One area in which behavior that results in serious medical conditions has remained largely outside the purview of public health regulation and research concerns injuries caused by accidents with guns.  Most gun injuries that result in deaths aren’t accidents.  They were caused by people who consciously decided to use a gun on themselves or someone else.  Together. suicides and homicides account for 98% of annual gun deaths; accidental or unintentional deaths account for only 2% of the total.  At least this is what the numbers look like that are published by the CDC.  In 2010, the last year for which we have complete numbers, gun suicides were 19,392, gun homicides were 11,078 and unintentional gun deaths were 606; the last number, as Ralph Cramden used to say on The Honeymooners, a mere “bag of shells.”

But now we have a very different argument being made by Michael Luo and Mike McIntire of the New York Times, who believe that the way in which coroners and other public health officials treat and report fatal gun injuries seriously undercounts the number of accidental gun deaths that occur each year.  In their article, published last September, the reporters dug into specific, coroner-level gun death reports in four different states and discovered that as many as half of the gun mortalities that were reported as homicides were, in fact, unintentional or accidental, a finding which if true for the entire country, would make a substantial difference in the ratio of homicides to accidents and might undercut a major argument on gun safety promoted by the gun industry and the NRA.

Why is there such a discrepancy in how gun deaths occur as opposed to how they are reported?  Because in many states and localities, any shooting of one person by another, regardless of age, is considered a homicide.  Or sometimes the same office will rule one accidental shooting as a homicide and the next one as an accident.  Luo and McIntire give examples of both, including a “homicide” in Texas where a 9-month-old was killed when his two-year-old brother opened a dresser drawer next to the crib, pulled out a gun and banged away.  Now I can’t imagine that even in Texas they could figure out how to execute a two-year-old for murder, but I also suspect that the parents weren’t charged with neglect, or abuse, or anything else.  Texas, along with a majority of other states, has no law requiring that guns be locked or locked away in the home, remember?

Of course if you listen to the NRA touting it’s Eddie Eagle program or the NSSF promoting its ChildSafe safety kits, you would think that the entire decline in unintentional gun injuries was due to them.  And in fact there has been a decline in accidental gun deaths over the last decade, from 726 in 2000 to 606 in 2010 (although the rate of gun injuries over the same period has gone up.)  But the question that emerges from Luo and McIntire’s reportage is whether the morbidity data that the gun industry uses to  pat itself on the back for its safety initiatives really tells us whether gun owners are being safe, or whether coroners and other medical workers are just playing fast and loose with different definitions of how gun accidents really occur?

These issues might be resolved and we could finally understand the true degree to which Americans suffer from unwise use of guns if politicians like Rand Paul would stop pandering to the NRA faithful and withdraw their cynical opposition to guns and public health.  I don’t blame the NRA for trying to hold the line against physicians or anyone else who might seek to limit or regulate the market for guns.  After all, they represent the gun industry, and when was the last time that any industry came out in favor of government controls? But it’s nothing short of disgraceful when a politician who also happens to be a licensed physician could pretend that public health should play no role in how Americans use their guns.  Note:  I didn’t say that public health should make the rules.  But public health should be able to explain gun accidents when there are no rules at all.