FIREARM VIOLENCE IN THE UNITED STATES: A MEDICAL OPINION

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   Most people don’t realize that over 30,000 people are purposely shot to death each year in the U.S. Moreover, rates of firearm-related violent crimes continue to climb, having increased by 26% since 2008. To gain perspective on these numbers, firearm deaths have now reached a yearly rate that equals that of automobile fatalities. What we can do to stem such violence is urgent but hampered severely by the rabid supporters of the second amendment and, of course, the gun lobby. Some clarification recently has been shed on this problem by a study appearing in the prestigious medical journal, the AMA sponsored Archives of Internal Medicine. These authors explored the question whether more restrictive firearm laws in a given state are associated with fewer shooting deaths. To answer this question, using sophisticated statistical methods, they measured the association between the rate of shooting deaths in a state-by-state rating (divided into quarters) of strength of legislation designed to limit sale and use of firearms. Their results were very illuminating: Those states with the fewest firearm regulations, as exemplified by Utah and Louisiana (0-2 laws), suffered the highest rate of firearm fatalities, which included both homicides and suicides. The states with the strictest pattern of regulation, as exemplified by Hawaii and Massachusetts (9-24 laws) experienced the lowest fatality rates. Indiana, my home State, fell into the second lowest category for regulation and, as expected, fell into the second highest incidence of firearm deaths.

    These authors freely admitted that finding an association between two factors—gun laws and mortality—does not prove that these two are causally related. But it sure raises important thoughts about what we as a society can do about this problem. Further research is obviously needed, but it is quite likely that more restrictive gun laws can save lives.

The experience in Australia adds strong support to this argument: In response to a mass shooting of 20 people by an assault weapon in 1996, the state enacted a comprehensive set of firearm law reforms. Among others, the regulations included a ban on civilian ownership of semiautomatic long guns and pump action shotguns. Financed by a small tax levy on all workers, this law was combined with a buyback program of those guns already in circulation. This included a prohibition of mail or internet gun sales with required registration of all firearms continuing to be legally held. Since then, there have been no mass shootings and an accelerated decline in total gun-related deaths.   

    Another study appearing in a major medical journal has added even more weight to these conclusions. In a study that included 27 different countries around the world, researchers found that there was a strong correlation between gun ownership rates and firearm-related deaths. Those countries with the highest rates of gun ownership, e.g. the U.S.A. (88.8 per 100 inhabitants) suffered the highest firearm-related deaths, whereas those with the lowest rates of such possession, i.e., Japan and the U.K. (0.6 and 6.2 per 100) enjoyed the lowest rate of such deaths. Interestingly these same researchers found a poor correlation between mental illness and firearm deaths. 

    Another proposed remedy, i.e. more aggressive attempts to identify, treat and constrain the huge numbers of those who are mentally ill, is an exercise doomed to failure.

Moreover, the limited relationship between mental illness and firearm deaths, as noted above, implies that trying to find and treat those suffering from mental illness would do little to reduce the number of gun-related fatalities. Hall and Friedman provided further confirmation of this concept (Mayo Clinic journal, November, 2013), by concluding that proper identification the small proportion of the mentally ill individuals capable of homicide prior to an actual act of violence is extremely difficult, if not impossible.

     Widespread arming of teachers and/or police officers is equally ridiculous, especially since it would increase chances for erroneous shootings in the absence of any expected benefits.

    With such limited options available, what are we left with? Although we need not scrap the second amendment, those who hold legislative power should seriously consider stronger laws restricting guns, while, at the same time, sponsoring and performing more comprehensive research on this urgent problem. If we value life, we cannot afford to wait!      

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