With all the talk and counter-talk this year about gun violence, I’m not sure that we have actually looked at the real issue at all. And the real issue goes like this.
Last year there were roughly 11,000 homicides, of which approximately 80% involved the use of guns. There’s endless talk about how the US is much more violent, and really much more gun violent than any other advanced country, and we need to do something about it. The NRA says that we need more armed citizens. The other side says we need less guns. Neither side can point to any definitive data to prove their point, but when did facts ever get in the way of opinions anyhow?
I want to talk about another kind of gun violence, the kind we don’t talk about at all. For every person who was shot with a gun in a criminal affair, more than two people (roughly 18,000) shot themselves with guns. That’s right. Gun suicide is more than twice as common as gun homicide, and I don’t notice anything in all the proposed bills floating through Congress that mentions this issue.
The one thing that everyone in Washington seems to agree on is that we need to add mental health records to NICS. Now maybe that would prevent some crazy person from buying a gun and walking onto a college campus to shoot at a whole bunch of people, but it would likely have little impact on gun suicides. In the majority of suicides, the victim actually saw a health professional within the last two weeks of their life. That’s the real problem with suicide; it’s a very impulsive, very private kind of behavior.
The private nature of suicide and mental health in general makes it even more difficult to understand the extent of the problem. Coroners and medical examiners are very careful when it comes to dealing with homicides, but suicides are usually family affairs, so even the cause of death is frequently stated as something else. For a country that is obsessed with health, we draw a line when it comes to mental health and we prefer at best to discuss it rarely, or at worst to ignore it completely.
Precisely because it’s private and impulsive, a gun is the perfect tool to use if someone decides to end their life. You don’t have to find a rooftop that you can get to, you don’t have to figure out how to tie a good knot around your neck, you don’t have to cram a fistful of pills down your throat. No wonder that guns are successful in 95% of the times they are used as a life-ending device, whereas hangings work only 50% of the time and more than 90% of pill overdoses result in a quick trip to the local hospital to have your stomach pumped out.
The NRA has gone off the deep end with this bizarre attempt to criminalize discussions between physicians and patients about the ownership of guns. When a patient tells a physician that he is feeling depressed, the doctor always asks whether the depression has provoked life-ending thoughts. And if the patient responds in the affirmative, how can the physician or other medical professional then not ask if the patient has access to a gun? If anyone reads this last paragraph and feels obliged to respond with the obligatory defense of the 2nd Amendment, do me and the other readers a favor and don’t waste our time.
I agree with the NRA that people who use guns to commit crimes need to be held fully accountable for their behavior and for the damages caused by the gun. But people who use guns to kill themselves can’t be held responsible because if they were able to think rationally, they wouldn‘t try to kill themselves in the first place. If we need a national strategy to deal with gun violence, it’s a strategy to deal with suicide, and that’s a discussion that hasn’t yet occurred.
Related articles
- Gun Violence: Mathematicians Attempt To Bring Logic To The National Debate (medicaldaily.com)
- The NRA Is Pleased That 7 More Americans Are Dead From Senseless Gun Violence. (theobamacrat.com)
Jul 30, 2013 @ 07:28:06
I have been told there are roughly two kinds of people who attempt to commit suicide, those who are really trying to “make a call for help,” and those who really mean it. People who choose a gun tend to really mean it, are not making a cry for help, and will find other ways to accomplish their purpose if they can’t get their hands on a gun.
In Japan private ownership of firearms is nearly non-existent, yet the Japanese commit suicide every year in very impressive numbers.
My thought is that if we can help those people, and I think that is a very big “if” perhaps we should, but we should not sacrifice the rights of law abiding people to obtain firearms, or even make it harder for them, just for the possible potential of saving the lives of people for a short time, who then will find another way to commit suicide.
In regards to the NRA I think their issue was laws that forced doctors to intrusively question people about their gun ownership, or keep records about gun ownership (“backdoor” gun owner registration through Obamacare).
For example, wellness and prevention programs may not require the disclosure or collection of information relating to the presence or storage of a lawfully possessed firearm or the use of a firearm. Note the very important phrase “may not require.” That doesn’t prevent a doctor from asking. It prevents these programs from requiring it.
