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Silencing the Science on Gun Research (Kellermann megabarf alert!)
JAMA ^ | December 21, 2012 | Arthur L. Kellermann, MD, MPH; Frederick P. Rivara, MD, MPH

Posted on 12/27/2012 3:28:49 PM PST by neverdem

On December 14, a 20-year-old Connecticut man shot and killed his mother in the home they shared. Then, armed with 3 of his mother's guns, he shot his way into a nearby school, where he killed 6 additional adults and 20 first-grade children. Most of those who died were shot repeatedly at close range. Soon thereafter, the killer shot himself. This ended the carnage but greatly diminished the prospects that anyone will ever know why he chose to commit such horrible acts.

In body count, this incident in Newtown ranks second among US mass shootings. It follows recent mass shootings in a shopping mall in Oregon, a movie theater in Colorado, a Sikh temple in Wisconsin, and a business in Minnesota. These join a growing list of mass killings in such varied places as a high school, a college campus, a congressional constituent meeting, a day trader's offices, and a military base. But because this time the killer's target was an elementary school, and many of his victims were young children, this incident shook a nation some thought was inured to gun violence.

As shock and grief give way to anger, the urge to act is powerful. But beyond helping the survivors deal with their grief and consequences of this horror, what can the medical and public health community do? What actions can the nation take to prevent more such acts from happening, or at least limit their severity? More broadly, what can be done to reduce the number of US residents who die each year from firearms, currently more than 31 000 annually?1

The answers are undoubtedly complex and at this point, only partly known. For gun violence, particularly mass killings such as that in Newtown, to occur, intent and means must converge at a particular time and place. Decades of research have been devoted to understanding the factors that lead some people to commit violence against themselves or others. Substantially less has been done to understand how easy access to firearms mitigates or amplifies both the likelihood and consequences of these acts.

For example, background checks have an effect on inappropriate procurement of guns from licensed dealers, but private gun sales require no background check. Laws mandating a minimum age for gun ownership reduce gun fatalities, but firearms still pass easily from legal owners to juveniles and other legally proscribed individuals, such as felons or persons with mental illness. Because ready access to guns in the home increases, rather than reduces, a family's risk of homicide in the home, safe storage of guns might save lives.2 Nevertheless, many gun owners, including gun-owning parents, still keep at least one firearm loaded and readily available for self-defense.3

The nation might be in a better position to act if medical and public health researchers had continued to study these issues as diligently as some of us did between 1985 and 1997. But in 1996, pro-gun members of Congress mounted an all-out effort to eliminate the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). Although they failed to defund the center, the House of Representatives removed $2.6 million from the CDC's budget—precisely the amount the agency had spent on firearm injury research the previous year. Funding was restored in joint conference committee, but the money was earmarked for traumatic brain injury. The effect was sharply reduced support for firearm injury research.

To ensure that the CDC and its grantees got the message, the following language was added to the final appropriation: “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”4

Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency's funding to find out. Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC's website lacks specific links to information about preventing firearm-related violence.

When other agencies funded high-quality research, similar action was taken. In 2009, Branas et al5 published the results of a case-control study that examined whether carrying a gun increases or decreases the risk of firearm assault. In contrast to earlier research, this particular study was funded by the National Institute on Alcohol Abuse and Alcoholism. Two years later, Congress extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.6

These are not the only efforts to keep important health information from the public and patients. For example, in 1997, Cummings et al7 used state-level data from Washington to study the association between purchase of a handgun and the subsequent risk of homicide or suicide. Similar studies could not be conducted today because Washington State's firearm registration files are no longer accessible.8

In 2011, Florida's legislature passed and Governor Scott signed HB 155, which subjects the state's health care practitioners to possible sanctions, including loss of license, if they discuss or record information about firearm safety that a medical board later determines was not “relevant” or was “unnecessarily harassing.” A US district judge has since issued a preliminary injunction to block enforcement of this law, but the matter is still in litigation. Similar bills have been proposed in 7 other states.

