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Will The ‘Public Health Approach’ Reduce Gun Violence?

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              There seems to be a general consensus in Gun-control Nation that the most effective way to deal with gun violence is to take a ‘public health approach.’ What this means is that we first define gun violence as a public health ‘threat, then we try to figure out which populations are more susceptible to the threat, then we figure out why the threat occurs, and then we come up with a plan which takes all those issues into account.

              Isn’t this what we did with Covid-19?  First, we learned that a lot of people were getting sick, and the sickness was a serious medial event. Then we learned that the most vulnerable populations were the seniors. Then we figured out that the disease spread mostly through close contact between hosts and potential hosts. Then we developed a vaccine and tried to get everyone to take the shot.

              Last year, probably 130,000 people were victims of gun violence. This year, it looks like the number will be more. So, what have we learned about how to deal with this problem using the ‘public health approach?’

              First, we have learned, and we have known this for many years, that most of the people who are both victims and spreaders of this particular health threat are males. We also know that with the exception of suicides, most of the victims and spreaders of gun violence are between the ages of 16 and 35. We also know that most of the victims and spreaders had some degree of contact before the outbreak of the violence itself. Finally, we also know that most of the victims and spreaders are located in high-crime, inner-city neighborhoods, and a disproportionate number are non-White.

              All the foregoing information can be found in a new book, Gun Violence Prevention, A Public Health Approach. The book, co-edited by our good friend Linda Degutis, was just published by the American Public Health Association, and is designed as “both a primer and a handbook for public health practitioners, advocates, students, policymakers and the public, and will make information about the public health approach to gun violence accessible.”

              The book is a collection of well-referenced articles covering just about all the relevant topics for which the public health approach should be understood and used – homicide, suicide, intimate partner violence, social justice, media, advocacy – the works.

              I applaud Linda Degutis and her co-editor, Howard Spivak, for putting together a fairly comprehensive analysis of how public health research and methodologies can be brought to bear against the violence caused by access to guns. There is, however, one little problem with the ‘public health approach’ to gun violence, which the co-editors mention at the very beginning of the text, but do not actually see it as a problem at all.

              Here’s what they say: “This is NOT a book about taking all the guns away. This is NOT about the Second Amendment. This is about creating an environment in which we can be safe given that there are guns present.”

              If the purpose of public health is to create a zero-sum result for any large-scale threat to health, then I hate to break it to Drs. Degutis and Spivak, but you can’t ever achieve that goal as long as the guns are around. The co-editors justify their argument by citing how public health has been used to make cars safer and reduce vehicular injuries while still allowing people to own and drive cars.

              But the analogy between auto injuries and gun injuries doesn’t work. And it doesn’t work for one, simple reason, namely, if someone is injured while driving from here to there, then we figure out whether it was the fault of the driver, or the fault of the car’s design, and we come up with strategies to fix one or both.

              If I were to walk into a room occupied by 15 people, then pull out my Glock 17 and empty the mag, I could kill everyone in that room in 20 seconds or less.

              Know what? That gun would be functioning exactly the way it should function and I would have used it the way it was designed and sold to be used.

Does The Public Health Approach To Gun Violence Work?

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              Want to reduce gun violence?  It’s simple.  Take the strategy employed by public health to reduce fatalities from car accidents and apply the same strategy to guns. Here’s a summary of the results: “This public health approach has saved millions of lives. We can learn from public health successes – like car safety – and apply these lessons to preventing gun violence.”

The above quote is from a Washington, D.C. outfit called the Educational Fund to Stop Gun Violence, one of many groups founded after the Sandy Hook massacre in 2012.

And here’s what a pediatrician writing an op-ed for The New York Times had to say about gun violence in 2016: “Please, can we stop framing this as an issue of rights — and see it as the public health crisis it is? We’ve organized to prevent deaths from cars and tobacco. It’s time we did this for guns, too.”

              So, we seem to have total and complete agreement within the groups that want to reduce gun violence that a ‘public health approach’ is the best strategy by far, and the proof of the value of this strategy can be found in how deaths from auto accidents has dropped year after year.