Another provision limits the ability to determine rates or eligibility for health insurance based on gun ownership. In other words, don’t use Obamacare to enact de facto gun control by raising the rates for health insurance for gunowners based on some bogus research that is politically motivated (which the CDC has proven it will do).
And another provision related to gun owners is that individuals do not have to disclose they own a gun. In other words you come into the doctor’s office and he starts questioning you, then you can say, “Sorry doc, that is none of your business.”
I think it is clear, and apparently very clear to the NRA, that Obamacare and health care insurance was likely to be the next big push for “backdoor” gun control.
lwk
free2beinamerica2.wordpress.com
Jul 30, 2013 @ 07:59:20
I find your comments very well done and informative. And I appreciate that. So let me respond, in no particular order.
I agree that because guns are so “efficient” that people who use them to commit suicide really want to end their lives, whereas someone who takes pills or cuts themselves may just want to draw attention to themselves. There’s only one problem. Many people who eventually end up killing themselves have tried to do it multiple times previously and failed. They didn’t get help and then eventually they get “serious” and pull out a gun. So unfortunately, it’s the gun that pulls them across the line from a “call for help” to a real suicide.
I’m not sure what suicide statistics (or any statistics) about any other country tell us about our country. We all make these comparisons and I’m leery of pushing them too far. Every country has a different culture, a different history, a different population, etc. Greenland has a suicide rate five (!) times higher than any other country and nobody knows why. By the way, I’m also leery of comparisons that are made between the US and other countries on the issue of gun ownership, etc. Why shouldn’t we have a lot of guns? Know any other country that ever made a Western movie?
I’m sorry but I can’t agree with you on most of what you say about the medical stuff. Under law and/or best practices, doctors are required to ask questions about all kinds of things that are perceived as risks, not just guns, but seat belts, suicidal thoughts, all kinds of things. What the NRA never points out, of course, is that the doctors are required to ask but the patients aren’t required to answer. They aren’t required to answer about anything, not about drug use, not about unprotected sex, not about guns, not about anything. And the non-compliance rate (the % of questions that patients don’t answer for whatever reason) runs around 40%.
If the only thing the NRA was concerned about was privacy I’d half-buy their argument. But they’re up to much greater mischief. What they are trying to do is create the impression that guns are like anything else; they aren’t dangerous and hence they don’t need to be regulated. So, for example, I am a NRA-certified trainer and when I go to sessions where the NRA Training Department talks to us about training, they tell us never to use the word “weapon” because it gives the wrong impression. They want us to use the word “tool” and they refer to handguns as “self-defense tools.” That’s total nonsense. Name me another “tool” which, if used improperly could result in someone standing a half mile away getting killed. I agree, the regulations go overboard. But I’m offended by the blatant lack of honesty that permeates these discussions about “self-defense tools.”
Thanks again for your comments.
Mike Weisser
Jul 30, 2013 @ 09:16:41
“Many people who eventually end up killing themselves have tried to do it multiple times previously and failed.”
But if they are really serious they _will_ find a way that works.
A lot of opinions on this I think are largely conjecture. People imagine that not having guns will save lives, and it might, and it might not. My personal view is that Americans have a right “to keep and bear arms” and unless one can prove a person is unfit for a demonstrated reason, e.g., criminality or dangerous insanity, then they should be able to exercise that right.
I don’t buy into the “if it will only save one life” justifications (not saying you used it, just mentioning it). The equation is too complex and people just look at one facet of a multi-faceted equation. Maybe some law might prevent a suicide one time, but at the same time cost the life of a person who didn’t have a firearm for self defense because of unintended consequences of that law.
“So unfortunately, it’s the gun that pulls them across the line from a “call for help” to a real suicide.”
I don’t buy “the gun pull[ed] them across.” Their own personal demons pulled them across. Unquestionably a gun may make it easier, and maybe that can be a good thing too.
Imagine a person is determined the kill themself. They take a gun and it is done in seconds and their pain is ended. A tragedy for perhaps friend and family but that person’s suffering is done.
