“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
“A Resettling Of The Hostages”: What The Tea Folk Want In The Fiscal Talks
To properly assess the lay of the land for the continuing fiscal negotiations in Washington, it’s kind of important to understand what those conservative Tea types fighting John Boehner actually want. You get the general impression they just want less compromise than Boehner. But the reality is quite different. Here’s an appropriate reminder from Breitbart’s Joel Pollak:
The present Tea Party dilemma did not begin in November 2012 but in January 2011, when the new Republican leadership in the House of Representatives excluded Tea Party members from the highest leadership positions. The Tea Party, used to opposing but not to governing, acquiesced in a faulty arrangement that allowed the Republican establishment to lead the legislative agenda, and to blame the Tea Party when it failed.
That is exactly what happened in the summer of 2011, when Speaker of the House John Boehner quashed efforts by Rep. Jim Jordan to rally support around the Tea Party’s preferred “Cut, Cap and Balance” proposal in the debt ceiling debate. Boehner then signed onto an ill-fated deal that led to the present “fiscal cliff” impasse–while the Tea Party, slandered by the mainstream media as “terrorists,” bore the burden of blame.
Sounds semi-reasonable until you focus on what the “Cut, Cap and Balance” proposal involves. Here’s a description from June of 2011:
1. Cut – We must make discretionary and mandatory spending reductions that would cut the deficit in half next year.
2. Cap – We need statutory, enforceable caps to align federal spending with average revenues at 18% of Gross Domestic Product (GDP), with automatic spending reductions if the caps are breached.
3. Balance – We must send to the states a Balanced Budget Amendment (BBA) with strong protections against federal tax increases and a Spending Limitation Amendment (SLA) that aligns spending with average revenues as described above.
The “Cut, Cap and Balance” Pledge that was signed by 12 senators and endorsed by every one of the viable GOP presidential candidates (including Mitt Romney) made all three elements a condition precedent to support for any debt limit increase.
Since constitutional amendments require passage in both Houses of Congress by a two-thirds vote, and the version being promoted by conservatives involves a radical and permanent reduction in federal spending, it ain’t happening unless and until vast changes in the composition of Congress occur–maybe on the order of four or five straight 2010-style GOP landslides. So we’re not talking about some temporary “hostage-taking” involving the debt limit, but the kind where the hostage is resettled in another country under armed guard for years.
It is rather important that the media and Democrats understand where the Tea Folk are coming from. They aren’t just trying to push the country towards their policy priorities. The whole idea, and the rationale for all the revolutionary trappings, rhetoric and other folderol, is permanent repeal of much of the domestic policy legacy of the twentieth century–back towards what they imagine the Founders (and for many of them, Almighty God) intended. For the most part, they have little to fear from voters back home. There is no price to be paid for craziness and intransigence, though in most cases there is decidedly a big risk in exhibiting reasonableness.
So that’s who we are dealing with, and best we can tell, there are enough of them in the House to keep Boehner from showing much reasonableness as well.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 27, 2012
“2012, The Year Of Conservative Absolutism”: The Republican Party Embraces An Inflexible And Combative Conservative Ideology
Between now and New Year’s Day, I will occasionally post thoughts about the big political phenomena of 2012. The biggest was the decision made the Republican Party’s rank-and-file and leadership to embrace an unusually inflexible and combative conservative ideology as it sought to topple an incumbent Democratic president and regain control of the Senate. In my opinion, this counter-intuitive approach had more to do with the ultimate results than any other single factor, including the Obama campaign’s great strengths and Mitt Romney’s personal weaknesses, and the thousands of daily events on the campaign trail we all talked about. The only thing that perhaps rivaled the unforced error of the GOP’s basic messaging was the steady if unspectacular improvement in the objective condition of the country–from the economy to national security to the first positive benefits of Obamacare–which made it easier for Democrats to make the election a clear choice of future policy paths.
It didn’t have to be that way. In Mitt Romney the GOP had a presidential nominee who would have been perfectly happy to campaign as a different version of himself, among the many versions he has presented over the years. Republicans did not have to choose a list of Senate candidates so bad–many either open extremists or former “establishment” GOPers afraid to risk conservative criticism–that they managed to lose seats in a cycle when big gains should have been relatively easy. The party’s dreadful performance among younger and minority voters was largely self-inflicted. Nobody made them raise reproductive rights as an issue, particularly in a year when their own pundits and candidates constantly insisted–as though mumbling to themselves–that “social issues” were off the table.
