Family Medicine Vital Signs

  By Osman Sanyer, MD

Note: This piece is intended to express the need for a public health approach gun safety.  It does NOT address the political issues related to gun ownership. The opinions below are those of the author.

It happened again this week. Two unarmed people were killed by an individual with a gun. This killing was particularly public, it occurred during the filming of a television interview. The assailant left some explanation of his motivations, but the complete story is not yet known. Truth be told, it doesn’t matter.  Two more people have been murdered, at gunpoint. Their assailant has taken his own life, also with a gun. There will be a frenzy of public outcry, a social media blitz framing rigid positions about the meaning of the Second Amendment to the Constitution, and hours and days of television coverage of the event and the pain and loss that is always the aftermath. And, nothing will change.

This is not a political piece. It is not intended to raise ire, to incite contemptuous debate, or to lay blame upon specific groups and individuals. This is about the responsibility that we have as members of the medical and public health communities to insist on the funding and development of meaningful research that results in reduced harm from gun violence. While the legal and political institutions in our society will continue to wrestle with the daunting task of coming to agreement of the intent of the Second Amendment, I believe that the medical and public health systems in this country can address our epidemic of gun violence in a more timely fashion. Federal funding earmarked for research to reduce gun violence has dried up. Since 1996, Congress has placed specific language in the annual appropriations bills that prohibit the Centers for Disease Control (CDC) and National Institutes of Health (NIH), among other federal institutions, from directing funds allocated for injury prevention toward research related to the goal of reducing firearm injuries and deaths. The funds appropriated to the CDC for the study of gun violence have been cut drastically (by some calculations more than 90%) between 1996 and 2011.

Gun deaths per capita have more than tripled since 2000, a period almost exactly correlating with the decreased federal funding on firearm research. In 2012 about 33,000 Americans were killed by firearms. Nearly one-third of these deaths are suicides. Self-inflicted gunshot wounds are the cause of more than half of the suicides in our country.

Overcoming this significant problem will take leadership, will, and perseverance. But there are clear examples in our recent public health history that prove that research and intervention can reduce harm through education and cooperative political engagement. One prominent example is that of motor vehicle safety. In 2012 about 34,000 Americans were killed in motor vehicle accidents. The death rate from car accidents has dropped by more than half since 1950 when there were about 24 deaths per 100,000 individuals from motor vehicle accidents. By 2012, this death rate had dropped to around 11 deaths per 100,000 people. One could say that we have succeeded in saving 35,000 lives per year through improved motor vehicle safety. We didn’t have to outlaw cars to accomplish this. Through interventions such as improvements in vehicle safety features, road and highway design changes, and driver education efforts regarding seatbelt and alcohol use, we have been able to dramatically reduce the death rate from automobile accidents. This accomplishment required a significant investment of public and private money to make the car, road way, and educational program alterations that have led to this improvement in mortality.

Given the success of the federally funded efforts to reduce motor vehicle deaths, it is difficult to understand the motivations and justifications for a choice to defund studies on gun safety. As a family physician, I feel obligated to speak out, to encourage my congressmen and Senators to reconsider this active defunding of gun violence research. If we practice as family docs long enough in any geographic location, we will all have patients whose lives are taken due to gun violence. The three patients associated with my practice who have been killed by firearms in the last decade have all committed suicide. I have seen and felt the lingering and immeasurable painful devastation of these losses.

Guns will be part of our society for the foreseeable future, perhaps forever.  I can accept this political and social reality if I know that we are doing everything we can to make ourselves safer with these guns in our midst. We have the resources, and the evidence shows that past investments in harm reduction research do save lives. It is time for physicians to join our public health agencies, and reach out to our communities, in order to engage our elected officials and insist on the funding of gun safety research.

Dr. Sanyer is a Family Medicine Physician and an Associate Professor (clinical) with the University of Utah Division of Family Medicine.