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Public Health and Gun Control: A Review
Part I: The Benefits of Firearms
Introduction: "A Gun in the Home"=20
I have related previously (Medical Sentinel, Spring and Summer 1997) how =
the 1991 American Medical Association=B9s (AMA) campaign against =
domestic violence launched for public relation consumption went hand in =
hand with the public health establishment=B9s 1979 stated objective of =
eradication of handguns in America, beginning with a 25 percent =
reduction by the year 2000.1-2 Towards that objective, in the 1980s, =
hundreds of articles describing politicized, biased, result-oriented =
research funded at taxpayers expense were published in the medical =
journals.3 One of the principle investigators was Dr. Arthur Kellermann, =
who now heads the Emory University School of Public Health.=20

A significant portion of the gun control agenda, not only of the public =
health but the entire health advocacy establishment, in fact, comes from =
Dr. Kellermann's landmark articles, particularly "Gun Ownership As a =
Risk Factor for Homicide in the Home," published in The New England =
Journal of Medicine (NEJM) in 1993.4 And yet, much of the methodology, =
not to mention conclusions in the article have been questioned by =
numerous investigators.5-7=20

Since at least the mid-1980s, Dr. Kellermann (and associates), whose =
work had been heavily-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=B9t. In a 1986 NEJM =
paper, Dr. Kellermann and associates, for example, claimed their =
"scientific research" proved that defending oneself or one=B9s family =
with a firearm in the home is dangerous and counter productive, claiming =
"a gun owner is 43 times more likely to kill a family member than an =
intruder."8=20

In a critical review and now classic article published in the March 1994 =
issue of the Journal of the Medical Association of Georgia (JMAG), Dr. =
Edgar Suter, Chairman of Doctors for Integrity in Policy Research =
(DIPR), found evidence of "methodologic and conceptual errors," such as =
prejudicially truncated data and the listing of "the correct methodology =
which was described but never used by the authors."5 Moreover, the gun =
control researchers failed to consider and underestimated the protective =
benefits of guns. Dr. Suter writes: "The true measure of the protective =
benefits of guns are the lives and medical costs saved, the injuries =
prevented, and the property protected < not the burglar or rapist body =
count. Since only 0.1 - 0.2 percent of defensive uses of guns involve =
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."5=20

In 1993, in his landmark and much cited NEJM article (and the research, =
again, heavily funded by the CDC), Dr. Kellermann attempted to show =
again that guns in the home are a greater risk to the victims than to =
the assailants.4 Despite valid criticisms by reputable scholars of his =
previous works (including the 1986 study), Dr. Kellermann ignored the =
criticisms and again used the same methodology. He also used study =
populations with disproportionately high rates of serious psychosocial =
dysfunction from three selected state counties, known to be =
unrepresentative of the general U.S. population. For example, 53 percent =
of the case subjects 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. In fact, in this study, gun ownership, the supposedly high =
risk factor for homicide was not one of the most strongly associated =
factors for being murdered. Drinking, illicit drugs, living alone, =
history of family violence, living in a rented home were all greater =
individual risk factors for being murdered than a gun in the home. One =
must conclude there is no basis to apply the conclusions of this study =
to the general population.=20

All of these are factors that, as Dr. Suter pointed out, "would =
expectedly be associated with higher rates of violence and homicide."5 =
It goes without saying, the results of such a study on gun homicides, =
selecting this sort of unrepresentative population sample, nullify the =
authors' generalizations, and their preordained, conclusions can not be =
extrapolated to the general population.=20

Moreover, although the 1993 New England Journal of Medicine study =
purported to show that the homicide victims were killed with a gun =
ordinarily kept in the home, the fact is that as Kates and associates =
point out 71.1 percent of the victims were killed by assailants who did =
not live in the victims=B9 household using guns presumably not kept in =
that home.6=20

While Kellermann and associates began with 444 cases of homicides in the =
home, cases were dropped from the study for a variety of reasons, and in =
the end, only 316 matched pairs were used in the final analysis, =
representing only 71.2 percent of the original 444 homicide cases.=20

