Now that physicians no longer have to fear being prosecuted for talking to their patients about guns, a whole cottage industry appears to have sprung up within the public health and medical communities to explain to doctors how they should talk to patients about guns. Because most doctors don’t own guns, and while the medical associations have all issued statements deploring gun ‘violence,’ such statements don’t give doctors any real insights into talking about a particular consumer product found in many of their patients’ homes. It’s easy to talk about seatbelts – every doctor drives a car. It’s not so easy to talk about guns.
Now it just so happens that guns as a medical risk has been understood for more than twenty-five years, thanks to the two New England Journal of Medicine articles published by Kellerman, Rivara and colleagues in 1993 and 1994. When these two articles appeared, Gun-nut Nation went on the offensive, a political assault which included getting CDC gun-research money thrown out. Nevertheless, from a medical point of view, what Kellerman and Rivara said back then still stands now.
If only the current-day physicians clamoring most loudly for increased concern about gun violence would follow the evidence-based findings of Kellerman and Rivara – but they don’t. Instead, the narrative being promoted within the medical community is to take a ‘consensus-based’ approach to counseling patients about guns.
With all due respect to my many friends in the medical and public health communities who are trying to find some way to reduce the 125,000+ intentional and unintentional gun injuries which occur every year, this ‘consensus-based’ approach is not (read: not) supported by any evidence-based research. Instead, it reflects the adoption of a narrative designed to shield these physicians from what they believe would otherwise be another assault from Gun-nut Nation and the alt-right.
If doctors actually believe that by saying they respect the ‘rights’ of their patients to own guns, they will somehow protect themselves from criticism from gun-rights groups, they have absolutely no idea how Gun-nut Nation views any attempt to question access to guns, particularly by people who, for the most part, don’t own guns. Much of the evidence-based data on gun violence comes from solid studies done at the Bloomberg School. That’s B-L-O-0-M-B-E-R-G. You think there’s a single gun owner out there who would ever believe anything coming from a program funded by the person now being referred to in gun magazines and gun blogs as the head of the ‘nanny state?’
And once the physician who wants to counsel his patients on gun risk makes it clear that he ‘respects’ the patient’s ‘right’ to own guns, he then can continue building his consensus-based approach by telling the patient that all he has to do is safely store his guns. To be sure, there are studies which find that when patients are counseled about safe storage, they go home and sometimes store their guns in a safer and more secure way. Is there one, single study which compares before-and-after safety counseling to changes in gun-violence rates? Not one. The assumption that safe storage leads to a significant decrease in gun violence is a nice idea, but medical treatments and counseling aren’t based nice ideas.
Let me break it gently to all my medical friends who find it easy and convenient to believe that once they tell a patient to go home and lock up his guns, that they have done what they need to do in this area of public health. The Kellerman/Rivara studies which indisputably found both a suicide and homicide risk from guns in the home did not – ready? – did not find any significant difference between stored and unstored guns. A slight difference perhaps in suicides; no mention of storage issues in homicides at all. Nor is there any mention about the need to be concerned about those beloved 2nd-Amendment ‘rights.’
Take it from a lifetime gun-nut like me. Want to reduce gun violence? Cut the bullsh*t. Get rid of the guns that create this violence – semi-automatic pistols, assault rifles and tactical shotguns.
That would only leave about 250 million guns floating around the United States. That’s not enough?
Feb 13, 2020 @ 11:19:30
Mike, since nobody under our system of government has dictatorial powers (O.K., President Bone Spurs excepted) how do we get there from here?
Feb 13, 2020 @ 13:26:52
Very simple. Make all guns designed for military or law enforcement on The NFA list. None of them are sporting guns.
Feb 13, 2020 @ 13:56:42
I like the sound of your approach. But how do we get it actually signed into law?
And speaking of Brendas, I’ve got a 5th-to-8th grade Brenda story of my own. Brendas have a way of dong that to guys.