Yet there they were, as prospects for winning the White House and the Senate slipped away, stuck not only with absolutist positions on abortion and LGBT rights that have become increasingly universal in recent years, but with equally absolutist and unpopular positions on tax rates for the wealthy, economic stimulus, health care, climate change, and “entitlement reform.” By the time Romney tried to pose as a “moderate” in the autumn, praying for media complicity in presenting yet another dishonest self-portrait, it was too late.
Yes, demographic trends played a big role in the outcome, but given economic conditions and what might have been a serious falloff in turnout for Obama’s 2008 coalition, a less ideologically rigid GOP would have had a decent chance to prevail.
This is all worth reiterating because there are scarce signs of any Republican reconsideration of basic ideological positioning following the election. Sure, they’ll move partway back to the George W. Bush positioning on immigration–though not without savage internal dissension–and will probably shut up about marriage equality in most parts of the country. Institutions associated with the Tea Party Movement, and some of its leaders, may decline in popularity–not that it much matters insofar as that movement’s point of view has now been largely internalized by the “Republican Establishment,” as Steve Kornacki notes at Salon today. But even as the image of an extremist party continues to sink in, and even as demographic trends make a party of old white people even less attractive to the entire electorate, the prospect of “better” candidates and shrunken midterm turnout patterns will almost certainly prevent any real internal change.
So those of us who thought Barack Obama deserved a second term, and who were horrified by what a Republican White House and Congress might have done–by now we’d be looking right down the barrel of the Ryan Budget being rammed through Congress via reconciliation–owe a lot to the many ideological enforcers of the GOP who made even modest accommodations to political necessity so difficult. And despite the frustrating inability or unwillingness of some in the Beltway media to grasp the basics of asymmetrical polarization, the conservative movement’s constant aggressions convinced enough self-conscious “centrists”–from Thomas Mann and Norm Ornstein to yours truly–that something unsavory was going on in the Elephant Party which had to be repudiated. This enabled Obama and his highly competent campaign to lead a united coalition through thick and thin, and–who knows?–may now help him govern despite all the obstacles he now faces.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 27, 2012
“Hijacked By Ideologues”: The Republicans Have Now Agreed To Raise Taxes For The Entire Country
The inside line from Washington is that there will be no Fiscal Cliff deal before the end of the year.
That’s not surprising. Unfortunately, it always seemed unlikely that our politicians would agree to any vote that could be framed as them having voted to “raise taxes” — which any deal before December 31 could have been framed as.
The more likely scenario seemed to be that politicians would wait until taxes increased automatically on January 1 and then heroically vote to cut them — at least some of them.
And that’s still my bet about what will happen in January.
But just because it seemed likely that politicians would be ruled by “politics” instead of pragmatism doesn’t mean this is something to be proud of.
And let’s be clear about what has happened in the past two months.
What has happened is that the political party that has based its entire existence on never agreeing to a tax hike of any kind has essentially agreed to tax hike for the entire country.
By not accepting the Democrats’ offer to extend the Bush tax cuts for ~98% of Americans, the Republicans have agreed to let taxes rise on ALL Americans.
The Republicans have done this, it appears, only (or at least mainly) in a stubborn attempt to preserve lower tax rates on the highest-earning Americans.
And now those tax rates, too, will go up.
And the economy will slow down.
The Republicans have tried to pin the blame for the tax hikes on the Democrats, but most Americans have seen through this. And rightly so. The Republicans agreed to the coming tax hikes when they voted for the legislation in the summer of 2011. And now, by refusing to extend the tax cuts for all Americans but the richest 2%, the Republicans have tacitly once again agreed to raise taxes on all Americans.
This is what happens when a party that used to be known for pragmatism and responsibility allows itself to be hijacked by ideologues.
A deal to mute the impact of the Fiscal Cliff and raise the debt ceiling should be within easy reach of reasonable people on both sides of the aisle.
Unfortunately, our government isn’t run by reasonable people anymore. Especially on the Republican side.
NOTE: This is my personal view, not “Business Insider’s” So if you want to lecture someone about how the Republicans are absolutely right to agree to raise taxes on the entire country just to avoid voting to increase taxes on the highest-earning Americans, please direct those notes to me.
By: Henry Blodgett, Business Insider, December 27, 2012
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