Now Mobilizing Against Gun Violence: Scientists & Public Health Professionals

Science publications have responded with passion to the massacres of seniors at a supermarket in Buffalo, New York, and school children in Uvalde, Texas. The editors of Scientific American called for “a lasting stop to the political obstruction” against federally funded gun violence research, adding, “We need to become the kind of country that says the lives of children are more valuable than the right to weapons that have killed them.”

H. Holden Thorp, editor-in-chief of the journal Science, argued in an editorial that scientists “should not sit on the sidelines” and that unfettered gun ownership, justified by the gun lobby under the Second Amendment’s right to bear arms, is as inconsistent with the Constitution as were slavery and the prohibition on a woman’s right to vote.

“Science can show that gun restrictions make societies safer,” Thorp wrote. “Science can show that mental illness is not a determinative factor in mass shootings. And science can show that racism is measurable and leads to violence.” He urged readers to “[p]ush lawmakers to finally break the partisan gridlock that has made moments of silence a regular observance,” adding: “The National Rifle Association and its minions must be defeated. It’s up to us because the victims of gun violence are tragically and devastatingly not here to protest themselves.”

This is a call to arms in a good way. It represents an attempt by the scientific community to again lead a battle it tried to launch three decades ago to study gun violence and inspire effective prevention policies. Back then, scientists were crushed by craven politics. But the death toll from sidelining them has proven devastating.

A terrifying toll

A report this spring by the Johns Hopkins School of Public Health University said the nation has lost 1,357,000 victims to firearms in the last 40 years. That exceeds the number of soldiers killed in all the wars in which the United States has fought.

US death rates are the by far the highest in the industrialized world. The nation’s gun death rate is eight times higher than it is in Canada; 50 times higher than in Germany; 100 times higher than in the United Kingdom; and 200 times higher than in Japan. While residents of the United States represent 1 out of every 25 people in the world, we account for 1 of every 7 deaths by guns.

In the United States, we have 120 firearms for every 100 people in this country, more than twice the level of the next most gun-flooded country: Yemen. Worse, the international trafficking of US-manufactured guns south of our border has had compound effects.

According to the Institute of Health Metrics and Evaluation (IHME), the United States, Brazil, Mexico, Colombia, Venezuela, and Guatemala accounted for half of the entire globe’s 250,000 gun deaths in 2016. Ioan Grillo, author of the 2021 book Blood Gun Money, estimates that 2 million arms have flowed from the United States to Mexico and Latin America over the past decade. Gun-laden cartels send drugs back to us. Grillo told National Public Radio this week that, with virtually no laws to prevent the trafficking, the US gun industry creates an “unstable neighborhood.” As US-made guns go to “some of the most violent criminals on the planet,” the United Nations estimates that nearly 600,000 people have fled Central American nations as a result.

Here at home, our violence has reached a record-breaking 45,222 deaths from firearms in 2020. That number includes 4,368 children and adolescents aged 1 to 19 killed by guns — a 77 percent increase from 2013. As has been widely reported, gun violence has now replaced motor vehicle crashes as the leading killer of youth. All this adds up to a level of gun violence that IHME researcher Moshen Naghavi calls “one of the greatest public health crises of our time.”

Gun research blocked

“Scientists have come off the sidelines to tell us what they need to fight gun violence. The response cannot be another drop in the bucket.” https://t.co/PzEygpEbAh

— Union of Concerned Scientists (@UCSUSA) June 10, 2022

The crisis has steadily worsened at least in part because the US public has long been denied the data with which to devise common sense policies to regulate firearms. In 1994, in the wake of the passage of the Brady Bill for background checks and an assault weapons ban, then-House Speaker Newt Gingrich promised the National Rifle Association (NRA) that he would block all gun legislation. The NRA was, by then, a shadow arm of the Republican Party. In the last two presidential elections, it gave 99 and 98 percent of its campaign cash to GOP candidates, according to Open Secrets.

