Docs, Guns, and the CDC

A major engagement in the war over the right to keep and bear arms was fought in the House of Representatives this past July. The House voted to shift $2.6 million away from the National Centers for Injury Prevention and Control (NCIPC) — a research unit of the Centers for Disease Control (CDC) — and earmark the funds for other health research projects. The funding was equivalent to the amount spent by the NCIPC in its campaign to redefine guns as “first and foremost, a public health menace.”

In a letter to House colleagues, Representative Jay Dickey (R-AR), who sponsored the amendment to redirect the NCIPC funding, explained that “NCIPC’s director of the division of violence preventionhas this to say about the political agenda at NCIPC: “What we have to do is find a socially acceptable form of gun control.” In a letter to Senator Arlen Spector (R-PA), who chairs the Subcommittee on Labor, Health and Human Services, and Education of the Senate Appropriations Committee, several senators who support the effort to curtail NCIPC’s anti-gun activities noted NCIPC Director Mark Rosenberg’s vision of “a long-term campaignto convince Americans that guns are, first and foremost, a public health menace.”

The redirection of $2.6 million away from NCIPC — a figure that amount to less than five percent of the unit’s total budget — has been described as an assault on public health by tools of the “gun lobby.” In reality, it is a modest and overdue effort to deprive the anti-gun lobby of a taxpayer subsidized propaganda organ. At stake as well is the scientific integrity of public health research.

Politicized Medicine

The medical establishment’s campaign to “pathologize” firearms is an outgrowth of an American Medical Association (AMA) crusade against domestic violence, which began in 1991. Numerous concerned physicians (including this author) eagerly enlisted in what was perceived as a worthwhile cause. However, the investigation of the seemingly interrelated topics of domestic violence and street crime, and the attempt to find workable solutions (as supported by the available scientific literature), have led many medical practitioners to a tragic but unshakable conclusion: The entrenched medical/public health establishment, acting as a willing accomplice of the gun control lobby, has conducted politicized, results-oriented, gun control research based on what can only be characterized as junk science.

This is so, in large part, because gun control is the pasture where the NCIPC’s milk cow is grazing. The Clinton Administration, whose domestic crime control strategy focuses on midnight basketball and gun control, was hardly inclined to devote funding to health research that undermined its preferred policy options. Some might find it curious that midnight basketball would be linked to gun control, but the connection is obvious: Both take a therapeutic approach to crime control. From the perspective, crime is a disease, and gun control is a public health issue, rather than an infringement of a constitutionally protected right.

Thus was born the scientific preposterous — but politically expedient — concept of guns and bullets as animated, virulent pathogens which must be contained by limiting gun availability — with the eradication of private gun ownership as the ultimate cure. The NCIPC’s assignment in this campaign was, and continues to be, to create a “scientific” basis — however spurious — for this campaign.

Dr. Patrick O’Carroll, a CDC official, was quoted in the February 3, 1989 Journal of the American Medical Association (JAMA) as saying:

” ‘Bringing about gun control, which itself covers a variety of activities from registration to confiscation, was not the specific reason for the [NCIPC’s] creationHowever, the facts themselves tend to make some form of [firearms] regulation seem desirableThe way we’re going to do this is to systematically build a case that owning firearms causes death.” [Emphasis added.]

In their zeal to create a new concept of “disease,” officials conveniently ignore Koch’s Postulates of Pathogenicity, the time-proven and logical series of scientific steps carried out by medical investigators to prove a microorganism is directly responsible for causing a particular disease. Guns and bullets, of course, have no infectious properties. Their ability to inflict harm is a matter of individual responsibility.

But there is another dimension neglected by the anti-gun medical faction — namely, the surfeit of scientific, sociological, legal, and criminological literature discussing benefits of firearm possession by law-abiding citizens. Unfortunately, data which demonstrate the health and safety benefits of gun ownership do not jibe with NCIPC’s prime directive, which has been “to systematically build a case that owning firearms causes death.”

