How research on gun violence is muffled, and who refuses to shut up

On the first day in the new year, I read one of what will become thousands of similar stories that will be published this year in the United States about how firearms were involved in completely senseless and preventable violence.

To understand why we have so many shootings, one may wish to buy this book: Armed America: Portraits of Gun Owners in Their Homes by Kyle Cassidy. Go to http://www.armedamerica.org/. The cover photo provides a shockingly good insight into the national crisis over gun related violence.
To understand why the United States has so many shootings, one may wish to buy this book, Armed America: Portraits of Gun Owners in Their Homes, by Kyle Cassidy. Go to http://www.armedamerica.org/. This book cover photo offers one perspective on the national crisis over the nation’s gun-related violence.

In this particular instance, a 54-year-old woman reportedly shot a  24-year-old man in the thigh over a dispute that he was shooting fireworks at her property in rural Lake Stevens, Wash. No, I am not making this up.

While no one died in this New Year’s eve confrontation, the story barely received three paragraphs of news coverage, as it lacked the dramatic horror that the media exploit when mass homicides occur involving often-legally purchased weapons. There were no dead children or mentally deranged men in military gear loaded with weaponry. Were this story to occur in Canada, or say Japan, it would have received much different coverage.

While we may assume this seemingly “bland” shooting will be counted in national data, that is not guaranteed. It likely could be ignored.

In response to uncertainty over national data, Slate Magazine, on Jan. 1, 2013,  published a story called How Many People Have Been Killed by Guns Since Newtown?. The article alleges guns statistics are “surprisingly hard to come by.” Slate claims it will track the toll of gun related killings with an an anonymous publisher with the Twitter feed @GunsDeath to create an interactive tracking feature. The articles asks readers  who know about gun deaths in their community that are not counted on its interactive map  to tweet @GunDeaths with a citation, and it will be added to the feed.

brady center stat count
The Brady Center keeps a daily tab on gun violence–go to the right corner of the center’s home page for the shooting count, based on CDC data.

The Brady Center, the best known nonprofit that is working to pass legislative fixes to issues such as the sale of semi-automatic weapons and closing loopholes that allow for guns sales without background checks, uses data from the Centers for Disease Control (CDC) (2008-09 estimates). It then makes an estimate of the number of killings a day that may not correspond to the most recent trends. The source data is captured by the CDC National Center for Injury Prevention and Control, reported and accessible through the web-based Injury Statistics Query and Reporting System.

A lesson in how to silence public health researchers, and yes it is about the money

Slate’s professed shock at the lack of poor tracking of gun-related fatalities should actually surprise no one who has monitored the muzzling of research on gun-related violence since the 1990s by the National Rifle Association (NRA), the gun industry’s lobby, and its allies in Congress.

According to a newly published article by Dr. Arthur L. Kellermann and Dr. Frederick P. Rivara (both of whom have MPH degrees), in the Dec. 21, 2012, edition of the Journal of the American Medical Association, gun research at research universities that is funded by the federal government has been systematically quieted by pro-gun forces since a ban was enacted on the CDC in 1996, mainly through budget language. Pulling funding, in effect, silenced the nation’s public health agency on a critical public health issue.

The budget language, which remains in effect today, stated “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.” While it is not clear why individual CDC officials or even highly paid medical and public health professionals have not more publicly risked their professional standing to challenge this language, the authors of the study note, “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.”

Rivara and Kellermann further state that the language restricting such research was expanded after a 2009 study that was federally funded, this time by the National Institute on Alcohol Abuse and Alcoholism, if a gun increases or reduces the risk of firearm assault. Congress, in 2011, during the Obama administration and amid the Tea Party insurgency of 2010, “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.”

The two authors highlight other efforts taking place national to stifle medical professionals from speaking out, such as Florida’s law (HB 155), which put health care practitioners at risk of penalties, including the loss of their licenses, “‘if they discuss or record information about firearm safety that a medical board later determines was not ‘relevant’ or was ‘unnecessarily harassing.'”

How silencing plays out at research universities, quietly and likely without intent

This blog has reported that the silence within the research community can be found at major public health research programs, such as the University of Washington School of Public Health, which  I attended from 2010 to 2012. I was unable to find any faculty actively teaching future public health leaders–my classmates–about firearms safety research or gun violence in the school’s public health curricula.

