Does Public Health Understand Gun Violence?

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              I have been reading and writing about gun violence for more than ten years. I have yet to see how one of the most significant factors that we need to understand about this peculiarly American form of behavior not only remains unstudied by all the public health mavens (read: experts) but isn’t even mentioned by this so-called scholarly community as an issue of concern.

              What I am referring to is the extraordinary differential between whites and blacks when we look at the numbers for homicides versus suicides committed with a gun. The difference is startling. For whites, the gun-homicide rate in 2021 was 3.05, for blacks it was 28.03. This puts the white gun-homicide in the United States right around Sri Lanka and Turkey, and considering that white Americans own ten times more guns that the residents of either those other countries, the rate of gun homicides suffered by American whites isn’t so bad.

              On the other hand, the rate of gun homicides experienced by American blacks is up there around countries like Sudan, Guinea, and the Dominican Republic. In 2021, the U.S. gun-homicide rate for blacks between ages 14 and 34 was – ready? – 64.05. The only country which matches that number in the entire world is El Salvador. No other country is even close.

              Looking at gun suicides, however, gives us a much different view of things.  In 2020, the rate of white gun suicides was 7.84, the black gun suicide rate was 3.95. When it comes to how guns are used in this country for ending a human life, as opposed to using a gun for hunting or sport, whites use guns to shoot themselves, blacks use guns to shoot someone else. In that respect, I’m still waiting for the first researcher to attempt an analysis of the differential between gun homicide and gun suicide using race as the fundamental variable in both types of events.  

When public health researchers try to explain the racial difference in gun-homicide rates, they invariably trot out the same old, same old narrative about the ‘hopelessness’ and all the other socio-economic blah, blahs, blippity-blahs about the inner-city or what is now referred to as ‘underserved neighborhood’ life. This narrative was a particular favorite of the gun-control academic crowd during the Covid-19 Pandemic, when the incidence of gun violence shot up and of course was explained as being caused by the increased socio-economic pressures spawned by the spread of a virulent and deadly disease.

              We don’t yet have numbers for shooting deaths in 2022 or 2023, but either the media is paying more attention to gun violence, or maybe the gun-violence rate has jumped even higher, or maybe a combination of both. But if the increase in both gun homicides and suicides in 2021 was due to the socio-economic stresses of the Pandemic, how come present-day gun violence seems to be happening even more frequently although the incidence of Covid-19 has gone way down? Duhhh….

               Thirty years ago, Art Kellerman and Fred Rivara published two articles which definitively made a connection between access to guns and medical risk. They did not qualify what types of guns, or whether the guns were locked away, or anything else. They simply looked at the incidence of homicide and suicide in households which contained guns.

              These two articles provoked a shitstorm on both sides of the gun debate, with pro-gun advocates claiming that guns were the most effective means to protect individuals from crime, and anti-gun advocates claiming that we needed to regulate gun ownership to a greater and more effective degree.

              How did the so-called public health gun experts situate themselves within this debate? They decided and continue to promote the idea that having guns around is okay, as long as they are used in a ‘responsible’ or ‘safe’ way.

              What does ‘responsible’ mean? It means whatever behavior these public health experts believe will reduce the risk from guns, although they have yet to produce any research which actually shows any causal linkage between gun-violence rates and more laws and regulations covering guns.

              I love the studies which correlate gun violence with gun laws, i.e., the more gun controls you put into the legal environment, the more you reduce violence caused by guns. Except the fact is that with a handful of exceptions, the states which have lots of gun-control laws and lower rates of gun violence, had those lower gun-violence rates before the new laws were passed. Oh well, oh well, oh well.

              Want to end gun violence? It’s very simple. Get rid of the guns which cause the violence. This week the Supreme Court refused to hear an appeal challenging an assault rifle ban passed by a second Illinois community – Naperville – which follows from an assault rifle ban passed by Highland Park in 2014. The Highland Park ban was upheld by the SCOTUS in 2015.

              How come the public health gun researchers who are all so worried about gun violence never make a peep about reducing gun violence by simply getting rid of the guns?

              Oh, I forgot. You can’t conduct public health research on gun violence unless you first commit yourself to programs which promote responsible behavior with guns. After all, didn’t C. Everett Koop promote the idea that tobacco wasn’t a health risk if people would smoke in a ‘responsible’ way?

Do Guns Make You Safe?


              So, once again a series of really nasty, mass shootings has opened up the debate on guns, a debate based on a very simple division of opinion, namely, whether a gun makes you more or less safe.

              Obviously, the pro-gun people promote the idea of a gun as being a very effective way to protect yourself, the anti-gun people arguing the reverse.

