The Cowardice of Our Leaders – Silencing Science on Gun Research

Gentle Reader – I posed a small question in this space some days ago, after the shooting deaths of 26 of us – 20 children and six adults.  Children who will never be older than they were that day. Children who will never smile at their parents again.  Children who will never grow to know the caress of a lover.  I asked, ‘what is wrong with us ?’  Herein is another piece that details a part of the answer.  Our Congress outlawed the use of federal funds for gun research.  They silenced the Centers for Disease Control, they silenced physicians.
These are men and women of both political parties – although mostly Republicans – who do not work for the people of the United States; they appear to be full time employees of the National Rifle Association.
Please read the article below.  See if you disagree.  Comments ?
AJ Layon

Silencing the Science on Gun Research
Arthur L. Kellermann, MD, MPH
Frederick P. Rivara, MD, MPH

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 al (5)  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 al (7) 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.

REFERENCES
1.  Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting  Systems: Fatal Injury Data.  http://www.cdc.gov/injury/wisqars/fatal.html. Accessed December  14, 2012.
2.  Kellermann AL, Rivara FP, Rushforth NB, et al. Gun ownership  as a risk factor for homicide in the home.  N Engl J Med.  1993;329(15):1084-1091.
3.  Farah MM, Simon HK, Kellermann AL. Firearms in the home: parental perceptions.
Pediatrics. 1999;104(5 pt 1):1059-1063.
4.  Omnibus Consolidated Appropriations Bill. HR 3610, Pub L No. 104-208. http:
//www.gpo.gov/fdsys/pkg/PLAW-104publ208/pdf/PLAW-104publ208.pdf.  September 1996.  Accessed December  19, 2012.
5.  Branas CC, Richmond TS, Culhane DP, Ten Have TR, Wiebe DJ. Investigating the  link between gun  possession  and  gun  assault.  Am  J Public Health.  2009;99(11):2034-2040.
6.  Consolidated Appropriations  Act 2012,  Pub L No. 112-74. http://www.gpo.gov/fdsys/pkg/PLAW-112publ74/pdf/PLAW-112publ74.pdf. December  2011.  Accessed December  19, 2012.
7.  Cummings P, Koepsell TD, Grossman  DC, Savarino J, Thompson  RS. The association between the purchase of a handgun and homicide or suicide. Am J Public Health. 1997;87(6):974-978.
8.  Wash  Rev Code  9.41.129. http://apps.leg.wa.gov/rcw/default.aspx?cite
=9.41.129. Accessed December  19, 2012.
9.  Reimer DJ, Chiarelli PW. The military’s epidemic of suicide. Washington Post. http://www.washingtonpost.com/opinions/military-commanders-should
-be-able-to-ask-about-gun-ownership/2012/12/07/d5dd9ba4-4097 -11e2-ae43-cf491b837f7b_story.html.  Published December 7, 2012. Accessed December 17, 2012.
10.  Congressional  Research  Service. American War and  Military Operations: Casualties:  Lists and  Statistics. http://www.fas.org/sgp/crs/natsec/RL32492.pdf. Accessed December  18, 2012.

Author Affiliations:

RAND, Washington, DC (Dr Kellermann); and Department of Pediatrics, Child Health Institute,  University of Washington, and Seattle Children’s Hospital, Seattle (Dr Rivara). Dr Rivara is also Editor, Archives of Pediatrics & Adolescent Medicine.

Corresponding Author: Frederick P. Rivara, MD, MPH, Department of Pediatrics, Child Health Institute, University of Washington, 6200 NE 74th St, Ste 120B, Se- attle, WA 98115-8160 (fpr@uw.edu).

©2012  American Medical Association. All rights reserved.                                                    JAMA, Published online December 21, 2012

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the past approximately 10 years, until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director of Critical Care Medicine in PA. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". You are welcome to respond to him at ajlayon@gmail.com.
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