The Republicans also clearly understood that, to block legislation, they would need to deep-six the data that could be used to build momentum for gun control. While Gingrich was speaker, Republican Rep. Jay Dickey of Tennessee sponsored a 1996 amendment to a federal spending bill stipulating that no federal funds to CDC could be used “to advocate or promote gun control.” In case scientists did not get the message that no funds meant none, Congress eliminated the $2.6 million in the CDC’s budget for gun research and told the agency to study traumatic brain injuries instead.

The blockade was reinforced in 2003 with the passage of an amendment forbidding the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) from publicly sharing data that might help trace the origin of guns used in crimes. The amendment passed just as the assault weapons ban was set to expire, despite the ban’s proven effectiveness against mass shootings.

All that effectively turned scientists studying gun violence into political prisoners. While the Dickey Amendment did not explicitly ban all gun research, experts in the field translated it to mean career suicide to publish anything linking guns to needless death, fearing that even raw data would be condemned as advocacy. By 2012, the CDC’s gun-research funding fell by 96 percent. By 2017, an analysis published in JAMA Internal Medicine found that the overall number of publications related to gun violence declined 64 percent between 1998 and 2012.

In contrast to the roughly 50,000 members of the American Association for Cancer Research, a 2018 article for the American Public Health Association estimated there were perhaps 30 gun-violence researchers in the entire United States. One of those researchers, Harvard University’s David Hemenway, told USA Today in 2020 that the Dickey Amendment had launched a quarter century where he could not honestly encourage a scientist to go into the gun research field “because they couldn’t make a living.”

Breaking the blockade

Things shifted slightly in 2019, in the wake of the Parkland, Florida, school shooting that left 17 students and teachers dead and 17 others injured. Congress restored funding for research on gun violence, allotting $25 million per year to be shared by the CDC and National Institutes of Health. The funding came after physicians and scientists went toe-to-toe with the NRA.

In late 2018, the America College of Physicians published a position paper in the Annals of Internal Medicine with a long list of recommendations for handgun and assault weapon regulation, background checks for mental illness and domestic abuse and more research on gun violence. The paper said, “Firearm violence is a public health threat in the United States that must not be allowed to continue.”

The NRA mocked the position paper in a Twitter missive, saying doctors should “stay in their lane.” The journal’s editors responded by writing that doctors “won’t be silenced.” More than 40,000 health care professionals signed an open letter, telling the NRA: “This is our lane.”

Needed: powerful gun research

If the NRA had stayed out of the way of medical researchers, we surely would have not seen the cost of gun violence spiral to $280 billion a year, about the same as the budget for the Department of Veterans Affairs, according to Everytown for Gun Safety. The vast majority of that cost is quality-of-life loss for pain and suffering, income lost to death and disability, and the immediate medical costs of treating victims. Before the Dickey amendment, a slew of studies published in The New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA), and the American Journal of Public Health (AJPH), among others debunked most every myth the gun lobby concocts to this day to flood the nation with arms.

A seminal 1993 NEJM study of economically and racially diverse counties in Tennessee, Ohio, and Washington state found that home gun ownership created nearly three times the risk of homicide within a household. The risk of homicide for women was nearly four times higher in a home with a gun.

“We found no evidence of a protective benefit from gun ownership in any subgroup,” that study said, including even the small percent of cases that involved forced entry. To the contrary, the research found that “A gun kept in the home is far more likely to be involved in the death of a member of the household than it is to be used to kill in self-defense.”

There’s an immense need for a wide range of research on gun violence today. You could start with the risk factors related to unfettered gun production and the potential for risk reduction from various kinds of regulation. President Biden says gun manufacturers should lose their immunity from being sued, but neither he nor Congress is appealing to gun makers to slow the assembly line.

