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Gun Violence Isn’t Just Violence.

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            Back in 1993, two eminent medical researchers, Art Kellerman and Fred Rivara, published studies which definitively showed a causal link between homicide and suicide with access to a gun in the home. It then took the CDC another 28 years to announce that gun violence was a ‘serious public health threat.’  

            Now we have a statement from the World Health Organization which also finds gun violence to be a serious public health threat. You can download the WHO statement right here.

            So, now that the CDC and the WHO have joined forces in the fight against gun violence, we should be able to develop a medical response to this public health crisis based on evidence-based research which has been conducted over the years.

            And here’s what the research tells us, according to the WHO: “Jurisdictions with restrictive firearms legislation and lower firearms ownership tend to have lower levels of gun violence. Measures include bans, licensing schemes, minimum age for buyers, background checks and safe storage requirements. Such measures have been successfully implemented in countries such as Austria and Brazil and in a number of states in the United States of America.”

            There’s only one little problem with this statement. When the WHO says that these various measures have reduced gun violence in ‘a number of states’ in the USA, the actual number of states which have seen a decrease in gun violence between 1998 and 2020 happen to be -ready? – three. That’s quite a number of states, wouldn’t you agree?

The national gun violence rate for all 50 states has actually increased by 25% over those same 22 years. And while we only passed one national gun law over that period of time, many states have implemented universal background checks, or red-flag laws, or safe-storage laws, or blah, blah, blah, and blabbety-blah.

While the liberal media and the medical community find it proper to refer to the current ‘epidemic’ of gun violence, I prefer to think about gun violence as ‘endemic’ to America, which is a fitting description that you can consider by reading a paper published by Dr. Katherine Christoffel when she was engaged in gun-violence research.

Incidentally, Dr. Christoffel’s paper was published in 2007. Since that date, somewhere around 525,000 Americans have been shot and killed either by themselves or by someone else who used a gun. And the WHO believes that this problem can be solved if every jurisdiction implemented the same laws that have worked so well in a ‘number of states?’

Am I missing something here? I guess the problem is that although I earned a PhD, my wife, who is an attending physician specializing in adolescent medicine always reminds me that I’m not a ‘real doctor.’  Maybe if I were a ‘real doctor,’ I would understand how and why the medical and public health communities which are concerned about gun violence continue to promote mitigating responses to the problem that ignore the most important factor in explaining the gun carnage which occurs in this country every day.

What is that factor? The existence of guns which are designed and manufactured only for the purpose of being used to commit a fatal and/or life-threatening injury to yourself or someone else. And it should be noted that the WHO doesn’t define violence in terms of ‘good’ versus ‘bad.’ Either you try to injure someone else, or you don’t.

The United States is the only country in the entire world which gives law-abiding residents free access to products which function properly when the front of the barrel is pointed at a human being, the trigger is pulled, the gun goes bang! and someone drops down dead.

The only reason that most of the people who take a bullet in their bodies survive the is because the shooter didn’t shoot straight. Nobody pulls out a gun and aims it at someone else’s knee. Otherwise, everything which leads up to the moment the shooting occurs is exactly the same whether someone dies or not.

I make this last point because every time one of the gun-control expert researchers talks about gun violence, they always start off by telling us that because of guns, the rate of fatal violence in the U.S. is 7 to 20 times higher than in any other advanced nation-state. Talk about making an irrelevant argument out of whole cloth….

I’m not against gun ownership, believe it or not. What I’m against is arguments on both sides of the gun debate being made and believed by well-meaning individuals who don’t know squat about guns.

Does Gun Violence Deserve a Public Health Approach?

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              So it looks like researchers in Gun-control Nation will get funding into the CDC budget for the third year in a row. Which is all fine and well except to tell you the truth, I never really understood why my tax dollars ever went to fund research into the causes and prevention of gun violence in the first place.

              I remember the first time I ever shot off a gun by accident.  I was sitting in my living room in South Carolina, playing around with my Colt 45 pistol and the damn thing just went off. I thought the gun wasn’t loaded. I was wrong. The round went through the front door, smashed the storm door, and ended up God knows where. At least it didn’t wind up in someone’s rear end.

