The role of gun violence and street crime in the United States and the world is currently a subject of great debate among national and international organizations, including the United Nations. Because the Second Amendment to the U.S. Constitution protects the individual right of American citizens to own private firearms, availability of firearms is greater in the U.S. than the rest of the world, except perhaps in Israel and Switzerland.
The Bogeyman --- 'Easy' Gun Availability
Nevertheless, many individuals and organizations, particularly the American Medical Association (AMA) and the American public health establishment are concerned about the number of gun deaths in the U.S. --- 30,000 average deaths annually in the past decade, calling it a public health epidemic.
Moreover, public health researchers decry that violent injuries with firearms affect disproportionately older children and adolescents; tragically, up to 4000 of these deaths occur in teenagers and young adults. In 2002, suicides accounted for 16,586 deaths; homicides for about 10,801 deaths; and unintentional injuries (accidental shootings) for another 776 deaths.
In some inner cities, 23 percent of students have witnessed violence in their schools and reportedly up to 12 percent of youngsters have carried a gun to school in any given academic year. With these frightening statistics, it's not surprising that many Americans believe that a greater effort should be made to enforce the 20,000 U.S. gun laws already in place and which sometimes are not fully enforced, particularly those pertaining to keeping guns away from minors, the mentally ill, and the criminal element.
Thus, the medical and public health establishments strongly support gun control measures they believe will reduce the availability of firearms and gun violence. Even the influential AMA has joined this political campaign, bolstered by medical journal editors, government officials, and the Centers for Disease Control and Prevention (CDC).
To promote this campaign, the public health establishment, including the AMA and the CDC, has propounded the public health/epidemiologic model for gun and violence research, which espouses the concept of guns and bullets as virulent pathogens that need to be stamped out by limited gun availability and ultimately eradicating guns from the civilian population. Similarly, the UN has repeatedly issued proclamations for the world community denouncing the trafficking of small arms and the possession of firearms by private citizens as a global threat.
The Public Health Gun Control Debate
With nearly messianic enthusiasm some public health officials and physicians have jumped into the gun control debate with unprecedented vigor.
Katherine Christoffel, M.D., a pediatrician and one of the founders of the Handgun Epidemic Lowering Plan (HELP), a stringent gun control organization, has declared, for example, that "...Guns are a virus that must be eradicated. We need to immunize ourselves against them." Furthermore, she says, "...Get rid of the cigarettes, get rid of the secondhand smoke, and you get rid of lung disease. It's the same with guns. Get rid of the guns, get rid of the bullets, and you get rid of death."(1)
Dr. Jerome Kassirer, a former editor-in-chief of The New England Journal of Medicine (NEJM), established the concept that when it comes to "assault" weapons, he subscribed to the "no-data-are-needed policy" of the NEJM and asserted that if a little gun control doesn't work, then, certainly more gun control is needed: "If we still found them wanting [gun control laws], we would be justified supporting even more stringent restrictions."(1)
But there is a great obstacle standing in their way. The Second Amendment to the U.S. Constitution reads: "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed." Pro-Second Amendment physician groups --- such as Doctors for Responsible Gun Ownership (DRGO) led by California physician Timothy Wheeler, M.D. and Doctors for Integrity in Policy Research (DIPR) led by Edgar Suter, M.D. --- do not agree with the application of the public health/epidemiologic model to gun control. They counter that prejudice against gun ownership by ordinary citizens is pervasive in the public health community in spite of professed objectivity and integrity in scientific research.
Wheeler and Suter have denounced a pattern of bias against firearms that is pervasive in the medical and public health literature that ignores the importance of individual responsibility and moral conduct. They cite authorities such as Dr. Mark Rosenberg, the former Director of the CDC's National Center for Injury Control and Prevention (NCIPC), who in 1994 told The Washington Post: "We need to revolutionize the way we look at guns, like what we did with cigarettes. Now it [sic] is dirty, deadly, and banned."(1)
A few public health officials like Dr. C. J. Peters, head of the CDC's Special Pathogens Branch, have expressed concerns about the direction public health has taken and reported to the Pittsburgh Post-Gazette, in the midst of the 1996 controversy over taxpayer-funded gun (control) research, "The CDC has got to be careful that we don't get into social issues...If we're going to do that, we ought to start a center for social change. We should stay with medical issues."(1)
Public health officials traditionally have followed Koch's Postulates of Pathogenicity for investigating, diagnosing and treating or controlling epidemic diseases. These steps developed by the illustrious German pathologist Robert Koch (1843-1910) state: First, the germ must be found growing abundantly in every patient and every diseased tissue. Second, the germ must be isolated and grown in the laboratory. Third, the purified germ must cause the disease again in another host. Koch's Postulates are a time-proven, simple but logical series of scientific steps carried out by medical investigators to definitively prove a microorganism is pathogenic and directly responsible for causing a particular disease. The Postulates do not apply to the problem of guns and violence.
