The fight between the NRA and the Obama administration is just political fog. The “excuse” is because of several high profile mass murders, yet the real problem is that the press publicizes and glorifies such murders, leading to “copy cat” crimes by the unstable.

One has to wonder at dear old Joe Biden’s remark, justifying an executive order on guns (instead of passing it the normal way via Congress, as had been done with the Brady Bill).

But that is a constitutional issue, and I am a doctor, not a lawyer. For doctors, violence and drug use are medical problems that we have to confront in our offices and emergency rooms.

Biden talked also about taking responsible action. “As the president said, if you’re actions result in only saving one life, they’re worth taking. But I’m convinced we can affect the well-being of millions of americans and take thousands of people out of harm’s way if we act responsibly.”

Millions of Americans? Thousands of people out of harms’ way?

Let’s look at the issue as a public health problem.

From the CDC: The Good News: 

The homicide rate is down.

the Bad News:

During 1991–2007, homicide was ranked as one of the top four leading causes of death each year for persons aged 1–40 years living in the United States.

So maybe old Joe is right.

The problem is that no one dares to point out that this is not a uniform problem in the USA.

Furthermore, vast disparities in homicide rates have been reported between males and females and among different age and racial/ethnic groups (2–6).

And if you say this on American television and you will be called a racist.

For example, previous studies have indicated that rates of death from homicide are particularly high among males (4–6), persons aged 15–34 years and <1 year (5), and blacks (2,3,5,6). Homicide rates for males are estimated to be approximately 3–4 times higher than that for females (4,5); among persons aged 20–24 years, the male homicide rate is 6 times higher than that for females (1,5). In addition, minority racial/ethnic children and young adults in the United States are disproportionately affected by homicide. During 1999–2002, among persons aged 10–19 years, the homicide rate for blacks was estimated to be 17.8 per 100,000 population, a rate 10 times that of whites (1.8 per 100,000) and higher than the rates reported for American Indians/Alaska Natives (AI/ANs) (6.0 per 100,000), Asian/Pacific Islanders (A/PIs) (2.9 per 100,000), and Hispanics (8.0 per 100,000) (2).

Since the problem of homicide is clustered among certain subgroups, the CDC suggests that schools be targeted to educate students in non violent behavioral techniques.

Despite the promising decrease in certain homicide rates, primary prevention efforts against violence should be increased, particularly among young racial/ethnic minority males. …For example, universal school-based interventions, at all school levels, that are aimed at reducing youth violence are promising. Such interventions teach students the skills to reduce violent and aggressive behavior, as well improve emotional well being, self-esteem, positive social skills, social problem-solving skills, conflict resolution skills, and team work (14).

A PDF on youth violence at the CDC site shows that as a result of the threat, five percent of children/teens carry weapons for self defense, and another five percent admit to skipping school because of fears of violence. Only one per cent of homicides occur inside schools, because the real story is that the fights occur going to and from school, on school grounds outside the building, or in the neighborhoods outside of school hours. So 7 percent report being injured or threatened on school property in the past year.

Yet this report includes all types of violence. What about gun related homicide?

The CDC has a 2011 report on urban gun violence here.

During 2006–2007, a total of 25,423 firearm homicides and 34,235 firearm suicides occurred among U.S. residents (1). These national totals include 4,166 firearm homicides and 1,446 firearm suicides among youths aged 10–19 years;

Yet gun violence is not limited to gangs killing each other. The dirty little secret is that some of the deaths are due to suicide, and others are by the police or people acting in self defense. Again from the CDC:

For 2007, a total of 15,882 fatal incidents involving 16,319 deaths occurred in the 16 NVDRS states included in this report. The majority (56.6%) of deaths was suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (28.0%), deaths of undetermined intent (14.7%), and unintentional firearm deaths (0.7%). Suicides occurred at higher rates among males, American Indians/Alaska Natives, non-Hispanic whites, and persons aged 45–54 years.

So how common are mass murders?

