[This is the first of a two part series. Part 2 is here.]
The editors of a number of medical journals are gun nuts. Not nuts about guns, but guns must drive them nuts.
Those with the Journal of the American Medical Association and its affiliated specialty journals are leaders of this pack. Its Internal Medicine journal is on a roll. It began releasing articles online in October arguing against gun possession, and has collected them in its print edition this month.
As the loyal opposition within the medical professions, DRGO addresses what’s right and, too often, wrong with the state of “medical research” about firearms. Which is usually neither medical nor research. It’s not related to the diagnosis or treatment of injuries and illnesses that affect humans. And it’s not sound, rationally premised, analytically valid scientific work. The entire notion of “gun violence as a public health issue”, let alone a “crisis”, is completely unfounded. (See “Can ‘Gun Violence’ Be Addressed as a Public Health Issue?”.)
So, on to this month’s malpractice. . .
The issue leads off with a Viewpoint, “Gun Violence and Firearm Safety in Medical School Curricula: Missed Opportunities to Improve Patient Health”. These essays are almost always couched in “Here I stand!” terms as if the authors were modern Martin Luthers bravely questioning tradition. These writers stand firmly in the mainstream of modern medical prejudice, daring nothing but professional acclaim from like-minded propagandists.
Here a medical student at Northwestern, Arianna Yanes, repeats the distressed physicians’ cries that they should include routine inquiries about gun ownership, use and handling. It’s great that she got a lead article in Internal Medicine on her résumé. It’s good that she recognizes the absence of firearm safety training in medical education, and that doctors “should be trained to communicate the risks of firearms” apolitically and not make it “about why people should or should not have guns.”
But she doesn’t get that limiting CDC funding on anti-gun propaganda has not restricted the growth of “research into gun violence prevention”; there is more than ever. She doesn’t see that routine inquiries and documentation of patients’ gun ownership is a privacy violation for people who have no desire for their weapons to be listed anywhere. And comparing gun ownership to “having lead paint on a bedside wall” misses the point that teaching gun safety is about following The Rules, not eradicating an environmental hazard.
The next Viewpoint is “Reducing Suicides Through Partnerships Between Health Professionals and Gun Owner Groups—Beyond Docs vs Glocks” by Catherine Barber et al. Ms. Barber is the director of Means Matter at Harvard’s School of Public Health. She usually argues anything to convince people that the general possession of firearms is the fundamental problem, but here she aims at a worthy target. Helping gun shops contribute to suicide prevention in perceptibly at risk customers is an incremental and positive step. The National Shooting Sports Foundation and the American Foundation for Suicide Prevention have joined forces on this, and it’s going national.
Providers, don’t lead with “Do you have guns at home?” but yes, advise removal of weapons when patients are struggling with self-destructive feelings. Good advice, as well as “If a friend is struggling . . . [tell them] ‘Let me babysit your guns for a while.’” But this ignores how difficult that can be in states imposing “universal background checks” on any transfer of a firearm outside of immediate family.
A brief editorial introducing the JAMA Internal Medicine “Firearm Violence” series is next, by Robert Steinbrook, MD (et al) of Yale. He believes “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.” He goes right into the fake news about motor vehicle accidents killing about as many people as overall “gun violence” (There are only about 1/50 the number of firearm vs. motor vehicle accidental deaths. The rest are suicides and homicides.)
Chana Sacks, MD of Brigham & Women’s Hospital in Boston addresses “The Role of Physicians in Preventing Firearm Suicides”. Yes, Dr. Sacks, “There is a consensus among physician organizations that gun violence is a public health issue”—but there is not among physicians generally. She is right that “Death from suicide . . . is clearly within the medical sphere” and that “access to firearms is a risk factor for suicide”, one that enhances lethality and suicide completion threefold. She doesn’t grasp that laws like Florida’s Firearm Owner Privacy Act penalize only inappropriately quizzing patients about gun ownership, not inquiring and acting when there may be health-related (i.e. danger) reasons.
