A doctor's approach to gun violence

August 17, 1999|By Stephen L. Cohen

AS THE gun battles continue to rage in the schools, on the streets and in the fractious House of Representatives, something is missing.

Amid all the emotional rancor, something has gotten lost in the controversy.

In a bygone era, they used to call it horse sense. Today, in the absence of any sense whatsoever, all that's left is the artful dodge.

Throughout the debate so far, reason has been trumped by strident hyperbole. But it need not be this way.

It would be helpful to approach the issue of gun mortality from a more clinical perspective, taking a cue from the medical community, which deals with death and morbidity all the time.

Perhaps if we saw the issue for what it really is -- a public health calamity -- we could bring all the power and insight of modern medicine to bear on the problem.

Potential causes

The first step in the search for a "cure" to the gun malady is to identify potential causes of the problem. Then, as with any medical condition, public health authorities could begin to test their theories.

But we can't test any theories -- or even gather useful information -- when special interest groups obstruct the search for solutions.

At a time when additional research is urgently needed, the gun lobby has called for the elimination of the National Center for Injury Prevention and Control (NCIPC), a division of the Centers for Disease Control.

The NCIPC has spearheaded much of the nation's research on gun mortality, but the National Rifle Association claims that the center has shown an "almost vicious sentiment against personal firearms ownership."

Though scientists have been known to disagree with CDC findings, no other organization has in recent memory accused the CDC of being "vicious" in its approach. It's a curious charge, given the CDC's mission to save lives, but it's entirely consistent with the NRA's desire to protect the status quo regarding gun ownership in America.

While the CDC may have focused unwanted attention on gun violence, it has also stressed a vital message: that further research is needed to shed light on the causes of firearms mortality.

In contrast, bitter rivals on both sides of the debate have insisted that either the media or the gun lobby is to blame for the epidemic of violence sweeping the nation.

Not surprisingly, gun-control advocates target the firearms industry while the NRA draws a huge bulls-eye on the foreheads of media moguls. Apparently, neither side has considered another option: Why not fire a few shots in both directions?

Of course, hitting something useful is precisely the goal of scientific research, but it's hard to hit anything useful when your eyes are closed.

It seems safe to assume that the NRA would agree with this notion. The Motion Picture Association of America, which is fighting legislation to create a commission on youth violence, needs its eyes pried open as well.

A good scientist would want to start his inquiry by examining the existing body of data on gun mortality.

Although we still have much to learn about the causes of gun violence, certain trends are already emerging from existing research.

Pediatric problem

Substantial data, for example, indicate that gun-related deaths are a major pediatric health problem in the U.S. In fact, firearm-related injuries are the second leading cause of death in children.

Every year, more than 5,000 children die as a result of gun homicides, suicides and unintentional shootings, and 20,000 more are wounded.

Accidental gun injuries account for almost 1,500 pediatric emergency room visits annually, and in 1994, nearly 200 children were killed in this manner.

Because of such staggering statistics, the American Academy of Pediatrics has called for aggressive action to reduce the danger of firearms to young people, including the removal of handguns from households with children. The AAP has even called for a ban on the manufacture, sale and private possession of handguns.

The nation's baby doctors aren't alone. In 1998, the Annals of Internal Medicine reported that 94 percent of internists and 87 percent of surgeons believe that firearm violence is a major public health issue.

The journal also reported that a majority of doctors surveyed support efforts to enact legislation to restrict the possession or sale of handguns.

NRA president Charlton Heston probably doesn't agree. But the NRA leader would be well advised to approach the problem as a serious public health issue.

If he really cares about the nation's pediatric population, he'll try to think like a health care provider: he'll analyze the available data and make an informed decision that puts the interest of the patient before all other concerns.

If Mr. Heston could think like a doctor, he'd make the right decision. Doctors must constantly make choices based on limited data, since there's so little certainty in the practice of medicine.

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