Now imagine they don’t have a gun. Now they use a rope and take minutes to die painfully and horribly by strangulation. So you have done them a really big favor, right, by taking away their gun? You have condemned them by unintended consequences to a much worse death than they would have experienced with the gun.
This is not entirely a theoretical discussion for me. I had a cousin, a young man in his prime, commit suicide after he killed another person in self-defense. He couldn’t live with that so he took his life. I say that only to point out that I know about suicide and its impact from personal experience. It was a shame, the young man had a great future ahead of him. But I honestly don’t know that there was much that could have been done to prevent it.
I am all for having suicide hot-lines and trying to help people when we can, if they will let us, but I do NOT support further gun restrictions or legislation that limits firearms ownership on the basis that it “might save some lives” when we know beyond a shadow of a doubt that not having firearms for self defense can be equally tragic.
It is wrong in my view to focus on the lives saved without an equal focus on the possibility of lives lost. Also I believe in a fair amount of individual free will and sometimes people choose of their own free will to not continue to live.
“Under law and/or best practices, doctors are required to ask questions about all kinds of things that are perceived as risks…”
And that is a problem. Doctors ought to be able to practice medicine and choose based on their best judgment what are “best practices.” Nothing wrong with medical associations recommending, but eventually I think doctors should have freedom to choose. Of course Obamacare is all about making that impossible.
“for example, I am a NRA-certified trainer and when I go to sessions where the NRA Training Department talks to us about training, they tell us never to use the word “weapon” because it gives the wrong impression.”
The other side of the debate uses every trick in the book to shape the debate with the use of perjorative words. If you want the NRA to certify you, then perhaps you need to consider their advice. We need to shape the debate from our side that firearms are primarily tools that are designed to _save_ lives, not take them.
I get into that debate all the time with people who say “guns are only designed to kill.” I don’t buy it. Based on how people use guns in self defense the opposite is true. Guns are designed to save lives. Only in a tiny percent of cases is a firearm actually fired in self defense (we know this from Kleck’s research).
I have no problem with the NRA doing all that it can to try to get people to portray firearms in a positive light for their positive contribution to society.
Regards,
lwk
free2beinamerica2.wordpress.com
Jul 30, 2013 @ 17:59:40
Thanks for your comments. Again thoughtful and judicious but I have to take issue with some of them:
1. Please don’t push the “freedom to choose” too far when it comes to medicine. The whole point of having medical associations prescribe certain protocols is precisely to make sure that the level of medical care is the same everywhere so that patients can be free to choose among equally-qualified doctors. And don’t for a second start down the road of how patients can make informed choices about doctors based on their “experiences” with doctors when , in fact, there isn’t a single person who has the slightest idea about how to judge medical practices without the benefit of at least the 7 years of training that all doctors must undergo to be certified. 2. I have trained over 2,000 people in safe gun and shooting techniques because I live in one of just four states that actually require any training before a license to own a gun is issued. And I make it clear to everyone that guns are lethal and need to be used in very safe ways. And the fact that the “other side” twists the argument is in no way a justification for the pro-gun people to, as you say, “shape” the argument by using words that simply distort reality. I was in the Army. We trained on weapons. How come when a civilian walks around with one of these weapons it all of a sudden becomes a “tool?” With all due respect, that’s nonsense. If we can’t win an argument with facts, I’m not interested in winning it because we have a better PR slogan. 3. Finally, on Kleck. He was criticized by anti-gun scholars for mistakes that are, for the most part, small potatoes. And I know Gary, by the way, and have corresponded with him for a book that I am just finishing on gun violence that will be published next month. What Kleck’s critics missed, however, is a fundamental flaw in his methodology as relates to the identity of the people he interviewed and the identity of the people whom they allegedly protected themselves from. You’ll have to wait until my book comes out but Kleck in fact agreed with me about his methodological problems, only it’s somewhat complicated so I’d rather hold off until I present the entire argument. Bottom line: his numbers on DGU are no more provable than the much lower numbers that come from the anti-gun side. 4. Very sorry that suicide has touched you personally, but that doesn’t change the argument. The more difficult it is to kill yourself, the better are the odds that you’ll seek help and instead of just saying to the doctor, “I feel depressed,” you might relate the story of how you tried to commit suicide and it didn’t work. At which point most doctors won’t let you leave their office without someone taking you to the intake department of a mental health facility. Sorry, those options don’t exist if you use a gun to end it.
