ONTD Political

The Ban on Gun Violence!... Research.

7:23 pm - 12/23/2012
Silencing the Science on Gun 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?

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. Nevertheless, many gun owners, including gun-owning parents, still keep at least one firearm loaded and readily available for self-defense.

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.”

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 al 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.

These are not the only efforts to keep important health information from the public and patients. For example, in 1997, Cummings et al 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.

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.

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%. Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively. 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. To put these numbers in context, during the same time period, 4586 Americans lost their lives in combat in Iraq and Afghanistan.

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.
a_phoenixdragon 24th-Dec-2012 03:10 am (UTC)
Sadly, I am surprised by none of this...*Headdesk*
wingstar102 24th-Dec-2012 03:36 am (UTC)
Yeah, neither am I. Makes me rage really hard.
maryseif 24th-Dec-2012 01:22 pm (UTC)
God I just wish SOMETHING would be done. There was another big shooting last night not far from me in Bellevue and it's just getting *scary*.
tilmon 24th-Dec-2012 04:09 am (UTC)
We need a Supreme Court that will rule against laws prescribing research topics and discussion. Laws restraining the conditions of research are one thing. Restraining the actual topic? That's censorship. You don't get to forbid finding out the truth just because you suspect it will undermine you.

Edited at 2012-12-24 04:09 am (UTC)
ahzuri 24th-Dec-2012 04:28 am (UTC)
Its a good way to keep people under your thumb, keep em in the dark and keep em stupid. Sad part is that many people won't even see that its happening, they will find way after way to try and justify the actions.
silver_apples 24th-Dec-2012 06:37 am (UTC)
I'm uncertain about this argument. Shouldn't the government have some say in how federal money is spent, beyond which agency gets it? What if someone wants to find a cure for homosexuality? I feel weird using that argument--slippery slope arguments irk me--but it's late and that's the best I can come up with.

But presumably the NIH and CDC and whoever else have an approval process for research and the allocation of their funding, and I'd rather doctors and scientists made this decision than politicians and lobbyists. Still, I'm not convinced it's a matter for the Supreme Court, unless it's part of a broader case about lobbyists and special interest groups.
lastrega 24th-Dec-2012 12:25 pm (UTC)
Yeah, but any application for research funding has to be justified with reference to the peer-reviewed literature and supported by evidence for the importance and scientific merit of the project. The government can and does set areas of research priority in publicly funded research, but it should not be banning the funding of research in a clear area of public need and interest.
grace_om 25th-Dec-2012 12:09 am (UTC)
Shouldn't the government have some say in how federal money is spent, beyond which agency gets it?

Sure, but the problem is when decisions about what research gets done is at the whim of elected officials who are beholden to lobbyists and campaign donors and don't care so much about the taxpaying/voting public (who don't know any better if no one is allowed to do the research).


grace_om 25th-Dec-2012 12:28 am (UTC)
Shouldn't the government have some say in how federal money is spent, beyond which agency gets it?

Sure, but the problem is when decisions about what research gets done is at the whim of elected officials who are beholden to lobbyists and campaign donors and don't care so much about the taxpaying/voting public (who don't know any better if no one is allowed to do the research).


roseofjuly 25th-Dec-2012 03:40 pm (UTC)
And when they don't understand the research. Such was the case when Sarah Palin criticized the fruit fly research without realizing that it's the basic building block for research on treatments for autism. That kind of stuff happens every day, because the people holding the purse strings don't understand the science. That's why one day I'd like to work in a Congressional office as a science liaison or whatever you call it.
grace_om 27th-Dec-2012 01:39 am (UTC)
I think what you say is true, but I fear it's also true that many of these people do not want to understand the science because that would conflict with their/their constituent's and donor's beliefs. Take Sarah Palin for example: she could never admit that fruit flies could tell us anything about people, because that would require accepting evolution.