Faulty and Biased Research

Among the most prominent members of the medical anti-gun faction is Dr. Arthur Kellermann of Emory University School of Public Health. Since at least 1986, Dr. Kellermann and his associates, whose research has been underwritten by the CDC, have published several studies purporting to show that individuals who keep guns in the home are more likely to be victims of homicide than those who do not. The Kellermann studies have been published in the New England Journal of Medicine (NEJM) and JAMA amid great fanfare, and their “findings” have been eagerly recited in the mainstream press.

One of Kellermann and company’s most famous “findings,” which were reported in a 1986 NEJM paper, is that an individual who keeps a gun in his house “is 43 times more likely to kill a family member than an intruder.” Although the study received relatively little critical scrutiny, its chief finding was quickly canonized by the press. One of the few qualified observers who carefully examined the 1986 study was Dr. Edgar A. Suter, chairman of Doctors for Integrity in Policy Research (DIPR), who refers to the dramatic risk-benefit ratio as Kellermann’s “43 times fallacy.”

In a critical review published in the March 1994 Journal of the Medical Association of Georgia (JMAG), Dr. Suter cited “methodologic and conceptual errors,” in the Kellermann study, such as prejudicially truncated data (that is, convenient omission of certain facts) and a reliance on non-sequiturs. He also noted that in the study, “the correct methodology was described but never used by the authors.”

Moreover, by confining the study to the body count, Kellermann failed to consider the protective benefits of guns. A proper tally of those benefits, Suter noted would include instances that do not involve the use of lethal force. According to Dr. Suter, “The true measure of the protective benefits of guns are the lives saved, the injuries prevented, the medical costs saved, and the property protected — not the burglar or rapist body count. Since only 0.1% – 0.2% of defensive gun usage involves the death of the criminal, any study, such as this, that counts criminal deaths as the only measure of the protective benefits of guns will expectedly underestimate the benefits of firearms by a factor of 500 to 1,000.”

In a 1993 NEJM article (the research for which was also heavily funded by the CDC), Dr. Kellermann again attempted to show that guns in the home are a greater risk to the victims than to the assailants. Kellermann dealt with critiques offered by Dr. Suter and other qualified scholars by simply ignoring them and using the same methodology employed in his 1986 study. However, the results of the 1993 study were further skewed by Kellermann’s selection of study populations with disproportionately high rates of serious psycho-social dysfunctions.

For example, 53 percent of the case subjects chosen by Kellermann had a history of a household member being arrested; 31 percent had a household history of illicit drug use; 32 percent had a household member hit or hurt in a family fight; and 17 percent had a family member hurt so seriously in a domestic altercation that prompt medical attention was required. Moreover, both the case studies and control groups in this analysis had a very high incidence of financial instability. As Dr. Suter points out, all of the factors listed above “would expectedly be associated with higher rates of violence and homicide.” The results of such a study cannot be extrapolated to the general population. Furthermore, the 1993 study once again failed to consider the protective benefits of firearms. This time, however, Kellermann and associates arrived at the downgraded but still incorrect “2.7 times fallacy.”

Despite what appeared to be premeditated errors in the 1993 study, its conclusions have permeated the establishment media. Further, because the data and the flawed conclusions have been published in “reliable” medical sources, they have been recited in medical journals and are regarded as credible by physicians, social workers, professional organizations, law enforcement, and policymakers.

Predictably, none of the attention lavished on Kellermann’s politically inspired conclusions has been given to studies conducted by Professor Gary Kleck of Florida State University, criminologists Don B. Kates and David Kopel, and the scholarly members of Doctors for Integrity in Policy Research. The studies of these conscientious investigators document that the benefits of gun ownership by law-abiding citizens have been greatly underestimated. In his monumental work, Point Blank: Guns and Violence in America, Professor Kleck found that the defensive uses of firearms by citizens amount to 2.5 million times per year and dwarf the offensive gun uses by criminals. Between 25 and 75 lives are saved by a gun for every life lost to a gun.

Significantly, medical costs saved as a result of gun use by 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. Yet, the AMA/CDC/NCIPC establishment ignores these findings, clings to the erroneous figures of Dr. Kellermann and other NCIPC researchers, and uses the suspect conclusions in formulating health and gun control policies.