This reduction increased tremendously the chance for sampling bias. =
Analysis of why 28.8 percent of the cases were dropped would have helped =
ascertain if the study was compromised by the existence of such biases, =
but Dr. Kellermann, in an unprecedented move, refused to release his =
data and make it available for other researchers to analyze.=20

Likewise, Prof. Gary Kleck of Florida State University has written me =
that knowledge about what guns were kept in the home is essential, but =
this data in his study was never released by Dr. Kellermann: "The most =
likely bit of data that he would want to withhold is information as to =
whether the gun used in the gun homicides was kept in the home of the =
victim."*=20

As Kates and associates point out, "The validity of the NEJM 1993 =
study=B9s conclusions depend on the control group matching the homicide =
cases in every way (except, of course, for the occurrence of the =
homicide)."6=20

However, in this study, the controls collected did not match the cases =
in many ways (i.e., for example, in the amount of substance abuse, =
single parent versus two parent homes, etc.) contributing to further =
untoward effects, and decreasing the inference that can legitimately be =
drawn from the data of this study. Be that as it may, "The conclusion =
that gun ownership is a risk factor for homicide derives from the =
finding of a gun in 45.4 percent of the homicide case households, but in =
only 35.8 percent of the control household. Whether that finding is =
accurate, however, depends on the truthfulness of control group =
interviewees in admitting the presence of a gun or guns in the home."6=20

The Problem with Scientific Surveys=20

Professor Gary Kleck has written extensively that false denial of gun =
ownership is a major problem in these survey studies, and yet Kellermann =
and associates do not admit or mention this fact.9 And this is critical. =
It would take only 35 of the 388 controls falsely denying gun ownership =
to make the control gun ownership percentage equal that of the homicide =
case households. As Kates and associates write, "If indeed, the controls =
actually had gun ownership equal to that of the homicide case households =
(45.4 percent), then a false denial rate of only 20.1 percent among the =
gun owning controls would produce the thirty-five false denials and =
thereby equalize ownership."6=20

Consider the fact that Kellermann and associates=B9 pilot study had a =
higher percent false denial rate than the 20.1 percent required to =
invalidate their own study, and yet, he and his associates concluded =
that there was no "underreporting of gun ownership by their control =
respondents," and their estimates, they claim were, therefore, =
considered not biased.4=20

In the Medical Sentinel, we have considered this type of bias** in =
response to a JAMA 1996 gun ownership survey. We reported on question =
#20 of that survey: "If asked by a pollster whether I owned firearms, I =
would be truthful? 29.6 percent disagreed/strongly disagreed."10 So =
according to this survey, 29.6 percent would falsely deny owning a =
firearm. We know that nearly one-third of respondents intentionally =
conceal their gun ownership because they fear further confiscation by =
the police as has happened in cities such as Washington, D.C., Detroit, =
and New York.=20

One must conclude on the basis of these errors that the findings of the =
1993 Kellermann study are invalidated, just as those of 1986 are =
tainted. Nevertheless, these errors have crept into and now permeate the =
lay press, the electronic media, and particularly, the public health =
literature and the medical journals, where they remain uncorrected and =
are repeated time and again and perpetuated. And, because the =
publication of the data (and their purported conclusions) supposedly =
come from "reliable" sources and objective medical researchers, it=B9s =
given a lot of weight and credibility by practicing physicians, social =
scientists and law enforcement These errors need to be corrected to =
regain the loss of credibility of public health in this area of gun and =
violence research.=20

Are There Benefits of Firearms?=20

What we do know, thanks to the meticulous scholarship of Prof. Gary =
Kleck and Doctors for Integrity in Policy Research (DIPR), is that the =
benefits of gun ownership by law-abiding citizens have been greatly =
underestimated. In Point Blank: Guns and Violence in America (1991),11 =
myriads of scientific publications, and his latest book, Targeting Guns =
(1997),9 Prof. Kleck found 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.5***=20