              I also remember the first time I ever shot a gun with the intention of killing someone else. It was an M-14, I was on the firing line at Fort Dix, NJ and I was told that if I didn’t hit the torso-shaped target 200 yards downrange I wasn’t going in for chow.

              Then in 1994 I read the two articles in the New England Journal of Medicine which found that access to a gun in the home created a health risk known as being dead. The research for these articles, by the way, was funded by the CDC and was the reason that the CDC didn’t fund any more gun research for twenty-five years.

              During that quarter century, somewhere around 300,000 Americans died before they otherwise would have died because either they or someone else picked up a gun and shot them with it.  Another 1.75 million got shot but somehow survived.

              Each year somewhere around 400,000 drivers and passengers get killed in car accidents, another several million are injured in a permanent way. We know exactly what to do to prevent these injuries from taking place – seat belts, speed limits, crash-proof design, a combination of safety features built into the vehicles and better training before drivers take to the road.

              So, what do my friends in Gun-control Nation say when it comes to reducing injuries from guns? They say we need the same kind of ‘public health’ research for guns that the taxpayers have funded for cars. And now that research has started up again.

              There’s only one little problem with this approach. It’s complete bullshit and anyone who subscribes to it doesn’t know anything about guns.

              The guns whose use is responsible for at least 90,000 of the 110,000 deaths and injuries suffered each year from gun violence are not guns that can be used ‘responsibly’ or ‘safely.’ They are guns that are designed for one purpose and one purpose only – to end human life.

And let’s not get into a whole thing about whether someone used a Glock or a Sig or a Beretta or a Smith & Wesson M&P in an ‘offensive’ or ‘defensive’ way. Cars are designed to make it easier and faster to move from here to there. Handguns like the ones listed above are designed to end human life in an easier and faster way.

Want to deny what I just said? You’re denying reality. And this denial of reality seems to be versant throughout the public health and medical communities.

I love how some medical organizations talk about approaching gun violence from a ’consensus’  point of view. What are they saying? That we can all sit down and figure out a way that law-abiding Americans can walk around their neighborhoods with a Glock or a Sig in their pockets and somehow the neighborhood will still be safe? 

I once had a conversation with a physician who runs a program which has social workers standing on the corner ready to intervene when/if two rival gangs come together and the ‘fuck you’s’ begin to fly. I asked him whether the social worker would alert the cops if one of the kids was carrying a gun.

“Of course not,” he said. “He would lose all credibility if he did that!”

If you can identify any threat to the human community that is worse than the threat represented by a 16-year-old wandering around with a loaded handgun in his pocket, I’ll immediately donate $100 to the charity of your choice.

If the government wants to spend my tax dollars on gun violence research, why don’t they give the money to the Department of Justice rather than the CDC? After all, the 90,000 shootings each year which involve both a shooter and a separate victim happen to be crimes.

Or maybe we should re-define homicides and assaults committed with guns as just another public health threat like unclean water or cigarettes sold to kids.

The Deadliest Pathogen: Guns and Homicide (Guns in America): Weisser, Michael R.: 9781792317866: Amazon.com: Books

Let’s Get Behind This Effort To Reduce Gun Violence.

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              Over the weekend, I received a message from our good friend, Shannon Watts, asking me to donate to an organization, Advance Peace, which is working to reduce gun violence. My only regret is that I couldn’t send more money because right now I am scraping together all my dough to give to the DNC for 2022.

              I’m not such a po’ boy that I won’t give Shannon another donation when she asks again, because I always do what Shannon asks me to do.

              Be that as it may, I wanted to spend a bit of time talking about the efforts of Advance Peace and other organizations which refer to themselves as conducting ‘deterrence’ programs to identify people most at risk of being involved with gun violence and offering them pathways that will deter the violence before it occurs.

              Getting down to the street level and working with individuals who are prone to get involved in the endless and continuous cycle of inner-city gun violence has been a strategy led by various groups since the 1990’s, chief among them being Ceasefire, a program that first started in Boston in 1996, and Cure Violence, which came out of Chicago in 2000. Both programs operate in cities across the United States.

              What makes Advance Peace unique in this workspace is the focus not on group deterrence, particularly working with members of gangs, but identifying the most vulnerable individuals, and dealing with them on an intensive, individual level. The targets of this effort are given eighteen-month Peacemaker Fellowships which hopefully will guide these Fellows into productive and non-violent lives.

