 and the BOR was ratified in 1791.

Such rights are not granted by government but government is required by the Constitution to protect those rights.

[xchrom]

5. recommend. -- among other things -- guns result in a public health issue.

[newfie11]

7. This has been brought up on other threads

I live on a farm in a very rural area. We have several rifles, and both my husband and I have concealed weapons permits.
All the people around us (Farms) also have guns of various type. If we needed to call the sheriffs office it would be at least 20-30 minutes before they arrive. I really do not think an intruder would politely wait for them to come.
I can tell you no one has shot anyone around here, no one has shot their self, and these guns are also used to shoot rattlesnakes, coyotes killing a newborn calf, etc. Most of the vehicles traveling these country roads are caring at least one rifle or handgun.
There are two sides to every story.

[MaryCeleste]

8. Note they consider self defense shootings homicides in the report

Which really skews things. Their choice of language also shows their perspective.

They also do not consider where the presence of a weapon, stopped a crime.

[Fire_Medic_Dave]

23. Thanks Mary

Surely these points weren't an apolitical decision when they were added.

David

[cosmik debris]

9. Traffic fatalities for the same period

http://www.boston.com/news/nation/washington/articles/2006/04/20/us_traffic_deaths_hit_15_year_high_in_2005/

Just to keep it in perspective.

"Total U.S. traffic deaths in 2005 reached 43,200, according to the statistics released by the National Highway Traffic Safety Administration."

If we take radical action against guns, shouldn't we take more radical action against automobiles? They are clearly a greater health risk than guns.

[dropkickpa]

13. Now

How many traffic deaths would there have been without all of the safeguards that are in place? Such as seatbelts, cars that don't blow-up, the need to have insurance, the requirement of passing a test (including a medical exam) to get a license, traffic laws and limits, etc.

I have nothing against gun ownership, but I think it is too damned easy for people to get a gun. And the whole "If you outlaw guns only outlaws will have them" argument doesn't wash with me, because just about every "illegal" gun out there WAS at one point a legally bought and owned weapon. There's been a breakdown somewhere along the line, because "illegal" guns did not all get there through theft, many/most were bought legally and sold illegally. Track guns like cars or something of that nature. Require that all gun owners pass a medical exam and also a written and practical test the same as with driving.

[cosmik debris]

14. I only responded to the OP's statement that guns are a health issue

Cars are a greater health issue regardless of what has happened in the past.

If we are going to attack the problems of public health and safety, we should keep our response proportional to the danger. For example, we should be more proactive with automobile safety than lawn mower safety.

"In the United States, approximately 9400 children younger than 18 years receive emergency treatment annually for lawn mower-related injuries."

(from the American Academy of Pediatrics)

[dropkickpa]

15. I agree

Your post just sent me off on a tangent. There's a whole lot of people who SHOULDN'T be driving, from a safety standpoint, but they are.

I think the thing is is that a gun is made for one purpose, to shoot stuff (be it people, animals, etc) while a cars main purpose is as a method of conveyance.

[cosmik debris]

16. But you have to see the result, not the intent

Lawn mowers are meant to cut grass, not children's feet.

(Actually, that's a bad example because you KNOW when you are exposed to danger from a lawn mower. You never know when you are exposed to risk from a fire arm.)

[benEzra]

17. I think a more relevant comparison would be guns and alcohol.

Alcohol kills far more Americans annually than guns do, but we take an intelligent approach to alcohol misuse; rather than trying to outlaw the responsible use of beer and wine, or outlawing drinks in dark-colored bottles, we set minimum age and ID requirements and prosecute those who misuse it. The Prohibition approach was tried, and it didn't work (it arguably exacerbated the alcohol problem). The same could be said of guns.

[cosmik debris]

18. I'm not too sure about that

There were 16,885 alcohol-related fatalities in 2005 – 39 percent of the total traffic fatalities for the year.

http://www.alcoholalert.com/drunk-driving-statistics.html

I don't have the number of ALL alcohol related fatalities, but that number is significantly lower than the number of fire arm deaths cited by the OP.

While the approach you support has been quite successful at reducing fatalities, its flaws are self evident. Just as we can't stop underage drinking, we can't stop illegal fire arm ownership. As dropkickpa mentioned, all guns were once legally purchased and owned.

[benEzra]

19. According to the CDC, alcohol kills 100,000 Americans annually.

I'm not too sure about that

I don't have the number of ALL alcohol related fatalities, but that number is significantly lower than the number of fire arm deaths cited by the OP.

According to the CDC, the annual death toll for alcohol is 100,000 deaths/yr. That number is inflated by a few percent, largely because of the way the NHTSA classifies an accident as "alcohol related" (if there is a drinker involved, the accident is classified as alcohol related even if the drinker was an innocent victim), but the true number is still well in excess of 80,000.

http://pubs.niaaa.nih.gov/publications/10report/intro.pdf
http://pubs.niaaa.nih.gov/publications/10report/chap01a.pdf

The Tenth Special Report to the U.S. Congress on Alcohol and Health presents significant
new scientific findings about alcohol abuse and alcoholism since the last Special
Report, issued in 1997. These findings clearly demonstrate that alcohol investigators
working in fields as diverse as epidemiology, genetics, neuroscience, toxicology, prevention,
and treatment are using the very latest tools and techniques of science to expand
our knowledge of how to prevent, reduce, and treat alcohol problems. Because alcohol
use problems exact such a personal, social, and economic toll on the American
people—-an estimated 100,000 lives and $184.6 billion annually—the scientific
progress described in the Tenth Special Report is heartening.

...