              Now it turns out that research on this issue definitively shows that access to a gun creates a risk to health. But since when do most people make decisions based on what some article published in a medical journal wants them to believe?

              So, here we go again with the same old, same old which means that the gun-control crowd has to figure out a narrative which will convince gun-owning Americans that they need to re-think how they feel about their guns.

              And by the way, since roughly 40% of Americans own a gun, and 60% believe that a gun represents safety and self-protection more than it represents a risk, there are a lot of non-gun owners out there who also buy the idea that having a gun around protects you and makes you safe.

              So, what do we do to figure out an effective response to the idea that guns are ‘good’ things to keep around?

              Well, the first thing we have to do is figure out why gun owners’ own guns. And for this information, the gun-control gang turns to their friends in public health who run what they refer to as ‘nationally representative’ surveys to figure out what’s on the brain of the people who need to be taught that they don’t need to own guns.

              Unfortunately, the so-called experts who design these surveys, know as much about guns as I know about nuclear fission, and the idea that well-meaning advocates for gun control would use the so-called research of this public health bunch to develop any narrative which would capture the attention of gun owners is a major reason why gun-control laws don’t result in any change at all.

              I can’t remember the last survey of gun owners by public health researchers which didn’t ask respondents why they own a gun? And when the survey is published, invariably the researchers trumpet the idea that they have discovered a fundamental shift in the mentality of gun owners who used to own guns for hunting and outdoor sport, but now own guns for armed, self-defense.

              Of course, you could learn the same thing by simply reviewing the annual report issued by the ATF on gun manufacture, which breaks down the number of handguns and long guns produced every year. In 2020, the gun industry produced 6.5 million handguns and 3.1 million rifles and shotguns. Think any of those handguns were used to pop a cap into Bambi’s rear end?

              But the issue isn’t whether gun owners are stocking up on self-defense guns rather than sporting arms; the real issue, which not one, single public health survey has ever asked, is how many of these folks who went out recently and bought a self-defense gun were already gun owners and decided to switch from guns used for sport to guns used for self-defense?

              Notwithstanding all the exultant crowing by the gun industry PR folks like the NSSF about all these newbies have been streaming into gun shops to buy their first gun, how come not one, single public health researcher has ever taken the trouble to ask a gun dealer (like me) to estimate the number of customers who come into their shop to buy a handgun as their first gun?

              Here’s my answer to that question. Ready? Almost none.

              That’s right. I stopped doing retail in 2015, but between 2002 and when I shut down my retail sales, I probably sold 2,800 handguns. And since my gun shop, like just about all gun shops, sold guns to the folks who lived in my town and the surrounding towns, I knew just about all my customers, and they were either folks who already owned guns or had been raised in a household where guns were around.

              The point is that when and if the gun-control community (of which I happen to be a long-time member) finally sits down and tries to figure out a narrative that will resonate to the other side, as opposed to figuring what to say to each other, they better be prepared to talk to people for whom guns have always been part of their lives, as well as the lives of their parents and probably further back on the family tree.

              Until and unless Gun-control Nation understands and accepts the essential commonality of gun ownership, we will simply continue to sit here arguing about this law and that law and going nowhere fast.

If You Read One Book About Gun Violence, Read This Book.

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              Philip Cook is an economist who began studying and publishing on gun violence in the late 1970’s, and it would not be an overstatement to say that he has been the singularly most influential and significant scholar in this field for the past forty years. I’m two years older than Phil, so I can afford to be magnanimous in my praise of his academic work and impact on the field.

              Anthony Braga is a criminologist who ranks as the best and the brightest of the next generation of scholars producing original and important research on issues related to gun violence, in particular, the effectiveness of policing strategies which focus on proactive measures to control violent criminality occasioned by the use of guns.

              The good news is that working together, Braga and Cook have now produced a book-length study, Policing Gun Violence, whose title perfectly encapsulates their respective primary research concerns: Braga on cops and Cook on guns.

              What we get from this vaunted collaboration is an approach to understanding the how and why of reducing gun violence which creates a more penetrating and hopefully more productive narrative for reducing gun violence than what is being bandied around the gun-control community today.

              If you look at the messaging from the major gun-control organizations – Brady, Everytown, Giffords – what has now become the standard response to a couple of thousand fatal and non-fatal gun injuries each and every week is the idea that law-abiding gun owners have to keep their guns safe – use them safely, store them safely, sell them to someone else safely, on and on again and again.

              Where does Gun-control Nation get this nonsense?  They get it from public health researchers who have become enamored of the ‘consensus’ approach to gun violence, which means coming up with gun-control strategies acceptable to both sides.