Incidentally, the health care costs incurred by gun shootings have been =
greatly exaggerated. DIPR, in an article published in the June 1995 =
issue of the JMAG, estimated that the actual U.S. health care costs of =
treating gunshot wounds is approximately $1.5 billion which amounts to =
0.2 percent of annual health care expenditures. The $20-$40 billion =
figure, so frequently cited by the mass media, and even medical =
journals, is an exaggerated estimate of lifetime productivity lost where =
criminals are given inflated, unrealistic life productivity estimates, =
as if their careers were suddenly expected to blossom into that of =
pillars of the community12 with projected salaries equaling those of =
managed care CEOs. Yet, despite these major detractions, the health =
advocacy establishment clings to the erroneous figures and =
extrapolations of Dr. Kellermann and other public health researchers, =
and use these erroneous figures in propounding health and gun control =
policies, to the detriment of public policy.=20

To catch up with the lost ground on the gun and violence research that =
has been accumulating in the criminologic and sociologic body of =
literature in the last couple of years, we have to look not only to the =
data collected by Prof. Gary Kleck and Dr. Edgar Suter, but also other =
prominent investigators. Recent data by Prof. John R. Lott, Jr., =
formerly with the University of Chicago and now at Yale University, in =
his book More Guns, Less Crime < Understanding Crime and Gun Control =
Laws (1998)13 has also been suppressed from dissemination in the medical =
journals and public health literature, except for the Medical =
Sentinel.1-2 In his book, Prof. Lott studied the FBI=B9s massive yearly =
crime statistics for all 3,054 U.S. counties over 18 years (1977-1994), =
the largest national survey on gun ownership and state police =
documentation in illegal gun use, and he comes to some startling =
conclusions:=20


  1.. 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 Jonesboro, Arkansas, and Springfield, Oregon, in =
1998; the Columbine High School shooting in Littleton, Colorado, in =
1999; or the 1993 shooting on the Long Island subway) < by a whopping 69 =
percent.=20

  2.. Allowing people 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 1,570 murders, 4,177 =
rapes, and 60,000 aggravated assaults would have been avoided annually.=20

  3.. Children 14 to 15 years of age are 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.=20

  4.. Prof. Lott found that when concealed carry laws went into effect =
in a given county, murders fell by 8 percent, rapes by 5 percent, and =
aggravated assaults by 7 percent.=20

  5.. For each additional year concealed carry gun laws have been in =
effect, the murder rate declines by 3 percent, robberies by over 2 =
percent, and rape by 1 percent.13=20
Suicide and "Crimes of Passion"=20

Let me now say a word about suicide and gun availability. Both Drs. =
Arthur Kellermann and John H. Sloan have written about suicides and have =
attempted to link these fatalities to the availability of guns in =
articles published in The New England Journal of Medicine.14-15 In =
reality, the overwhelming available evidence compiled from the =
psychiatric literature is that untreated or poorly managed depression is =
the real culprit behind the high rates of suicide. The evidence is =
authoritative on this point as classified in the Diagnostic and =
Statistical Manual of Mental Disorders of the American Psychiatric =
Association and any standard psychiatric text. From the social science =
of criminology, in fact, we solve the seeming paradox that countries =
such as Japan, Hungary, and in Scandinavia which boast draconian gun =
control laws and low rates of firearm availability have much higher =
rates of suicide (2 or 3 times higher) than the U.S. In these countries =
where guns are not readily available, citizens simply substitute for =
guns other cultural or universally available methods for killing =
oneself, such as Hara-kiri in Japan, drowning in the Blue Danube as in =
Hungary, suffocation (with poisonous gases such as carbon monoxide from =
automobile exhausts), or simply hanging 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.11,16 I believe the health =
advocacy establishment must consider the fact that guns and bullets are =
inanimate objects that do not follow Koch=B9s Postulates of =
Pathogenicity (which prove definitely and scientifically a =
micro-organism is responsible for a particular disease), and recognize =
the fact that behind every shooting there is a person pulling the =
trigger < and who should be held accountable. The problem is more =
complex than just easy availability of firearms and guns and bullets as =
animated, virulent pathogens, needing to be stamped out by limiting gun =
availability, and ultimately, eradicating guns from law-abiding =
citizens.=20

