“Silencing The Science”: How The Gun Lobby Shut Down Gun Violence Research
On December 14, a 20-year-old Connecticut man shot and killed his mother in the home they shared. Then, armed with 3 of his mother’s guns, he shot his way into a nearby school, where he killed 6 additional adults and 20 first-grade children. Most of those who died were shot repeatedly at close range. Soon thereafter, the killer shot himself. This ended the carnage but greatly diminished the prospects that anyone will ever know why he chose to commit such horrible acts.
In body count, this incident in Newtown ranks second among US mass shootings. It follows recent mass shootings in a shopping mall in Oregon, a movie theater in Colorado, a Sikh temple in Wisconsin, and a business in Minnesota. These join a growing list of mass killings in such varied places as a high school, a college campus, a congressional constituent meeting, a day trader’s offices, and a military base. But because this time the killer’s target was an elementary school, and many of his victims were young children, this incident shook a nation some thought was inured to gun violence.
As shock and grief give way to anger, the urge to act is powerful. But beyond helping the survivors deal with their grief and consequences of this horror, what can the medical and public health community do? What actions can the nation take to prevent more such acts from happening, or at least limit their severity? More broadly, what can be done to reduce the number of US residents who die each year from firearms, currently more than 31 000 annually?1
The answers are undoubtedly complex and at this point, only partly known. For gun violence, particularly mass killings such as that in Newtown, to occur, intent and means must converge at a particular time and place. Decades of research have been devoted to understanding the factors that lead some people to commit violence against themselves or others. Substantially less has been done to understand how easy access to firearms mitigates or amplifies both the likelihood and consequences of these acts.
For example, background checks have an effect on inappropriate procurement of guns from licensed dealers, but private gun sales require no background check. Laws mandating a minimum age for gun ownership reduce gun fatalities, but firearms still pass easily from legal owners to juveniles and other legally proscribed individuals, such as felons or persons with mental illness. Because ready access to guns in the home increases, rather than reduces, a family’s risk of homicide in the home, safe storage of guns might save lives.2 Nevertheless, many gun owners, including gun-owning parents, still keep at least one firearm loaded and readily available for self-defense.3
The nation might be in a better position to act if medical and public health researchers had continued to study these issues as diligently as some of us did between 1985 and 1997. But in 1996, pro-gun members of Congress mounted an all-out effort to eliminate the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). Although they failed to defund the center, the House of Representatives removed $2.6 million from the CDC’s budget—precisely the amount the agency had spent on firearm injury research the previous year. Funding was restored in joint conference committee, but the money was earmarked for traumatic brain injury. The effect was sharply reduced support for firearm injury research.
To ensure that the CDC and its grantees got the message, the following language was added to the final appropriation: “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”4
Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.
When other agencies funded high-quality research, similar action was taken. In 2009, Branas et al5 published the results of a case-control study that examined whether carrying a gun increases or decreases the risk of firearm assault. In contrast to earlier research, this particular study was funded by the National Institute on Alcohol Abuse and Alcoholism. Two years later, Congress extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.6
These are not the only efforts to keep important health information from the public and patients. For example, in 1997, Cummings et al7 used state-level data from Washington to study the association between purchase of a handgun and the subsequent risk of homicide or suicide. Similar studies could not be conducted today because Washington State’s firearm registration files are no longer accessible.8
In 2011, Florida’s legislature passed and Governor Scott signed HB 155, which subjects the state’s health care practitioners to possible sanctions, including loss of license, if they discuss or record information about firearm safety that a medical board later determines was not “relevant” or was “unnecessarily harassing.” A US district judge has since issued a preliminary injunction to block enforcement of this law, but the matter is still in litigation. Similar bills have been proposed in 7 other states.
The US military is grappling with an increase in suicides within its ranks. Earlier this month, an article by 2 retired generals—a former chief and a vice chief of staff of the US Army— asked Congress to lift a little-noticed provision in the 2011 National Defense Authorization Act that prevents military commanders and noncommissioned officers from being able to talk to service members about their private weapons, even in cases in which a leader believes that a service member may be suicidal.9
Health researchers are ethically bound to conduct, analyze, and report studies as objectively as possible and communicate the findings in a transparent manner. Policy makers, health care practitioners, and the public have the final decision regarding whether they will accept, much less act on, those data. Criticizing research is fair game; suppressing research by targeting its sources of funding is not.