The US military is grappling with an increase in suicides within its ranks. Earlier this month, an article by 2 retired generals—a former chief and a vice chief of staff of the US Army— asked Congress to lift a little-noticed provision in the 2011 National Defense Authorization Act that prevents military commanders and noncommissioned officers from being able to talk to service members about their private weapons, even in cases in which a leader believes that a service member may be suicidal.9

Health researchers are ethically bound to conduct, analyze, and report studies as objectively as possible and communicate the findings in a transparent manner. Policy makers, health care practitioners, and the public have the final decision regarding whether they will accept, much less act on, those data. Criticizing research is fair game; suppressing research by targeting its sources of funding is not.

Efforts to place legal restrictions on what physicians and other health care practitioners can and cannot say to their patients crosses an even more important line. Yet this is precisely what Florida and some other states are seeking to do. Physicians may disagree on many issues, including the pros and cons of gun control, but are united in opposing government efforts to undermine the sanctity of the patient-physician relationship, as defined by the Hippocratic oath. While it is reasonable to acknowledge and accept the Supreme Court's recent decision regarding the meaning of the Second Amendment, it is just as important to uphold physicians' First Amendment rights.

Injury prevention research can have real and lasting effects. Over the last 20 years, the number of Americans dying in motor vehicle crashes has decreased by 31%.1 Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively.1 This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions.

Given the chance, could researchers achieve similar progress with firearm violence? It will not be possible to find out unless Congress rescinds its moratorium on firearm injury prevention research. Since Congress took this action in 1997, at least 427 000 people have died of gunshot wounds in the United States, including more than 165 000 who were victims of homicide.1 To put these numbers in context, during the same time period, 4586 Americans lost their lives in combat in Iraq and Afghanistan.10

The United States has long relied on public health science to improve the safety, health, and lives of its citizens. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence. Otherwise, the heartache that the nation and perhaps the world is feeling over the senseless gun violence in Newtown will likely be repeated, again and again.

AUTHOR INFORMATION

Corresponding Author: Frederick P. Rivara, MD, MPH, Department of Pediatrics, Child Health Institute, University of Washington, 6200 NE 74th St, Ste 120B, Seattle, WA 98115-8160 (fpr@uw.edu).

Published Online: December 21, 2012. doi:10.1001/jama.2012.208207

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

REFERENCES

Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting Systems: Fatal Injury Data. http://www.cdc.gov/injury/wisqars/fatal.html. Accessed December 14, 2012
Kellermann AL, Rivara FP, Rushforth NB, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med. 1993;329(15):1084-1091
PubMed | Link to Article
Farah MM, Simon HK, Kellermann AL. Firearms in the home: parental perceptions. Pediatrics. 1999;104(5 pt 1):1059-1063
PubMed | Link to Article
Omnibus Consolidated Appropriations Bill. HR 3610, Pub L No. 104-208. http://www.gpo.gov/fdsys/pkg/PLAW-104publ208/pdf/PLAW-104publ208.pdf. September 1996. Accessed December 19, 2012
Branas CC, Richmond TS, Culhane DP, Ten Have TR, Wiebe DJ. Investigating the link between gun possession and gun assault. Am J Public Health. 2009;99(11):2034-2040
PubMed | Link to Article
Consolidated Appropriations Act 2012, Pub L No. 112-74. http://www.gpo.gov/fdsys/pkg/PLAW-112publ74/pdf/PLAW-112publ74.pdf. December 2011. Accessed December 19, 2012
Cummings P, Koepsell TD, Grossman DC, Savarino J, Thompson RS. The association between the purchase of a handgun and homicide or suicide. Am J Public Health. 1997;87(6):974-978
PubMed | Link to Article
Wash Rev Code 9.41.129. http://apps.leg.wa.gov/rcw/default.aspx?cite=9.41.129. Accessed December 19, 2012
Reimer DJ, Chiarelli PW. The military's epidemic of suicide. Washington Post. http://www.washingtonpost.com/opinions/military-commanders-should-be-able-to-ask-about-gun-ownership/2012/12/07/d5dd9ba4-4097-11e2-ae43-cf491b837f7b_story.html. Published December 7, 2012. Accessed December 17, 2012
Congressional Research Service. American War and Military Operations: Casualties: Lists and Statistics. http://www.fas.org/sgp/crs/natsec/RL32492.pdf. Accessed December 18, 2012