It should be noted Dr. Rivara is an adjunct faculty member of the UW School of Public Health, and Dr. Kellermann and he are also graduates of the same school (for their MPH degrees). Dr. Kellerman was in fact my graduation commencement speaker, and proved to be a passionate scientist and advocate to all of us. However, my review of courses did not reveal any classes focussing on gun violence as a public health issue; this does not mean Dr. Rivara and other faculty did not cover this topic in their classes. (It should also be noted that a keyword search for “guns” on the UW SPH web site today, Jan. 2, 2013, yielded only three pages, one focussing on Dr. Rivara and another focussing on Dr. Kellerman.)

During my studies there, I repeatedly raised this anomaly to my professors and during seminars in front of as many faculty as possible–often to the point of becoming an annoyance to those who had heard me ask the same questions repeatedly. But short of actually sitting in on faculty strategy sessions or having any survey data, it is impossible for me to know the reasons why my former school choose not to include this topic in its curricula. There were and remain classes on issues that do receive federal funding: tobacco cessation, obesity and nutrition, maternal and child health, and much more. All are worthy topics, but these were the winners, guns was a loser.

My guess remains it was purely a matter of funding, or lack of funding, and the intense internal pressure on junior faculty to pursue research dollars highly coveted by all departments that were not tied to this pariah topic. Thus the silencing of research continued, without any alarm bells raised from a larger community of researchers, who should be the most active and who should have been leaders, locally and nationally. That is how it works.

Dr. Rivara’s primary role is as a faculty member at the UW School of Medicine, Department of Pediatrics. To his credit, he has shown continued national leadership on gun violence. He and Dr. Kellerman deserve great praise for their lifelong service and work on this topic. Hopefully their article also will shame and embarrass their distinguished academic peers–locally and nationally–into either creating endowed teaching positions or a campaign drive to fund research that can shed light on this national public health crisis that has seized the nation’s attention since the massacre of 20 children and six faculty in a public school in Newtown, Conn. in December. MPH students also can lobby for change too, despite the hazards of confronting faculty who grade and often employ them as assistants.

Given that many faculty at these institutions can earn salaries well above $200,000 annually, some may be reluctant to jeopardize their professional careers or positions in the name of public-minded research on a topic that is at the center of one of the nation’s greatest moral debates since the Civil Rights movement and perhaps since the violent ending of slavery during the Civil War.

Gun researchers who have not been silenced by budget threats

Researchers not blocked by the ban on the CDC and NIH have shown that a prized policy goal of the NRA and gun makers, expanding “standing your ground laws,” have lead to more homicides.Researchers have found that states with a stand your ground law record more homicides than states without such laws.

Data from the study by Hoestra and Cheng, as published on the NPR.org web site (Jan. 2, 2013).
Data from the study by Hoekstra and Cheng, as published on the NPR.org web site (Jan. 2, 2013).

Two economics researchers at Texas A&M University, Mark Hoekstra and Cheng Cheng, found that the laws “do not deter burglary, robbery, or aggravated assault. In contrast, they lead to a statistically significant 8 percent net increase in the number of reported murders and non-negligent manslaughters.” The findings run counter to the argument of the primary proponent of such legislation, the NRA.

On average, there are about 500-700 more homicides a year among the 23 states with stand your ground laws because of these laws: “One possibility for the increase in homicide is that perhaps [in cases where] there would have been a fistfight … now, because of stand your ground laws, it’s possible that those escalate into something much more violent and lethal,” says Hoekstra.

The Newtown massacre and musings on guns, morality, and public health

The brutal massacre of 20 young children and six public school employees in Newtown, Conn., on Dec. 14, brought to mind one of the greatest speeches in U.S. history, President Abraham Lincoln’s Second Inaugural Address. On March 4, 1865, well into the fifth year of the bloodiest U.S. conflict, to resolve the criminal institution of slavery, Lincoln evoked unusually strong biblical and moral language that he normally avoided.

