You may have missed this story. It received relatively little coverage compared to the well documented loss of life in a Newtown Connecticut elementary school, an Oregon shopping mall, a Colorado cinema, a Minnesota business and most recently a South Carolina church. Approximately 34,000 people die annually in the United States from firearms. The history of bans on gun research is an important story and helps explain why things don't seem to change.
The first shot in this conflict was fired in 1993 with the publication of an article in the New England Journal of Medicine, one of the most prestigious and rigorous medical periodicals in print. The study, Gun Ownership as a Risk Factor for Homicide in the Home, sought to determine whether keeping a firearm in the home confers protection against crime, or increases the risk of violent crime in the home. Funding was provided by the National Center for Injury Prevention and Control (NCIPC), a branch of the Center for Disease Control and Prevention (CDC).
The researchers controlled for potentially confounding variables that could skew results such as illicit drug use, prior arrests and a history of being hit or hurt in a fight at home. After eliminating those cases they found that guns kept in the home increased the risk of homicide nearly 3 fold.
The most common reason given for having a gun in the home is protection. This study suggested that guns in the home make you less safe. The National Rifle Association (NRA) fired back.
NRA lobbyists called the research incompetent, politicized science and appealed to pro-gun senators for a response. These senators approached Arlen Spector, senator from Pennsylvania and chairman of the Health and Human Services Committee. An attempt to eliminate the NCIPC failed. However funding for the CDC budget was cut by $2.6 million, precisely the amount spent on firearm injury research the previous year. Funding was subsequently restored but allocated to traumatic brain injury.
In addition, the following clause was attached to the 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." Exactly what this did and did not allow was unclear. No CDC employee was willing to risk further funding cuts to find out. Firearm injury research disappeared.
The CDC was not the only casualty in this conflict. In 2009, a study investigated whether carrying a hand gun increased or decreased the risk for firearm assault. On average, guns did not protect those who possessed them from being shot in an assault. The research was funded by the National Institute on Alcohol Abuse and Alcoholism. In 2011, Congress broadened the restrictive clause to include all Department of Health and Human Services agencies, including the National Institutes for Health (NIH).
Not only health agencies have been censored. The United States military has experienced a dramatic increase in suicides. Attempts to study the problem have been stymied by a provision in the 2011 National Defense Authorization Act that prevents military commanders from questioning soldiers about their private weapons, even in the context of suspected suicidality. Two retired generals have petitioned Congress to repeal the provision.
After the Sandy Hook Elementary School shootings in Newtown Connecticut, President Obama attempted to put an end to the suppression of firearm research with an Executive Order. It has not worked. Congress continues to block dedicated funding. The President sought $10 million for gun violence research at the CDC in the last two budgets. Both were voted down in the House of Representatives.
The CDC was organized in 1946 as the nation's health protection agency. Its domain includes anything that threatens the public's health. To accomplish this mission it conducts critical research and provides essential information. The aim of these activities is to guide decision making for the prevention of morbidity and mortality. Implementing specific measures to decrease the leading causes of death is at the heart of their work.
So what are the leading causes of death?
In the first half of life (1-44 years), more Americans die from injuries than from any other cause. The number one killer for 50% of our lifespan would seem an appropriate target for the CDC. However a certain category of injury is not considered an acceptable focus for CDC intervention.
The reduction in deaths due to motor vehicle accidents provides an instructive example of how a major public health problem related to a technological advance can be managed.
In 1960, unintentional injuries caused 93,803 deaths; 41% were due to car crashes. The National Highway Safety Bureau was created in 1966 in an attempt to make our roads safer. Its first director, Dr. William Haddon, a public health physician, applied standard public health methods and epidemiology to preventing motor-vehicle-related injury.
Using an infectious disease model, he observed interactions between host (human), agent (motor vehicle), and environment (highway). This research approach translated into legislation that set standards for new safety features including head rests, energy-absorbing steering wheels, shatter-resistant windshields, and safety belts. An estimated 255,000 deaths were avoided by seat belts alone between 1978 and 2008.
Changes in driver and passenger (host) behavior also have reduced motor-vehicle crashes and injuries. Research results informed the enactment and enforcement of traffic safety laws, that have led to safer behavioral choices. Examples include enforcement of laws against speeding, driving while intoxicated, and enforcement of safety-belt, child-safety seat, and motorcycle helmet use laws.
In 2013, unintentional injuries caused 130,557 deaths; the number due to car accidents has been reduced to 33,804 or 25%. While this represents a dramatic improvement, motor vehicle safety remains an ongoing public health concern which continues to be aggressively studied.
In 2013, firearms resulted in 33,636 deaths, approximately equivalent to the motor vehicle death toll. Firearms, like motor vehicles, represent a technological advance with a high casualty rate. There is an easily identifiable host (human), agent (gun) and environment. Why would we not study this phenomenon with the same public health methods that yielded such effective lifesaving interventions for motor vehicles?
Speaker of the House, John Boehner famously said, "I'm sorry, but a gun is not a disease. And guns don't kill people; people do." This is a statement made with one eye closed. If, in 1960, they had said, "I'm sorry, but a car is not a disease. And cars don't kill people, people do.", motor vehicle related deaths would not have been reduced by half. Good research, as it is practiced at the CDC, welcomes scrutiny, criticism and verification. Not funding the study of gun-related injury is a form of repression our country can ill afford.