April 11, 2016

Ready, Aim, Fire

Firearms are a geriatric issue. The reason: suicide is more common in older people than in the general population and guns are the method of choice for older people who kill themselves. In fact, elderly white men have the highest suicide rate in the country (29/100,000 compared to the national average of 12.4 deaths/100,000). White men over 85 have a particularly high suicide rate: 47/100,000. A study in the Lancet could in principle help remedy this problem by shedding light on which of the existing firearms laws have any effect.

Examining data on suicides and homicides in the United States between 2008 and 2010, the researchers identified 32,000 gun-related deaths. They then looked at the site of death and existing firearm legislation. The results: 25 types of firearm legislation are found across the 50 states. Of these laws, 9 were associated with a decrease in mortality, 9 with an increase in mortality, and 7 were equivocal. The 3 state laws with greatest evidence of statistically significant benefit are universal background checks to buy guns, universal background checks to buy ammunition, and ID requirements for buying firearms. The single law most likely to lead to an increase in violent deaths is “stand your ground” legislation. The authors of the study projected that if there were federal level implementation of universal background checks, gun-related deaths would fall from 10.35/100,000 to 4.46/100,000.

Now there are serious methodological problems with this study, as US newspapers were quick to point out: basically, it compares what was happening in various states before a particular law was enacted to what happened afterwards and assumes that any changes in gun violence were due to the law. But it’s entirely possible that there were other things going on in those states that led to the change in gun violence. In some cases, especially states where the law seemed to make matters worse, the changes that were occurring might have led to the decision to enact the legislation in the first place. But this kind of study is the best we have right now. And there’s a reason we don’t have anything better.

The reason we don’t have better studies on the effectiveness (or lack of effectiveness) of various gun control measures is that the CDC, and to a large extent, the NIH, are prevented from funding such studies. Thanks to the “Dickey Amendment,” passed by Congress in 1996, “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate [for] or promote gun control.” This clause effectively scared the CDC, which spends millions on studies of highway safety, from supporting any research on guns. And in 2011, the Dickey amendment was extended to the NIH.

Congress has made a few attempts to repeal the Dickey amendment as recently as in January, 2016, after the San Bernardino shootings. They went nowhere. The irony is that even the most rabid right-wing politicians and their supporters who want to shrink the federal government, in the most extreme cases eliminating Medicare, Medicaid, social security, and the income tax (the view of the Koch brothers, according to Jane Mayer’s book, Dark Money) believe that the one role the federal government is to protect its citizens from physical harm. 

If the federal government is to keep us safe, it has to know how best to achieve that end. Neither ideology nor common sense are the best guides to determining effectiveness. Research on how to reduce gun violence is essential—and it’s a geriatric issue.

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