This FaceBook Post generated comments that said, this is why this country is so great and also why it is is so “f’d up” (https://www.facebook.com/photo.php?fbid=314047015290064&set=o.113895238664965&type=1&theater)
This facebook post generated comments that said, this is why this country is so great and also why it is so “f’d up” (https://www.facebook.com/photo.php?fbid=314047015290064&set=o.113895238664965&type=1&theater)

He first stated that the continuing expansion of slavery was the goal of the South. “All knew that [slavery] was, somehow, the cause of the war. To strengthen, perpetuate, and extend this interest was the object for which the insurgents would rend the Union … .” Then Lincoln, in language well understood by his countrymen, further noted the sins and injustice of slavery had brought the wrath of an Old Testament God upon the nation: “Fondly do we hope–fervently do we pray–that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue, until all the wealth piled by the bondsman’s two hundred and fifty years of unrequited toil shall be sunk, and until every drop of blood drawn with the lash, shall be paid by another drawn with the sword, as was said three thousand years ago, so still it must be said the judgments of the Lord, are true and righteous altogether.”

A moral issue?

In short, Lincoln held his country morally accountable for that “peculiar institution.” He used moral language, much the way Dr. Martin Luther King, Jr., a century later, used similar language to address the injustices of discrimination and racism in the Jim Crow South and throughout the country. Such language by elected officials, however, has been mostly absent from the national debate over firearms violence that is involved in the death of more than 11,000 U.S. residents annually (homicides alone).

But the debate over the regulation or expansion of guns and automatic weaponry on the open market may have turned a page with Newtown shooter Adam Lanza’s killing spree. He used at least three guns (Glock 10 mm and a Sig Sauer 9 mm handguns and a Bushmaster .223-caliber) that were first obtained legally. He stole all of them from his well-to-do mother after killing her.

This Bushmaster .223, as of Dec. 16, was being advertised for sale on the Internet.
This Bushmaster .223, as of Dec. 16, was being advertised for sale on the Internet.

The availability of such lethal weaponry is far from an aberration. The Bushmaster .223 can easily be purchased now. Here’s one ad I found on Dec. 16; the weapon is described as intended for military combat.

In response to this mass murder of mostly kids, Peter Drier, professor of politics and chair of the Urban & Environmental Policy Department at Occidental College, posted a piece on Dec. 15, on the Alternet web site titled “The NRA’s Wayne LaPierre Has Blood on His Hands: The Brady Campaign to Prevent Gun Violence has a 62-page list of mass shootings in America since 2005. It is Wayne LaPierre’s resume.” Drier asserts that “the long list of killings is due in large measure to the political influence of the [National Rifle Association] NRA—and the campaign finance system that allows the gun lobby to exercise so much power.” In short, the NRA, the gun industry it lobbies for,  the NRA’s alleged 4 million members, and officials in elected office are all morally accountable for downstream effects of firearms proliferation.

Who is morally accountable for mass gun shootings like Newtown's? Just the shooter or weapons industry promoters like NRA CEO Wayne LaPierre,
Who is morally accountable for mass gun shootings like Newtown’s? Just the shooter or weapons industry promoters like NRA CEO Wayne LaPierre.

The NRA’s influence

The NRA, of course, alleges that the Second Amendment to the Bill of Rights gives individual Americans the right to possess guns, even combat weapons designed for the mass killing of people. The NRA also, in my opinion, falsely alleges that regulating gun sales and ownership is an attack on our constitutional freedoms–even our “civil rights.” Such language is devoid of both logic and rationality, and absent any moral foundation. I continue to find “literalist” interpretations of the U.S. Constitution, which also legitimized slavery for decades, as irrelevant to the complexities of a public health crisis that weapons-related violence has become in this country.

But, the NRA is more than a gun lobby. Its annual budget exceeds more than $250 million. It donates generously to political campaigns. It runs a non-profit foundation that boasts having raised $160 million. It runs a multimedia operation to promote its extremist views. It is, at the state level, aggressively promoting gun rights such as “stand your ground” laws. In the U.S. Senate, John Thune (R-S.D.) introduced a measure that would force all states that issue concealed carry permits to recognize the permits from other states. More importantly, the NRA promotes both the culture of weapons proliferation and a social media ecosystem that enables extremist views to proliferate, both inside its ecosystem and in the blogosphere, where many NRA talking points pepper the comments section of news stories on gun violence.

