Death by Gun Violence — A Public Health Crisis

By Howard Bauchner, MD (1); Frederick P. Rivara, MD, MPH (2); Robert O. Bonow, MD, MS (3); Neil M. Bressler, MD (4); Mary L. (Nora) Disis, MD (5); Stephan Heckers, MD (6); S. Andrew Josephson, MD (7); Melina R. Kibbe, MD (8); Jay F. Piccirillo, MD (9); Rita F. Redberg, MD, MSc (10); John S. Rhee, MD, MPH (11); June K. Robinson, MD (12)
JAMA (Published simultaneously in JAMA and the 11 JAMA Network Journals), October 9, 2017

Author Affiliations:

1) Editor in Chief, JAMA and The JAMA Network
2) Editor, JAMA Pediatrics and JAMA Network Open
3) Editor, JAMA Cardiology
4) Editor, JAMA Ophthalmology
5) Editor, JAMA Oncology
6) Editor, JAMA Psychiatry
7) Editor, JAMA Neurology
8) Editor, JAMA Surgery
9) Editor, JAMA Otolaryngology–Head & Neck Surgery
10) Editor, JAMA Internal Medicine
11) Editor, JAMA Facial Plastic Surgery
12) Editor, JAMA Dermatology

The shooting in Las Vegas, Nevada, that left 59 people dead, 10 times that number wounded, and thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what we as a nation can and should do about guns. The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence. The 36,252 deaths from firearms in the United States in 2015 exceeded the number of deaths from motor vehicle traffic crashes that year (36,161). That same year, the US Centers for Disease Control and Prevention reported that 5 people died from terrorism. Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception.

Guns do not make individuals, their families, or homes safer and they result in far more deaths to loved ones than to an intruder intending to cause harm. Often forgotten is that 60.7% of the gun deaths in 2015 in the United States were suicides. Means used to attempt suicide matter; guns will result in suicidal deaths well over 90% of the time, whereas ingestion of pills or wrist cutting will be unsuccessful more than 90% of the time. The majority of people who try to commit suicide but survive the attempt will not go on to die from suicide; if the attempt is with a gun, there will be no second chance at life.

The journals of the JAMA Network are dedicated to improving the health of people across the globe. We do so by addressing the most important public health problems harming people and publishing the best science that can be done. The journals have published important work on gun violence; in the past year this has included studies on differences in gun use during terrorist attacks in the United States compared with other countries, the effect of exposure to gun violence in the media on children’s interest in real guns, the relationship between firearm laws and firearm homicides and suicides, and the association of “stand your ground” laws with homicide and suicide. Research on gun violence is important, although Congress over the last 2 decades has placed limits on that science from being conducted. This attempt to suppress research into gun violence resulted in a 64% decline in the number of firearm studies per million citations in SCOPUS between 1998 and 2012.

Physicians and other health care professionals can do more. The US Court of Appeals for the 11th Circuit has ruled that attempts to prevent physicians from asking and counseling patients about guns violate the First Amendment. As with any epidemic, prevention is important. Physicians and others should ask about guns in the home, especially for high-risk patients, and advise about removal and safe storage. Good evidence has shown that safe storage of firearms is effective in reducing misuse. Physicians can conduct appropriate screening and early intervention for suicide, the most common cause of gun deaths.

We, as editors of the journals in the JAMA Network, are committed to providing policy makers, as well as the medical community and the US public, with accurate, timely information to guide interventions that will reduce injuries and deaths from guns. Numerous polls have shown that the majority of citizens want action that will make a difference. Other countries have acted: when a mass shooting happened in Australia 2 decades ago, the federal government responded with legislation within 2 weeks of the event banning semiautomatic rifles. Since 1996, there has not been a mass shooting on that continent.

Guns kill people. More background checks; more hotel, school, and venue security; more restrictions on the number and types of guns that individuals can own; and development of “smart guns” may help decrease firearm violence. But the key to reducing firearm deaths in the United States is to understand and reduce exposure to the cause, just like in any epidemic, and in this case that is guns.…

Suppose we identified a public health hazard that caused 36 deaths. There would certainly be considerable interest in the nature of the problem and what could be done about it. Suppose that were 360 deaths instead. That would be national news that would be followed up with Congressional hearings. Suppose it were 3,600 deaths. Whoa. Yet, in 2015, there were 36,252 deaths from firearms in the U.S.

So where is Congress on this? The latest gun tragedy in Las Vegas included the use of bump stocks – devices that allow semi-automatic weapons to fire in rapid succession just like machine guns. So bipartisan legislation was introduced to ban these devices. Speaker Paul Ryan responded by saying that this was a matter for the regulators, so no legislation will be introduced on the House floor. The National Rifle Association – NRA – still owns Congress.

Unfortunately, the well meaning editorial by the 12 JAMA Network editors is all too typical of the responses to these tragedies. Gun violence is tragic, and we should do something about it. Pause. (Time to get back to work.)

Since 1968, more U.S. residents have died from gun violence than have have died in battle during all the wars the country has fought since its inception.

It’s time to get serious about gun violence. Let’s sit down at the negotiating tables with an opening position that all guns throughout the nation be collected and melted down – no compromises – though we would listen to counter proposals.

What does this have to do with single payer? Eliminating gun violence would reduce our national health expenditures in a beneficial way – one of the prime goals of an improved Medicare for all.

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