And, within the context of gun availability, much has been said about =
the "crimes of passion" that supposedly take place impulsively, in the =
heat of the night or the furor of a domestic squabble. Criminologists =
have pointed out that homicides in this setting are the culmination of a =
long simmering cycle of violence. In one study of the police records in =
Detroit and Kansas City it was revealed, for example, that in "90 =
percent of domestic homicides, the police had responded at least once =
before during the prior two years to a disturbance," and in over 50 =
percent of the cases, the police had been called five or more times to =
that dysfunctional domicile. Surely, these are not crimes of passion =
consummated impulsively in the heat of the night by ordinary citizens, =
but the result of violence in highly dysfunctional families in the =
setting of repeated alcohol or illicit drug use; it is also the setting =
of abusive husbands who after a long history of spousal abuse finally =
commit murder, and increasingly, wives defending themselves against =
those abusive husbands, representing acts of genuine self-defense.6 Part =
II follows.=20

All references cited in this text are found at the conclusion of Part II =
of this essay.=20

Footnotes:=20

* Personal communication via e-mail, 09/21/99.=20

** Because of the reluctance of some investigators even those funded by =
taxpayers to share scientific data with other researchers, the Medical =
Sentinel, the official, peer-reviewed journal of the Association of =
American Physicians and Surgeons (AAPS), established the open data =
policy for public review of research impacting on the formulation of =
public policy, http://www.haciendapub.com/press2.html.=20

*** This has been substantiated by a Department of Justice study in 1997 =
under the Clinton administration which found that up to 1.5 million =
citizens use firearms to protect themselves and their property yearly.=20