              The program run by Advance Peace in Sacramento went from July 2018 through December of the following year. For all of 2019, Sacramento registered a 21% decline in gun homicides and gun assaults. As someone who spends part of every day looking at gun-violence data, I can tell you that a 21% decrease in a city the size of Sacramento is a very, very big deal.

              But what about the bottom line? How much are we paying to see this evident reduction in gun violence? The ROI (costs versus benefits) is often cited as a reason such programs are pie-in-the-sky responses which can never be sustained. True or not true?

              You can find a very detailed financial analysis of the Advance Peace Sacramento program on their website. The analysis was done by faculty at Berkeley’s Institute of Urban and Regional Development (IURD), so this report is a no-bullshit deal. And here’s what it says:

  • The Fellows were 98% male, average age of 23 years, 96% African-American, 65% with prior arrest or incarceration, 84% unemployed and 84% victims of a prior gun injury.
  •  By the end of 2019, 64% completed the program, 90% had no new gun charges, 44% had no new arrests, 25% achieved positive life-changing milestones, and 20% were employed.

What did these numbers mean in terms of ROI? By dividing the financial benefits of the program by its costs, for every dollar that was spent on the program, the city of Sacramento did not lose between $18 and $41 in costs that would have occurred had gun violence in the city remained at its pre-program level. These costs included policing, incarceration, medical and unemployment expenses.

So, both in terms of the human and financial results of this effort, we have to say that the Advance Peace program scored well. And let’s not forget that this was one of th4e first two such programs that ran in 2019, the other being a program in Richmond, CA which had comparable results.

Interested in reducing urban violence in a community where you live? You can connect with Advance Peace and begin the process of bringing them to your city right here.

Because I’m Mike the Gun Guy™ and Mike the Gun Guy™ always has to say something a little critical about efforts to reduce gun violence even when he likes a particular effort very much, as is the case with Advance Peace. So here goes.

According to the IURD report, the program staff interrupted and therefore prevented 58 gun assaults by mediating at least 58 conflicts where someone was carrying a gun. In other words, without the presence of Advance Peace in these high-violence neighborhoods, perhaps 58 or more individuals would have been injured or killed. Fine.

But – and it’s a very important but – after these mediations took place, what happened to the gun? The report is silent on that point.

Is it realistic to talk about permanently lowering the violence level in any community or neighborhood when the number of guns floating around in that area stays the same? Cn we realistically pin our hopes for the reduction of community violence if the means of committing that violence doesn’t change?

Don’t get me wrong. The work being done by Advance Peace is important and really does deserve all our support. You can and should send them some dough right here.

Let’s just not forget the other side of the coin which is that gun violence wouldn’t be tearing up inner-city community life without all those guns.

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A Surgeon Talks About Gun Violence.

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The author of this piece is a surgical resident in Pennsylvania and this column, along with her painting (above) was published in the June 10th edition of the New England Journal of Medicine.

To say that the Covid-19 pandemic has changed all our lives dramatically is an understatement. The population of North Philadelphia is no exception. In a city where gun violence was rampant before Covid, bloodshed has only increased with the upheaval of the structure of everyday life. Over the past year, there have been more than 2200 shooting victims and 500 homicides in Philadelphia, reflecting increases of 54% and 40%, respectively, over 2019.1,2 In November 2020, while completing a trauma rotation, I witnessed the aftermath of such violence. One boy, along with many others from that time, will always haunt me.

When he arrived in the trauma bay, he was alive. He had been shot in the chest. I immediately started working to gain access to his femoral vein as another doctor monitored his airway. His legs were kicking as he screamed, “Help me! Help me!” As I focused on securing the central line, I noticed that the nurse holding his legs down no longer needed to apply as much force. His writhing had slowed, then stopped. I looked up at the head of the bed, where the trauma chief and the attending stood, and glanced down just in time to see the light in the patient’s eyes go out. “Don’t leave, don’t die. We’re here,” I pleaded silently.