Using a public health lens to debate gun violence

In addition to embracing moral language, the national debate should also use a public health lens and the widely available data at all times to bury the completely false NRA propaganda that “guns don’t kill people, people kill people.” For example, the Harvard School of Public Health’s Injury Injury Control Research Center examined peer-reviewed research and reported three main findings that point to the association between gun proliferation and homicides, including in the United States:

1. Where there are more guns there is more homicide.
2. Across high-income nations, more guns = more homicide.
3. Across states, more guns = more homicide.

A public health approach involves looking at the data, having a population focus (rather than focusing on the motives of a mentally disturbed killer), examining the policies and systems that enable guns to continue impacting the public’s health, and focusing on forces that develop dangerous personal behaviors—even the embracing of ideas that promote harmful activities such as owning guns. The conservative-leaning Seattle Times, which has not called for any legislative action to address firearms violence this past week (following two mass killings), pulled together some data from public sources on Dec. 15, regarding mass murders involving firearms (my comments in italics):

  • Shooting sprees are not rare in the United States.
  • Eleven of the 20 worst mass shootings in the past 50 years took place in the United States.
  • Of the 12 deadliest shootings in the United States, six have happened from 2007 onward.
  • America is an unusually violent country. But we’re not as violent as we used to be. (See the graph below.)
  • The South is the most violent region in the United States.
  • Gun ownership in the United States is declining overall. (However, we have more than 300 million guns in the U.S.–a staggering figure.)
  • States with stricter gun-control laws have fewer deaths from gun-related violence.
  • Gun control, in general, has not been politically popular. (This fact  overlooks how campaign funding impacts local and national races.)
  • But particular policies to control guns often are.
  • Shootings don’t tend to substantially affect views on gun control.
Duke University sociology professor Kieran Healy complied OECD data on violence in developed countries (excluding Estonia and Mexico) and concluded “America is a violent country.” Such data points to both a pathology toward violence and how aassults in the U.S. end up with lethal consequences (his data does not distinguish cause of death from say guns to knives.) Go to: http://www.kieranhealy.org/blog/archives/2012/07/20/america-is-a-violent-country/
Duke University sociology professor Kieran Healy compiled OECD data on violence in developed countries (excluding Estonia and Mexico) and concluded “America is a violent country.” Such data points to both a pathology toward violence and how assaults in the U.S. end up with lethal consequences (his data do not distinguish cause of death from say guns to knives). Go to: http://www.kieranhealy.org/blog/archives/2012/07/20/america-is-a-violent-country/

A 2003 study by EG Richardson and D Hemenway  (called “Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003”) found that he United States has “far higher rates of firearm deaths-firearm homicides, firearm suicides, and unintentional firearm deaths compared with other high-income countries” and that the “United States is an outlier in terms of our overall homicide rate.”

Referencing this study, the Brady Campaign concludes that “the United States has more firearms per capita than the other countries, more handguns per capita, and has the most permissive gun control laws of all the countries.” The Brady Campaign further notes that “of the 23 countries studied, 80% of all firearm deaths occurred in the United States; 86% of women killed by firearms were U.S. women, and 87% of all children aged 0 to 14 killed by firearms were U.S. children.”

More blood from the sword … for the lash?

What remains to be seen is if the preponderance of data and the moral outrage that may have been generated by the Newtown shootings will create change.

President Obama, the day of the shootings, held a press conference and said, “We’re going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics.” Gun control advocate and billionaire New York City Mayor Michael Bloomberg dismissed such talk immediately:  “Not enough,” Bloomberg said. “We have heard all the rhetoric before. What we have not seen is leadership — not from the White House and not from Congress. That must end today.” To date Obama has not used his office to promote any national legislation or even national dialogue on gun policy.

One thing is certain: there will be more mass murders in the United States involving legally obtained and legally sold firearms. And I am left paraphrasing Lincoln and wondering: how much more blood from such gun-related killings will have to be spilled to atone for our nation’s continued shortcomings to control what other developed nations have managed to do, and do for decades?