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<DIV><FONT size=3D2><A=20
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aapsonline.org/aaps/press/medsentgun1.htm</A></FONT></DIV>
<DIV><FONT size=3D2></FONT>&nbsp;</DIV>
<DIV>
<H3>Public Health and Gun Control: A Review</H3>
<H3>Part I: The Benefits of Firearms</H3><B>Introduction: "A Gun in the=20
Home"</B>=20
<P>I have related previously (Medical Sentinel, Spring and Summer 1997) =
how the=20
1991 American Medical Association=B9s (AMA) campaign against domestic =
violence=20
launched for public relation consumption went hand in hand with the =
public=20
health establishment=B9s 1979 stated objective of eradication of =
handguns in=20
America, beginning with a 25 percent reduction by the year =
2000.<SUP>1-2</SUP>=20
Towards that objective, in the 1980s, hundreds of articles describing=20
politicized, biased, result-oriented research funded at taxpayers =
expense were=20
published in the medical journals.<SUP>3</SUP> One of the principle=20
investigators was Dr. Arthur Kellermann, who now heads the Emory =
University=20
School of Public Health.=20
<P>A significant portion of the gun control agenda, not only of the =
public=20
health but the entire health advocacy establishment, in fact, comes from =
Dr.=20
Kellermann's landmark articles, particularly "Gun Ownership As a Risk =
Factor for=20
Homicide in the Home," published in The New England Journal of Medicine =
(NEJM)=20
in 1993.<SUP>4</SUP> And yet, much of the methodology, not to mention=20
conclusions in the article have been questioned by numerous=20
investigators.<SUP>5-7</SUP>=20
<P>Since at least the mid-1980s, Dr. Kellermann (and associates), whose =
work had=20
been heavily-funded by the CDC, published a series of studies purporting =
to show=20
that persons who keep guns in the home are more likely to be victims of =
homicide=20
than those who don=B9t. In a 1986 NEJM paper, Dr. Kellermann and =
associates, for=20
example, claimed their "scientific research" proved that defending =
oneself or=20
one=B9s family with a firearm in the home is dangerous and counter =
productive,=20
claiming "a gun owner is 43 times more likely to kill a family member =
than an=20
intruder."<SUP>8</SUP>=20
<P>In a critical review and now classic article published in the March =
1994=20
issue of the Journal of the Medical Association of Georgia (JMAG), Dr. =
Edgar=20
Suter, Chairman of Doctors for Integrity in Policy Research (DIPR), =
found=20
evidence of "methodologic and conceptual errors," such as prejudicially=20
truncated data and the listing of "the correct methodology which was =
described=20
but never used by the authors."<SUP>5</SUP> Moreover, the gun control=20
researchers failed to consider and underestimated the protective =
benefits of=20
guns. Dr. Suter writes: "The true measure of the protective benefits of =
guns are=20
the lives and medical costs saved, the injuries prevented, and the =
property=20
protected &#8249; not the burglar or rapist body count. Since only 0.1 - =
0.2 percent=20
of defensive uses of guns involve the death of the criminal, any study, =
such as=20
this, that counts criminal deaths as the only measure of the protective =
benefits=20
of guns will expectedly underestimate the benefits of firearms by a =
factor of=20
500 to 1,000."<SUP>5</SUP>=20
<P>In 1993, in his landmark and much cited NEJM article (and the =
research,=20
again, heavily funded by the CDC), Dr. Kellermann attempted to show =
again that=20
guns in the home are a greater risk to the victims than to the =
assailants.4=20
Despite valid criticisms by reputable scholars of his previous works =
(including=20
the 1986 study), Dr. Kellermann ignored the criticisms and again used =
the same=20
methodology. He also used study populations with disproportionately high =
rates=20
of serious psychosocial dysfunction from three selected state counties, =
known to=20
be unrepresentative of the general U.S. population. For example, 53 =