Everything happened so quickly, like a choreographed dance. The urgency in the room was palpable. Everyone had a role, and all those roles were equally vital to the objective. One resident was intubating the patient. The chief resident took a scalpel to the left chest, just caudal to the nipple, curving cranially as he drove the knife to the bed. He saw me beside him and handed me the scissors. I opened the chest to find blood, as another resident placed a chest tube on the right. Blood sprayed out under pressure. I knew what that meant. I wielded the metal mallet and hammered the bladed bar across the sternum, extending the thoracotomy into a clamshell. We placed the Finochietto retractor, opened the pericardium, and cross-clamped the aorta. Blood was everywhere.

I scooped blood and clots out of his thorax to identify the injuries. And there they were. An 8-cm hole blown through the right atrium and a 10-cm hole in the posterior inferior vena cava. We did our best to clamp the holes and attempt cardiac massage. The clamps were not big enough. They would not hold, as blood leaked around them during attempts to squeeze the heart. We started sewing urgently, in an attempt to stop the bleeding and pump the heart. Even with our best efforts and several transfusions, there was no bringing him back. He had left us. What I saw before me was a teenager covered in his own blood, his chest flayed open in the attempt to save his life. The dance was over, and it had not been fast enough.

The attending called out the time of death. The room had quieted, and the teams shuffled out. I stayed, alone with the shell of a human, left to close the chest that I had opened. I closed his eyes and covered his lower body in a blanket, then began meticulously sewing his chest closed with silk.

When I was finished, I trudged to the locker room to change my scrubs – my pants were soaked in dark blood. I was shaking from the adrenaline crash, and my eyes were swimming with tears. As I pulled off my scrub pants, I realized the blood had seeped through to my skin. A nurse in the locker room looked at my shins in horror and brought me chlorhexidine wipes, a gentler solution than the bleach wipes I was using to scrub away the blood. I knew I had to pull myself back together. I knew my pager could go off any minute for the next trauma. I walked the halls and did what was required of me to finish my 24-hour shift. I felt numb as I walked out to the garage the next morning. I called my sister on the drive home, and I finally let myself fall apart and cry. “I am a surgeon. I am supposed to be able to stop bleeding.”

Over the course of the 6-week rotation, I was involved in seven emergency thoracotomies in patients with gunshot wounds. It was difficult, but over time I found peace in the quiet after each procedure concluded. I gently closed the patients’ empty eyes, covered their bodies, and sutured. Somehow, in making that closure perfect while I thought about their too-short lives and the loved ones they’d left behind, I felt that I was honoring the victims. Looking back now, I think that maybe in choosing to take on the task of approximating the skin of those corpses, I was really trying to put myself back together. I had been changed by what I had seen, and I knew it. I spent time coping outside work by painting a picture of that first boy (see image). I let myself feel the pain again with each stroke of scarlet paint across his body.

I wanted others to know about these violent deaths. I wanted people to know what I had gone through, what I had seen. I wanted them to understand it on a deeper level than the statistics they read in the news reports.

As I attempted to tell the people around me, however, I realized it was too heavy, too painful. It made them uncomfortable. My brother, an Army Ranger, who had recently returned from deployment overseas, pulled me aside. “We signed up for jobs where we see horrific things,” he said, “so that those we love don’t have to see them.”

Later, I was recounting the gory details of my rotation to one of my attendings, explaining how angry and frustrated I was. This was not what I had signed up for, I told him.

“Yes, you did,” he assured me. “You just didn’t know it.”

His response will stay with me, along with the faces of so many patients in their final moments. I am certain that no one can fully prepare for what they will encounter in medicine, nor what the profession will require of them. I certainly did not foresee the coming of a pandemic before starting this career. The reality is that we are often witnesses to the lowest and darkest moments in many of our patients’ lives. Residency takes from us in myriad ways; above all, it demands our time. I now know that it is paramount to set aside time to cope with loss and death — not only for our immediate well-being, but also for our self-preservation. Three years into my career as a surgeon, I am beginning to understand the true gravity of what I signed up for.

The Medical Plan To Reduce Gun Violence That Doesn’t Work.

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              Doctors for America is a liberal advocacy group that was formed in 2008 to help promote the Affordable Care Act and now continues to push for all kinds of goody-goody medical things. One of their goody-goody’s is reducing gun violence for which they have produced a video which depicts a physician talking to a gun owner about how he stores his guns.

              The gun owner is a young married guy with a daughter in the home. The physician asks him where he stores the guns when he’s not hunting, and he claims he puts them on a high shelf which is out of his daughter’s reach. The doctor tells him that what he should really do is lock the guns up because they otherwise there’s a risk of suicide or accidental injury. The guy playing the role of the patient agrees.