              There’s only one little problem, however. And the problem is that not only have fatal car accidents stopped dropping, but they have begun to show an increase at the same time that the number of cars on the road and the number of miles being driven by those cars is way down.

              The National Safety Council estimates that total vehicle deaths for 2020 will be at least 42,060, which is an 8% increase over 2019. The mileage death rate for 2020 will probably increase by 24% over 2019, largely because the total number of miles driven last year has decreased by 13% from the previous year.

              In case you’ve forgotten, 2020 was when the economy almost came to a complete halt because of Covid-19. Which is why the number of cars on the road and the number of miles driven by those cars went down from the year before. That being the case, how come we experienced such an increase in vehicle deaths when, if anything, the fatalities from car accidents in 2020 should have been way down? Duhhh…

              Last year when gun fatalities spiked everyone immediately knew the reason. It was because so many people were going into gun shops and buying guns, a buying surge which is still going on. Now the fact that the reporter who covered this issue for The New York Times derived her evidence by using the number for all calls received by the FBI-NICS call center which basically is twice as many calls as the center receives for gun transfers, oh well, oh well.

              It turns out that if you look at the trend of fatal car accidents from 1999 until now, deaths stayed above 40,000 from 1999 until 2006, and then began dropping to 35,000 until they levelled off in 2010 and stayed roughly the same until they increased again in 2016 and then went way up this past year.

              This trend, believe it or not, happens to be more or less the same trend for gun deaths over the past 20 years: increased numbers until 2005, then a decline until 2014, then an upward trend again with really bad numbers in 2019 and even worse last year.

              So, we have more guns and gun deaths go up. We have less cars on the road but car deaths also go up. Is there a chance that maybe the reasons for gun violence has nothing to do with how many Americans own guns?

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

The ‘Consensus-Based’ Approach To Gun Violence Is Wrong.

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              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?

A New Plan For Ending Gun Violence.

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              Some of our friends in the surgery and public health departments of the University of Massachusetts Medical School have just published an important editorial about gun violence asking whether we can do for gun violence what has recently been done for vaping and e-cigarettes. What they basically argue is that the 4-month ban on these products enacted in Massachusetts, a move that is apparently spreading to other states, creates a template for how we should be dealing with another threat to public health, namely, the threat posed by gun violence.

              The authors of this well-reasoned piece point out that as of October 8, 2019 vaping products were responsible for the deaths of at least 26 young persons, with more than 1,200 hospitalizations as well.  On the other hand, what thy refer to as the ‘epidemic’ of gun violence claimed nearly 40,000 lives in 2017, even though we have identified the agent which causes the problem (the gun) and we have developed “proven means” to reduce this particular health threat.

              The editorial calls for a “temporary ban on the future sale of guns and assault rifles in the United States while we more systematically study gun safety,”  a rather novel idea for dealing with gun violence which copies the temporary ban on vaping products going into effect in Massachusetts and possibly other states.

              With all due respect to the co-authors of this editorial (in the interests of full disclosure, as they say, I should state that one of the authors, Dr. Michael Hirsh, co-directs with me the Wood Foundation which sponsors multi-city gun buybacks every year) I would like very much to know exactly what means have been proven to reduce gun violence, because such means certainly haven’t been put into effect.  In 1999, the national gun-violence rate was 9.89. It bounced around until 2011 and has been steadily climbing ever since. It was at 11.69 in 2017, and if the open-source reports used by the Gun Violence Archive are at all reliable, the last several years have certainly not seen any decline in gun violence rates at all.

              But the purpose of this column is not to nit-pick this word or that word with the authors of what is really a strong and commendable editorial on moving forward with some kind of serious gun-violence reduction plan. Rather, I want to address a much more fundamental issue which arises from the idea that we find ourselves in the midst of an epidemic of gun violence, a perspective which is shared by virtually all the researchers and advocacy groups dealing with this problem today.

