Michael R. Weisser's Blog, page 121

A New Video From Brady And The NRA Better Watch Out.

I just watched one of the best YouTube videos on guns that I have ever seen.  It is posted  by the Brady Campaign and you can view it directly on YouTube or pull it down from the new Brady website called crimadvisor.com.  The website, like the video, is a tongue-in-cheek riff on a campaign the Brady folks have been running for years which correlates rates of gun violence with state gun laws, the idea being that states with stricter gun controls experience less gun violence.  Brady’s new effort to sell this idea is a website that spoofs TripAdvisor and a remarkably original video that sets a new standard for the gun debate on both sides.

The bizarre notion that we protect ourselves with laws is a direct challenge to the NRA mantra which says that the best way to protect ourselves is with guns.  If it were up to the NRA, we’d go back and undo the GCA68, get rid of background checks entirely and let all those ‘law-abiding’ folks out there walk around with their unlicensed guns and protect the rest of us from the criminals and the thugs.  The NRA promotes this armed citizen nonsense through its video channel that features a group of very serious-minded  folks didactically delivering  one boring commentary after another on the hows and whys of carrying guns.

                I have never been comfortable at the extent to which the pro-gun community uses video to promote its agenda if only because so much of the content used to create their digital messaging simply isn’t true.  For example, last year one of the NRA commentators, Billy Johnson, criticized the General Social Survey which showed that gun ownership had declined from 50% of all households to just 34% over the previous  twenty years, citing a Gallup Poll which stated that more than 40% of all American households actually contained guns.  The only problem is that what Johnson didn’t say was that while Gallup had a higher number for gun-owning households, its survey had also shown a decline in gun ownership over the same period of time.  By omitting this critical information, Johnson was able to pretend that the GSS finding about declining gun ownership wasn’t true.  What was really true was the way in which Johnson distorted the evidence to support his own point of view.

But the whole point of video is that it’s not the facts per se that gets your message across to the audience, but the personality, stagecraft and overall artistry of what viewers are watching which drives the message home.  And here is where, when it comes to the gun world, the new Brady video has absolutely no peer.  Close my eyes for a second and I thought I was listening to Woody Harrelson and Juliette Lewis in Natural Born Killers, the 1994 Oliver Stone – Quentin Tarantino movie where two psychopaths go roaming around the Southwest attacking everyone and everything in sight with their guns.

But while the on-screen antics of the Brady gun-toting wannabes create an element of satire and cleverness that’s just plain fun, it’s not that difficult to slip behind the sarcastic message of this production and perceive the basic argument of the Brady campaign that localities with weak gun regulations make us less, not more safe from crimes with guns.  If you need some hard data to convince you further about where Brady stands, the video moves easily and seamlessly to the website where you can examine the gun-law environment in all 50 states.

I hope that Brady’s video goes viral and that this will be the first of a series of productions in which our two as-yet unnamed characters hold forth on a variety of relevant issues related to guns.  The real challenge in social media is not reaching the folks who are already committed to what you believe; it’s reaching the folks who can become committed because they like the way you say it, and this video says it better than it’s ever been said.

Buy on Amazon.

Who Won And Who Lost In The Battle Over The Cop-Killer Ammo? Everyone.

A week before the ATF was going to stop receiving public comments about its proposal to ban so-called ‘armor-piercing’ ammo the agency shut down the whole process, announced they were going back to the drawing board and, at some later date not specified, would revisit the whole issue again. The ATF received more than 80,000 emails and if you think some of them came from the International Bible Holiness Movement or another of the frontline anti-gun violence groups, think again.

And if you don’t believe the NRA isn’t celebrating, you’re wrong on that one, too.  They immediately posted victory statements from Wayne and Chris, sent news releases out to ever-welcoming Fox which featured their next President, Rand Paul, speaking out against the ATF, and of course went out of their way to label the ATF decision as a “defeat” of their arch-enemy and all-time best gun salesman, a.k.a. Barack.