percent of=20
the case subjects had a history of a household member being arrested, 31 =
percent=20
had a household history of illicit drug use, 32 percent had a household =
member=20
hit or hurt in a family fight, and 17 percent had a family member hurt =
so=20
seriously in a domestic altercation that prompt medical attention was =
required.=20
Moreover, both the case studies and control groups in this analysis had =
a very=20
high incidence of financial instability. In fact, in this study, gun =
ownership,=20
the supposedly high risk factor for homicide was not one of the most =
strongly=20
associated factors for being murdered. Drinking, illicit drugs, living =
alone,=20
history of family violence, living in a rented home were all greater =
individual=20
risk factors for being murdered than a gun in the home. One must =
conclude there=20
is no basis to apply the conclusions of this study to the general =
population.=20
<P>All of these are factors that, as Dr. Suter pointed out, "would =
expectedly be=20
associated with higher rates of violence and homicide."<SUP>5</SUP> It =
goes=20
without saying, the results of such a study on gun homicides, selecting =
this=20
sort of unrepresentative population sample, nullify the authors'=20
generalizations, and their preordained, conclusions can not be =
extrapolated to=20
the general population.=20
<P>Moreover, although the 1993 New England Journal of Medicine study =
purported=20
to show that the homicide victims were killed with a gun ordinarily kept =
in the=20
home, the fact is that as Kates and associates point out 71.1 percent of =
the=20
victims were killed by assailants who did not live in the victims=B9 =
household=20
using guns presumably not kept in that home.<SUP>6</SUP>=20
<P>While Kellermann and associates began with 444 cases of homicides in =
the=20
home, cases were dropped from the study for a variety of reasons, and in =
the=20
end, only 316 matched pairs were used in the final analysis, =
representing only=20
71.2 percent of the original 444 homicide cases.=20
<P>This reduction increased tremendously the chance for sampling bias. =
Analysis=20
of why 28.8 percent of the cases were dropped would have helped =
ascertain if the=20
study was compromised by the existence of such biases, but Dr. =
Kellermann, in an=20
unprecedented move, refused to release his data and make it available =
for other=20
researchers to analyze.=20
<P>Likewise, Prof. Gary Kleck of Florida State University has written me =
that=20
knowledge about what guns were kept in the home is essential, but this =
data in=20
his study was never released by Dr. Kellermann: "The most likely bit of =
data=20
that he would want to withhold is information as to whether the gun used =
in the=20
gun homicides was kept in the home of the victim."<SUP>*</SUP>=20
<P>As Kates and associates point out, "The validity of the NEJM 1993 =
study=B9s=20
conclusions depend on the control group matching the homicide cases in =
every way=20
(except, of course, for the occurrence of the homicide)."<SUP>6</SUP>=20
<P>However, in this study, the controls collected did not match the =
cases in=20
many ways (i.e., for example, in the amount of substance abuse, single =
parent=20
versus two parent homes, etc.) contributing to further untoward effects, =
and=20
decreasing the inference that can legitimately be drawn from the data of =
this=20
study. Be that as it may, "The conclusion that gun ownership is a risk =
factor=20
for homicide derives from the finding of a gun in 45.4 percent of the =
homicide=20
case households, but in only 35.8 percent of the control household. =
Whether that=20
finding is accurate, however, depends on the truthfulness of control =
group=20
interviewees in admitting the presence of a gun or guns in the=20
home."<SUP>6</SUP>=20
<P><B>The Problem with Scientific Surveys</B>=20
<P>Professor Gary Kleck has written extensively that false denial of gun =