              This would be like asking the CDC to come up with a solution for tobacco use that would be preferred by smokers, or maybe a way to deal with alcoholism by figuring out how to solve the problem which the binge-drinkers among us would also prefer.

              On the very first page of their spellbinding treatise, Braga and Cook waste no time getting to the heart of the matter: “Gun violence is a multifaceted problem requiring a multifaceted response. But an essential component of any comprehensive effort is more effective policing. Most instances in which one person shoots another are crimes.”

              Bingo! That’s it. We finally have an analysis of gun violence which starts at the beginning of the problem and not at the end. The end of gun violence is the guy lying in the street with a bullet in his head. The beginning of the problem is the decision by someone else to commit a violent crime. And that decision is in no way going to be influenced or affected by whether or the gun used in that assault was used safely or not.

              It’s too bad that one out of every seven or eight Americans lives in a crime-ridden, underserved, urban neighborhood. It’s too bad that many, if not most of the people living in those neighborhoods happen to be black. It’s too bad that the median household income for blacks is 40 percent lower than the median household income for whites. But mitigating and ultimately eliminating the ‘root causes’ of violence means nothing to the kid who disses another kid and then finds himself looking down the barrel of a gun.

              This past weekend two young guys got into an argument at the food court in my nearby shopping mall. One thing led to another, a gun got pulled out, a shot was fired and a third individual, described as an ‘innocent bystander’ fell down dead. This mall has a stated policy  as a gun-free zone. There are also armed security guards on continuous patrols.

              You think the guy who walked into this mall with a gun in his pocket spent one second thinking that he was violating the rules when he decided not to leave his gun out in his car? But the point of Braga and Cook’s book is an analysis of the methods and strategies that cops need to use to keep this guy from ever getting his hands on a gun.

              Which is why this book so timely, so coherent, and so important for everyone to read.

An Important Plan to End Gun Violence.


              Back in 1997 a Republican-led Congress decided that they didn’t want to hear anything more about gun violence, so they deleted a provision in the annual CDC budget which previously had funded gun research. It was called the Dickey Amendment and it remained in place until last year.

              Some of the slack in gun research was taken up by The Joyce Foundation, a liberal, grant-making operation in Chicago which began making grants to support gun research in 1993, and by 2019 had given out $32 million for this kind of work.

              I happen to have been a recipient of Joyce support when the Foundation generously helped fund the CME-accredited gun violence conference I organized in Chicago in 2016.

              This year, even though the CDC has once again begun providing funds for gun research, the Joyce Foundation has still awarded $566,905 to support programs about guns. What I am going to talk about in this column should not, in any way be taken as the slightest criticism of the Joyce Foundation’s presence in this field.

              The Joyce Foundation has just published an important document which needs to be read by everyone – researchers, advocates, practitioners – in the GVP field. The document, “Toward a Fair and Just Response to Gun Violence: Recommendations to Advance Policy, Practice and Research,” can be accessed here. It is based on a series of virtual meetings which brought together “advocates, prosecutors and defense attorneys, policy experts, researchers, violence intervention practitioners, and members of law enforcement, all experts in their fields.”

              Many of the recommendations in this report have become SOP for all gun-control initiatives, I am referring to the idea of expanding community-based interventions, which are now embodied in the new federal gun bill that Joe signed last week.

              On the other hand, what is new and different about the Joyce report is the recommendations which emphasize supply-side solutions to the problem, which is the first time I have seen a recognition within the GVP community that neighborhoods which suffer high rates of gun violence need to be seen not just as locations where poverty creates unlawful behavior, but as marketplaces for the supply and diffusion of guns.

              Unfortunately, the specific recommendations which are promoted for reducing the movement of guns into this market are not based on anything having to do with how markets function or how such functions can be changed. If anything, the recommendations are nothing more than a rehash of a basic GVP consensus which assumes that regulating the behavior of individuals whose activities create a market can somehow reduce the supply of products into that market, regardless of any changes in market demand.

              So, for example, the report calls for specific licensing of handgun purchases, citing as the value of this strategy a 40% drop in gun homicides in Connecticut after a more detailed permit system for handgun purchases went into effect in 1995. All fine and well but if the researchers had extended their analysis for another decade beyond 2005, they would have discovered that Connecticut’s gun-homicide rate in 2012 rose by 68% over the rate in 2005.

              The report also calls for stricter regulation of gun dealers, in particular revising the ‘willful violation standard’ used by the ATF to determine whether a dealer is consciously ignoring relevant gun laws in order to transact an illegal sale. The definition of ‘willful’ needs to be made more explicit because the courts keep allowing dealers to continue in business eve though they commit ‘willful’ violations multiple times.