                Any time the gunnies can push back the U.S. Government on a gun issue, they’ll celebrate their victory as yet another step towards enshrining the 2nd Amendment as the unquestioned law of the land. By the same token, the gun-sense folks will bemoan yet another defeat at the hands of a seemingly all-powerful NRA and try to figure out how to keep this embarrassing loss from happening again.

I happen to think that both sides are barking up the wrong tree.  Whether they know it or not, the ATF’s decision to shelve its new armor-piercing guideline is actually a victory for all of us who want laws to be reasonable, responsible and fashioned to reflect both reality plus a dose of good old common sense.  The Law Enforcement Officers Protection Act which created the whole issue of armor-piercing ammunition in the first place was a careless and thoughtless example of legislative stupidity that should never have been proposed, never passed and never signed into law.  If the ATF’s determination to step back from enforcing this statute turns it into a dead letter, nobody who’s committed to government as a force to secure the common good should be at all upset.

The bill was originally introduced by Congressmen Jack Brooks of Texas and Mario Biaggi of New York.  There were actually two separate pieces of legislation, the Brooks bill being somewhat less restrictive than Biaggi’s measure, but they would ultimately be combined into one law that would eventually get through Congress and go to President Bush’s desk in 1986.  The bill had support from most of the national police associations and while the NRA cautioned against passage, the gun-rights group kept most of its powder dry for another day.

The law was passed by voice vote in both chambers so that none of our elected representatives had to go on record for supporting or opposing the measure, a cute compromise which also made it easy for the NRA to pretend it opposed the law even though some of the organization’s most staunch supporters, such as Brooks, could appear to be pro-gun while actually voting for the bill.  If you think that a non-recorded vote creates a little stench, you’ll really have to hold your nose if you read the testimony about the issue that was given before the House Judiciary Committee in May, 1985.

It turns out that nobody knew how to define ‘armor-piercing’ ammunition and no serious testing was conducted to determine which types of ammunition should be covered by the law. Unable to define the what, why and how of ammunition that might penetrate a vest, the Committee relied on testimony from ex-cops like Mario Biaggi who wanted to outlaw all kinds of ammunition shot from handguns because people didn’t normally use rifles to attack the police.

The serious testing and research that Congress should have demanded was never carried out and now all we have is a law that creates a good stink. The NRA should hardly be claiming a big victory nor should the other side be wallowing in defeat.  We all lost on this one back in 1986.

 

 

A Medical Voice From The Past Explains Gun Violence In The Present.

I don’t usually applaud anything that the quack physician, Timothy Wheeler,  posts on his Doctors for Reponsible Gun Ownership website, but he’s done us all a favor today by digging up a remarkable article that was originally published in 1980 by Lester Adelson, who served for many years as the Deputy Coroner of Cuyahoga County.  In case you don’t know it, Cuyahoga is a.k.a. Cleveland, which means that Dr. Adelson knew a lot about gun violence.  I’ll ignore the usual stupidities of Wheeler and get right to what Adelson said, because thirty-five years after the fact much of what Adelson observed then remains relevant today.

Adelson confronts us first not with the issues of mortality and morbidity from guns, but with a much more profound problem, namely, the quality of life experienced by those who survive a gunshot wound.  He notes that an increasing number of gun-violence victims survive the assault, which is even more true today than it was thirty years ago.  But he then raises the post-trauma quality of life issue of which we know very little.  Adelson mentions in passing that survivors of gun violence have shortened lives, but he offers no data and I can’t recall a single study which sheds information on this fact.  He also talks about post-incident psychological trauma, again an acknowledged result of being at the wrong end of the barrel when a gun goes off, but we lack specific data to better understand this issue as well.

                Think about this: there may be more than 1.5 million of us alive today who at some point endured the pain, suffering and physical/psychological damage caused by a bullet puncturing and exiting our bodies or remaining inside.  What kind of lives do these folks lead after they are discharged from the hospital and told that everything’s “o.k.?”  Can they go back to work?  Will they live out a normal life-span or expire at an earlier age?  We keep very good records on cancer patients in order to determine whether the treatment they received kept their cancers in remission or resulted in reappearance of the “emperor of all maladies.”   But the survivors of gunshot wounds, unless they come back to the hospital with another gunshot wound, are largely on their own.