A Sinister Objective

Behind the faulty research and the dissemination of this biased information lies a sinister objective. This objective was discussed by respected criminologist Don B. Kates in a 1995 Tennessee Law Review article entitled “Guns and Public Health.” After examining the activities of NCIPC and its allies, Kates concluded: “Based on studies, and propelled by leadership from the Centers for Disease Control and Prevention (CDC), the objective [of defining guns as a public health risk] has broadened so that it now includes banning and confiscation of all handguns, restrictive licensing of owners of other firearms and eventual elimination of all firearms from American life, excepting (perhaps) only a small elite of extremely wealthy collectors, hunters or target shooters. This is the case in many European countries.”

According to Kates, “In this connection, the term ‘gun control’ needs some clarification. That term could mean no more than non-controversial measures to prohibit gun misuse or gun possession by high-risk groups. In the literature we are analyzing, however, ‘guns are not…inanimate objects, but in fact are a social ill,’ and controlling them implies wholesale confiscation from the general public so as to radically reduce gun availability to ordinary people.”

As a neurosurgeon who has spent countless hours treating victims of gunshot wounds, this writer has witnessed the deplorable consequences of armed violence. But we must have the moral courage to pursue the truth and find viable solutions through the use of unbiased, sound, scholarly research. Regrettably, the CDC, particularly the NCIPC, and a distressingly large portion of the medical establishment have pursued a grossly politicized agenda and have, in essence, become a powerful arm of the gun control lobby — at measurable expense to the traditional mission of protecting public health.

One particularly damning example of the CDC’s blatant support for the gun-banning lobby is found in the Spring 1995 issue of the Injury Prevention Network Newsletter. An article entitled “What Advocates Can Do” includes the following statement: “Make your support for federal, state and local gun laws known to your representative. This may include: opposing repeal of the assault weapons banrestricting ammunition availability by caliber and quantitymaintaining restrictions on issuance of concealed weapons permits…” This same newsletter discloses that it was “supported in part by Grant #R49/CCR903697-06 from the Centers for Disease Control and Prevention.” In other words, by the taxpayers — including gun owners.

Public Challenge

In a letter to Senator Arlen Specter, Chairman, Dr. William Waters of Doctors for Integrity in Policy Research protested the “overt political activism of the NCIPC staff and their federally-funded researchers.[T]here seems to be a tacit assumption — perhaps even foundational concept — among many public health researchers that firearm prohibition/control provides a ready solution to many of society’s ills. We believe that this view is expressed in the NCIPC’s approach to the problem of violence, since the research performed is fantastically narrow in scope, excludes most of what is known about violence in human societies from consideration or study, and is often performed using abysmally poor methodology.” When supporters of NCIPC’s findings and funding are challenged, Dr. Waters observed, they take refuge in tautology: “There seems to be a tendency on the part of those defending the NCIPC to simply reiterate figures depicting the problem of firearms violence/injury as justification for the agency’s existence.”

Concerned about the political corruption of public health research and possible violations of the public trust, DIPR representatives sought to educate key members of Congress and the Senate; others took the case directly to the public via local and syndicated radio and television shows, including National Empowerment Television (NET). A critical breakthrough occurred when Dr. Timothy Wheeler, president of the California-based Doctors for Responsible Gun Ownership, appeared on the CBS program This Morning to debate Dr. Jerome Kassirer, editor-in-chief of the NEJM. Dr. Kassirer had defended the supposed objectivity of the CDC-supported gun studies in a previous NEJM editorial.

Dr. Kassirer’s defense of the CDC provided an opportunity for Dr. Wheeler to display, on camera, a copy of the anti-gun issue of the Injury Prevention Network Newsletter cited above. The cover of that issue, which bore the title, “Women, Guns and Domestic Violence,” displayed an illustration of a menacing handgun blasting away at the defenseless female symbol. Wheeler was also able to share some of the “neutral” recommendations offered within that tax-funded newsletter. Here is a sampling from the publication: “Put gun control on the agenda of your civic or professional organization. Release a statement to the media or explain in your organization’s newsletter why gun control is a women’s (or nurses’ or pediatricians’…) issue. Ask TV and print media to name the gun manufacturer in every story it runs involving gun violence. Organize a picket at gun manufacturing sites, perhaps with posters showing pictures of victims of gun violenceWork for campaign finance reform to weaken the gun lobby’s political clout. Boycott publications that accept advertising from the gun lobby or manufacturers…Get media attention for your events. Encourage your local police department to adopt a policy prohibiting officers from recommending that citizens buy guns for protection.”