(A)lcohol may have a greater effect
on nonfatal than fatal health consequences (for
example, researchers have estimated 15.6 percent
of all life years lost to disability in established
market economies were due to alcohol, compared
with 5.1 percent of all life years lost due to
mortality) (Murray and Lopez 1996b, 1997b)

The per-cause breakdown is found elsewhere in that report, and some citations are also found in the 1997 edition.

While the approach you support has been quite successful at reducing fatalities, its flaws are self evident. Just as we can't stop underage drinking, we can't stop illegal fire arm ownership. As dropkickpa mentioned, all guns were once legally purchased and owned.

The thing is, we already tried the Prohibition model against alcohol; it was a miserable failure. The flaws inherent in the current alcohol regulatory paradigm are much less than the flaws in the alcohol prohibition paradigm, and mirror the failures of the decades-long prohibition on cannabinoids (which has not reduced cannabinoid availability in the slightest, but has greatly worsened the context of that availability).

The prohibition paradigm would be even less workable with regard to guns.

[dropkickpa]

20. An outright ban wouldn't work

Nor would I support one. But creating some sort of tracking system for firearms and making owners responsible for keeping that firearm (and proving that they still have it, etc etc) very well could. If a monetary fine of sufficient amount were attached to, say, not being able to show your firearm to prove continued possession of said item or official documentation of sale, many would be a lot more reluctant to go the easy route of just selling it to a friend, who sells it to a friend who pawns it etc etc etc until it ends up in a bad place and misused.

[benEzra]

21. Granted. That would require a different political climate, though...

one in which the gun-control advocates were NOT trying to ban popular guns, mandate pre-1861 magazine capacities, mandate storage conditions, etc. In the current climate, there is the well-justified fear that the gun-control lobby would use any such system in order to push the U.S. down the path of Australia, Canada, and the UK over the next several decades, and until that threat passes, opposition to registration will undoubtedly continue.

[Tumbulu]

22. thank you for your good posts

I agree with you completely. Especially the insurance part cited in your first post. I cannot understand why liability insurance is required for everyone operating a car but not a firearm.

[dmallind]

25. I have no real problem with this

I'm not a RKBA absolutist and I do not think registration etc infringes on anyone's right to keep and bear arms. There is no right to keep and bear arms WITHOUT ANY RECORD despite how much some of my fellow shooting enthusiasts seem to think so.

It bothers me not one whit that the government may (and probably does - 4473 info does not disappear into black holes and anything that is recorded can and probably will be retained) know I am in possession of guns, nor that I would be expected to register the transaction for any I sell legally. There is a logistical challenge in that there would need to be a regsitration effort to begin with, and compliance would be low at first, but I'd have no problem complying. Same with insurance as long as based on actuarial risk not political punitive measures. again there is no right to keep and bear arms with no cost.

However surely it would also be sensible to extend some of the advantages of such a system to firearms just like cars have as mentioned above, if we want to impose some of the disadvantages. Since usually it's the pro-gun folks who are accused of being unwilling to compromise (despite thousands of existing gun restrictions) - could we not expect compromise on the following, based on that car model?

A license to operate a firearm would be valid for operating a gun in any legal manner in all states rather than having to unload your concealed weapon and store it out of reach based on what city or state you are in.

A license would only be suspended or revoked based on illegal actions performed by that specific person and the same for insurance rates.

The qualifications for getting a license would be based only on age, basic shooting ability and understanding of laws for firearms, rather than on whether the local police chief likes you?

[dropkickpa]

26. This all sounds good to me

Insurance, separate from homeowners, would be a good idea. And licensing should be the same across the board state-wide, just as it is for cars.

NONE of these things should be a threat to responsible gun owners. The government knows how many cars, homes, etc that you own, why not firearms.

[dmallind]

27. Herein lies the (highly implausible) only potential solution

Frankly to my was-a-controller-now-owner brain which still retains the arguments of both it has to come down to something where a compromise is reached. Gun controllers have to realize that with our constitution, our history, our sociology and with the already widespread prevalence of guns and the knowledge to make them, that anything approaching putting the genie back in the bottle and significantly curtailing access to firearms is impossible, and more than likely ineffective even if it were. Enthusiasts have to realize that the days of being able to buy serious weaponry in a completely anonymous fashion are, and indeed should be, over. Infringement means what it says. Adding paperwork and keeping records is not infringement. My (putative) right to drive, and certainly my (very real) ability to do so in a reasonable manner that combines freedom for me and protection for others is in no way infringed by needing to pass a test, have insurance, and maintain a valid license.

It would be, and yes probably SHOULD be, the same for guns. Frankly even as a pro-gun fellow it's always amazed me and even irked me that you have to go through more hoops to prove you are capable of riding a moped before you can legally operate one than you do a gun.

Now as we all know anyone banned from driving can get a car. People drive without licenses and insurance. They would own guns that way too, but at least the vast majority who are law abiding (which my fellow gun owners always remind others is analogous to the vast majority of gun owners who are likewise law abiding) would follow the rules, and the ability of people who should not have a gun to procure one would be somewhat reduced, while minimally inconveniencing legal owners. In fact with the compromises above that in return we'd get a national reciprocal license and shall-issue guidelines nationwide to legal owners I'd suggest this would be an overall positive in the convenience stakes for us too, while giving controllers everything they want in the areas of "gun show loopholes" and licensing requirements. It would satisfy neither the "all guns are evil and should be banned" loons nor the "cold dead hands dammit and we should all be able to mail order our own GE mini guns anonymously" loons, but then again nothing rationbal ever would.