Guess what?  If you take the trouble to lock your guns away or put a lock in each individual gun, you are safer than if you don’t.  This is the conclusion of a new study whose senior author, Dr. Frederick Rivara, has produced a long and distinguished list of indispensable peer-reviewed publications in the field of gun violence.  In fact, you could probably say that Dr. Rivara is one of the founders of the public health approach to understanding the risks of gun ownership. 

               Unfortunately, figuring out how many Americans each year are victims of gun violence is one thing, figuring out what to do about it is something else.  And for a whole bunch of reasons, the strategies that public health has developed and employed to mitigate other injuries (car accidents, backyard pools, household poisons) don’t seem to have worked as well when it comes to guns. In 2001, the CDC estimates that the number of fatal and non-fatal unintentional gun injuries was 18,498; in 2013 the number was 17,369.  That’s a drop obviously, particularly when we consider that the civilian gun arsenal has increased by perhaps as much as 50% over the same period of years.  But it’s not the end of the world by any means.

               The good news, on the other hand, is that the medical profession seems willing to get itself back into the center of the gun debate which, if we agree that gun violence is a public health issue, is where doctors belong.  Last year eight major medical organizations issued a ‘Call to Action,’ basically promoting more medical engagement in dealing with gun violence and leading public health researchers have also published editorials advising physicians about the cultural challenges they face in counseling patients about guns.

               So the medical community appears to be moving towards consensus about the need for doctors to talk to patients about gun safety, focusing in particular on safe storage as a way to cut down on accidental injuries and deaths.  The only problem with this approach is that the outcomes of safe storage campaigns studied by Dr. Rivara and his colleagues does not really indicate that such programs necessarily work.  In fact, of the seven safe storage programs evaluated, it turns out that only four “were effective at promoting safe firearm storage practices,” and one of those studies which provided free gun safes to Eskimo villagers only resulted in residents adding a piece of furniture to their homes but did not substantially alter whether guns were kept locked or unloaded in each home.

               Even if the evaluations of safe storage programs had not yielded such ambiguous results, I have a more fundamental problem with the whole notion that the medical response to unintentional gun injuries should be based on the idea that safe storage behavior makes any real difference at all.  Because if you look at the age breakdown of gun accident victims (and the data, of course, must be analyzed with care) the first thing you notice is that victims under the age of 15 represent less than 4% of accidental shootings as a whole. Which means that the folks who commit accidental shootings happen to be either the owners of the guns or friends of the gun owner who just make a stupid mistake when they pick up the gun.  Remember when Dick Cheney shot another hunter back in 2006? The guy just happened to be in his line of fire as Cheney was shouldering his 28-gauge because someone had flushed a quail.

               If physicians want to counsel patients about gun accidents, the first thing they need to do, and it has not yet been done, is to figure out why, how and when gun accidents actually occur. Because until we understand the behavior that leads to accidents, advising patients about how to store guns safely is truly putting the veritable cart before the veritable horse.  Don’t want to have a car accident?  Leave your car in the garage.