Of all incidents occurring in 2007 in the 16 states included in this report, 2.2% were known to have multiple victims.

And how many deaths come from gun violence?

Firearms accounted for 48.2% of injury deaths.

And in a day when libertarians are insisting that drug legalization would lower the crime rate, one has to note:

Tests for alcohol were conducted for 73.8% of decedents, and drug tests for amphetamines, antidepressants, cocaine, marijuana, and opiates were conducted for 52.5%, 43.2%, 55.8%, 36.5%, and 54.1% of decedents, respectively. Among decedents who tested positive for alcohol (33.4%), 59.1% had a blood alcohol concentration (BAC) of >0.08 g/dL (the legal limit in the majority of states). Opiates, including heroin and prescription pain killers, were identified in 26.2% of cases tested for these substances (antidepressants [23.5%], cocaine [13.5%], marijuana [11.1%], and amphetamines [4.6%]) (Table 2).

So, inner city minorities who take drugs are most at risk. School shootings are rare.

Yet no one wants to talk about the main problem of guns for middle class Americans: Suicide:

Firearms were used in the majority (50.7%) of suicide deaths.

President Obama’s problem is that every redneck knows he once ridiculed “people who cling to religion and guns”, and there has been a lot of disdain by the progressive friends of the administration for this subgroup of America.

Which is why I laugh at their recommendations:

More background checks and restrictions for legal gun owners.

Hello: criminals don’t buy guns that way.

From PBS Frontline:

Average number of firearm thefts that occur every year in the US: 341,000
(Source: US Dept. of Justice, Bureau of Justice Statistics, Guns and Crime, 4/94)

Number of firearms in the US: 223 Million
(Source: US Dept. of Justice, Bureau of Justice Statistics, Guns Used in Crime, 7/95, from ATF data)

Percentage of L.A. High School students who say they could obtain a gun for less than $50: 25
(Source: ACLU report: From Words to Weapons, 3/97)

Percentage of arrestees who say it is easy to get a gun illegally: 55
(Source: Arrestees and Guns: Monitoring the Illegal Firearms Market, 5/96)

So the dirty little secret is that anyone who wants to get a gun can do so, and without enforcing the law, more “gun control’ laws are useless.

The reason I, as a doctor, support making guns harder for “ordinary” folks to buy is because it might result in a lowering of suicides.

And many arguments that deteriorate into murder could be cut by limiting access to firearms.

But what about the NRA’s argument for self defense? Ah, the problem is lack of proper statistics: For example, as Michigan Live points out

Officially, there were 117 justifiable homicides involving civilians in Michigan from 2000 to 2010. Another 95 were killed by police, according to the statistics.

One reason those numbers are low is simple, MLive’s investigation found.

Police are reporting the cases as criminal homicides. When it’s later determined to be justifiable, they don’t change the easy-to-recode electronic records. It’s as simple as changing a “1” to a “4.”

That was the case in Kalamazoo County, where FBI statistics show only one justifiable homicide between 2000 and 2010. There were eight, three by civilians and five by police, MLive found.

And, of course, there are few accurate statistics where just the knowledge that someone has a weapon might defer crime.

Finally, Pediatricians in the US often ask questions about health risks, including seat belts, locking up medicines, and gun safety. This point needs to be emphasized, because although several of the recent “mass murders” in the headlines got guns illegally from friends (Columbine), the problem is that in several other cases the teenagers stole them from relatives (Red Lake, Newtown).

Gun control laws didn’t stop these crimes, but no one is pointing to personal responsibility in keeping guns from criminals or the unstable.

The Newtown massacre might have been prevented if Mom had locked up or disabled her guns when they not being used, and many cases of teen suicide or suicide in young men or in the elderly might be prevented if family members had taken precautions and locked up or kept them from access to guns.

Yet this would not stop all such murders: in the Red Lake incident, where the troubled teen stole the guns from his grandfather, a policeman, even the most strident gun control laws wouldn’t have prevented the massacre.

Nancy Reyes is a retired physician living in the rural Philippines.

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