              There is not one, single study ever produced which shows any direct connection between safely storing guns and eliminating or even reducing gun violence – not one. The idea that safe storage represents an effective response to gun injuries is an assumption promoted by physicians and medical advocacy groups who actually believe that they can gain the confidence of gun owners by pretending that it’s okay to own a gun.

              It’s not okay. The research by Art Kellerman, Fred Rivara and their colleagues published more than a quarter-century ago clearly proves that access to a gun in the home represents a medical risk, and this research did not qualify those guns in terms of whether they were stored safely or not.

              The Hippocratic Oath requires physicians to identify and then work to reduce medical risks. Simply put: Medical groups which promote the safe storage nonsense are violating the Hippocratic Oath. They get away with this crap because their members and their audiences know as much about guns as they know about guns – zilch.

              Want to see another example of how the medical community is completely and totally divorced from reality when it comes to talking about guns? There’s an organization called UpToDate that publishes an online reference database which physicians can use to read the latest studies on any medical problem, as well as print out simple summaries and advice for patients to read. The website is probably accessed by just ab out every primary-care doctor in the United States.

              Here is how UpToDate describes what it does: “a global community consisting of thousands of physician authors and editors who share a singular passion: writing and editing evidence-based information that helps clinicians everywhere practice the best medicine.”

              So now let’s look at the section on gun violence and, in particular, the handout that physicians can print and give to patients regarding the risk of their guns: Patient education: Gun safety for families (The Basics) – UpToDate. Scroll halfway down the page and you’ll see what UpToDate believes a parent should tell a child in order to teach the kid about gun safety: Do not touch the gun. Move away from the gun. Tell an adult. 

              Now take a look at what the National Rifle Association says is the proper way to teach your child gun safety. You can see it right here: Eddie Eagle | NRA Explore.  Scroll down slightly and guess what you’ll see? You’ll see the exact, same safety message for kids that you’ll see on the UpToDate page.  The NRA has been pushing this nonsense for years but now they have an ally in the medical community to help spread their message around.

              How can any doctor utilize any messaging about guns which was developed by the same organization which got a law passed in Florida that would have criminalized any physician who counseled patients about gun risk? Groups like Doctors for America should be ashamed of themselves for even thinking that there’s some kind of common ground which they can occupy with gun owners to reduce gun risk without getting rid of the guns.

              If any physician would like to explain to me how promoting ‘safe storage’ of guns isn’t a violation of the Hippocratic Oath, I’m all ears.

An Important Reference Work On Gun Violence.

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              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?

When Are We Really Going To Start Talking About Gun Violence?

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Last week I wrote a column raising concerns about the so-called ‘consensus-based’ approach to gun violence being promoted by physicians and public health researchers, many of whom seem to be convinced that as long as they claim to ‘respect’ the 2nd Amendment, that Gun-nut Nation will be more amenable to support all those ’reasonable’ gun laws, one such law having just been blocked by the Virginia State Senate.

This idea of not being opposed to the 2nd Amendment is a riff on another idea which started to appear in the medical literature when doctors began talking about counseling patients who own guns, the riff being the importance of ‘respecting’ the ‘culture’ of people who own guns. Here’s a sample of this approach from several of our most dedicated and respected gun-violence researchers:  ”The provider’s attitude is critical. Patients are more open to firearm safety counseling when providers are not prescriptive but focus on well-being and safety—especially where children are concerned—and involve the family in respectful discussions. Conversations should acknowledge local cultural norms; be individualized; and, when possible, occur within a well-established clinician–patient relationship.”

Given the fact that most physicians aren’t gun owners themselves, exactly how should these clinicians gain the knowledge they need in order to counsel about guns while taking care not to make negative judgements about ‘local cultural norms?’ The only peer-reviewed resource which attempts to define the cultural ‘norms’ associated with gun ownership is the research published by our friend Bindu Kalesan, who asked 4,000 respondents to report on the degree to which their social activities were in some way or another connected to their ownership of guns. What she found was that roughly one-third of the gun owners reported some degree of social contact with other gun owners.