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting Systems: Fatal Injury Data. http://www.cdc.gov/injury/wisqars/fatal.html. Accessed December 14, 2012
Kellermann AL, Rivara FP, Rushforth NB, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med. 1993;329(15):1084-1091
PubMed | Link to Article
Farah MM, Simon HK, Kellermann AL. Firearms in the home: parental perceptions. Pediatrics. 1999;104(5 pt 1):1059-1063
PubMed | Link to Article
Omnibus Consolidated Appropriations Bill. HR 3610, Pub L No. 104-208. http://www.gpo.gov/fdsys/pkg/PLAW-104publ208/pdf/PLAW-104publ208.pdf. September 1996. Accessed December 19, 2012
Branas CC, Richmond TS, Culhane DP, Ten Have TR, Wiebe DJ. Investigating the link between gun possession and gun assault. Am J Public Health. 2009;99(11):2034-2040
PubMed | Link to Article
Consolidated Appropriations Act 2012, Pub L No. 112-74. http://www.gpo.gov/fdsys/pkg/PLAW-112publ74/pdf/PLAW-112publ74.pdf. December 2011. Accessed December 19, 2012
Cummings P, Koepsell TD, Grossman DC, Savarino J, Thompson RS. The association between the purchase of a handgun and homicide or suicide. Am J Public Health. 1997;87(6):974-978
PubMed | Link to Article
Wash Rev Code 9.41.129. http://apps.leg.wa.gov/rcw/default.aspx?cite=9.41.129. Accessed December 19, 2012
Reimer DJ, Chiarelli PW. The military's epidemic of suicide. Washington Post. http://www.washingtonpost.com/opinions/military-commanders-should-be-able-to-ask-about-gun-ownership/2012/12/07/d5dd9ba4-4097-11e2-ae43-cf491b837f7b_story.html. Published December 7, 2012. Accessed December 17, 2012
Congressional Research Service. American War and Military Operations: Casualties: Lists and Statistics. http://www.fas.org/sgp/crs/natsec/RL32492.pdf. Accessed December 18, 2012



TOPICS: Crime/Corruption; Editorial; Foreign Affairs; Politics/Elections
KEYWORDS: afghanistan; banglist; guncontrol; iraq; kellermann; secondamendment
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To: E. Pluribus Unum; marktwain; Salena Zito; Myrddin; Billthedrill; Ancesthntr; wardaddy; ...
E. Pluribus Unum, thanks for title of Don B. Kates and Gary Mauser's study, Would Banning Firearms Reduce Murder and Suicide?(PDF)

marktwain linked Mass Killings Stopped by Armed Citizens on two of my recent threads. I verified all of its links. If someone tries to disable that webpage, I'm linking all of its links below current links and posts.

Two Cautionary Tales of Gun Control

Stopping the spread of deadly assault weapons--summary of Feinstein Bill, incl. registry requirement

Is it True Armed Civilians Have Never Stopped a Mass Shooting?

Mother Jones's Own Reporting Contradicts Its Conclusions on Gun Violence

Guns in schools can save lives - Disarming law abiding citizens left them sitting ducks.

I used the original titles, some are Wikipedia titles, for the links within Mass Killings Stopped by Armed Citizens:

Pearl High School shooting

Appalachian School of Law shooting

The Chronicle, Muskegon, MI, 8/23/95

Jeanne Assam and the New Life Church Shooting

Gun-shop employee prevents massacre(California, 1999) by marktwain!

A Massacre We Didn't Hear About

Statistics show concealed carry saves many lives, takes few

RV PARK KILLINGS: 'Witness shooter' recounts shootout with gunman who killed two in Early

Shooter with hit-list shot dead in AT&T store

College Student Shoots, Kills Home Invader

Trolley Square shooting

Victims Released; No Charges Filed Against Reno Man In Winnemucca Shootings

Parker Middle School dance shooting

Police identify man who shot, killed pastor’s mother at church

Tyler courthouse shooting

Clackamas Concealed Carry Showdown – The Full Story

P.S. Arthur Kellermann, one of the authors in the JAMA article, has written some of the most outrageous "studies" about guns in the medical literature, e.g. he equated the risk of criminal acquaintances getting killed with family and friends if someone kept a gun in their home.