Gun violence is an aspect of criminology and not of medicine. Guns and bullets are not virulent pathogens but inanimate objects that are wielded by individuals who should be held accountable when they misuse them.
Despite a surfeit of scientific and epidemiologic studies in the sociologic, legal, and criminologic literature that discuss the benefits of firearm possession by law-abiding citizens --- physicians and the general public are not being informed about this vital information by the AMA, the CDC and their outlets, the medical journals.
Citizenship and the Beneficial Aspect of Gun Ownership
Recent scholarship in the criminologic, sociologic, and legal literature shows that the defensive uses of firearms by citizens amount to 2.5 million uses per year and dwarf the offensive gun uses by criminals. Between 25-75 lives are saved by a gun for every life lost to a gun. Medical costs saved by guns in the hands of law-abiding citizens are 15 times greater than costs incurred by criminal uses of firearms. Guns also prevent injuries to good people and protect billions of dollars of property every year.
Moreover, the actual U.S. health care costs of treating gunshot wounds is approximately $1.5 billion, which is less than 0.2 percent of the U.S. annual health care expenditures. The $20-$40 billion figure so frequently cited in the medical literature, has been found to be deliberate and exaggerated estimate of lifetime productivity lost, where every victim of crime is assumed that had not his life ended untimely he would have become a wealthy successful citizen. Reality points otherwise: Many "victims" are criminal elements who have been killed in the act of perpetrating serious crimes either by the police or by law-abiding citizens acting in self-defense.
Since at least the mid-1980s, Dr. Arthur Kellermann of Emory University, whose work had been funded by the CDC, published a series of studies purporting to show that persons who keep guns in the home are more likely to be victims of homicide than those who don't. In a 1986 NEJM paper, Drs. Kellermann and Donald T. Reay claimed that defending oneself or one's family with a firearm in the home is dangerous and counter productive, noting that, "a gun owner is 43 times more likely to kill a family member than an intruder."(2) This conclusion, though, was severely criticized by numerous investigators, who have not only discerned evidence of methodologic and conceptual errors in the study, but also found that the authors, most significantly, had failed to consider and underestimated the protective benefits of guns.(3-5)
On the other hand, Prof. John R. Lott, Jr., reviewed the FBI's massive yearly crime statistics for all 3054 U.S. counties over 18 years (1977-1994), the largest national survey on gun ownership and state police documentation in illegal gun use. The data show that while neither state waiting periods nor the federal Brady Law is associated with a reduction in crime rates, adopting concealed carry gun laws cut death rates from public, multiple shootings (e.g., as those which took place in Dunblane, Scotland, and Tasmania, Australia in 1996 or the infamous Columbine High School shooting in Littleton, Colorado, in 1999) --- by an amazing 69 percent. Allowing law-abiding citizens to carry concealed weapons deters violent crime --- without any apparent increase in accidental death. If states without right to carry laws had adopted them in 1992, about 1570 murders, 4177 rapes, and 60,000 aggravated assaults would have been avoided annually.(6)
In Prof. Lott's survey, children 14 to 15 years of age were found to be 14.5 times more likely to die from automobile injuries, 5 times more likely to die from drowning or fire and burns, and 3 times more likely to die from bicycle accidents than they are to die from gun accidents.
When concealed carry gun laws went into effect in a given county, murders fell by 8 percent, rapes by 5 percent, and aggravated assaults by 7 percent.(6)
Suicide, Accidental Shootings, Children and Guns
Several gun researchers have written about suicides and have linked these fatalities to the availability of guns.(7) Medical critics, however, cite the overwhelming evidence compiled from the psychiatric literature that untreated or poorly managed depression is the real culprit behind the relatively high rates of suicide in the U.S. Moreover, countries such as Japan and Hungary, and in Scandinavia --- all of which boast draconian gun control laws and low rates of firearm availability - have much higher rates of suicide (2 and 3 times higher) than the U.S.(5,8,9) In those countries, citizens simply use other cultural or universally available methods, such as Hara-kiri in Japan, drowning in the Danube as in Hungary, suffocation (with poisonous gases such as stove or automobile exhausts), or simply hanging and strangulation like in Denmark and Germany, or even drinking agricultural pesticides as is commonly done in Sri Lanka. And in these countries, citizens commit suicide quite effectively by these methods at higher rates than in the U.S. (Figure 1)
A child's death from any cause is a tragedy. In 2000, 600 children and adolescents died of accidental gunshot wounds, 2700 perished in motor vehicle accidents, 3600 children died from burns, 3900 died of drowning, and 12,100 died from poisoning. These are all tragedies, but do we want to ban automobiles, matches, swimming pools, and household chemicals? Firearm accident rates in the United States have been declining steadily since the turn of the century, because of the emphasis placed on gun safety and education courses, including the National Rifle Association's Eddie Eagle program which has touched in excess of 11 million youngsters in the U.S. (Figure 2)
As far as teenage violence is concerned, more than 20,000 laws are already on the books, including a sizable number pertaining to the proscription of handgun possession by minors and banning guns on school grounds. Yet, despite all the media's sensationalization of crime, the latest available FBI statistics for 2000 show that, like the not-so-well known drop in gun accident rates, there has also been a steady decline in homicide rates for every segment of American society. In fact, in the U.S., murder and violent crimes have reached 30 and 25-year low rates, respectively. The opposite has been the case in Australia and Great Britain.