Feb 13, 2020 @ 15:14:47
How far back do you want to go? M-1 carbine? M1911? 1903 Springfield? Or just the stuff designed since the sixties, e.g., the M-15, Beretta, and stuff like that?
Feb 15, 2020 @ 07:45:22
How about all weapons used by peace officers are unrestricted. You can juggle it anyway you want. Either force all police to use 10-round magazines and pump shotguns…..maybe go back to the 80s and break out the ORIGINAL S&W M&Ps or you can start thinking about guns practically.
Feb 13, 2020 @ 12:42:17
This is of course assuming the Kellermann studies weren’t hot scientific garbage, which they were. if Kellermann had been conducting ACTUAL science, rather than partisan propaganda the Dickey Amendment would have never passed.
Feb 13, 2020 @ 13:34:09
Thanks Tom. Your comment is a perfect demonstration of what physicians fear: gratuitous attacks by people with no expertise in the field at all. You’re always welcome to post your opinions. But they are opinions, not evidence-based, okay?
I have read just about every public health paper published on gun violence. Many are not very good and I have said so in print. The two articles by Kellerman/Rivera are evidence-basedcand don’t bother to dig up the critical stuff that was published after they wrote these pieces, okayKellerman had to make a revision if the homicide piece but he did.
These pieces represent valid and serious research. Unless of course you havevdonecsuch research but not gotten around to publishing it yet.
Feb 14, 2020 @ 16:37:06
There have been dozens of papers refuting the work and you know it.
But this book was really good.
https://www.amazon.com/gp/aw/d/164307217X/ref=dbs_a_w_dp_164307217x
Feb 13, 2020 @ 17:08:10
I got curious about the articles from 1993 and 1994 and found one:
Source: https://www.nejm.org/doi/full/10.1056/NEJM199310073291506
“Gun Ownership as a Risk Factor for Homicide in the Home
Arthur L. Kellermann,
Frederick P. Rivara,
Norman B. Rushforth,
Joyce G. Banton,
Donald T. Reay,
Jerry T. Francisco,
Ana B. Locci,
Janice Prodzinski,
Bela B. Hackman,
and Grant Somes”…….
CONCLUSIONS
The use of illicit drugs and a history of physical fights in the home are important risk factors for homicide in the home. Rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance.”
Three things stand out to me: 1)illicit drugs and physical fights are risk factors, 2)the article does not say anything about what types of guns and 3)there they go again with the goofy word “associated” as if it means causality.
Since in my home we don’t take drugs of any kind legal or not and and have no physical fights in our house I guess I can relax about being a homicide victim.
Feb 13, 2020 @ 18:00:35
Henry Schaffer, a Prof. of Biomath and Genetics at NC State, wrote a critique of Kellerman et al “Serious Flaws in Kellerman, et al (1993) NEJM (December, 1993) by Henry E. Schaffer, Ph. D. I think you are right: if you do drugs, fight at home, get drunk a lot, have a bad temper, hang with the wrong crowd, and have guns around, some of which had higher associations than guns, its only a matter of time.
To my knowledge, no one has done a study of gun vs. non gun owning households in places like Los Alamos that have a very low violence rate to isolate guns alone rather than all the other conflating variables. But its not my field.
Time to review this stuff again.
Feb 14, 2020 @ 09:25:28
To answer everyone above. Public health has a problem diagnosing any health issue which occurs for behavioral reasons. And the only reason that the CDC tracks any product injuries of any kind is because when Nixon created the Consumer Protection Commission they needed data on product injuries in order for the Commission to determine whether a product needed to be recalled or not. And since shooting someone or yourself does not indicate a design problem with a gun, the only real reason happens to be the behavior of the person using the gun.
Which then creates a second problem. You can’t interview the people who use the gun because either they are dead (suicide) or they haven’t been caught, or if they have been caught, they can’t be interviewed anyway. So this puts public health in a real quandary because how do you figure out why someone does anything without asking them why they did it?
Which is exactly the reason I wrote this column and the reason I have said again and again that the public health ‘approach’ to gun violence misses the mark.