              When we use the word ‘epidemic,’ we usually refer to a medical problem which arises without warning, often for reasons that initially we do not understand, and requires a comprehensive effort to both cure the victims of the disease as well as to protect populations which have  not yet been infected by the threat. This was exactly how the public health community responded in 2014-2016 to Ebola, which ended up infecting 28,000 and killing roughly 11,000 people in West Africa but was contained almost wholly within that  geographic zone.

              The United States isn’t suffering from an epidemic of gun violence. We are suffering from a threat to health which is endemic to certain locations and certain populations within the United States. Not only does gun violence occur virtually every day in certain, clearly-identified locales involving clearly-identified populations, but this medical threat has been going on in these same locations for what is now a century or more.  All fine and well that public health has discovered the existence of this problem since Columbine and Sandy Hook. It’s hardly new news to residents of cities like Philadelphia, Baltimore, St. Louis and Detroit.

              Sorry Thomas Abt, you don’t end gun violence by going into the ghetto, planting trees and cutting the grass. You get rid of gun violence by getting rid of the guns that are used to commit gun violence.

              This still needs to be said?

What Should Doctors Say To Patients About Guns?

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Today a group of well-meaning and thoroughly ignorant physicians are getting together in New York City to discuss for the umpteenth time the appropriate medical response to what is called a ‘national public health crisis;’ i.e., injuries caused by guns. They will no doubt draft yet another set of proposals to deal with the problem which will include all the usual things – more research funding, comprehensive background checks, ‘red flag’ laws, assault rifle ban, maybe even a mandatory delay in gun transfers or mandatory training before someone can walk around with a gun.

The reason I say these medical professionals are ‘thoroughly ignorant’ is because none of them know anything about guns. If they did know something about guns, they would understand that you can’t make something ‘safe’ which is designed not to be safe. How do we define the word ‘safe?’ It means that when we use something the way it’s supposed to be used that no injury occurs.

That being said, let me break the news gently to all those folks shooting their mouths off at today’s meeting in New York: The guns which are used to commit virtually every act of gun violence happen to be designed for one purpose and one purpose only – to kill or injure either the user of the gun or someone else. To use such guns in a ‘safe’ way is to invent a narrative that could only be taken seriously by people who know absolutely nothing about guns.

Want to ban assault rifles? Fine. Such a ban might result in reducing the number of people killed or injured with guns by, at best, 2 percent. What about the other 98 percent? Oh no, we can’t ban Glocks, we can’t ban tactical shotguns, the Constitution says Americans can own  those guns. And the last thing that medical professionals would ever want to be accused of doing is coming up with a response to a public health problem that didn’t align with 2nd-Amendment rights.

I have never understood how or why physicians need to be concerned about what the Constitution says or doesn’t say about guns when the evidence-based research that physicians are supposed to use to define all medical practice clearly proves that access to a gun is a significant health risk. Is the risk somehow lessened by locking the guns up or locking them away?  Sorry, but I have to gently break something else to my medical friends: There is not one, single study which has ever shown any connection whatsoever between ‘safe storage’ and the injuries caused by guns.

There are studies all over the place which find that when patients are counseled on safe behavior with guns, many of them later report that they have taken the doctor’s advice and are behaving with their guns in a safer way. But none of these studies are based on a before-and-after analysis of gun violence rates; it is simply assumed, with no evidence whatsoever, that behaving in a safe way with guns results in gun-violence rates going down.

When anyone puts their hand on a live gun (that’s a gun with ammunition ready to go) they have moved into a high-risk zone. And the only way to mitigate that risk is to make it impossible for anyone to put their hands on that gun. Now there happen to be many people (one of them me) who have decided for all sorts of reasons that they have no problem accepting that risk. There are also a lot of people who still like to ‘light up a Lucky’ or walk around with 40 extra pounds on their frame. And by the way, the Constitution gives every American the ‘right’ to do both.

Would any physician ever claim, in the interests of  ‘non-partisanship,’ that these patients should be advised to find a safer way to eat or smoke? Of course not. And that being the case, the physicians who think they can find some kind of neutral pathway to reducing gun violence are simply showing their ignorance about guns.

