Medical establishment argues for gun control: longform report


Second Amendment rights advocates can finally rest assured that Hillary Clinton won’t be coming for their guns anytime soon.

But the medical establishment may be.

In a massive, unprecedented report on gun safety research, JAMA Internal Medicine this morning published some exhaustive commentary, analysis and research about gun safety. They posed questions including:

Should the medical community have a right to counsel patients about gun safety?

With access to guns a proven driver of suicide, why aren’t we doing more to stop it, and how can we get laws changed to make it easier for us to do that?

What has been the result of Florida’s “Stand Your Ground” self-defense law?

“Firearm violence in the United States has continued unabated,” JAMA writes in an editorial leading off the series.  “In June 2016, a mass shooting at the Pulse nightclub in Orlando, Fla. killed 49 people and wounded 53 others. As of October 15, 2016, Chicago had recorded more than 570 homicides this year, levels not seen since the 1990s. Shootings in which four or more people are injured or killed (including shooters) occur almost daily.”

Yet after reviewing their research, the oft-heard argument, “Guns don’t kill people, people kill people” still holds true. That’s not to say some of their findings regarding suicide prevention don’t make for solid arguments for physicians being able to counsel those at risk of hurting themselves.

“This series follows from the belief that if the United States were to implement a coordinated and sustained public health, research, and law enforcement commitment to prevent firearm violence, many lives would be saved,” JAMA writes in the editorial. “In 2014, firearm injuries were responsible for about the same number of deaths in the United States as motor vehicle crashes. Although deaths from motor vehicle crashes have substantially decreased since 2000, deaths from firearm injuries have substantially increased, mostly from suicides.”

Accounting for 33,599 U.S. gun deaths in 2014

The grisly death-by-firearm breakdown goes like this:

Suicide: 21,334

Homicide: 19,945

Unintentional: 586

Legal intervention: 464

Undetermined: 270

For a total of 33,599 gun deaths in the U.S. in 2014.

“In a research letter, Alcorn documents the reasons and consequences of the low number of studies about firearm injuries and gun violence in the United States,” the editorial argues. “From 1985 to 1999, publications increased markedly. Soon after the 1996 ban on the Centers for Disease Control and Prevention’s funding for such research, publications plateaued at about 90 articles annually through 2012. In 2013 and 2014, publications increased again after the mass shooting of school children and educators at Sandy Hook Elementary School in Newtown, Conn. In December 2012.”

Federal funding of ‘gun control advocacy’ research banned

In a systematic review of firearm laws and firearm homicides published as part of today’s JAMA report, Dr. Lois Lee and colleagues from Boston Children’s Hospital, Harvard Medical School and Harvard T.H. Chan of Public Health essentially find inconclusive data regarding whether stricter gun controls stop people from killing one another. Essentially, there is no “magic bullet” for stopping the bloodshed.

“In the aggregate, stronger gun policies were associated with decreased rates of firearm homicides, even after adjusting for demographic and sociologic factors,” the authors concluded after evaluating 34 articles published from 1970 to the present in PubMed, the nation’s medical research database. “Laws that strengthen background checks and permit-to-purchased seemed to decrease firearm homicide rates. Specific laws directed at firearm trafficking, improving child safety, or the banning of military-style assault weapons were not associated with changes in firearm homicide rates. The evidence for laws restricting guns in public places and leniency in gun carrying was mixed.”

The authors called for better research and more funding for such research, as did the accompanying JAMA editorial. “Given the 19,000 deaths from firearm homicide each year, many of which are preventable, it continues to be a national shame that the United States does not fund sufficient robust research to inform this public health imperative and establish which types of firearm laws work. Since 2012, federal law has banned all Department of Health and Human Services agencies, not just the Centers for Disease Control and Prevention (CDC) from using funds ‘in whole or in part, to advocate or promote gun control.’ This vague language continues to have a negative effect on federal funding of firearm injury and gun violence research. Some states, local governments, and private philanthropists try to fill the void.”

An analysis of Florida’s ‘Stand Your Ground’ self-defense law

In an original investigation published as part of the firearm series, researchers from University of Oxford, London School of Hygiene and Tropical Medicine, and University of Pennsylvania, Philadelphia, examined whether Florida’s “Stand Your Ground” self-defense law had an impact on homicides

I’m curious whether the study’s conclusions take into consideration that homicide is a legal term. If so, then its claim that firearm-related homicides went up by 31.6 percent monthly (homicides in general went up 24.4 percent monthly) implies that the shooters all were convicted of murder, as opposed to some of them being found not guilty under the self-defense clause. That was not immediately clear to me.

While I do not want to trivialize any loss of life, it is important to know whether self-defense was legitimately used. Only the court system decides that, and the court system was not specifically referenced in the piece.

“Throughout the United States, the application of lethal force as a means of self-defense is governed by criminal law,” the authors wrote. “Since the colonial era, it has been an individual’s ‘duty to retreat’ from perceived threats before resorting to any use of force.”