Based on this research, should physicians assume that a patient who owns guns may also feel somehow identified with the social activities that revolve around gun ownership and gun use; i.e., shooting range visits, hanging around a gun shop, joining a gun club? Sounds fair to me.

There’s only one little problem. What do all these social activities involving guns have to do with reducing gun violence? Nothing. Why do I say nothing? Because the guys who go to the shooting range to sight in their beloved shotgun before hunting season, or the guys who stop off at the gun shop to play around with the latest toys on display, or the guys wandering around the gun show munching on a donut because the wife doesn’t need the grass cut or the driveway cleared that weekend, aren’t the folks whose behavior or culture or whatever you want to call it creates 85% of the injuries that we define as ‘gun violence’ each year.

That’s right. Assuming that intentional, non-fatal gun injuries run around 75,000 – 80,000 a year, add that number to the 15,000 fatal intentional gun injuries in 2017, and divide it by that number plus the 20,000 suicides.  Sorry, it’s only 83%. Of course, we know that all this mayhem is created by legal gun owners, right? Yea, right.

The public health ‘threat’ known as gun violence happens to be the handiwork of young men, most of whom live in inner-city neighborhoods and start fooling around with guns by the time they are 14 years old. And by the way, these are also the kids who have overwhelmingly dropped out of school, even though school attendance is never (read: never) used as an indicator of gun risk by all my friends doing all that public health research designed to ‘inform’ policy-makers about the efficacy of various ‘reasonable’ gun laws.

Want to sample gun culture?  Try: https://www.youtube.com/watch?v=0ZGJcV19gRw. After you watch it, watch it again. Then talk to me about how we need to ‘respect’ the culture of gun owners, okay?

What I am saying is simply this: Either we begin to talk realistically about the causes of gun violence or we don’t. Right now, we don’t.

Should We Ban Assault Rifles?

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              I normally don’t watch the Democratic debates because it’s still too early in the primary season and no matter who ends up with the nomination I’m going to vote blue every, single time. You see, I have this congenital physical ailment which when I get into a voting booth and reach for the Republican lever, my arm gets paralyzed and I can’t vote. I’m a bone fide gun nut and a yellow-dog Democrat and I’m proud of both.

              So I didn’t watch the debate last night but I did happen to see commentaries about the exchange between Buttigieg and Beto over Beto’s call for a mandatory buyback of AR-15’s. As I understand it, the media has decided that the Democrats are split between a ‘middle’ led by Joe and a ‘radical’ led maybe by Bernie, maybe by Warren, maybe by Ocasio, blah, blah, blah and blah. And the media has further decided that Buttigieg is somewhere in the middle while Beto is somewhere on the extreme. And what the media has decided is the acid test for where these two guys perch is over the issue of getting rid of AR-15’s.

              Now who would have ever thought that any kind of gun issue would be used to define the basic stance of the candidate who wants to lead the blue ticket in the national election next year?  I can see defining the candidates on something like universal health care, or whether or not to ‘tax the rich,’ or some other issue which hits in the middle of the must-do zone. But guns?

              Anyway, the argument between Buttigieg and Beto erupted because the kid from Texas has opted for a mandatory buyback of assault rifles, while Buttigieg wants to try and remain somehow relevant to Gun-nut Nation by saying that we can ask but shouldn’t require that gun owners turn over those lethal guns. And the way that Buttigieg is framing the argument is to challenge Beto to explain exactly how he is going to force assault-rifle owners to turn over their guns.

              Beto doesn’t yet have a plan to invoke the coercive authority of the government to get rid of all those black guns, but why should he be made to come clean on this issue when Liz Warren has promised to reduce gun violence by 80 percent without yet producing any plan at all? And let me tell you something about Lizzie; she produces position papers on just about everything under the sun. But so far we still don’t know how 120,000 fatal and non-fatal gun injuries each year will be cut down to 20,000 or less. So why should we expect Beto to explain how the government will pick up and throw out some crummy, semi-automatic guns?

              If this is the best that Buttigieg can do to vault himself ahead of Beto in the polls, I think he should go back to South Bend and figure out to keep the city parks neat and clean. That’s what municipal mayors are paid to do – collect the garbage, sweep the streets, make sure that everyone scoops up their doggie doo-doo, essential city services like that.  If someone asked me to go out and campaign for Buttigieg after he challenged Beto on something as stupid as whether an assault weapon buyback should be mandatory or not, to quote my old friend Jimmy Breslin, rather I should go lay brick.