Want to get rid of gun violence? Get rid of the guns designed to cause gun violence. An approach which, by the way, doesn’t run counter to the 2nd Amendment at all.

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.

Attacking John Lott Doesn’t Explain Gun Violence.

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              If there is one person more disliked than anyone by Gun-control Nation, that person has to be John Lott. His book, More Guns, Less Crime, is considered the single, most important reason behind Gun-nut Nation’s embrace of armed, self-defense, and his ongoing effort to eliminate gun-free zones provokes anger and negative reactions throughout gun-control land.is book, More Guns

              In fact, at least one noted gun-control researcher, Stanford’s John Donohue, has basically created an entire academic career based on articles critical of Lott. Not far behind Donahue is the chief of gun research at Harvard, David Hemenway, who has likewise published multiple denunciations of Lott’s work.

              I happen to believe that the attacks on Lott’s work reflect the failure of liberal social science to explain what is really the only issue in the entire gun debate which needs to be understood, namely, how is it that less than ten percent of the individuals who each year commit a serious act of violence against someone else commit this violence by using a gun? John Lott’s basic thesis, that criminals switch from face-to-face crimes (assault) to anonymous crimes (burglary) is an attempt to explain the behavior which lies behind at least three-quarters of all gun injuries. Have either Donahue or Hemenway ever attempted any explanation of this problem? They have not.

              I have two criticisms of Lott’s work. First, the idea that criminals switch from one type of crime to another type of crime assumes that one type (assault) is really no different from another type (burglary), and that criminals switch their modus operandi depending on how they perceive degrees of risk from different types of criminal behavior. This assumption flies in the face of everything we know about criminal behavior and to argue, a la Lott, that the issuance of concealed-carry licenses (CCW) creates a ‘substitution effect’ for burglary versus assault, is to misread the nature of how and why these very different types of crimes occur.

              Second, and more important is the fact that most of the perpetrators and victims of gun violence are individuals who share similar socio-economic circumstances and demographic profiles. Both groups are overwhelmingly minority males living in under-served neighborhoods who rarely, if ever qualify for concealed-carry licenses, an argument Lott has made in other works. If the average inner-city resident is more frequently armed than years ago, this simply cannot be explained with reference to the spread of CCW over the past forty years.

              For all the sturm und drang whipped up by Donohue, Hemenway and others about the pernicious impact of Lott’s research, I have yet to see one, single response to his work which even hints at the issues I have raised above. It really doesn’t take a rocket scientist to sit down, pull some numbers together and create a regression analysis model that will yield a result which aligns with your particular point of view. Want to argue, as Hemenway argues, that we have high rates of fatal gun injuries because we own so many guns? Use the number of guns as your independent variable to control against fatal gun injuries and the United States will wind up on top every, single time. Now the fact that we have absolutely no idea how many of those 300 million guns are in the hands of people who might use those guns to commit a violent crime, oh well, oh well, oh well.

              I think my friends in public health gun research need to stop confusing research with hot air. God knows we have enough of the latter on both sides of the gun debate; it’s the former where most of the necessary work remains totally undone. Gun injuries are the only injury tracked by the CDC where the person who is injured and the person who commits the injury are two different people at least seventy-five percent of the time. I’m still waiting for anyone in the public health research community to ask why this fundamental fact escapes their research.

When It Comes Gun Violence, Guns Aren’t Cars.

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              Way back in February, a ‘summit meeting’ was held in Chicago, bringing together 44 medical associations whose representatives spent a weekend patting each other on the back for how engaged they have all become over the issue of gun violence. If I am sounding somewhat skeptical of this so-called ‘historic’ event, it’s because nearly a half-year has gone by and I am still waiting for any of these groups to actually do something tangible to reduce gun violence.

              If anything, many of these physician-led organizations actually spend time, money and effort to increase gun violence by donating millions of dollars to members of Congress who then go out and vote down each and every effort to pass the most benign and least-restrictive gun laws. In the last three election cycles alone, the American College of Emergency Physicians gave GOP Congressional candidates nearly two million bucks, and this bunch has the nerve to show up at Chicago to help lead the medical effort to respond to injuries caused by guns? Yea, yea, I know. These GOP officeholders may be voting the wrong way on guns, but they deserve financial support from the medical community because they vote the right way on so many other issues, like getting rid of Obama-care, gutting Medicaid, positive things like that.