Efforts to place legal restrictions on what physicians and other health care practitioners can and cannot say to their patients crosses an even more important line. Yet this is precisely what Florida and some other states are seeking to do. Physicians may disagree on many issues, including the pros and cons of gun control, but are united in opposing government efforts to undermine the sanctity of the patient-physician relationship, as defined by the Hippocratic oath. While it is reasonable to acknowledge and accept the Supreme Court’s recent decision regarding the meaning of the Second Amendment, it is just as important to uphold physicians’ First Amendment rights.
Injury prevention research can have real and lasting effects. Over the last 20 years, the number of Americans dying in motor vehicle crashes has decreased by 31%.1 Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively.1 This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions.
Given the chance, could researchers achieve similar progress with firearm violence? It will not be possible to find out unless Congress rescinds its moratorium on firearm injury prevention research. Since Congress took this action in 1997, at least 427 000 people have died of gunshot wounds in the United States, including more than 165 000 who were victims of homicide.1 To put these numbers in context, during the same time period, 4586 Americans lost their lives in combat in Iraq and Afghanistan.10
The United States has long relied on public health science to improve the safety, health, and lives of its citizens. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence. Otherwise, the heartache that the nation and perhaps the world is feeling over the senseless gun violence in Newtown will likely be repeated, again and again.
By: Arthur L. Kellerman, MD, MPH and Frederick P. Rivara, MD, MPH, The Journal of The American Medical Association, December 21, 2012
“Not A Pox On Both Houses, Just The GOP’s”: Republicans Are Responsible For The Fiscal Cliff And Washington Gridlock
The public is furious at Congress. The business community is furious at Congress. The president is furious at Congress. Heck, the Congress is furious at Congress!
The “Plan B” debacle has further eroded House Speaker John Boehner’s standing in his own caucus. It hasn’t helped much out in the countryside either, telegraphing an image of inaction and disorganization.
All that seems to be left to come out of the Republicans is finger pointing and petty politics. Democrats are so mad that they aren’t far behind either.
But it is the Republicans who have been boxed in by their own extremism. We are to a point where the leadership of the congressional Republicans may be constitutionally (I don’t mean capital “C”) incapable of achieving a deal on almost anything controversial that comes before them. They are so far out of the mainstream, and they answer to their most extreme members, that it is nearly impossible for them to deliver on legislation, without jeopardizing their jobs.
Right now it is the fiscal cliff, next it will be the debt ceiling, then immigration, then climate change, then confirmation of presidential appointments and judges. And somehow Republicans still believe that paralysis will allow them to win elections. They are so caught up in the politics and strapped into their own ideological straight jackets that the word compromise does not leave their lips.
Forget that such intransigence is bad for the country. Forget that the public overwhelmingly supports President Obama’s positions. Forget that the vitriol directed at Congress is at an all time high and only climbing.
Sure, the Republicans now represent more extreme districts politically. Sure, many of them could get beat in a primary if they acted responsibly. Sure, the interest groups headed by the likes of Grover Norquist or now Jim DeMint will come down their throats. But, really, you don’t have the backbone, the spine, the courage to sign on to a compromise that helps the nation? Even when the public has shown in poll after poll that is what they want? Why did you run for Congress in the first place?
The notion of legislators taking on the tough problems and solving them is almost a relic with this crop of Republicans. They don’t see how important it is to work across the aisle and actually accomplish something. Think about it: Would Ronald Reagan tolerate this nonsense? How about George H.W. Bush? How about Dwight Eisenhower? Or Everett Dirksen? Or Howard Baker?
The time for Tea Party extremism is over. Real Republicans should recognize that.
By: Peter Fenn, U. S. News and World Report, December 28, 2012
“NRA Misleads On Assault Weapons”: The ’94 Assault Weapons Ban Was Full Of Loopholes, But Studies Prove It Was Effective
As Democrats move to once again ban assault weapons and NBC host David Gregory gets investigated for using a high-capacity magazine, banned in D.C., as a prop in his interview with the NRA’s Wayne LaPierre, one key question still hasn’t been properly addressed by the media thus far — did the 1994 Assault Weapon Ban actually work?
Even Gregory, who convincingly played a devil’s advocate to LaPierre Sunday, was dismissive of its effect on Sunday. “I mean the fact that that it just doesn’t work is still something that you’re challenged by if you want to approach this legislation again,” he said of the ban to New York Democratic Sen. Chuck Schumer, a supporter of the ban.