Gun Violence and Civil Liberties --- International Perspective
Australians are learning the lessons of indiscriminate, draconian gun control laws the hard way. In 1996, a criminally insane man shot to death 35 people at a Tasmanian resort. The government immediately responded by passing stringent gun control laws, banning most firearms, and ordering their confiscation. More than 640,000 guns were seized from ordinary Australian citizens.(10)
As a result, there has been a sharp and dramatic increase in violent crime against the disarmed law-abiding citizens, who in small communities and particularly in rural areas are now unable to protect themselves from brigands and robbers. That same year in the state of Victoria, there was a 300 percent increase in homicides committed with firearms. The following year, robberies increased almost 60 percent in South Australia. By 1999, assaults had increased in New South Wales by almost 20 percent. Two years following the gun ban/confiscation, armed robberies rose by 73 percent, unarmed robberies by 28 percent, kidnappings by 38 percent, assaults by 17 percent and manslaughter by 29 percent, according to the Australian Bureau of Statistics.
Interestingly, the same thing occurred in Great Britain. Following a 1996 massacre of school children by a madman in Dunblane, Scotland, the British government banned and ordered the confiscation of most firearms. Since then a horrific crime wave has taken place in England and Scotland. In 1998, the U.S. Department of Justice declared that the rate of muggings in England had surpassed that in the U.S. by 40 percent, while assault and burglary rates were nearly 100 percent higher in England than in the U.S.
To make matters worse for England --- and this is also true for Canada --- in those countries where citizens are disarmed in their own homes, day burglary is commonplace and dangerous because criminals know they will not be shot at if caught flagrante delicto. Not so in the U.S., where burglars not only prefer night burglaries but try to make sure homeowners are not at home to avoid being shot at by the intended victim.(11)
The rising tide of thievery and burglaries in England has dubbed Britain "a nation of thieves," wrote the London Sunday Times (January 11, 1998), which noted: "More than one in three British men has a criminal record by the age of forty. While America has cut its crime rate dramatically Britain remains the crime capital of the West. Where have we gone wrong?"
Depending on the level of culture and social progress, violence can take different forms in different societies. For example, in the mid-twentieth century, the communist government of dictator Joseph Stalin killed more Soviet citizens through privation, forced labor, and famine than succumbed on the battlefields of Russia fighting the Germans in World War II.
More recently, in 1994, the Hutu-led Rwandan government massacred between 800,000 and 1.1 million people mostly Tutsis in a genocide carried out largely with machete-wielding government forces. The massacres took place despite the nearby presence of United Nation "peace-keeping" forces armed with automatic weapons who failed to intervene.
In an interesting article, researchers Andrés Villaveces and associates reported on the effect of a gun ban on homicide rates in two Colombian cities, Cali and Bogotá.(12) The authors were careful to note that indiscriminate banning of firearm carrying, enforced with intrusive police measures, such as checkpoints, search and seizures during traffic stops, etc., may not have a similar effect in cities where homicides are less common. Nevertheless, in those high crime South American cities where drug trafficking is also a serious problem the measures resulted in a reduction of homicide rates.
Some authorities argue that such measures could and should be used in the U.S. (and perhaps Great Britain and Australia) to reduce homicide rates and gun violence.
Opponents counter with constitutional and civil libertarian arguments and point out the deep cultural and political differences between the U.S. and countries such as Colombia torn by severe political strife and social instability. Studies in the U.S., in fact, as previously shown, have demonstrated that concealed carry gun laws actually reduce crime in those states in which they have been implemented. Unregulated gun carrying in such cities as Cali and Bogotá (114.6 and 60 homicides per 100,000 persons-year, respectively; and 88 per 100,000 for Colombia as a whole) cannot be satisfactorily compared to the U.S. (9.7 per 100,000), where we have a system of state-regulated, concealed carry, gun licensing.