According to a report released last month by the Department of Justice, US gun manufacturers pumped out 11.3 million weapons in 2020, nearly triple the number in 2000. The number of weapons produced per person has skyrocketed between 2000 and 2020. While the US population rose by 18 percent, guns manufactured per 100,000 people rose 187 percent.

The top weapon being manufactured between 2000 and 2009 was rifles. Today, it is pistols. In addition, US imports of handguns have quintupled since 2000, from 747,000 per year then to 4 million per year today. Even worse, homemade, untraceable “ghost guns” now make up at least a quarter of all guns recovered at crime scenes in California, a state with some of the nation’s strictest gun laws.

You could continue with research into the relationship between carnage and profits. Right now, dead schoolchildren appear to be good for business in the gun industry, with stocks soaring after massacres as investors assume that gun owners will stock up in fear of new restrictions. Uvalde was no different: in the aftermath, Smith & Wesson and Sturm, Ruger & Company saw record gains on Wall Street.

The link between gun “rights” and racism

We also need research on the underlying connection between activism for gun rights and racism. While shooters and victims can be of any color or class, there is a pernicious connection between the explosion of firearm sales over the last 15 years, and the fear among many White people of losing majority status in the national population. Those anxieties are symbolized by former President Trump’s mainstreaming of “you will not replace us” White nationalism and the Republican Party’s attacks on voting rights and teaching about racism in schools.

A 2019 Pew Research Center survey found that nearly half of White respondents said a majority nation of color would “weaken American culture.” Several other studies confirm significant feelings of threat among White people at the prospect of becoming a demographic minority.

A 2020 study by Vanderbilt University political science professor Larry Bartels found that 51 percent of Republicans felt, “The traditional American way of life is disappearing so fast that we may have to use force to save it.” The possibility of using force is so real for Republicans that 41 percent of them agreed that “A time will come when patriotic Americans have to take the law into their own hands.” Bartels found that the strongest predictor “by far” for these anti-democratic sentiments was “ethnic antagonism — especially concerns about the political power and claims on government resources of immigrants, African Americans, and Latinos.”

That makes it no surprise how strongly a majority of White people are attached to guns. A Pew Research Center analysis last year found that just 45 of White respondents favor a tightening of gun laws, compared to a respective 75 percent, 72 percent and 65 percent of Black, Asian and Latino respondents.

“Gun rights,” according to a study published last year in the journal Criminology, can been seen as a modern “dog whistle” of racial resentment. The seven researchers from four universities found that racial resentment increases the chances of someone voting for a candidate who receives NRA funding and opposes gun control. The most direct explanation, the researchers wrote, is that “the ability to own and carry a gun without being perceived as a threat [is] understood by many as an expression of White privilege.” Supporting pro-gun candidates thus may be perceived as “a way to protect that privilege.”

In recent years, the White privilege of gun rights, which goes back to slave codes banning possession of guns by Black people, has blatantly been in the nation’s face — in the NRA’s general silence about the tragedies of Black legal gun owners, Black gun shoppers and Black children playing with toy guns being shot dead by police or in the “justified” killings of Black people by White civilians under “stand your ground” laws. The gun rights community has also been unmoved by the decades of Black homicides in communities parched for jobs and good schools but flooded with trafficked guns. The racial double standard is so obvious that 61 percent of respondents in a new USA Today poll say racism and white nationalism are factors in gun violence, along with mental health and loose gun laws.

A 2020 study from researchers at the University of Illinois at Chicago found racial resentment to be a “key predictor” of White gun ownership that correlates with owning more weapons, rationalizing guns for “security,” and NRA membership. That may help explain why many passionate white gun owners seem so willing “to rationalize the extraordinarily high rates of gun violence that the country is facing.” The level of rationalization is startlingly clear in a new poll by CBS News. Despite a total of 31 dead in Buffalo and Uvalde, 44 percent of Republicans agreed that mass shootings are “unfortunately something we have to accept as a free society.”