Some noteworthy articles about politics, foreign or military affairs, IMHO, FReepmail me if you want on or off my list.

21 posted on 12/27/2012 7:49:01 PM PST by neverdem ( Xin loi min oi)
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To: neverdem

Thanks for the ping!


22 posted on 12/27/2012 9:34:37 PM PST by Alamo-Girl
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To: TigersEye
This ended the carnage but greatly diminished the prospects that anyone will ever know why he chose to commit such horrible acts.
If you're looking for a rational motivation for an insane act committed by a mentally ill person then something's not right with your head, doc.
There’s insanity, and then there’s irrationality. There is a difference. Caligula was just as violent as this Connecticut fruit-loop, and so was King Herod with his slaying of the innocents. But Herod had his own logic - “If anyone else thinks they’re going to be king, they will have to kill me - and I will kill them first!” Likewise, the Connecticut fruit-loop had a plan - to become famous and make “everyone” care about what made him tick. So if the good doctor wants to analyze what could be done differently to prevent this sort of thing, best he would start by analyzing the effects of what the journalists and the politicians do in response to such outrages. Instead of joining the chorus of journalists and politicians who are doing wrong, or at best irrelevant, things.

If you don’t assume a priori that your favorite government civil rights violation will inevitably improve things and have no unintended consequences, maybe you will consider that the vast number of legally owned guns has resulted in remarkably - according to your illiberal “liberal” logic - few casualties. From there you might consider the extent to which gun ownership as an antibody against violence. Antibodies can certainly have ill effects in the form of autoimmune disorders, but the existence of such disorders does not make you think that antibodies are something the body would be better off without. But when you frame the issue as how to reduce gun violence, rather than violence overall, you are doing exactly that - trying to reduce autoimmune disease, at the risk of worsening disease in general.

The United States has long relied on public health science to improve the safety, health, and lives of its citizens. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence. Otherwise, the heartache that the nation and perhaps the world is feeling over the senseless gun violence in Newtown will likely be repeated, again and again.
If you really took a public health approach, the first thing you would notice would be politically incorrect - the fact that violence is not uniformly distributed among ethnic groups. Your public health approach would then be to quarantine the people among whom the violence is concentrated. Oh, that isn’t what you meant?? Surprise, surprise!! I guess your approach to violating civil rights is much more, I guess you would call it, “nuanced.”

23 posted on 12/28/2012 2:56:11 AM PST by conservatism_IS_compassion (The idea around which “liberalism" coheres is that NOTHING actually matters except PR.)
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To: conservatism_IS_compassion
"If you really took a public health approach, the first thing you would notice would be politically incorrect - the fact that violence is not uniformly distributed among ethnic groups. Your public health approach would then be to quarantine the people among whom the violence is concentrated. Oh, that isn’t what you meant?? Surprise, surprise!! I guess your approach to violating civil rights is much more, I guess you would call it, “nuanced.”

LOL....great shot! And in reality, the "quarantining" of said group is taking place even in the absence of "public health studies". It's called "going to PRISON", where the members of said group reside in numbers far higher than their percentage in the general population.

24 posted on 12/28/2012 3:43:02 AM PST by Wonder Warthog
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To: conservatism_IS_compassion
...maybe you will consider that the vast number of legally owned guns has resulted in remarkably - according to your illiberal “liberal” logic - few casualties.

I assume you are directing that at the author not me.

25 posted on 12/28/2012 12:43:30 PM PST by TigersEye (Who is John Galt?)
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To: neverdem
(Screed -- JAMA, I'm surprised at you!):

Decades of research have been devoted to understanding the factors that lead some people to commit violence against themselves or others. Substantially less has been done to understand how easy access to firearms mitigates or amplifies both the likelihood and consequences of these acts.



IOW .....
We have to PROVE by using STATISTICS that
| gun ownership <=> MurderDeathKill |

< / off Sandra Bullock>

Somehow I think he's trolling for another Bellesiles "study".

26 posted on 12/28/2012 1:44:37 PM PST by lentulusgracchus
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To: CyberAnt
I wonder if it had anything to do with all the Satan Worship stuff they found in his bedroom ..??