Two other points from Adelson’s article deserve mention.  First, he confronts the degree to which we are immune to the issue of gun violence, noting that if Cuyahoga County experienced as many deaths each year from typhoid fever as they did from guns, there would be “mass hysteria.”  And Adelson wrote this article in 1980, well before shooting deaths in Cleveland and other major cities peaked in the 1990’s.  But this comment struck a chord because I recall that we started rushing medical supplies to Central Africa to ward off Ebola which, if it killed the same number of people in a year who are killed by gunshots in America (roughly 30,000), would have been considered an epidemic by the WHO.

The second, and perhaps more important point raised by Dr. Adelson is the recognition that gun homicides and crimes aren’t the same thing.  The idea that gun violence and crime are synonymous has been a convenient way for the pro-gun folks to distinguish between ‘law-abiding’ gun owners who shouldn’t have their guns regulated, as opposed to criminals who do the bad things with guns and just need to be locked away.  Adelson cuts right through this nonsense when he says, “The accessibility of a firearm permits the instantaneous metamorphosis of a law-abiding (hot-headed?) person into a murderer,” citing data which shows that most homicides are not associated with other felonies and often erupt in the context of a domestic dispute.

Adelson’s brilliant and prescient article underscores one thing that is true beyond a shadow of a doubt: guns are very, very lethal and no matter what an idiot like Tim Wheeler says, putting one into someone’s hands creates medical risk.  That’s not just a problem for gun owners per se, it’s an issue that physicians always need to address.

 

Can The ATF Beat The NRA? I Won’t Take The Short Odds.

Last week I wrote about the decision by the ATF to ban certain types of 5.56 ammunition based on whether it could be chambered in AR-style handguns, several of which have been on the market for the last few years.  And while nobody can show that any cop has ever been shot or even menaced by one of these guns, the fact that there are now weapons classified as handguns that use such ammunition means that this ammunition might be carried in one of those guns, thus constituting a violation of the 1986 ‘armor-piercing’ law.

As suspected, once the ATF began asking for public responses to this possible change in the regulations governing the definition of ‘sporting’ ammunition, the usual suspects began cranking up on both sides.  Mark Glaze, former head of Everytown,  got himself onto Fox and Friends while Josh Sugarmann, who runs the Violence Policy Center, put out a long piece on Huffington Post.  Both of them argued that the ATF wasn’t trying to find a back-door method of getting rid of AR ammunition, but only responding to product innovations developed by black gun manufacturers whose AR-style handguns loaded with M855 and SS109 ammo, would be capable of penetrating bullet-proof vests. I can’t pass up the opportunity to mention, by the way, that the most popular AR-style handgun is made by Bushmaster and is appropriately called the “Patrolman’s Pistol.”

                Meanwhile, not to be undone by the spate of gun-sense activity, the pro-gun folks swung into high gear, launching not only a national petition campaign through the usual social media channels, but also getting one of their Capitol Hill minions, Congressman Robert Goodlatte (R-VA) to author and circulate a letter in the House of Representatives that raised “serious concern” about the ATF’s proposed new guidelines for exempting ammunition from the ‘armor-piercing’ ban.  The letter quickly garnered over 230 signatures, and while you could probably get as many House members to sign a letter stating that the Earth was flat, I’m not so sure that the importance or true intent of this letter is clearly understood.

The Congressional letter to the ATF is a milestone for the pro-gun community because, for the first time, a significant number of elected officials are supporting the idea that the AR-style rifle should be considered a ‘sporting’ gun.  In fact, according to the letter, such rifles are used for “target practice, hunting, organized and casual competition, training and skills development, and instructional activities.”  The gun industry has been trying to promote AR-style rifles as ‘sporting’ guns because the market for real sporting guns – hunting rifles and shotguns – is drying up.  Millennials don’t hunt, but they do grow up playing video games, and the most popular games are shooting games which feature black guns.