              I shouldn’t be surprised at how the physicians who met in Chicago and then published a detailed pronouncement on gun violence could be so willing to ignore the egregious behavior of the professional associations to which they belong. Because if you take the trouble to read the high-sounding document which came out of the meeting, you quickly become aware of the fact that the selfsame blindness about political contributions which is endemic to the medical profession infects their views on how physicians should respond programmatically to the issue of gun violence as well. And the blindness appears right at the beginning of this Magna Carta which says that physicians should adopt a public health model “that has been so effective in improving outcomes in traffic-related injury.”

              Ever since I organized the first medical conference on gun violence which awarded CME credits, I have been listening to this nonsense about how we can reduce gun violence by using the public-health template which was developed to reduce injuries on our highways, byways and streets. And the reason that the public health approach to gun violence is nonsense is very simple, namely, that cars are designed to move people from here to there without causing an injury; guns are designed to cause injuries – that’s what guns do. When I hit the brake and my car doesn’t slow down, obviously there’s some kind of defect which needs to be fixed. When I pull out my Glock and shoot me or someone else in the head, my Glock is working exactly the way it was designed to work.

              I have read virtually every single pronouncement by every single medical organization, public health researcher, journalist, advocate and everyone else, and I have yet to see any of them, even one of them mention this obvious and basic fact. So let me state it as simply as I can, okay? Guns aren’t ‘safe.’ That’s not how they work. That’s not what they are designed to do. I have owned guns for more than 60 years. I have sold more than 11,000 guns in my gun shop. I know a little bit more about guns than any of these self-professed medical experts, most of whom have never even put their hands on a gun.

              The physicians who attended the Chicago ‘summit meeting’ will immediately respond by reminding me that there’s something out there called the 2nd Amendment which gives their patients the ‘right’ to own a gun. To which my answer is this: So what? Since when should physicians develop proper responses to medical threats based on whether or not patients have a Constitutional ‘right’ to purchase and own a product which creates that threat?

Here’s Your Opportunity To Study Gun Violence. Don’t Miss It.

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              Our friends at the Hopkins-Bloomberg school have produced and published what I believe is the first attempt to create a comprehensive curriculum on gun violence. This is a very impressive online effort and should be viewed, used and studied by everyone who would like to see gun violence come to an end. In fact, if I were running a group which advocates gun control, I would insist that every member of the group register and go through the course. For that matter, I would post the course on my Facebook page and suggest that other FB admins do it too.  In fact, I’m posting and pinning the course on my FB page right now.

              The good news is that the entire curriculum is video-delivered by members of the Hopkins faculty, all of whom know how to stand up in front of a classroom and deliver lectures in a clear and organized way. The better news is that the website is user-friendly and the lessons can be easily accessed even by users with only a slight degree of digital skills. Finally, the lessons are all on video, but you can also refer to text, and there are reading lists attached for further study, as well as a review quiz at the end of each lesson.

              If you take the program seriously, watch every lecture, read the relevant assignments, do all quiz exercises and give feedback, you are looking at more than 11 hours of study time.  In other words, this is serious stuff and the entire effort is obviously meant to be taken seriously. Incidentally, along with four members of the Hopkins faculty, there are lessons provided by outside experts, including our friends Jeff Swanson and Adam Winkler, and of course the website includes forums so that every student also gets a chance to shoot his or her mouth off. God forbid there would actually be a website out there which doesn’t afford everyone the opportunity to make some noise, right?

              If my last sentence reads in a somewhat sarcastic vein, it’s not by accident. One of the reasons I like this effort is because it is advertised up front as being based on ‘evidence;’ i.e., the content is tied to relevant research in the field. Now that doesn’t mean that all the research is totally correct or that more research needs to be done. But the whole point here, it seems to me, is to inject fact-based knowledge into the gun debate, rather than just creating another digital forum for opinions, a.k.a. hot air. The gun-control movement has come into its own since Sandy Hook; if anything, when it comes to the argument about the role of guns in American society, for the first time gun control appears to have trumped gun ‘rights.’ All the more reason why the discussion needs to proceed on evidence drawn from serious research, not opinions out of thin air. 