Don't mind me though, I'm an old and cynical govt scientist ;-> I wish you the best of luck in your career and having a positive influence on science in politics. It's so important for the future of country, and indeed, the world.
roseofjuly 27th-Dec-2012 03:22 pm (UTC)
Thanks :) What agency do you work for, if you can say? I'm currently in grad school (getting my PhD - social sciences, although I have an appreciation for all kinds of scholarly work) and I'd like to eventually either be a professor or work as a researcher for a government agency like NIH, SAMHSA, CDC, etc.
grace_om 28th-Dec-2012 05:36 am (UTC)
I work for a state agency now, but I've worked for/at EPA and NIH, as well as abroad. Feel free to contact me privately, if you have questions I might be able to help with. :-)
roseofjuly 25th-Dec-2012 03:39 pm (UTC)
Yes, there's a peer-review process, but the money actually has to be there and a lot of the way the money is spent depends on the funding agency's priorities. The scientists who review the grants only make a recommendation - even if you get a perfect score, you can't be 100% you'll get funded. And a lot of the scoring has to do with what the agency wants. Before they even get together a grant proposal, most scientists talk to their program officer (an employee of the agency whose job it is to guide scientists) to see if their topic will be well-received. The program officer knows what the agency's funding priorities are. For example, right now, HIV, cancer, and obesity are hot topics and you can get funding for those. There are other topics that are less "sexy," so to speak, and even the best program officers may advise their scientists not to waste their time trying to get funded for that (or find a way to spin the grant proposal so it seems related to a hot topic).
romp 24th-Dec-2012 08:26 am (UTC)
Sounds good to me. Isn't there a vicious cycle of marijuana being dangerous by the gov't because it hasn't been proven otherwise and the research is hard to come by because it's illegal?
skellington1 24th-Dec-2012 08:04 pm (UTC)
Yup.

But I'm sure my state'll be working on that pronto, what with our recent legalization and all. :P

(The other issue with MJ is just that it's a natural product with a high degree of variation).
hinoema 24th-Dec-2012 05:08 am (UTC)
Over the last 20 years, the number of Americans dying in motor vehicle crashes has decreased by 31%. Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively. This progress was achieved without banning automobiles, swimming pools, or matches.

1. Automobiles, swimming pools and matches have a functional purpose other than killing; they are not solely created to cause death by traumatic injury.

2. No one is trying to ban guns, just regulate them so that using a gun requires at least as much responsibility and maturity as driving a car, and abusing that responsibility has at least as much consequence. Stop trying to destroy the argument by making it ridiculous.

3. STFD, article. Old cliché arguments are old.
silver_apples 24th-Dec-2012 06:18 am (UTC)
Either I'm misunderstanding you or you misunderstood the article. The argument here is that research into injury prevention can lead to reduced injury rates without banning the cause of the injuries. Research into gun-related injuries and death could help prevent future gun-related injuries and death, but the research has been forbidden because people are afraid of having their guns taken away. The author is saying that refusing to allow the research is bad, not that if pools don't get banned than guns shouldn't be either.
hinoema 24th-Dec-2012 07:32 am (UTC)
True; I'm thinking more of how such an argument is inevitably used, regardless of framing. Plus both can be done- ban assault rifles and high power weapons, and study how to best regulate the rest. (Personally, I have no problem with banning pretty much everything except low power hunting rifles for civilians, so...)

I also wonder who is actually banning this research. Usually a statement like "people are afraid of having their guns taken away" is a cover for special interests.

Edited at 2012-12-24 07:33 am (UTC)
grace_om 25th-Dec-2012 12:03 am (UTC)
Well, it would seem to be gun manufacturers who control the message -- the message which is then put out by the NRA. It's very reminiscent of big tobacco and the fight to regulate cigarettes on public health grounds.

Terri Gross(NPR "Fresh Air") aired an interesting interview recently on this topic. He talked about the restrictions against research on gun violence. I hadn't heard this before, but as someone who works in risk assessment it didn't surprise me. We are constantly under legal and financial pressure not to investigate things, because...no risk assessment = no risk in the minds of those seeking profits from something which may be quite harmful (or possibly not, but we'll never know without independent investigation).
tabaqui 24th-Dec-2012 03:58 pm (UTC)
Well, happy rage-filled Xmas-eve to you, too! Pisses me off so hard when funding and the research for it is tied into political friggin' *agendas* that are *not* in the public interest.
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