The Congressional letter is important in another respect because it raises an issue that is toxic to the pro-gun crowd; i.e., the idea that something related to guns is being banned. Here’s the relevant quote: “Under no circumstances should ATF adopt a standard that will ban ammunition that is overwhelmingly used by law-abiding Americans for legitimate purposes.”  I don’t know if the NRA wrote this letter for Goodlatte or not, but to refer to the new ammunition guidelines as a method to “ban” ammunition is to guarantee that every gun-owning activist in America will climb on board this campaign.

Don’t get me wrong.  I’m not criticizing groups like the Violence Policy Center for framing their side of the argument by supporting common-sense policies that will protect cops. But if the intent of the framework is only to keep people from using the ‘armor-piercing’ ammo in new handgun designs, why not just issue an advisory letting everyone know that loading M855 or SS109 ammo into a semi-automatic handgun was against the law? The gun-sense community had to know that the ATF’s decision to withdraw the exemption for all uses of this ammo would be construed, rightfully, as a ban.  Want to take the short odds on the ATF in this argument?  I don’t.

Thanks To The 9Th Circuit, Sunnyvale Continues To Be A Hi-Cap Mag-Free Town.

This week’s decision by the Ninth Circuit upholding the ban on high-capacity magazines in Sunnyvale, CA, is another post-Heller indication of the way in which most Courts will decide 2nd Amendment cases going forward.  Because on the one hand the notion that Americans have the right to defend themselves with guns now appears to be a cornerstone of jurisprudence about gun ownership.  On the other hand, there is yet to be a decision which questions the ability of governments at the state and local level to regulate both the determination as to the fitness of individuals to own guns, as well as regulating the types of weapons that can be used.

The Sunnyvale case is different from other magazine-capacity laws recently passed in Connecticut and New York, for example, because it not only bans the sale or transfer of magazine with capacities in excess of 10 rounds, but also requires residents who own such magazines to get rid of them altogether, either by removing them beyond the city’s limits, turning them into the police or transferring them to a gunsmith.  In other words, this law, known as Measure C, effectively makes Sunnyvale a hi-capacity magazine-free town.  And similar ordinances appear to be going forward in other California jurisdictions, including Los Angeles.

                These laws are anathema to the NRA and the pro-gun community for two reasons.  First, they represent a growing trend to move the issue of gun control away from Washington, DC and focus gun-control activism at the state and local levels.  And while the NRA has no equal at the national lobbying level, gun ownership becomes a vulnerable status in states where a majority of residents don’t own guns.  This was clearly demonstrated in last year’s re-election of Connecticut’s Governor, Dannell Malloy, whose support of a restrictive, post-Sandy Hook gun law may have given his campaign a boost in the polls. The gun law pushed through the state legislature by Andy Cuomo also proved to be a non-issue in his re-election last year.

The other problem facing the pro-gun crowd has to do not with the specific rulings per se, but rather the degree of scrutiny that appears to be applied in just about every gun case that reaches the appellate level.  Increasingly, Circuit courts are basing their review of lower-court decisions using ‘intermediate’ scrutiny, rather than the ‘strict’ scrutiny that the gun-owning community would prefer.  And what is important about this trend is that it is based on the notion, explicitly stated in the Sunnyvale decision, that the law being reviewed reflect “government’s stated objective to be significant, substantial, or important,” which Sunnyvale was able to prove based on its responsibilities to promote public safety.

The problem for the gun folks in this respect is that this approach completely undercuts one of the most cherished notions of current pro-gun arguments, namely, that ownership of a gun is the surest way to make us safe.  This has been the mantra of the gun industry ever since the decline in hunting required a new rationale for buying guns, and it is now believed by a majority of Americans whether they own guns or not. But the good news about the American judicial system is that, by and large, jurists don’t usually base their decisions on public-opinion polls.  And to the extent that one of government’s fundamental responsibilities remains securing law and order, the primacy of individual citizens to protect themselves, pace the 2nd Amendment, cannot be sustained.