ownership is a major problem in these survey studies, and yet Kellermann =
and=20
associates do not admit or mention this fact.<SUP>9</SUP> And this is =
critical.=20
It would take only 35 of the 388 controls falsely denying gun ownership =
to make=20
the control gun ownership percentage equal that of the homicide case =
households.=20
As Kates and associates write, "If indeed, the controls actually had gun =

ownership equal to that of the homicide case households (45.4 percent), =
then a=20
false denial rate of only 20.1 percent among the gun owning controls =
would=20
produce the thirty-five false denials and thereby equalize=20
ownership."<SUP>6</SUP>=20
<P>Consider the fact that Kellermann and associates=B9 pilot study had a =
higher=20
percent false denial rate than the 20.1 percent required to invalidate =
their own=20
study, and yet, he and his associates concluded that there was no=20
"underreporting of gun ownership by their control respondents," and =
their=20
estimates, they claim were, therefore, considered not =
biased.<SUP>4</SUP>=20
<P>In the Medical Sentinel, we have considered this type of =
bias<SUP>**</SUP> in=20
response to a JAMA 1996 gun ownership survey. We reported on question =
#20 of=20
that survey: "If asked by a pollster whether I owned firearms, I would =
be=20
truthful? 29.6 percent disagreed/strongly disagreed."10 So according to =
this=20
survey, 29.6 percent would falsely deny owning a firearm. We know that =
nearly=20
one-third of respondents intentionally conceal their gun ownership =
because they=20
fear further confiscation by the police as has happened in cities such =
as=20
Washington, D.C., Detroit, and New York.=20
<P>One must conclude on the basis of these errors that the findings of =
the 1993=20
Kellermann study are invalidated, just as those of 1986 are tainted.=20
Nevertheless, these errors have crept into and now permeate the lay =
press, the=20
electronic media, and particularly, the public health literature and the =
medical=20
journals, where they remain uncorrected and are repeated time and again =
and=20
perpetuated. And, because the publication of the data (and their =
purported=20
conclusions) supposedly come from "reliable" sources and objective =
medical=20
researchers, it=B9s given a lot of weight and credibility by practicing=20
physicians, social scientists and law enforcement These errors need to =
be=20
corrected to regain the loss of credibility of public health in this =
area of gun=20
and violence research.=20
<P><B>Are There Benefits of Firearms?</B>=20
<P>What we do know, thanks to the meticulous scholarship of Prof. Gary =
Kleck and=20
Doctors for Integrity in Policy Research (DIPR), is that the benefits of =
gun=20
ownership by law-abiding citizens have been greatly underestimated. In =
Point=20
Blank: Guns and Violence in America (1991),<SUP>11</SUP> myriads of =
scientific=20
publications, and his latest book, Targeting Guns (1997),<SUP>9</SUP> =
Prof.=20
Kleck found that the defensive uses of firearms by citizens amount to =
2.5=20
million uses per year and dwarf the offensive gun uses by criminals. =
Between=20
25-75 lives are saved by a gun for every life lost to a gun. Medical =
costs saved=20
by guns in the hands of law-abiding citizens are 15 times greater than =
costs=20
incurred by criminal uses of firearms. Guns also prevent injuries to =
good people=20
and protect billions of dollars of property every year.<SUP>5***</SUP>=20
<P>Incidentally, the health care costs incurred by gun shootings have =
been=20
greatly exaggerated. DIPR, in an article published in the June 1995 =
issue of the=20
JMAG, estimated that the actual U.S. health care costs of treating =
gunshot=20
wounds is approximately $1.5 billion which amounts to 0.2 percent of =
annual=20
health care expenditures. The $20-$40 billion figure, so frequently =
cited by the=20
mass media, and even medical journals, is an exaggerated estimate of =
lifetime=20
productivity lost where criminals are given inflated, unrealistic life=20
productivity estimates, as if their careers were suddenly expected to =
blossom=20
into that of pillars of the community<SUP>12</SUP> with projected =
salaries=20
equaling those of managed care CEOs. Yet, despite these major =
detractions, the=20
health advocacy establishment clings to the erroneous figures and =
extrapolations=20
of Dr. Kellermann and other public health researchers, and use these =
erroneous=20
figures in propounding health and gun control policies, to the detriment =
of=20
public policy.=20
<P>To catch up with the lost ground on the gun and violence research =
that has=20
been accumulating in the criminologic and sociologic body of literature =
in the=20
last couple of years, we have to look not only to the data collected by =
Prof.=20
Gary Kleck and Dr. Edgar Suter, but also other prominent investigators. =
Recent=20
data by Prof. John R. Lott, Jr., formerly with the University of Chicago =
and now=20
at Yale University, in his book More Guns, Less Crime &#8249; =
Understanding Crime and=20
Gun Control Laws (1998)13 has also been suppressed from dissemination in =
the=20
medical journals and public health literature, except for the Medical=20
Sentinel.1-2 In his book, Prof. Lott studied the FBI=B9s massive yearly =
crime=20
statistics for all 3,054 U.S. counties over 18 years (1977-1994), the =
largest=20
national survey on gun ownership and state police documentation in =
illegal gun=20
use, and he comes to some startling conclusions:=20
<P>
<OL>
  <LI>While neither state waiting periods nor the federal Brady Law is=20
  associated with a reduction in crime rates, adopting concealed carry =
gun laws=20
  cut death rates from public, multiple shootings (e.g., as those which =
