It took four strong bodies to carry her into the cholera treatment center, where she appeared in a state of dehydration so severe it was clear she was only hours from death. Immediately, several nurses were at her bedside searching for a vein to give her the fluids she would need to save her life. We could quickly see that they were low on supplies as they placed an IV bare-handed, saving the only box of gloves they had for an implausibly more dire situation. Previously in my medical training, the only things I had witnessed that could kill a healthy human with such rapidity were trauma-related injuries and firearms.
This was Haiti, post-Hurricane Matthew, where I was deployed by the Centers for Disease Control and Prevention (CDC) as part of their cholera response team. It is quite common for the CDC to declare states of emergency for deaths due to disease, suicide, and now even prescription drugs to mobilize teams such as ours to respond quickly to prevent further morbidity and mortality. However, currently, annual national deaths due to firearms are threefold higher than the entirety of deaths during the most recent Ebola epidemic, 300 times higher than the number of infants born with Zika in the US and only just shy of the number of opiate and heroin related deaths. And yet no formal epidemic has been declared.
The landscape for gun-related research changed 20 years ago, when a landmark article was published by Arthur L. Kellerman in the New England Journal of Medicine. This study demonstrated that owning a gun increased the risk of homicide in the home, regardless of drug use, arrest or a history of violence among household members. Kellerman essentially disproved the adage “guns don’t kill people, people kill people.” The National Rifle Association responded by lobbying and suggesting that the researchers were biased against guns despite the journal’s stringent peer-review process, and this eventually aided the passage of the Dickey Amendment, which mandated that “none of the federal 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.”
As doctors pause when they see 15 narcotic prescriptions in one month, shouldn’t gun stores be alarmed when they see a single individual purchase 15 semi-automatic weapons?
Some argue that this amendment doesn’t actually ban the CDC from researching gun violence, it simply has cut congressional funding, which should permit the continuation of research. In theory, this is true. However in practice, it is incorrect. As much of the funding for the CDC comes from the Congressional budget, and due to the mere fact that the director is federally appointed, there exists a very real fear that any dissidence including the use of non-federal funds to perform gun-related research outside of reporting simple statistics could costs jobs and jeopardize other vitally important public health projects.
But how could the CDC, as our country’s leading voice in public health, not be part of the epidemiological investigation of firearm deaths? The invaluable lessons already learned from investigating the opiate crisis has led to CDC’s investment of million dollars in surveillance programs for opiate-related hospital admissions and death, and the widespread support of prescription monitoring programs that have created a “background check” for all patients who request or require narcotics. This program allows doctors to see the number, frequency, and even state location of all narcotic prescriptions by patient, and can quickly flag a patient who may exhibit “drug-seeking” behavior.
Could we apply these same lessons to gun violence and use improved surveillance to identify clusters of gun deaths unrelated to mass shootings? Could we used enhanced background checks for guns via argumentation of the FBI’s “National Instant Criminal Background Check” that while evaluating prior criminal and psychiatric history, does not include a history of the number and type of weapons or bullets previously purchased by individuals? As doctors pause when they see 15 narcotic prescriptions in one month, shouldn’t gun stores be alarmed when they see a single individual purchase 15 semi-automatic weapons?
Prevent our government’s public health sector from aggressively tackling this issue is an exception to how we have handled every other public health crisis as a country. To allow the NRA to dictate a public health research priority is as absurd as allowing Merck to claim that any research that results in the tempered use of opiates is inherently inaccurate.
The CDC defines an epidemic as “increase in the number of cases of a disease above what is normally expected in that population in that area.” It is beyond reason that 33,000 annual deaths due to firearms per year and the recurrent mass shootings of innocent children and adults have not resulted in the declaration of a crisis.
When is enough enough?