I have just finished reading and studying a collection of articles which together constitutes the most important reference work on gun violence which currently exists. The book, Pediatric Firearm Injuries and Fatalities, is a collection of 15 articles edited by Eric Fleegler and Lois Lee, both of whom are pediatric-ER doctors at Boston’s Children’s Hospital, so they’ve seen plenty of gun injuries over the years. You can buy the book here.

              The collection is described as a ‘Clinician’s Guide to Policies and Approaches to Firearm Violence.’ Each contribution is a summary of research on a particular aspect of gun violence, along with copious footnotes and ‘Take Home Points,’ the latter lists some basic strategies that clinicians can use for responding to injuries caused by guns.

              Let’s be clear. This isn’t a collection of original, evidence-based articles. It’s a collection of articles which summarize all of the research which has been done to date on specific aspects of gun violence, in particular gun violence which impacts kids. And don’t make the mistake of thinking that by limiting the contents to pediatrics, that you won’t get an overview of gun-violence issues as a whole. Because pediatrics happens to include everyone up to age twenty-four, and by that age you are looking at a majority of the gun-violence events which occur every year.

              This encyclopedic work is divided into two sections: risks and interventions. The risks are homicides and assaults, accidents, suicides, international comparisons, and school shootings. The interventions cover counseling patients before and after shootings, community-based programs, safety design for guns and legislative advocacies.

              Together, these articles cover just about every aspect of what clinicians need to know in order to develop effective responses to gun violence. Together, the articles cite more than 700 references to evidence-based research which means that this work is not ground in opinion but in facts, a welcome change from the way most gun discussions are framed.

              That being said, as usual I have several issues with specific content in this valuable collection which need to be raised. First and foremost is the degree to which public health gun research continues to focus the research on every issue except what I consider to be the most important issue, namely, how, and why gun violence actually takes place.

              The articles which define gun risk are overwhelmingly based on CDC data which tells us all about the victims of gun violence but nothing about the perpetrators of same. I don’t understand how public health researchers can refer to the ‘epidemiology’ of this particular health threat when little, if any time is spent trying to figure out how and why a certain population uses a gun in what the gun industry would call an ‘inappropriate’ way. After all, shooting someone isn’t the usual way that a dispute between two people is resolved.

              Because we know very little about who actually shoots guns inappropriately, how can we really create effective public policies and clinical procedures for reducing such behaviors? I don’t think, in fact, that we should assume that evidence-based research on gun violence can guide our policy strategies when the evidence tells us little, if anything about the people whose behavior we are trying to change. I should add, by the way, that in 4 of the 5 states which implemented comprehensive background checks after Sandy Hook, gun violence rates went up, not down.

              Finally, I have a big problem with the degree to which the entire gun-control community – physicians, researchers, advocates – invariably propose linking up to every relevant ‘stakeholder’ in the gun violence debate with the exception of the most important stakeholders of all – the companies who manufacture the guns.

              If you believe that companies like Glock or Smith & Wesson aren’t concerned about gun violence and gun safety, this only demonstrates that you haven’t gone into a gun shop and purchased a new gun. Because every gun shipped from a factory to a retailer must have a warning which says that the gun, if misused, could result in injury or death. And the warning is printed in big, red letters, okay?

              I’m not saying the gun industry isn’t culpable for many of the injuries and trauma caused by the products they make and sell. What I am saying is that I don’t understand how you can regulate any industry without bringing the representatives of that industry into the discussion as well.

              Those caveats aside, Fleegler and Lee have published a volume which everyone needs to read.  Got something better to do in the Age of Covid-19?