Regards,
Mike Weisser
Jul 30, 2013 @ 23:59:06
“The whole point of having medical associations prescribe certain protocols is precisely to make sure that the level of medical care is the same everywhere so that patients can be free to choose among equally-qualified doctors.”
In other words some authorities decide what is good. Then using power augmented from government granted powers to license they push down from the top to force conformity among the ranks. Sounds like a system perfectly designed to discourage creativity and original thought.
As usual in such schemes the justification is the greater good of patients.
I personally would prefer a free market system that rewards innovation not dictated by the permission of authorities (often a dirty word in my lexicon, especially when that authority gets and seeks the power of government to enforce that authority).
I read a book once about medicine in the 19th century where hospitals were places you went when you expected to die. If you were a pregnant woman then your chances were probably much better the farther you stayed away from the hospital.
The authorities like to tell me what a great job they have done, but I have suspicion we might have done a lot better without all these authorities empowered to push down conformity.
“And don’t for a second start down the road of how patients can make informed choices about doctors based on their “experiences” with doctors when , in fact, there isn’t a single person who has the slightest idea about how to judge medical practices without the benefit of at least the 7 years of training that all doctors must undergo to be certified.”
Sorry, but I will take a second to say that patients can make pretty good choices if they have accurate information. The kind of information they really need is what results the doctor has gotten. I may not be able to look at a doctor’s education and make a good judgment about his ability to replace my knee joint with an artificial one. But if I have access to an Angie’s List I might have a lot better information to make an informed decision on. In fact Angie’s List is starting to cover this sort of thing now.
What is the old saying? “The proof is in the pudding.”
I will listen to authorities, and will do my checking on important things and in the end the decision is, and should be, my decision. I don’t want some authorities deciding what is best for me and forcing all suppliers to sell me the same product.
I think it is better to have some “bottom up” competition and let people make their decision based on whatever criterion they choose. If they want to listen to the AMA fine, that’s their business. If they want to take a chance with a new guy on the block with a different protocol, well then that ought be their choice.
My favorite saying from the 1960s: “Question authority”
“I was in the Army. We trained on weapons. How come when a civilian walks around with one of these weapons it all of a sudden becomes a “tool?””
Maybe beause in the military, and I am a Navy Vietnam Veteran, we trained to kill. As a civilian I carry a tool that is intended to save lives, not take them.
“What Kleck’s critics missed, however, is a fundamental flaw in his methodology as relates to the identity of the people he interviewed and the identity of the people whom they allegedly protected themselves from.”
I wasn’t really referring to whether Kleck’s number of defense uses was accurate. That I don’t know. What I was pointing out is that whatever the real number, the fact is that the firearm is rarely ever fired. People threaten people and those people go away and leave them alone most of the time. People actually killing other people in self defense is relatively rare. That is a point that I believe Kleck has made, and it was the point I was making.
“The more difficult it is to kill yourself, the better are the odds that you’ll seek help, …”
So what?
Everyone is going to die. I don’t care how many years of medical school you have you can’t change that. You will die. I will die. If you have seen violent death, and I suspect you have, then you know as well as I do that sometimes there is nothing you can do.
As long as you don’t help pass restrictive laws that keep law abiding citizens from owning firearms I wish you well in helping people from killing themselves. But when it comes down to it I think it is better some die through suicide (and homocide) than millions lose the freedom that was our birthright. I don’t want to be part of the generation that loses that.
Regards,
lwk
free2beinamerica2.wordpress.com
Jul 31, 2013 @ 06:23:59
You remind me of the way I do my taxes. Most people start with Line 7: wages, salaries, tips and go from there. I start with Line 67, Amount to be refunded to you and put in how much I want back and then work backwards.