              Mandating or not mandating a buyback of assault rifles isn’t going to make any great difference in how we deal with the violence caused by guns. What a buyback does, mandated or not, is to keep the issue of gun lethality where it belongs, namely, whether people understand the risks inherent in owning certain kinds of guns.

If you want to own an assault rifle and assume the risk, that’s fine. We all do risky things every day. But anyone who tells you that an AR-15 is just another ‘sporting’ gun is either lying or doesn’t know anything about guns.

How Should We Deal With Gun Violence?

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Turner Syndrome is a genetic abnormality which results from an absence or partial absence of the X chromosome, preventing the development of healthy ovaries in women, as well as certain heart defects.  It can be detected by genetic screening prior to birth, but sometimes a diagnosis doesn’t take place until the teen or young adult years. Once diagnosed, “girls and women with Turner Syndrome need ongoing medical care from a variety of specialists,” so says the Mayo Clinic. In other words, it’s a complicated disease.

How often does this disease appear? Roughly 1 out of 2,500 live births. If we take the best estimate for the number of fatal and non-fatal injuries caused by one person shooting a gun at someone else, the incidence of this type of gun violence within the age cohorts 16 through 34, would also be around 1 out of every 2,500 individuals in those age groups.

If we didn’t experience 90,000 fatal and non-fatal intentional gun assaults each year, it would be difficult to argue that gun violence should be considered a public health problem at all. But wait a minute, you say. What about the 20,000 people who end their lives every year by using a gun? Isn’t gun-suicide also a problem that needs to be addressed?

Of course we need to eliminate gun suicides but the issue in that instance is quite simple because overwhelmingly, people who commit gun suicides happen to use a gun that they legally own. And they use a gun because they know using a gun will almost always get done what they want to get done.

But that’s not the case with the homicides and aggravated assaults which account for more than 80% of all gun violence every year. This public health event is almost always committed by individuals who do not have legal access to the gun used in the assault. Which means that even before they use the gun to hurt someone else, they have already committed a serious crime. It’s called ‘illegal possession’ of a firearm which, under Federal law, can be punished by as much as five years in jail.

For all these reasons, I find it difficult to understand how my friends who conduct public health studies on gun violence seem to go out of their way to avoid contact with criminologists who have produced significant research on violent crime. I am referring, for example, to the study by Paul Tracy and Kimberly Kempf-Leonard, Continuity and Discontinuity in Criminal Careers, which analyzed the life histories of the 27,160 men and women born in Philadelphia in 1958, and followed them through 1984; in other words, from birth through age 26.

This longitudinal study allows criminologists to do what public health researchers do not do, namely, develop a profile of potentially high-risk behavior over time, rather than relying on one data entry for one point in time; i.e., when someone with a gun injury shows up for treatment in an ER. Here’s the bottom line: “The frequency of delinquent activity is the most consistent and strongest predictor of adult crime.”

What we get from public health gun research are the immediate symptoms which appear when the injury occurs. What we get from criminology is the case history leading up to the medical event. Can we really develop effective public policies to reduce gun violence without combining both?

This is why I began today’s column with a brief discussion of a medical problem – Turner’s Syndrome – that occurs within the overall population to the same degree as another medical problem – gun violence – occurs within the age cohorts which exhibit the overwhelming number of injuries caused by guns.

Diagnosing and treating Turner’s Syndrome is a very complicated affair. To repeat: it requires ‘ongoing medical care from a variety of specialists.’ Why should we approach gun violence in any less of a comprehensive way?  When it comes to gun violence, public health and criminology should stop avoiding each other and join together to solve this dread disease.

Khalil Spencer: It’s Not About Assault Rifles, It’s About Assaults On Decency.

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Along with the current discussion about gun control, assault rifle bans, and domestic terrorism, Uncle Sam is working on reinvigorating the nuclear weapons program in New Mexico and South Carolina. Given that a few of us in Northern New Mexico are affiliated with certain large Federal installations involved with making things that can create very large holes in the ground, I see a lot of chatter about both topics. This leaves me uneasy.