Florida’s law removed that “duty of retreat” when a threat is made on a person’s property, as almost half the states have. Florida’s law went further and removed “duty of retreat” when threats are made in public places.

“Advocates of the laws suggest that the increased threat over retaliatory violence deters would-be burglars, resulting in fewer intruder encounters,” the authors wrote. “Critics are concerned that weakening the punitive consequences of using force may serve to escalate aggressive encounters. They also argue that these laws may exacerbate racial disparities in homicide where threats motivated by racial stereotypes produce unnecessary fatalities.”

The authors admitted their study has several limitations. “Circumstances unique to Florida may have contributed to our findings, including those that we could not identify … Finally, there has been considerable debate over the potential of the Florida law to deter crime and improve public safety. Our study examined the effect of the Florida law on homicide and homicide by firearm, not on crime and public safety.”

The role of physicians in preventing firearm suicides

Perhaps the strongest arguments made in the JAMA firearm series are for finding ways to better prevent firearm owners from committing suicide. Ironically, states with some of the strictest gun control laws have created a situation whereby it is difficult to transfer ownership from a suicidal person to someone else, even temporarily.

In a “Special Communication” in the JAMA series published by Alexander D. McCourt of Johns Hopkins Center for Gun Policy and Research and Johns Hopkins Bloomberg School of Public Health and colleagues, policies in Maryland, Colorado, and California are examined. All take different approaches to firearm transfers.

“In the United States, suicides account for 63 percent of firearm deaths, and self-inflicted firearm injury is responsible for half of all suicides,” the authors write. “Firearm suicide affects nearly all age groups. In 2014, there were 929 suicides by firearm among person aged 10 to 24 years, 9,612 for those aged 25 to 54 years, and 9,277 for those aged 55 and older.”

The letter makes the case that some individuals experiencing psychological distress can be talked into giving up their guns, at least temporarily, although the public health experts admit no data is available to back up this claim.

“Reducing access to firearms and other lethal items is a recommended, evidence-based practice to prevent suicide,” claim the authors. “In the case of a firearm owner at elevated risk of self-harm, the recommendation would be to temporarily store the gun away from home or store it locked in such a way that the at-risk person does not have access at least until the mental health crisis has resolved.”

While many doctors’ organizations have encouraged their members to talk to patients about gun control when appropriate, many admit they choose not to.

“Universal background checks before firearm purchase are effective public health measures, but should be supplemented with specific protocols for temporary transfer of firearms from the home and for storage,” the authors recommend. “Protocols for temporary transfer may help to reduce the risk of other forms of firearm violence, including intimate partner violence situations where the firearm owner can be persuaded to voluntarily remove a firearm from the home.”

The authors recommend “incorporating and improving on aspects of Colorado’s exemptions to background checks” to include:

  1. “Clear statutory provisions that allow for temporary storage by federally license firearm dealers, law enforcement, officials, family members and friends.”
  2. Allow period of transfer to last at least 14 days or longer if recommended by a physician or mental health professional. Make sure children or any other unauthorized user cannot access where the firearm is being held.
  3. “Limit the liability related to these temporary transfers to instances of gross negligence or reckless behavior by the person who transfers the firearms.

“Efforts to educate physicians and the public should carefully explain these provisions to allay fears about potential liability associated with the temporary transfer of firearms from the home and to encourage transfers for suicide prevention,” the authors conclude. “Public health professionals and firearm organizations should collaborate to develop tailored and effective messaging that is acceptable to physicians, mental health professionals, and the public. Policy changes should also be evaluated to assess whether they have the intended effect of reducing firearm suicides.”

Reducing gun violence: Compromises that have worked

In yet another JAMA viewpoint in the series titled, “Reducing Suicides Through Partnerships Between Health Professionals and Gun Owner Groups – Beyond Docs vs. Glocks,” the authors from Harvard Injury Control Research Center says that in some states firearm retailers have been part of the solution.

“In New Hampshire, where over 85 percent of firearm deaths are by suicide, a group of firearm retailers, gun rights advocates, public health and mental health professionals began meeting in 2009 to examine the role gun shops might play in reducing suicide,” according to the piece. “The New Hampshire Firearm Safety Coalition’s first products were posters and brochures aimed at gun shop customers that promoted the ‘11th Commandment of Firearm Safety:’ Be alert to signs of suicide in friends and family and help keep firearms from them until they have recovered. Materials suggested options like temporarily storing guns away from home (i.e. with a friend, if local law allows, at a self-storage unit or at a gun shop), or keeping the guns at home under new lock and key that the vulnerable person has no access to until they have recovered. Unannounced visits at all 65 independent gun shops in the state found that 48 percent were displaying at least one of the materials, a good uptake for information on a topic as difficult as suicide.”

For the record, I never have been a fan of guns and I do not own one. In fact, I can’t even imagine owning one, even though I have been the victim of violent crime more than once.

But I have come to understand in recent years why people should have the right to bear them in matters of self-defense. And it is a fundamental right granted to us by our forefathers, so any attempt to restrict it in even the slightest of ways should be made with great caution, particularly in an uncertain nation    and an uncertain world.

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