              I committed more than 500 ‘willful’ violations when the ATF inspected the transfers conducted in my shop between 2007 and 2014. Every, single one of these willful violations occurred because we forgot to write down the federal firearms license number of the one wholesaler from whom we bought all our new guns.

              Why was this violation of federal law a willful attempt by me to avoid regulations and maybe sell guns out the back door? Because when I received my dealer’s license in 2001, some guy from the ATF showed up, spent about five minutes talking about procedures and disappeared. Had I appealed the ATF’s finding that I willfully violated federal law, of course the court would have told the ATF to get lost.

              Would it be, to quote Grandpa, such a ‘gefailech’ (read: big deal) if somewhere in that report or in any report, if my dear GVP friends would maybe just mention the idea that we could end gun violence simply and easily by just ending the commerce in certain types of guns?

              And if you think the 2nd Amendment doesn’t allow us to restrict the ownership of bottom-loading, polymer-framed, semi-automatic handguns and long guns, then you don’t know anything about the 2nd Amendment and you don’t know anything about guns.

              ENJOY THE HOLIDAY!!!

Gun Violence Is Not Public Health.


              Several months ago, the medical community rejoiced when the new Director of the CDC, Rochelle Walensky announced that going forward, gun violence would be considered a ‘threat’ to public health. This statement ended what had long been a disappearance of discussion and research about gun violence within the CDC, and it coincided with the resumption of research government funding for gun-violence research both by the CDC and the NIH.

              All fine and well, because there’s no disputing the fact that guns are used to kill and injure more than 125,000 Americas every year. But defining a medical problem as a ‘threat’ to health is one thing, defining it as a ‘threat to public health’ is something else. Because the latter implies or explicitly promotes the idea that everyone in a particular community is at risk, ad when it comes to intentional injuries caused by guns, this is simply not true.

              From 2016 through 2020, the total number of gun homicides was 76,713, for a per-100K rate of 4.87.  The numbers aren’t exact, but fatal gun violence in other advanced (OECD) countries is roughly 7 to 20 times lower than it is in the United States.

              But guess what happens when we calculate the gun-homicide rate in the United States just for the part of our population which is White? The per-100K rate drops to 2.39, which is still at the top end of the OECD country, but not by much.  And if you then calculate gun-homicide rates on the per-capita basis not of population but on the number of civilian-owned guns, the White population of the United States is so much less threatened by gun violence that the whole argument becomes a joke.

              Because when scholars like David Hemenway explain our high rate of gun violence because we own those 300 million or 400 million guns, almost all those guns are owned by White Americans which, according to the CDC numbers, are simply not responsible for all those gun deaths. The number of Blacks killed by guns from 2016 through 2020 was almost ten times the number of Whites, for a population which is one-fifth the size of the Whites living in the United States.

              Now if you want to say that a certain medical problem is a public health issue only for a certain population defined by race, or gender, or anything else, go right ahead. But that’s not what the CDC is saying – Doctor Walensky didn’t qualify her statement about guns as a ‘threat’ to the public health of any particular group.

              Why didn’t she? Because the medical community has decided that guns wouldn’t threaten anyone’s health if they were all safely stored. The idea that you can take a Glock, or a Sig, or a Beretta and keep it in the house without the gun increasing medical risk has become the basic response of physicians to how we can eliminate those 125,000 fatal and non-fatal gun assaults every year without infringing on the ‘rights’ of any law-abiding adult to own a gun.

              Now the fact that there has yet to be one, single evidence-based study which shows a reduction in the gun-violence rate of any community when more gun owners adopt safe-storage behavior means that the entire push to use safe storage as a medical response to gun violence is based on nothing more than a unproven assumption that when the gun is taken out of the gun safe or the locked drawer it will be used in a non-violent way.

              Which only demonstrates how far from reality the medical community exists when it comes to gun violence, because most of the guns which are used to commit intentional assaults are designed and sold to be used exactly for that purpose – shooting and killing someone else. And by the way, when the World Health Organization defines violence, they make no distinction between trying to injure someone as an offensive or a defensive act. Violence is violence, period. And that’s what guns manufactured by companies like Glock and Sig and Beretta, and all the other handgun companies are designed to do.

              The idea that the head of the CDC would go on national television and announce that gun violence is a public health threat but oh, by the way, we can bring a medical solution to the problem if every gun owner would safely store his or her guns isn’t just a sick joke, it’s a fraud.  And as long as the medical community continues to support this fraud, they will have plenty of opportunities to sit at conferences and share their feelings about the violence caused by guns.

Does Gun Violence Deserve a Public Health Approach?


              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

Will The ‘Public Health Approach’ Reduce Gun Violence?


              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.


              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.


              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?

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