Whoooa! First I've heard of that! Is this something the MSM are passing over lightly? Air-brushing, as it were, their portrait of another Tea Party-crazed zombie killer?

27 posted on 12/28/2012 1:50:50 PM PST by lentulusgracchus
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To: TigersEye
. . . maybe you will consider that the vast number of legally owned guns has resulted in remarkably - according to your illiberal “liberal” logic - few casualties.
I assume you are directing that at the author not me.
Yes. I’m afraid that one of the hazards of posting an article with which you disagree is the default tendency for rebuttals of the article to get addressed to you.

28 posted on 12/28/2012 3:05:40 PM PST by conservatism_IS_compassion (The idea around which “liberalism" coheres is that NOTHING actually matters except PR.)
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To: Zeko
Kellerman's original study, which appeared in the June 1986 New England Journal of Medicine was flawed in many ways. The sample was taken almost entirely from Kings County Washington, which is hardly representative of the nation as a whole.

The infamous "43 to 1" statistic which was spawned by this 'study' postulates that a gun in the home is 43 times more likely to kill the owner or a family member than to kill an intruder. 37 of those 43 instances were suicides, so the people who died under those circumstances chose to kill themselves and would have done so regardless of whether a gun was available.

That still leaves 6 to 1 where someone in the home is supposedly more likely to be killed than in intruder. The reason I underlined the word killed is because any instances where brandishing the weapon was enough to scare off an intruder, or firing the weapon resulted in either no injury or a non-lethal injury to the criminal was not counted as a defensive use of the firearm.

Also; in domestic disputes where a woman defends herself from an abusive spouse or partner, a self-defense death was counted as a 'family member being killed' for the purposes of the study.

Perfect example of a study being manipulated to support a predetermined conclusion.

29 posted on 12/28/2012 3:35:26 PM PST by American Infidel (Instead of vilifying success, try to emulate it)
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To: conservatism_IS_compassion

Thanks. Just wanted clarification. That done; I agree with your points completely. 300 - 400 million guns in private hands and only a few thousand are killed with guns each year. Tear that figure down and most of those shootings are done by people who live like feral animals many of whom the courts have already had a chance to deal with.


30 posted on 12/28/2012 3:39:08 PM PST by TigersEye (Who is John Galt?)
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To: neverdem

Check these out:

http://dailyanarchist.com/2012/07/31/auditing-shooting-rampage-statistics/

http://sistertoldjah.com/archives/2012/12/21/about-that-armed-deputy-at-columbine/

Apologies if they’re already posted.


31 posted on 12/28/2012 10:06:29 PM PST by FreeKeys (When morons are allowed to vote public policy is shaped by demagoguery, not the facts of reality.)
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To: FreeKeys

Thanks for the links.


32 posted on 12/28/2012 10:35:47 PM PST by neverdem ( Xin loi min oi)
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To: neverdem

I had no idea that Arthur “Like hell I’m gonna let you look at my raw data” Kellerman was still around.


33 posted on 12/28/2012 10:48:58 PM PST by Redcloak (Winter is coming.)
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To: lentulusgracchus; All

That’s what I read .. and they compared it to the movie killer too .. saying it was much of the same stuff.

There are spiritual forces at work - whether people want to believe it or not.

And .. if anybody was paying attention, has anybody but me noticed the similar wide-eyed stare as the other two multiple killers: the guy in AZ; the movie theatre guy and now the school shooting. If you put them all in a row - it’s obvious to anyone who cares to see - they all have the very same vacant stare.

Very worrisome to me.


34 posted on 12/29/2012 1:19:47 PM PST by CyberAnt ("America is the greatest nation on the face of the earth".)
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To: CyberAnt
If you put them all in a row - it’s obvious to anyone who cares to see - they all have the very same vacant stare.

Yes, I saw that. But I don't think it's the same thing as the battle-fatigued "thousand-yard stare" people talked about after Guadalcanal, in the faces of men who'd pulled long stretches of intense combat.

Or maybe it is -- video game burnout?

35 posted on 12/29/2012 5:24:55 PM PST by lentulusgracchus
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To: lentulusgracchus

Actually, it’s demonic.


36 posted on 12/30/2012 4:11:11 PM PST by CyberAnt ("America is the greatest nation on the face of the earth".)
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