Federally subsidized CDC researchers also became directly involved in anti-gun rights agitation. For example, NCIPC-funded researchers and staff served as faculty at the Handgun Epidemic Lowering Plan (HELP) “strategy conference,” held in Chicago in 1993 and 1995. Those meetings assembled “like-minded individuals who represent organizations [that seek to] use a public health model to work toward changing society’s attitude so that it becomes socially unacceptable for private citizens to have guns.”

Dr. Katherine Christoffel, one of the founders of this conference, is known for her anti-firearms activism. Dr. Christoffel has stated: “Guns are a virus that must be eradicated. We need to immunize ourselves against them.” Taking the pathological perspective on guns to its most ridiculous extreme, Christoffel has declared: “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 deaths.”

Another conference on firearm violence held in 1992 at the University of Iowa was underwritten in part by CDC/NCIPC funds which had previously been allocated to the study of rural injuries and farm occupational hazards. Significantly, the only non-academic faculty member invited to the 1992 conference was Sarah Brady of Handgun Control, Inc. A similar event, “National Violence Prevention Conference — Bridging Science and Program” was held in 1995; the CDC/NCIPC co-hosted the event with the University of Iowa Injury Prevention Research Center, and NCIPC Director Dr. Mark L. Rosenberg offered the event’s inaugural speech.

Peer Jury

The growing evidence of anti-gun partisanship at the NCIPC provoked the interest of freshman Congressman Bob Barr (R-GA). In a letter to CDC Director David Satcher, Barr requested an investigation of “whether certain taxpayer-funded grant money is being used to advocate opposition or endorsement of federal legislation, and, among other things urges picketing activities…I consider these activities, involving federal taxpayer dollars, to be not only questionable but illegal. I find it highly offensive that federally appropriated monies are being used for lobbying.”

On March 6, 1996, three physicians — Drs. Waters and Wheeler, and this author — and noted criminologist Don B. Kates, were given the opportunity to testify before the House Appropriations Subcommittee on Labor, Health and Human Services and Education. Testimony focused on the CDC/NCIPC’s use of suspect data, skewed study populations, dubious research models, and result-oriented research. The panel was also informed that NCIPC researchers violated accepted scientific practice by refusing to release and make available to other researchers their original data for further critical analysis — an indispensable part of genuine peer review.

Testimony was also offered concerning the inappropriate diversion of taxpayer monies to research for dissemination of partisan newsletters, as well as the participation of NCIPC staff and researchers in partisan anti-gun gatherings. In addition, there was an examination of the redundant nature of much of the injury prevention research performed by the CDC/NCIPC. For example, the Department of Transportation does research into automobile-related injuries; the Labor Department’s Occupational Safety and Health Administration keeps track of workplace injuries; the Justice Department keeps records on domestic violence; and, of course, Health and Human Services maintains the National Institutes of Health, which is involved in violence prevention, mental health, drug and alcohol abuse, and numerous other subjects. Curiously, the politicized anti-gun campaign may be the only non-redundant research effort underway at the CDC/NCIPC.

The amendment offered by Representative Jay Dickey, which would de-fund NCIPC’s anti-gun initiative, may not survive the conference committee process. Furthermore, the constitutionally appropriate course of action would be to eliminate all funding for the NCIPC, thereby saving taxpayers nearly $50 million annually and, most importantly, effecting a major step forward towards de-politicizing medical research.

Written by Dr. Miguel Faria

(This article originally appeared in The New American, Vol. 12, No. 20, September 30, 1996, p. 35-38.)

Copyright ©1996 American Opinion Publishing Incorporated.