It is also why white gun rights owners yawn at the extraordinarily high number of guns in this nation. The number of firearms background checks, a rough indicator of guns sales, was stable at between 8.4 million and 8.9 million for the first five years of the administration of NRA-endorsed George W. Bush. But the 2008 election of Barack Obama, the nation’s first Black president, inspired a new level of hysteria from the NRA and Republican presidential candidates lying about how Democratic candidates would take guns away.

By the 2020 election of Joe Biden, the number of annual checks was nearly 40 million, quadruple that of Bush-era levels. The NRA’s fear mongering doesn’t always push Republican presidential candidates over the top, as evidenced by Obama’s and Biden’s victories, but it has helped cement the White vote. Donald Trump, endorsed by the NRA, won a majority of both White men and White women in both his 2016 victory and 2020 defeat.

Most White people voted for the NRA’s candidates even though the science shows that owing a gun is a virtual death wish for White households. A 2020 study published in The New England Journal of Medicine found that men who own guns are eight times more likely to commit suicide than non-gun owners. Women who own guns are 35 times more likely to commit suicide than nonowners. Of the 45,222 firearms deaths that year, more than half (24,292) were suicides. White people, 61.6 percent of the population, accounted for 82 percent of suicides.

Glimmers of hope?

It is too soon to know if Buffalo and Uvalde will move the United States to interrupt what amounts to one of the world’s greatest acts of fratricide. There have been several mass shootings since then, including a mass shooting at a Tulsa hospital that took the life of two doctors, a receptionist, and a patient. The Tulsa shooting hit close to home for me as one of the doctors, orthopedic surgeon Preston Phillips, was a close friend and colleague of one of my fraternity brothers, Augustus A. White III of Harvard Medical School.

The only measures Senate negotiators are talking about are raising the age to purchase assault weapons from 18 to 21, and encouraging states to enact “red flag” laws to take guns from people deemed an imminent threat. That is a long way away from dealing with the proliferation and lethality of modern weapons and the ease of acquiring them. A 2017 study published in the Annals of Internal Medicine found that 1 out of every 5 guns in the United States is purchased without a background check, because the 1993 Brady Bill does not cover private sales at gun shows or online.

Too few are also yet talking openly about a large-scale boost of funding for research that could put game-changing facts on the table in Washington, DC. A recent blog post by my colleague Andrew Rosenberg noted that the CDC’s $8 million in gun violence research grants to the states in 2020 is a pittance compared to the overall $660 million in federal auto safety grants that same year. Similarly, an editorial last week in The Lancet medical journal cited a 2019 study that found the $12 million spent annually to investigate gun violence against children and adolescents pales next to the $88 million and $335 million for research on motor vehicle crashes and cancer respectively for this age group.

As proof that research matters, the CDC says overall cancer mortality has fallen 27 percent since 2001. The death rate from motor vehicle accidents is half of what it was in 1969. You could also add tobacco. The annual $300 million for tobacco research has helped cut adult cigarette smoking rates from 42.6 percent in 1966 to 12.5 percent today.

“There is no shortage of practical measures,” The Lancet editors said. “What is really needed is courageous leadership from Democrats and Republicans.”

A similar call came last week in a guest column in Scientific American by Eric Fleegler and Lois Lee, two pediatric emergency physicians and firearms researchers from Boston Children’s Hospital. They called $25 million a year in federal research “a drop in the bucket,” compared to the $3.8 billion the government spends at the National Heart, Lung, and Blood Institute.

Under a headline that said, in part, “Thoughts and prayers do not stop bullets,” the researchers wrote that the nation must finally ask itself if individual rights are more important than stopping the killing of thousands of children a year. “Never again should we have to list the names of innocent children shot and killed in their elementary school,” they wrote. “Yet history, and a contemptuous lack of action from our elected officials, predicts we will.”

The time has come for the nation to defy this kind of prediction. Scientists have come off the sidelines to tell us what they need to fight gun violence. The response cannot be another drop in the bucket.

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