There’s a dearth of quality empirical research on the efficacy of the ban, thanks in part to Congress’ statutory limitations on the type of gun violence research the federal government is allowed to conduct. Pro-gun lawmakers made it illegal for research agencies to advocate for gun control, which effectively means looking for any connection between guns and gun violence, but the evidence suggests the law had positive effects, if not as much as advocates would like.
The single formal assessment of the ban, as required by Congress in passing the law, was conducted by criminologists Christopher Koper, Jeffrey Roth and others at the University of Pennsylvania (Koper is now at George Mason). The National Institute of Justice, the research arm of the Department of Justice, paid for the evaluation, which was first conducted in 1999 and updated in 2004, and looked at everything from homicide rates to gun prices.
A few key findings emerged. Overall, banned guns and magazines were used in up to a quarter of gun crimes before the ban. Assault pistols were more common than assault rifles in crimes. Large-capacity magazines, which were also prohibited, may be a bigger problem than assault weapons. While just 2 to 8 percent of gun crimes were committed with assault weapons, large-capacity magazines were used in 14 to 26 percent of of firearm crimes. About 20 percent of privately owned guns were fitted with the magazines.
But even though assault weapons were responsible for a fraction of the total number of gun deaths overall, the weapons and other guns equipped with large-capacity magazines “tend to account for a higher share of guns used in murders of police and mass public shootings,” the study found.
This shouldn’t be surprising to anyone paying attention to the recent history of mass shootings. In just the past year, the same .223 Bushmaster AR-15 assault rifle was used in the Aurora, Colo., theater massacre, the shooting at the Clackamas Mall in Oregon, the Newtown elementary school shooting, and, just a few days ago, the killing of two firefighters in upstate New York. Jared Loughner used 33-round high-capacity magazines in a handgun to shoot former Congresswoman Gabrielle Giffords and more than a dozen others. Seung-Hui Cho used a 15-round magazine to kill 32 and wound 17 at Virginia Tech in 2007.
An October 2012 study from Johns Hopkins, which looked at newer data than Koper’s, concluded that that “easy access to firearms with large-capacity magazines facilitates higher casualties in mass shootings.”
So, according to the official study, was the ban effective in stopping killings? The short answer is yes, though it’s a bit unclear because of the massive loopholes in the law. “Following implementation of the ban, the share of gun crimes involving AWs [assault weapons] declined by 17 percent to 72 percent across the localities examined for this study (Baltimore, Miami, Milwaukee, Boston, St. Louis, and Anchorage),” the Koper study concluded.
Data from the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) also shows a significant drop in assault weapon usage in gun crimes. In the five-year period before the enactment of the ban, the weapons constituted almost 5 percent of the guns traced by the Bureau (the ATF is responsible for tracking guns used in crimes), while they accounted for just 1.61 percent of gun traces after the ban went into effect — a drop of 66 percent. The effect accelerated over time, as the guns presumably became harder to find.
The problem with the ban, as both gun rights advocates (seeking to cast aspersions on the law) and gun control proponents (seeking to explain its limited impact) agree, is that it was weak to the point of being meaningless. As the bill made its way through Congress, gun lobbyists managed to create bigger and bigger carve-outs, the largest being the grandfathering in of guns and magazines produced and owned before the ban went into effect. The guns and magazines could also continue to be imported, as long they were produced before the law went into effect.
At that time of the ban, there were already more than 1.5 million privately owned assault weapons in the U.S. and 25 million guns equipped with large-capacity magazines. Another almost 5 million large-capacity magazines were imported during the ban. These could continue to be used and traded completely legally.
“The ban’s exemption of millions of pre-ban AWs and LCMs ensured that the effects of the law would occur only gradually. Those effects are still unfolding and may not be fully felt for several years into the future,” Koper and his colleagues added.
The other big exemption in the law was the narrow definition of what the government considers an assault weapon. The ban initially targeted 18 gun models, and then prohibited any future models that contained two or more “military-style” features. Some of these features are decidedly superficial, such as a collapsable stock or muzzle shroud, leading the NRA to dismiss the category of assault weapons as artificial and “cosmetic.” Indeed, gun manufacturers were able to legally produce and sell nearly identical guns to ones that were now prohibited by making a few minor tweaks.