took=20
  place in Jonesboro, Arkansas, and Springfield, Oregon, in 1998; the =
Columbine=20
  High School shooting in Littleton, Colorado, in 1999; or the 1993 =
shooting on=20
  the Long Island subway) &#8249; by a whopping 69 percent.=20
  <P></P>
  <LI>Allowing people to carry concealed weapons deters violent crime =
&#8249; without=20
  any apparent increase in accidental death. If states without right to =
carry=20
  laws had adopted them in 1992, about 1,570 murders, 4,177 rapes, and =
60,000=20
  aggravated assaults would have been avoided annually.=20
  <P></P>
  <LI>Children 14 to 15 years of age are 14.5 times more likely to die =
from=20
  automobile injuries, 5 times more likely to die from drowning or fire =
and=20
  burns, and 3 times more likely to die from bicycle accidents than they =
are to=20
  die from gun accidents.=20
  <P></P>
  <LI>Prof. Lott found that when concealed carry laws went into effect =
in a=20
  given county, murders fell by 8 percent, rapes by 5 percent, and =
aggravated=20
  assaults by 7 percent.=20
  <P></P>
  <LI>For each additional year concealed carry gun laws have been in =
effect, the=20
  murder rate declines by 3 percent, robberies by over 2 percent, and =
rape by 1=20
  percent.<SUP>13</SUP> </LI></OL>
<P><B>Suicide and "Crimes of Passion"</B>=20
<P>Let me now say a word about suicide and gun availability. Both Drs. =
Arthur=20
Kellermann and John H. Sloan have written about suicides and have =
attempted to=20
link these fatalities to the availability of guns in articles published =
in The=20
New England Journal of Medicine.<SUP>14-15</SUP> In reality, the =
overwhelming=20
available evidence compiled from the psychiatric literature is that =
untreated or=20
poorly managed depression is the real culprit behind the high rates of =
suicide.=20
The evidence is authoritative on this point as classified in the =
Diagnostic and=20
Statistical Manual of Mental Disorders of the American Psychiatric =
Association=20
and any standard psychiatric text. From the social science of =
criminology, in=20
fact, we solve the seeming paradox that countries such as Japan, =
Hungary, and in=20
Scandinavia which boast draconian gun control laws and low rates of =
firearm=20
availability have much higher rates of suicide (2 or 3 times higher) =
than the=20
U.S. In these countries where guns are not readily available, citizens =
simply=20
substitute for guns other cultural or universally available methods for =
killing=20
oneself, such as Hara-kiri in Japan, drowning in the Blue Danube as in =
Hungary,=20
suffocation (with poisonous gases such as carbon monoxide from =
automobile=20
exhausts), or simply hanging like in Denmark and Germany, or even =
drinking=20
agricultural pesticides as is commonly done in Sri Lanka. And in these=20
countries, citizens commit suicide quite effectively by these methods at =
higher=20
rates than in the U.S.<SUP>11,16</SUP> I believe the health advocacy=20
establishment must consider the fact that guns and bullets are inanimate =
objects=20
that do not follow Koch=B9s Postulates of Pathogenicity (which prove =
definitely=20
and scientifically a micro-organism is responsible for a particular =
disease),=20
and recognize the fact that behind every shooting there is a person =
pulling the=20
trigger &#8249; and who should be held accountable. The problem is more =
complex than=20
just easy availability of firearms and guns and bullets as animated, =
virulent=20
pathogens, needing to be stamped out by limiting gun availability, and=20
ultimately, eradicating guns from law-abiding citizens.=20
<P>And, within the context of gun availability, much has been said about =
the=20
"crimes of passion" that supposedly take place impulsively, in the heat =
of the=20
night or the furor of a domestic squabble. Criminologists have pointed =
out that=20
homicides in this setting are the culmination of a long simmering cycle =
of=20
violence. In one study of the police records in Detroit and Kansas City =
it was=20
revealed, for example, that in "90 percent of domestic homicides, the =
police had=20
responded at least once before during the prior two years to a =
disturbance," and=20
in over 50 percent of the cases, the police had been called five or more =
times=20
to that dysfunctional domicile. Surely, these are not crimes of passion=20
consummated impulsively in the heat of the night by ordinary citizens, =
but the=20
result of violence in highly dysfunctional families in the setting of =
repeated=20
alcohol or illicit drug use; it is also the setting of abusive husbands =
who=20
after a long history of spousal abuse finally commit murder, and =
increasingly,=20
wives defending themselves against those abusive husbands, representing =
acts of=20
genuine self-defense.<SUP>6</SUP> Part II follows.=20
<P>All references cited in this text are found at the conclusion of Part =
II of=20
this essay.=20
<P><B>Footnotes:</B>=20
<P>* Personal communication via e-mail, 09/21/99.=20
<P>** Because of the reluctance of some investigators even those funded =
by=20
taxpayers to share scientific data with other researchers, the Medical =
Sentinel,=20
the official, peer-reviewed journal of the Association of American =
Physicians=20
and Surgeons (AAPS), established the open data policy for public review =
of=20
research impacting on the formulation of public policy,=20
http://www.haciendapub.com/press2.html.=20
<P>*** This has been substantiated by a Department of Justice study in =
1997=20
under the Clinton administration which found that up to 1.5 million =
citizens use=20
firearms to protect themselves and their property yearly. </P>
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