The 9th Circuit ventured directly into this issue by noting that the NRA indicated that most defensive shootings required the crime-stopping shooter to bang off only one or two rounds.  I can’t find the link to this report but if it was quoted accurately, it’s a great irony that the NRA finds itself unable to justify the ownership of hi-cap magazines based on its own research into the use of guns for self-defense.  Maybe localities considering banning hi-cap mags should also bring in the NRA to testify on their behalf.

Why Not Stand In Front Of Kroger’s And Have An Argument About Guns?

When Shannon Watts and her Moms first started campaigning to turn popular retail destinations into gun-free zones, the pro-gun noisemakers went ballistic, accusing her (and the eminence grise behind her) of all sorts of nefarious schemes to leave Ma and Pa Shopper unprotected from  thugs, criminals, ISIS-wannabes and God knows who else might be trying to kill or maim the American family as it fulfills its self-appointed destiny to shop until we drop. And it didn’t take long for some of the pro-gun bloggers to dig up the usual stories about how several shoppers were held up outside of Target stores which was no doubt caused by Target’s decision to ask customers to leave their guns at home.

Now the gun internet is agog at the most recent efforts by Shannon and her ladies to push yet another retailer – Kroger – into taking a no-gun stance. But this time around they are celebrating the fact that, until now, the supermarket chain has refused to give in. To show you how loony the gun debate can sometimes become, Breitbart pitched in with its usual anti-gun screed by announcing that Kroger’s reported third-quarter profit increase was no doubt due to its refusal to buy into the Mom’s demand that shoppers leave their guns at home.

                I happen to believe that the campaign to create gun-free retail zones is the most creative and positive step ever made by the gun-sense crowd.  What it does, for the very first time, is challenge the most sacred and stupid rationale for gun ownership in this country, namely, the idea that guns protect us from crime.  This idea has been assiduously and constantly promoted by the gun industry for the past twenty years, and it is nothing more than whole cloth.  There is not one, single, credible study that proves any connection between crime rates and access to guns. Period.

Now before all my usual critics send out their comments about how I have finally revealed myself to be against the 2nd Amendment in every shape and form, let me make one thing very clear.  Note in the previous paragraph that I did not say that guns don’t protect us from crime.  What I said is that there’s no evidence to support the argument either way.  In case you didn’t know it, that’s what the word ‘any’ really means.

I can’t blame the gun industry for wanting to make Americans believe that guns are a good way to keep us from getting assaulted, robbed or worse.  After all, once Americans began living in suburbs and getting off the farm, the whole nature of gun ownership began to change.  What are you going to do?  Tell Mr. and Mrs. Suburbanite they still need the shotgun wedged behind the front door to go out and shoot the wolf or coyote that’s hungrily eyeing their cows or sheep?  There ain’t no cows or sheep.

The funny thing is that the gun industry has done a pretty good job of convincing gun owners that there’s still a need to own a gun.  Not only do the polls show that a clear majority of the gun-owning population not only believes they need guns for self-defense, but this is a complete reversal from the results of the same polls conducted twenty years ago which showed that a clear majority of gun owners owned guns for hunting and sport.  The fact that there’s nothing behind this attitudinal shift except incessant, pro-gun hot air is beside the point. People believe what they want to believe.

Which is why I am so impressed with the Mom’s strategy to put feet on the ground and make people think and talk about this issue as they enter retail stores.  Because what better place to meet the ‘average’ American than in front of a supermarket, a mall or a discount chain?  And what better way to challenge the assumptions and marketing riffs of the gun industry than with a direct, face-to-face talk?  You never know.  Maybe both sides will learn what the other side really wants.

 

Will Banning The Ammo Ban The Guns? Rush Thinks So.

You know that something’s up in the gun business when Rush Limbaugh starts talking about gun control.  And what he was talking about today was the decision by the ATF to create a new standard for exempting certain kinds of so-called ‘armor-piercing’ bullets from the ban that Congress placed on such ammo in 1986.  The law was designed to prevent civilians from buying or carrying ammo whose bullets could penetrate body armor worn by police, but manufacturing exemptions were routinely granted if the ATF determined that the ammo was going to be used for ‘sporting purposes,’ which usually meant that it would be used in rifles, as opposed to handguns whose use usually served no hunting or sporting purposes at all.