Since the ban was allowed to lapse in 2004, there hasn’t been another comprehensive national study. There is, however, some encouraging data on the state level. A Washington Post analysis of gun seizures in Virginia showed a significant drop in the number of high-capacity magazines seized by police during the 10 years the ban was in effect, only for the number to return to pre-ban levels after the law expired. In 1994, the year the ban went into effect, police in the state seized 1,140 guns with high-capacity magazines. In 2004, its last year on the books, that number had dropped to 612. By 2006, it was back to over 1,000.
Garen Wintemute, the director of the Violence Prevention Research Program at the University of California, Davis Medical School, looked at his state’s experience and found a troubling pattern in who purchases guns that were once banned. First, “among those purchasing handguns legally, those with criminal records were more likely than others to purchase assault-type handguns,” he told Salon. Second, “among those purchasing handguns legally who had criminal records, those purchasing assault-type handguns were much more likely than those purchasing other types of handguns to be arrested for violent crimes later.” He wasn’t able to study rifles because the state’s archive of purchases was limited to handguns.
Abroad, the data is even more convincing. In Australia, a 1996 mass shooting that left 36 dead led the conservative government to act swiftly to ban semi-automatic assault weapons with a much stronger law. They did not grandfather in old guns and paid to buy back old ones. Gun-related homicide plummeted by 59 percent between 1995 and 2006, with no corresponding increase in non-firearm-related homicides. Meanwhile, gun suicides — which are responsible for most firearm deaths in most developed countries — dropped by a whopping 65 percent. Robberies at gunpoint also dropped significantly. In the decade prior to the ban, there were 18 mass shootings. In the decade following it, there were zero.
The resounding success of the Australian model shows where the U.S.’s attempt to ban assault weapons failed. By the same token, it shows where we could succeed by implementing a real ban without the carve-outs of the the 1994 law.
By: Alex Seitz-Wald, Salon, December 26, 2012
“Freedom Isn’t Free”: Congress Won’t Act On Gun Control, But The President And The States Can
It has now been nearly two weeks since the Newtown massacre once again cast an ugly shadow of gun violence over our country. In the ensuing fortnight, the pundits have been working overtime generating their ideas on “what to do” about guns.
Their ideas aren’t new: Ban assault weapons. Limit high-capacity magazines. Make access to mental health care as easy as access to a gun. All reasonable ideas, though it must be acknowledged that 1) such hand-wringing after past shootings has faded rather quickly as the public moves on and 2) if anything, because today’s congressional districts are drawn up so safely, lawmakers are less inclined to do anything about guns than ever before.
Let’s face facts: Congress hasn’t passed a major gun control bill since 1994, when at the behest of Ronald Reagan, it approved an assault weapons ban (long since expired) and, in 1993, the Brady Bill, which requires background checks on gun buyers when a gun is bought for the first time. (Subsequent sales of those used weapons are often unregulated, thus the so-called “gun show loophole.”) The fights to pass those laws were nasty and protracted, and in the ensuing years, positions have hardened even more. Bottom line: As disturbing and outrageous as the Newtown massacre was, there is essentially zero chance that Congress will do anything of substance about it.
So what can be done?
The Constitution grants any president of the United States executive powers. Some have argued that President Obama could exercise them to close the gun show loophole — which has arguably allowed up to 40 percent of all private gun purchases to occur with no background check whatsoever, just pay and be on your way. This appears to be easy politics. Even before Newtown, a survey by GOP pollster Frank Luntz said that 85 percent of non-NRA gun owners and 69 percent of NRA members favored this.
Look for this to be among the recommendations given to Obama by his “gun czar,” Vice President Biden. These background checks could also include any known information on a customer’s mental health. The Justice Department has also studied the idea of better information-sharing among different agencies, sort of like how the CIA and FBI began working better together after the Sept. 11, 2001 terror attacks. These are all ideas worth discussing, though state’s rights and privacy laws are legitimate barriers.
Even the National Rifle Association has a few ideas. The NRA’s Wayne LaPierre, blaming just about everyone other than his own organization for Newtown, says Hollywood is at fault for gratuitous violence, as are the manufacturers of violent videogames (one, he said, was called “Kindergarten Killer”). He calls this kind of content “the filthiest form of pornography.” On this one point, LaPierre is right. Parents should know better than to expose their kids to this kind of garbage. But here’s a question for Mr. LaPierre: If the NRA insists that the Second Amendment is sacred and must be protected, is it not hypocritical to suggest that the First Amendment, whose free speech protections cover movie and game makers, be weakened? (It’s a moot point anyway: The Supreme Court, in June 2011, upheld the free speech rights of videogame makers to spew out their filth.)