Another Viewpoint is “The Road Ahead for Personalized Firearms”, by Joseph Simonetti , MD, MPH (et al) at the Denver VA Medical Center. Simonetti, like many ivory tower fantasists, is inspired by the possibilities for injury prevention of [not very] “smart” guns. He does review problems with relying on technology in firearms more objectively than most. But his preferred path to adoption is through the “federal government . . . expanding the development and early adoption of personalized firearms.” This ignores one of the free market’s best qualities, sorting out by user assessment the true value of things new and different. Gun owners and users are the most important judges of whether to trust purposely compromised firearms to work on demand.
David Humphreys, PhD (et al) in Social Policy and Intervention at Oxford, wrote “Evaluating the Impact of Florida’s Stand Your Ground” Self-defense Law on Homicide and Suicide by Firearm: An Interrupted Time Series Study”. (An actual study—note how little original research actually appears in print like this.) The authors claim to have shown that Florida’s 2005 SYG law increased total homicides by 24% and gun homicides by 32%. They compared Florida’s experience from 1999 to 2014 with states they say did not have SYG laws during the same time (New York, New Jersey, Ohio, and Virginia).
- Virginia did have a longstanding version of a SYG law during the entire study period. Besides, the demographics and culture of the other three “control” states are quite different from Florida’s. Thus, comparing the experiences in Florida to these non-comparable “control” states is a non-starter.
- The study’s introduction mentions other studies that have found either a far lower or no change in homicides associated with SYG. The broadest study, in numbers of states and years, found none.
- In the Data Analysis section, the authors report that they did not analyze Hispanic, African-American, or female groups separately due to inadequate numbers. Thus, disparate effects based on ethnicity and genders were ignored in the overall findings.
- Their graphs showing pictorially the changes in Florida homicide and gun homicide rates are very curious. These show gently declining rates before 2005, but abruptly spike right about October 2005, the month SYG became law. Then they continue the same gentle decline from that peak that characterized them before.
- This study (as nearly all that find firearms increase danger) did not examine “the effect of the Florida law . . . on crime and public safety.” So the known value of suppressing criminals’ initiative by posing more risk to them in more places was disregarded.
- They made no attempt to discriminate justified or negligent homicide from intentional homicide (murder). Justified homicides may well have properly increased with the expansion of legal defense options to include SYG. (Although actual defense uses of that law have been rare.)
The trends they chart do not show real-world behavior. The effect of any new law is not seen instantly; it becomes apparent over time, as people become aware of it and subsequently may modify their behaviors based on its opportunities and consequences. A law expanding justifiable homicide possibilities was highly unlikely to be suddenly used as an excuse to go people hunting, no matter what the media feared.
John Lott, PhD of the Crime Prevention Research Center reviewed this piece and interpreted the data points differently and more realistically, too. (Some points above also come from Lott.) His graph of Florida homicides showed a gradual trend upward, peaking in mid-2007 then beginning an identical gradual decline after. He also questions why only those 4 states were selected as controls, when the greatest reliability is obtained with the greatest number of study and control subjects.
In Chapter 13 of his newest book, The War on Guns, he shows how SYG laws have steadily reduced murders (i.e., unjustified, non-negligent homicides), rape and aggravated assaults. He addresses SYG laws as adopted or not across all the states, analyzed over equal numbers of years before and after. Interestingly, robbery ticked up overall from its lowered rate in year 7 after, although in Florida it kept dropping. Also in 2005-2006, Florida’s average arrest rate for murder dropped from 82% to 67%, for reasons that are not clear. Was this related to differences in the identification of homicides? More than one thing at a time changes in life and in data.
More to come on Thursday!
— DRGO Editor Robert B. Young, MD is a psychiatrist practicing in Pittsford, NY, an associate clinical professor at the University of Rochester School of Medicine, and a Distinguished Life Fellow of the American Psychiatric Association.
[This article was written with assistance from the DRGO Publications Review team.]