Fewer Guns, Less Deaths, the JAMA Debate.

Running rampant throughout cyberspace; throwing gasoline onto the fires for guns rights advocates; appearing in print newspapers; running as tickers across televisions and video screens; erupting into shouting matches on Talk TV and Radio, and being attacked as liberal, socialistic, and the popular Obama flavored Kool Aid are stories with headlines such as “More Gun Laws = fewer deaths, 50-state study says.”

A quick Google search:

The comment sections in many of these online stories are just as terrifying as to what is being said by “experts” on TV and radio.  Terrifying in that the majority of statements, whether for or against gun control, are based solely on emotions and the material presented within the respective media source.  At least to this stage, little within the general public appears to be based upon rationale thinking and certainly not a reading of the actual study, “Firearm Legislation and Firearm-Related Fatalities in the United States.

The study appears in JAMA Internal Medicine.  The authors, their affiliations, and the journal citation are:

Eric W. Fleegler, MD, MPH; Lois K. Lee, MD, MPH; Michael C. Monuteaux, ScD; David Hemenway, PhD; Rebekah Mannix, MD, MPH

Author Affiliations: Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts (Drs Fleegler, Lee, Monuteaux, and Mannix); Harvard Medical School, Boston (Drs Fleegler, Lee, Monuteaux, and Mannix); and Harvard School of Public Health, Boston (Dr Hemenway).

JAMA Intern Med. 2013;():1-9. doi:10.1001/jamainternmed.2013.1286.

Where is the sinister agenda?

Within the study itself, the authors acknowledge many of the limitations.  For example:

“As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.” 

“Although multiple studies have examined the relationship between federal and state firearm laws and homicide and suicide rates, the overall association between firearm legislation and firearm mortality is uncertain and remains controversial.” 

“It is important to note that our study was ecological and cross-sectional and could not determine cause-and-effect relationship.” 

“Our study has limitations. First, the legislative strength score, which tallies a single point per law, has not been validated. Neither has the weighted Brady scoring system, and we are unaware of any such scoring systems that have been validated.”

What if…

media, commentators, opponent, and proponents might be better served if the intent is to push a particular agenda by reading the actual study and this invited commentary by Garen J. Wintemute, MD, MPH.  The author’s affiliations and journal citation appear below:

Responding to the Crisis of Firearm Violence in the United States

Comment on “Firearm Legislation and Firearm-Related Fatalities in the United States” by Garen J. Wintemute, MD, MPH

Author Affiliations: Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento.

JAMA Intern Med. 2013;():1-2. doi:10.1001/jamainternmed.2013.1292.

This extended five paragraph quote could and maybe should be the basis for the debates about the relevancy of the study.

In the end, Fleegler et al provide no firm guidance. Do the laws work, or not? If so, which ones? Should policymakers enact the entire package? Some part? Which part? Frustrated policymakers sometimes ask to hear from 1-armed scientists, to avoid “on the one hand . . . on the other hand” summations of the evidence that end with competing recommendations. Here, there can be no recommendation at all; it is as if the scientists have both hands tied behind their backs.

In fact, that is precisely what has happened—not just to these investigators, who did well with the data available to them, but to firearm violence researchers generally. The disappearance of the Centers for Disease Control and Prevention (CDC) research program in this field in the 1990s has been well documented.  A complementary program at the National Institute of Justice survived longer, thanks to the tenacity of its program officer, but ended after she retired in 2008.

Today, with almost no funding for firearm violence research, there are almost no researchers. Counting all academic disciplines together, no more than a dozen active, experienced investigators in the United States have focused their careers primarily on firearm violence. Only 2 are physicians. Only 1 has evaluated the effectiveness of an assault weapons ban.

Why did this happen? In the early 1990s, scientists were producing evidence that might have been used to reform the nation’s firearm policies. To those whose interests were threatened by such reforms, it made perfect sense to choke off the production of the evidence. This effort was led by Congressman Jay Dickey, self-described “point person for the NRA.” It succeeded. When rates of firearm violence were at historic highs and appeared to be increasing, the government abandoned its commitment to understanding the problem and devising evidence-based solutions.

This is not how the United States usually responds to a public health emergency. In the 1960s, the nation recognized a fast-growing crisis related to motor vehicle traffic fatalities. We created an agency, led by internist-epidemiologist William Haddon, MD, to launch an aggressive research effort and recommend and implement evidence-based interventions. The motor vehicle industry waged what the Supreme Court called the “regulatory equivalent of war” against airbags, one of the most important of those interventions. On airbags and other matters, the industry lost; the public’s health and safety won. The effects of these contrasting approaches are clear.

Sadly emotion, and creating points out of nothing, seems to be winning against referring to the source material and critical thinking.

Personal disclaimer:  My graduate degrees are in history with my primary focus being Southern and United States Political.  So according to a few of my “favorite” elected officials pushing for educational reform, I have no useful skills since my “formal education” did not train me for a specific job.  Fortunately, however, friends and colleagues in such fields as medicine, chemistry, physics, engineering, computer science, accounting, and so on, often ask if I could assist with some research, proof an article, or just offer an opinion about something in their fields.  Perhaps I am more fortunate to have spent a childhood in the strawberry fields with my Grandfather who had no formal schooling, but still built the community’s water system before my birth, and to still speak with my Dad who earned his high school diploma and worked as a welder and airplane mechanic before seeing a job advertisement for an entry level position and later becoming a store manager for K&B.

Teaching is not about giving someone knowledge; it is about teaching someone how to acquire knowledge and apply what they know to the situation at hand.

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