The announcement by the ATF was picked up by Rush not because he cares a wit about guns, but because he could then go into a riff about how the ‘regime’ was once again using Executive actions to promote liberal policies which Congress would never pass.  By the time I turned off Rush off turned on my computer, the web was crawling with denunciations of the latest threat to 2nd Amendment rights, with the NRA calling the plan a “disaster” and the blogs following suit.  Because what the ATF is proposing is a ban on the manufacture of the 5.56×45 round, which just happens to be a cartridge designed for the AR-15.  Get rid of the ammo, get rid of the gun, right?

                The ATF might have left this whole issue alone were it not for the decision by gun makers to begin manufacturing handguns chambered for 5.56×45.  And this decision was based on the fact that AR-15 rifles, which had been a major part of the upswing in gun sales after the election of the Kenyan in 2008, can be turned into handguns by simply substituting a barrel of shorter length.  And since the determination of what constitutes a ‘sporting’ cartridge is based on whether it is designed primarily for rifle as opposed to handgun use, now that civilians can start walking around with AR-15 handguns, the exemptions for sporting use of the ammunition no longer hold.

What the ATF is now proposing are exemptions for this ammunition based on a much narrower definition of the kinds of guns for which such ammo would be used.  Basically, ammo manufacturers will be able to make and sell this cartridge only if it is loaded in a rimfire round (which is much less dangerous) or used in a single-shot handgun which, by definition, is rarely found in the hands of the bad guys committing all those crimes with guns.  Which doesn’t mean that AR-15 shooters won’t have anything to load into their guns, ipso facto they might as well throw the guns away.  What it does mean, however, is that the gun industry will finally have to fess up to the fact that AR-15 rifles, marketing campaigns notwithstanding, aren’t really sporting guns at all.

The AR-15 sold in the United States can actually take two rounds:  the 5.56×45 NATO cartridge with a 62-grain bullet, and the .223 Remington cartridge, normally loaded with a 55-grain shell. The difference, as you might suspect, is that the 5.56×45 penetrates more deeply, is significantly more lethal, and when loaded into a 5.56×45 chamber, tends to be a bit more accurate than the 223. The 5.56×45 was adopted by the military because of its lethality, and it’s a stretch to think of it as a ‘sporting’ round.

The gun industry is challenging the ATF ruling not because it will mean the end of ‘black’ guns, but because they want to have it both ways.  On the one hand they want to promote AR-15s as the newest style of sporting guns for hunting or just plain fun.  On the other hand, they also want to promote these weapons as the latest and greatest ‘tools’ for personal defense.  Either way, I guarantee you that the net result of Limbaugh’s rant will be a disappearance of all AR-15 ammo within the next couple of days.

 

 

What Can Doctors Do To Reduce Gun Violence? Tell Us What Only They Know.

Next week’s issue of the New England Journal of Medicine will contain an editorial, “Guns, Society and Medicine,” written by the Journal’s former editor, Jerome Kassirer.  This editorial follows hard on the heels of another editorial, “Preventing Firearm Injury and Death” which just appeared in the Annals of Internal Medicine.  The good news about these statements is that they appear to reflect a growing consensus in the medical community that physicians should play a more active role in the debate about guns.  The bad news, it seems to me, is that the manner in which physicians appear to be lining up to engage in the debate may actually diminish the value of what they have to say.

The statement in the Annals, signed off by eight medical professional organizations (AAP, ACEP, ACP, etc.) calls for vigorous support of the following measures: universal background checks, elimination of physician “gag” laws, restrictions on the sale of assault rifles and high-capacity feeding devices, additional research, improved mental health services and avoidance of stigmatization through non-specific reporting laws.  These measures were adopted by the eight medical societies after the American Bar Association confirmed that they did not conflict with 2nd-Amendment rights.

                In his NEJM editorial, Jerome Kassirer voices his support for these same measures but notes that gun-safety advocates appear to be losing the battle due primarily to the “reality that gun-control advocates are ’outgunned’  by the NRA.”  It should be noted, inter alia, that in the twelve months following Sandy Hook, dues received by the NRA jumped more than 60% from $108 million in 2012 to $175 million in 2013, an increase due to the ability of the organization to sell the idea that the public outcry over what happened in Newtown would result in all guns being taken away.