You start every discussion with the idea that it’s all about freedom and work backwards and somehow you’ll make the “facts” fit the argument.
Good luck with Angie’s list. Next time you have a tightening in your chest or a lump in your abdomen, see how much you learn from Angie’s list about whom to go and see. What the hell, as you say, we’re all going to die anyhow so why prolong the process? You’re scraping the bottom of the barrel on that one.
You confuse freedom with choice. Nobody’s forcing you to go to one doctor or another. But what the associations are saying is that there are certain things a doctor must check to determine whether or not you’re healthy. Do you know what those things are? Of course not. That’s why they went to medical school and you and I didn’t. Oh, I forgot. You don’t need medical school. You can do “research” on the internet. And if you want to try out the new guy on the block that’s fine. But do you really believe that you’re in a position to know whether he’s any good just because you went for a checkup and he told you that you were okay?
I actually had my annual check-up yesterday. My doctor, who’s an internist, told me he wanted to test my potassium level because one of the medications I take has been linked to low potassium. How did he find this out? Because the Association of Internal Medicine sent him a notice because they were sent a notice by the drug company that makes the drug. That’s what the associations do; they are the way in which the latest news about drugs and medical procedures are communicated to doctors. But you don’t need to worry about that; you can get the information from Angie’s List, right? Wrong.
People can be very creative and follow rules at the same time. It’s not all one or the other.
As for the weapon versus tool idea; you’re grasping at straws. But keep grasping. The biggest problem in the gun debate is that the two sides simply have no idea what the other side is talking about. People who don’t own guns know nothing about guns and people with guns have no idea how crazy they sound to people without them. I’m only going to kill someone with my gun as a last resort so that makes it a tool. Are you in the real world? It’s a gun. It wasn’t developed to scare people. It was developed to kill. It’s the perfect killing device. None better. And this is being said to you by someone who has sold over 40,000 of them and is proud of every one I sold.
Take care.
Jul 31, 2013 @ 08:59:23
“Good luck with Angie’s list. Next time you have a tightening in your chest or a lump in your abdomen, see how much you learn from Angie’s list about whom to go and see.”
A free market encourages third parties with real expertise to essentially sell that expertise as third party advice. There are people who make their living by dispensing advice on what car to buy, or what computer to buy (or not buy). Angie’s List largely operates on the principle of reputation. If you are interested in Service A then Angie’s List will rate people who offer that service based on reputation. It may also warn you of people who have a history of performing poor work.
I would submit to you the assertion that reputation is a pretty good yardstick for making an informed choice. It is a principle just as useful for choosing medical providers as any other provider of a service or product.
Here is an example. My family doctor found a lump on my prostate some years ago. He advised me to see a specialist. I did and the diagnosis was cancer. Now at this point I did a fair amount of research on various surgeries that could be performed, and who had the best reputation for outcomes. The AMA did not make it easy for me to find that information.
But fortunately for me the youngish doctor was a specialist in doing a robotic type surgery, and had a super reputation, and in fact performed the operation and I am alive and well (and symptom free) today.
I could have just blindly went along with the adivce of experts and maybe the result would have been the same. But in principle I like to have choices and in a free market I can (and should be able) to buy third party advice not under the thumb of a monolithic set of authorities that brook no other opinions than their own.
That is a principle of Libertarianism and I am perfectly willing to bet my life on it.
“What the hell, as you say, we’re all going to die anyhow so why prolong the process? You’re scraping the bottom of the barrel on that one.”
I read an article not long ago, and I would point you to it if I could remember where. Basically the storyline went like this. What do doctors often do when diagnosed with a disease like a serious late term cancer? According to this article many doctors will choose to not do much of anything in some cases because they have a pretty good idea that the treatment will be expensive, painful, and not likely to extend their life meaningfully.
“You confuse freedom with choice. Nobody’s forcing you to go to one doctor or another.”
I am not sure that I am the one that is confused. Yes, they may not want to force me to go to one doctor or another. No, what they want to do is to insure that it doesn’t make any difference which doctor I go to because they want to make sure they are all clones dispensing exactly the same advice and treatment, all approved by appointed authorities.