Guns and bombs are necessary evils albeit fascinating creations when not employed for their intended purpose. That’s why people enjoy shooting sports, especially with military design rifles, for example, as described here and here. But lethal weapons are solutions of last resort to real problems. Whether someone is kicking down your door or your frontier at o-dark thirty, you need a way to defend yourself. The problem is, when things get to the point of a shooting war, whether in the kitchen or the Ardennes, the less destructive solutions have failed or have been ignored. Cleaning up the blood and lost treasure gets more complicated as weapons become more advanced. During the American Revolution, a few thousand soldiers faced each other and opened fire when they could see the whites of each others eyes. The American Civil War, which bled America white, was the harbinger of WW I with trench warfare and the introduction of modern weapons. Nowadays, advanced heavy weapons and highly lethal infantry weapons (not to mention, nukes) can blow somewhat larger holes in the other side’s strategic interests. High capacity semiauto weapons can drench the neighborhood with a rainsquall of full metal jacket (or jacketed hollow point, I suppose). Or as Bruce Cockburn once sang, “who put that bullet hole in Peggy’s kitchen wall?”. Nowadays, it would be more than one hole. I think Bruce thought up that song when people generally shot at each other with revolvers.

Things won’t get better if we concentrate on more guns and bombs as solutions. There are more of us in the U.S. (and of course on the planet) and here at home, resources are becoming more unequal, leading to rising stress. Our civilization’s reliance on dinosaur juice, methane, and coal to power our cars, homes, and other stuff is on track to double atmospheric CO2 concentrations over Holocene levels by mid-century. This will, by most reputable accounts, lead to global energy retention via the Tyndall effect resulting in heating on the order of 1.5-4 degrees C and the associated climate adjustments that likely are associated with warming (sea level rise, changes in regional precipitation, changes in average temperatures, more extreme weather due to changes in the jet streams, etc). As an aside, note the uncertainties here. We can predict the big picture, but not the details, hence the constant bickering.

If you think forced migration due to climate and political problems is bad now, I suggest a friendly trip in the time machine to see what things will look like in a few decades. For those who are skeptical of forward climate models, we have plenty of historical geochemical records suggesting significant change is likely in the century to come. Even on the regional scale, we see the results on societies of past climate change in the abandoned settlements of the American Southwest and Greenland. I wrote something for the Albuquerque Journal about that here. Far fewer humans lived back then, so there were places to resettle. Where do people resettle in a few years, as their wells run dry and crops wither, now that we live in a No Vacancy world?

Our ability since the Industrial Revolution to change atmospheric chemistry and thus the atmosphere’s ability to retain the sun’s heat, in a nutshell, is why humans can profoundly – at least with respect to our own existence – impact climate.

me, in the Albuquerque Journal


My guess is we will probably deal with climate change using guns and bombs, since that seems to be the historical tradition. Yes, I am increasingly pessimistic. With the world order drifting towards authoritarianism, nationalism, xenophobia, and ethnic/racial extremism and increasingly, with people showing up unannounced at each other’s national doorsteps, I think the stresses will overcome reason. Plus, its been 74 years since we had a world war. Few living today remember what a world war looks like and frankly, I worry that today’s leaders can only see war as an abstraction. Reagan and Gorbachev knew WW II. Putin and Trump do not. My parent’s generation, now pretty much gone, saw it in its smoke, blood, and destruction filled reality.

The bottom line is if we continue to fixate on using Maslow’s Handgun to stave off change rather than hunkering down to fix what is broken, we will kick the underlying problems down the road until a crisis overcomes us and we solve the problems with…guns and bombs. Its the way Homo sapiens has always done it before. Why change now? Because the guns and bombs are too lethal to use? That’s the underlying idea behind deterrence, but it assumes rational actors acting in their best interest. Hmmm. Does anyone see a potential problem with that assumption? Orwell did:

The passage in the Declaration of Independence that starts, “We hold these truths to be self-evident,” with its references to equality, liberty, and happiness, is literally impossible to translate into Newspeak. “The nearest one could come to doing so,” Orwell wrote, “would be to swallow the whole passage up in the single word crimethink.”

Tom Stern, discussing Orwell’s idea of Newspeak.


As Kurt Vonnegut, who himself rode out the WW II Dresden firebombing, ironically enough in a slaughterhouse, would say, “So it goes“. Unless we choose otherwise.

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