              Talking about evidence, I have only one suggestion to make to the faculty that created this course, and it’s a suggestion which obviously flows from my own background when it comes to the issue of guns. If it were possible to revise the curriculum at some point, I would ask the faculty to consider adding a section which explains the meaning of the word ‘gun.’ After all, if we want to learn about a certain kind of violence which is defined by the use of a certain object which we call a ‘gun,’ shouldn’t we make sure that all our learners know how to define that object in terms of how it’s designed, how it’s manufactured, how it works and doesn’t work?. I see too many instances on various gun-control forums, FB pages, and questions directly asked of me which indicate a knowledge deficit on both sides of the gun debate about the product which causes the violence itself.

              That’s a minor quibble.  I hope the Hopkins faculty will take seriously the work they have done and promote its access every chance they get. And when you finish reading this text, go to the website and sign up for the course.

Can We Reduce Gun Violence With A Public Health Approach?

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              Our friends at the Coalition  to Stop Gun Violence (CSGV) recently posted an editorial that described gun violence as a ‘public health crisis’ because it has an “adverse impact on community health.” The notion that we can reduce and ultimately eliminate the 40,000 gun deaths suffered each year by taking a public health solution to the problem has become the standard mantra in gun-control circles, not the least of which because of the possibility that CDC research money on gun violence may be coming back into play.

              We love the notion of public health. Maybe we didn’t invent it, but we sure have used the public health approach to deal with serious threats to the human community, most notably and recently AIDS. And since gun violence is certainly widespread enough to be considered a threat to the human community, and since it also tends to impact most severely on certain identifiable groups within the community, obviously we can and should utilize the public health approach to this health threat as well. So say all the public health experts on gun violence.

I’m not a physician. I’m not a public health researcher. I can, if I choose, ask to be introduced as ‘Doctor Weisser,’ but that’s only because I earned a lowly Ph.D.

 On the other hand, I know something about guns. And based on what I know and what all these public health experts don’t know,  I disagree.

I disagree with the ‘public health approach’ to gun violence because the information that we need to evaluate in order to figure out a valid public health response to this particular threat to the human community doesn’t exist. And it won’t exist even if the CDC dumps not just 50 million into gun research, but 500 million or more.

I don’t hear any of the public health experts talking about this problem at all. In fact, these experts go out of their way to deny the importance of even collecting such data, despite saying again and again that any public health strategy must be ‘evidence-based.’

A public health approach requires that first you figure out why certain people get sick. Then you figure out how the sickness spreads from victim to victim, then you figure out how to prevent the spread of the illness either through immunization strategies, public policies or both. In the case of gun violence, we know who gets sick. But we have absolutely no idea how the illness spreads from one person to another because we don’t know anything about the agent who spreads the disease – the shooter – and we don’t know anything about the instrument whose presence creates the disease – the gun.

We don’t know anything about the agent because in the case of self-inflicted fatal injuries the agent is dead. In the case of the agent spreading the disease, he either isn’t identified or if he is, he’s locked up in jail. At which point we aren’t dealing with a public health issue. We’re dealing with a crime. Finally, both groups of agents use the same instrument, a gun, and we don’t know how they got their hands on the gun.

Back in March, three major public health scholars appeared before a House committee and testified about the need to restore CDC gun research funds. When asked, all three esteemed experts denied the necessity to create a national gun registry – not needed at all. A national registry happens to be the only way to figure out the movement and use of the instrument which has to be present in every instance of gun violence. Somehow, this never gets said.

I’m saying it now. Either my friends in the public health community stop promoting the nonsense that whatever they are doing won’t threaten the beloved 2nd Amendment, or they can stop pretending that they can come up with any kind of serious public health solution to the threat posed by guns. It’s simple.  Either – Or.

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