I have been listening to gun-safety advocates bemoan the political power and financial muscle of the NRA for more than twenty years while, at the same time, researchers continue to publish articles which rightly demonstrate that the losses from gun ownership outweigh the gains.  There simply is no question that scholars like Hemenway, Cook, Webster and so many others have produced a body of literature about gun risk that cannot be honestly challenged by the other side.  But the other side isn’t interested in participating in a scholarly debate.  The other side is interested in selling guns.  And as long as guns are legal commerce, why shouldn’t it be up to the individual consumer to decide whether gun ownership represents a risk?

The answer to that question, and the role that I believe physicians should play in the gun debate can be found in a substantive piece of research that was also published this week in the Annals.  This work covered the medical histories of everyone discharged in 2006-2007 from an ER in Washington State and found that the patients who were admitted for a gun injury, particularly if they had a previous gun or violence-related arrest, had a significantly higher chance of coming either back to the ER with another injury or winding up in the morgue.  The research plan focused primarily on more than 9,000 patients who were treated for violent injuries, of whom 680 were in the ER because they were injured with guns.

What seems to be missing from the recommendations to reduce gun violence proposed by the medical associations and echoed by Dr. Kassirer is the fact that in the Seattle study, each of those 680 patients represented at least one direct, face-to-face contact with a clinician who had to deal with the medical risk of guns.  Thanks to data mining, we know a lot about the demographic profiles of these patients, but only the physician who treated them was in a position to ask and possibly learn what happened, why it happened, and whether it would happen again.  The answers to those questions and how those answers could shape policy, is a contribution to the gun debate that only doctors can make.

Is Gun Violence A Recurring Disease? A New Study Says ‘Yes.’

What are the odds that someone who is discharged from a hospital after treatment for a gunshot injury will return to the hospital with another serious injury or will be arrested for committing a serious crime?  For the first time a study attempts to answer that question based on enough data to discuss how the medical community should respond to people who seek medical help after being assaulted with a gun.  The Annals of Internal Medicine contains a study of more than 9,000 patients who were admitted to hospitals in Washington State with violent injuries in 2006-2007 and were then followed through December, 2011 or to their next subsequent hospitalization, arrest, or death, or whichever came first.  The findings about this group were then compared to 68,000 patients who were discharged during the same two-year period but had been treated for non-violent injury, along with a comparison to 180,000 patients comprising the general population.

                Before we compare the long-term experiences of all three groups, let’s look at the composition of the violent injury group itself.  Of all patients treated between 2006 and 2007 for violent injury, roughly 7.5% were admitted for injuries involving guns, or what the researchers refer to as firearm-related hospitalizations or FRH.  But the FRH number was actually 21% of all assaults, since 65% of all serious injuries were self-inflicted (accidents and the like.)  The ratio of one out of five assaults in which a gun was used is no different from what the FBI reports across the nation as a whole.

Patients admitted in 2006-2007 for gun injuries were also typical of this population in general, with nearly 75% being less than 40 years old, and 85% being male.  Racial data was not available for this study, but interestingly, one-third of all victims of gun violence in Washington State paid their hospital bills with private insurance, whereas the Urban Institute recently calculated that less than 5% of all hospital admissions for gun-related violence were covered by private plans.

Here’s the bottom line.  A patient who was treated and discharged for a gun injury in 2006 and 2007 had a significantly higher chance of then being killed with a gun or being arrested for some kind of violent assault.  A history of criminality prior to the hospitalization increased the likelihood of post-discharge victimization or criminal behavior even further.  The point is that a medical encounter for the treatment of gun violence does not just represent a challenge to respond to the injuries caused by the specific gun-related event.  It is also a harbinger of further medical challenges to come and should be understood and responded to in the context of an ongoing and continuous medical risk.