LaPierre has also suggested, as you’ve no doubt heard, that guns in schools might have prevented the Newtown massacre. “The only thing that stops a bad guy with a gun is a good guy with a gun,” he insisted. LaPierre, whose rantings caused former President George H.W. Bush to quit the NRA in outrage in 1995, seems to have forgotten that an armed guard at Columbine High School couldn’t prevent the murder of 12 students and a teacher (he fired four times and missed). There were plenty of good guys with guns at the Fort Hood army base in 2009. And on and on.
So why not go after guns — and the NRA itself — the way 46 states went after cigarettes back in the 1990s? Guns are similar to cigarettes in one key respect: Long after they are used, both incur very large and ongoing costs that states, local communities, and thus taxpayers are forced to absorb. Aside from the immediate anguish and grief that can result from the use of a gun, the economic burden is spread over many years, in the form of lost work, medical care, insurance, law enforcement, and criminal justice. One study puts a price on this: $174 billion a year.
The societal cost of just one gun homicide averages $5 million, according to the institute. That includes $1.6 million in lost work; $29,000 in medical care; $11,000 on surviving families’ mental-health treatment; $397,000 in criminal-justice, incarceration and police expenses; $9,000 in employer losses; and $3 million in pain, suffering and lost quality of life.
Who pays for much of this? You do. Doesn’t matter whether you have a gun or not. Just like smoking. You pay for much of its after-effects whether you smoke or not.
Here is what the states did about cigarettes: In November 1998, Big Tobacco, worn down by legal wrangling on dozens of fronts, agreed to pay 46 states a minimum of $206 billion over 25 years. The landmark deal, known as the Master Settlement Agreement (MSA), exempted Philip Morris, R.J. Reynolds, Brown & Williamson and Lorillard from private tort liability resulting from harm caused by tobacco use. In addition to paying billions, the companies agreed to end or limit marketing of cigarettes, fund anti-smoking education campaigns, and dissolve industry-funded trade groups such as the “Tobacco Institute.”
The landmark agreement with the states wasn’t designed to put cigarette makers out of business, just make them more accountable and responsible for the use of their product, which was and remains legal. Guns, by virtue of the Second Amendment, are even more protected, but this hardly excuses their defenders from accountability for their use. Only a handful of states and the District of Columbia have laws governing private sales at gun shows. Those who lack such laws can cite states’ rights, a legitimate point — but often it’s the taxpayers in those states who pay for years to come. States with tougher laws can sue neighboring states that don’t to recover their costs; the NRA can be sued for similar reasons. Want a gun? Oppose reasonable restrictions on them? Fine. But you know the saying: Freedom isn’t free. Give those who oppose tighter gun laws an economic incentive to comply.
By: Paul Brandus, The Week, December 26, 2012
“A Very Naughty Boy”: John Boehner Gets More Than 2,000 Lumps Of Coal For Christmas
House Speaker John Boehner will be greeted by more than 2,000 pieces of coal when he returns to Washington after what was unlikely to have been a relaxing vacation in Ohio amid the standoff over the fiscal cliff.
The coal is being delivered by The Action—a campaign to end the Bush-era tax cuts for the wealthiest 2 percent—which says Boehner has been extra “naughty” this year.
Last week, Boehner proposed legislation called “Plan B” that would have ended the Bush-era tax cuts on those with income of up to $1 million, but some House Republicans refused to support it. Democrats and Republicans disagree over whether the nation’s wealthiest taxpayers should see higher rates, but both parties agree they want to avoid tax increases for the middle class.
On NaughtyBoehner.com, The Action entreats supporters to call Boehner’s office because he “is desperate to protect the richest Americans at the expense of the rest of us.” For each call made, the campaign promises to hand deliver one lump of coal to Boehner’s office. As of this writing, the campaign counts 2333 pieces of coal as ready for delivery.
President Barack Obama will be back in Washington Thursday to try to negotiate once more with Congress to avoid the fiscal cliff before tax increases and spending cuts kick in at the end of the year.
By: Elizabeth Flock, Washington Whispers, U. S. News and World Report, December 26, 2012
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