Have you ever heard the story about Henry Ford and black cars? He resisted the innovation to paint cars in different colors as offered by other manufacturers. He famously said, “Any customer can have a car painted any colour that he wants so long as it is black.”
“But what the associations are saying is that there are certain things a doctor must check to determine whether or not you’re healthy.”
Exactly. They want the legal power and authority to determine what is best for other people. They stifle competition and it looks like that over my lifetime they have worked to make health care largey unaffordable to many (certainly along with escalating government interference in the market for health care).
“Do you know what those things are? Of course not. That’s why they went to medical school and you and I didn’t.”
I don’t know what things are often necessary to keep my car healthy either. I didn’t go to mechanics school either. But there are good ways based on reputation to find out who has had the best results and at the best price.
Would you agree that one of the major problems with medicine as practiced today is that it doesn’t incentivize people very much to queston the price and quality of an individual provider? But it is that questioning, and not appointed authorities, that acts to keep costs down in many other not so regulated industries.
About the NRA and their dispensing of guidelines to instructors. How is that any different than the AMA and medical authorities pushing down and guaranteeing conformity among medical practitioners?
I pointed out in an earlier reply how in the 19th century hospitals were places to go to die, and how the attention of a doctor then was more likely to kill a pregnant woman than help her due to a lack of adquate sanitation and resitance of medical authorities at that time to innovation. Do you disagree with that as a very high level history?
Wikipedia has an article “List of preventable causes of death”:
http://en.wikipedia.org/wiki/List_of_preventable_causes_of_death
According to that list “Preventable medical errors in hospitals” ranks higher than “Firearms deaths.” Something to think about.
Regars,
lwk
free2beinamerica2.wordpress.com
Jul 31, 2013 @ 11:43:12
You’re talking apples versus oranges so let me set you straight. I’m not talking about the AMA. The AMA does not set practice standards. It’s a feel-good, PR organization for doctors, just like the NRA is a feel-good, PR organization for gun owners. I’m talking about the professional medical associations that are organized by specialty (American Academy of pediatrics, American Academy of Internal Medicine, American Academy of Surgeons, etc.) These organizations set practice standards for their specialty and more important, also set the curricular standards for what is taught in medical school and what is covered in the residency program for each specialty. It doesn’t matter whether your MD went to Harvard Medical School or Podunk Medical School, or wherever, he learned the same thing wherever he went which means that the knowledge base that every MD uses in treating a patient within his specialty is the same. It also means that in order to practice anywhere in the US, the MD will be doing it the way that all doctors agree it should be done based on shared experiences. And these associations, when it comes to setting standards, aren’t run by bureaucrats, they are run by physicians in the particular specialty. This is a great advance in American medicine, we are the only country to do this and it basically means that if you live in a community that isn’t commuting distance to a major medical center you can still get the same care, assuming that a doctor in our particular specialty practices in your community.
Your young doctor who used robotic surgery was able to use that surgery because his specialty association approved its use. Doesn’t mean that everyone was using it; doesn’t mean that everyone who used it was more or less skilled than everyone else. But the use of robotics, which are now standard in many types of surgeries, didn’t come about because some younger, more innovative doctors decided to buck the “experts” who were trying to make them conform and thus cut down competition. As I said to you previously, you can find a reason why competition is the answer to everything, but at least get your facts straight before getting on your horse.
Jul 31, 2013 @ 15:22:21
We’re probably talking past each other at this point. I personally do not like the bureaucratic way medicine is regulated. You insist it isn’t bureaucratic. I think competition is a good thing no matter what the product or service is. I believe non-medically trained people can make informed decisions about medical practitioners based on proven performance and results.
On the doctor who did my robotic surgery, my point was not that he was “bucking” the system or doing something others were not. From what information I could find he does nothing but this surgery and doctors and patients all thought he did it very, very well. He has a great reputation in my area. His reputation got him the job.
Regards,
lwk
free2beinamerica2.wordpress.com