Other studies have also shown that violent injury is a recurring disease.  Earlier this year JAMA Pediatrics published an article which showed a clear division between two youthful populations, ages 14-24, who were treated by Emergency Departments in Flint, MI.  The groups were divided between those patients whose first visit to the ER was for violent injury, the other group came to the ER for something else.  What then happened was that a significant number of the patients who first sought medical care for injury returned to seek care for the same problem again. Not a single member of the latter population that came to the ER for something other than violent injury ever sought medical care for any kind of serious assault.

The Annals issue containing the study on violent recidivism also held an editorial in which eight of the major medical associations (ACP, AECP, AAP, ACS, etc.,) called for stronger physician commitment and endorsed a list of public health initiatives to deal with the medical risks of guns.  But I think that physicians need to do more than just support public health strategies in this regard.  What they really should do is develop effective medical strategies based on research like the articles cited above.  After all, it’s ultimately what the doctor tells the patient which makes any difference at all.

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You Can Carry A Concealed Gun In Florida But It Better Be Concealed.

The movement to establish open carry of guns as a constitutional right, an offshoot of the Constitutional Carry movement and particularly active in Texas, took a big hit this past week in the gunshine state when the Florida 4th District Court of Appeals took up the case of Norman vs. Florida and ruled against the petitioner’s claim that denying him open carry was an abridgement of his 2nd Amendment right.  What basically happened was that a Florida resident named Dale Norman was arrested in 2013 because his handgun was seen and reported to the police as he was walking down a Fort Pierce street.  He was convicted of violating a Florida statute that prohibits open carry of handguns, his appeal was then handled by a group called Florida Carry, which appears to be a group of military veterans who evidently like to parade around showing off their guns.

In its unanimous opinion, the Court first noted that it was embarking on a voyage into the vast terra incognita of laws covering carrying guns outside the home, which was first acknowledged to exist in the 2008 Heller decision that recognized the Constitutional right of citizens to keep a gun only inside the home.  But since the SCOTUS also recognized that the 2nd-Amendment right to private gun ownership was based primarily on the use of a gun for self-defense, it wasn’t long until the issue of whether the self-defense boundaries would be extended beyond the home also came under judicial review.

                Where jurisprudence seems to be moving is towards the recognition that concealed-carry is, indeed, a Constitutional right, but that the government can also restrict or at least regulate the issuance of CCW as long as the regulations are “reasonable and do not effectively destroy the right in practice by imposing a substantial limitation” on carrying guns outside the home.  And here is where the pedal meets the metal, so to speak, because what irks the pro-gun movement most of all, is the idea that government should be able to impose limitations of any kind on the ownership or use of guns by law-abiding folks.

Be that as it may, there doesn’t seem to be a judge anywhere in the United States who is willing to depart from the standard rationale for government regulation of firearms, namely (to quote the Florida 4th District) that “that the government has a substantial interest in regulating firearms as a matter of public safety.”  And this ‘substantial interest’ takes the form of a near-unanimous agreement by courts to apply intermediate, rather than strict scrutiny to deciding the constitutionality of laws covering ownership and use of guns.

If the pro-gun push for fewer restrictions on guns were ever to convince the country’s jurists that gun laws should be adjudicated only through the application of strict scrutiny review, then the gun-sense movement might as well pack it up and go home.  Because what strict scrutiny means is that a law can only be considered constitutional if it is narrowly tailored to achieve its result, whereas intermediate scrutiny means that the law only needs to serve accepted, general ends.  If regulating gun ownership was no longer accepted as a compelling government interest unless the government could prove that every gun law achieved some specific safety result, you could kiss gun regulations goodbye.

Which is exactly what Dale Norman and his attorneys and his supporters were hoping would happen in the 4th Florida District Court of Appeals in West Palm Beach. But it didn’t turn out that way at all.  And the reason the District Court upheld his conviction was because it found that, given Florida’s liberal issuance of concealed-carry permits, one simply couldn’t sustain the argument that Florida was in any way preventing its residents from using guns outside their homes for self-defense.  Believing that you are safer because you carry a gun is one thing, waving it around in public to scare off the bad guys is something else.