The situation in Colombia, a country virtually devoid of the rule of law and immersed in anarchy, warfare and daily acts of terrorism, is not analogous to the U.S., a constitutional republic imbued with individual liberties and the rule of law.
Many educators and criminologists assert that we must lay the blame for gun violence where it belongs: An increasingly permissive culture that for many years has been mired in political correctness and where public schools no longer teach traditional morality and the discernment between right and wrong, leading to situational ethics and moral relativism. To the detriment of children, building self-esteem has been placed ahead of personal morality and teaching them to distinguish between right and wrong. There is also lack of discipline at home and in schools because parents and teachers are afraid of reprimanding the young for fear of being denounced by social workers, charged with child abuse, and prosecuted by the state.
A study by the U.S. Dept. of Justice's Office of Juvenile Justice and Delinquency Prevention tracked 4000 juveniles aged 6-15 inDenver (CO), Pittsburgh (PA), and Rochester (NY) from 1993-1995. The investigators found that children who use firearms with parental supervision, as far as hunting and target shooting, are less likely to commit acts of violence and street crimes (14 percent) than children who have no guns in their homes (24 percent); whereas children who obtain guns illegally do so at the whopping rate of 74 percent.(13)
This study also provides more evidence that in close nuclear families, where children are close to their parents, youngsters can be taught to use guns responsibly. These youngsters, in fact, grew up to be more responsible in their conduct and more civil in their behavior.
We can be compassionate and still be honest and have the moral courage to pursue the truth and find viable solutions through the use of sound, scholarly research. The problem of guns and violence should be no different.(14) We have an obligation to reach our conclusions based on objective data and scientific information rather than on ideology, emotionalism or partisan politics.
1. Faria MA Jr. The perversion of science and medicine (Part I): On the nature of science; (Part II): Soviet science and gun control; (Part III): Public health and gun control research; (Part IV): The battle continues. Medical Sentinel 1997;2(2):46-53 and Medical Sentinel 1997;2(3):81-86.
2. Kellermann AL, Reay DT. Protection or peril? An analysis of firearm-related deaths in the home. N Engl J Med 1986;314:1557-1560.
3. Suter E. Guns in the medical literature --- a failure of peer review. J Med Assoc Ga 1994;83(3):137-148.
4. Kopel DB. Children and Guns in Guns Who Should Have Them, New York, NY, Prometheus Books, 1995, pp. 309-443.
5. Faria MA Jr. Public health and gun control --- A review (Part I): The benefits of firearms. Medical Sentinel 2001;6(1):14-18and (Part II): Gun violence and constitutional issues. Medical Sentinel 2001;6(1):11-18 and Faria MA Jr. Public health and gun control- A review(Part II): Gun violence and constitutional issues. Medical Sentinel 2001;6(1):11-13.
6. Lott JR Jr. More Guns, Less Crime --- Understanding Crime and Gun Control Laws. Chicago, IL, University of Chicago Press, 1998.
7. Sloan JH et al. Firearm regulations and rates of suicide: A comparison of two metropolitan areas. N Engl J Med 1990:322:369.
8. Kopel DB. The Samurai, the Mountie, and the Cowboy: Should America Adopt the Gun Controls of Other Democracies? Buffalo, New York, NY, Prometheus Books, 1992.
9. Kates DB, Schaffer HE, Lattimer JK, Murray GB, Cassem EH. Guns and public health: epidemic of violence or pandemic of propaganda? Tennessee Law Review 1995;62:513-596.
10. Faria MA Jr. Gun control in Australia - chaos down under. Medical Sentinel 2000;5(3):107.
11. Faria MA Jr. More gun control, more crime. Human Events, July 9, 1999, p. 654.
12. Villaveces A, Cummings P, Espitia V, et al. Effect of a ban on carrying firearms on homicide rates in 2 Colombian cities. JAMA 2000;283(9):1205-1209.
13. U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, "Urban Delinquency and Substance Abuse," 1999, p. 18.
14. Bennett JT, DiLorenzo TJ. From Pathology to Politics: Public Health in America. New Brunswick, NJ, Transaction Publishers, 2000. See also the review of this book by Faria, MA Jr. Public health - from science to politics. Medical Sentinel 2001;6(2):46-49.
Miguel A. Faria, Jr., M.D., Editor emeritus of the Medical Sentinel of the Association of American Physicians and Surgeons (AAPS), http://www.hacienda pub.com. This article is excerpted in part from Medical Warrior: Fighting Corporate Socialized Medicine and updated from previous writings on this subject. Copyright©2002 Miguel A. Faria, Jr., MD.
Originally published in the Medical Sentinel 2002;7(4):112-115, 118. Copyright ©2002 Association of American Physicians and Surgeons.