POSITION STATEMENT ON FIREARMS VIOLENCE PREVENTION

San Francisco Bay Area Chapter of Physicians for Social Responsibility

Approved: Thursday, February 15, 2001

Background

Firearms violence is at epidemic levels in California and in the United States. In 1998, there were over 30,000 fatal shootings in this country.[1] Over 4,000 Californians are killed annually by firearms.[2] For every fatal gunshot wound, it is estimated that at least 2-3 people suffer non-fatal firearms injuries.[3,4] By comparison, there were approximately 3,000 deaths due to polio in the entire United States at the height of the polio epidemic in 1952. The current rate of firearms deaths in the U.S. is comparable to the rate of deaths due to AIDS.[2] By 1991, the annual number of firearms related deaths exceeded the number of deaths due to motor vehicle accidents in seven states, including California.[5] It is estimated that the annual cost of medical treatment of gunshot injuries in the United States is $2.3-4 billion. [6,7] The overall cost to society of firearms related injuries in the United States has been estimated to be $112 billion annually.[8]

Firearms related deaths and injuries are particularly rampant in children and young adults in this country. There have been multiple studies in the medical literature documenting the dramatic increase in pediatrics firearms injuries over the past four decades.[9,10,11,12,13] The rate of firearms-related deaths for U.S. children younger than 15 years of age is nearly 12 times greater than the rate in the other 25 leading industrialized nations of the world.[14,15] A child in the United States is currently far more likely to catch a bullet than to catch the measles.[1,16] The homicide rate for U.S. males ages 15-24 is more than ten times higher than in most other developed countries, with three quarters of homicides being committed by firearms in the U.S. while less than a third of homicides are committed by firearms in most other countries.[17]

The much higher rate of firearms violence in the United States as compared with all other industrialized countries is associated with a much higher rate of firearms ownership in the U.S.[18,19,20] Within the United States, as well, the community rates of firearms violence generally parallel community rates of firearms ownership.[21,22,23] Based on public health models of disease and injury prevention, it would be expected that the most effective method of reducing firearms injuries and deaths in the U. S. would be to reduce firearms availability.[24] In fact, there is convincing evidence demonstrating that enactment and enforcement of legislation that reduces firearms availability is effective in reducing firearms fatalities.[25,26,27,28,29,30,31,32]

There are approximately 200 million privately owned firearms in the United States.[33] It is estimated that 30-40% of adults keep firearms in their homes.[34] Most persons who keep firearms at home cite personal protection as the reason for having guns.[34,35] Multiple studies have shown, however, that rather than being protective, having a gun in the home greatly increases the chances of a household resident being shot and killed or injured.[36,37,38,39,40,41,42] In one of the best known studies, it was found that for every time a gun in the home was used to kill an intruder, there were 43 firearms-related deaths of a household member.[39] Most families that own guns keep them loaded, unlocked, or both.[43] In many situations, children have access to guns. In a survey of school children, 59% of those in 6th through 12th grades said they “could get a handgun if they wanted one.”[44] Having a gun in the home increases the likelihood that domestic violence will result in homicide.[45] In the period between 1976 and 1987, more than twice as many women were murdered by a spouse or intimate acquaintance with a gun than were killed by a stranger with a gun, knife, or any other kind of weapon.[46]

Numerous physicians specialty associations, including the American College of Physicians,[47] the American Academy of Family Physicians,[48] the American Academy of Pediatrics,[49] the American College of Surgeons,[50] the Eastern Association for the Surgery of Trauma,[51] and the American College of Emergency Physicians[52] have issued position statements calling for reductions in firearms violence. Physicians for Social Responsibility has been actively working toward firearms violence prevention, as have other cross-specialty physicians’organizations including Physicians for a Violence-Free Society. In addition, many lay organizations, including Handgun Control, Inc., The Center to Prevent Handgun Violence, The Violence Policy Center, and most recently, the Million Mom March Foundation (formerly the Bell Campaign), have actively promoted legislation and educational programs to reduce firearms violence.

The most significant firearms legislation to be enacted at the federal level over the past decade has been the Brady Handgun Violence Prevention Act, implemented in February, 1994. The Brady Bill requires background checks and a 5-day waiting period prior to the purchase of a handgun from a federally licensed firearms dealer. Other, less far-reaching firearms violence control measures have included enactment and enforcement of tougher state and local gun control laws[25,27,53] tougher licensure for firearms dealers[54,55] the development of firearms safety locks,[56] and bans in some states on assault weapons[57] and low-priced, concealable handguns.[58,59] The effectiveness of such measures is difficult to assess using typical medical research methodology. Investigators are not able to randomly assign “treatment” and “control” groups, it is difficult to control for confounding variables, there is not a uniform reporting system for firearms injuries, and the extent and effect of illegal gun trafficking is hard to assess. Nevertheless, recent trends in firearms fatalities suggest that these measures may be having an effect. From 1993 to 1997, there was a 21% drop in overall firearms mortality in the U.S.[1]

Though the recent decline in firearms fatalities gives reason for hope, firearms violence is still epidemic in our country. For the firearms fatality rate in the United States to drop to the average level for the other 35 leading economic nations of the world, there would have to be an 88% decline from 1993 levels.[60] For the U.S. rate to drop to the level in England, where private possession of handguns is prohibited outside of sporting and hunting clubs, the U.S. rate would have to drop 97% from 1993 levels.[60]

A significant obstacle to curbing the firearms epidemic in the United States is the pro-gun lobby. In particular, the well-funded and highly political National Rifle Association (NRA) lobbies against even the most moderate gun control measures. The arguments of the pro-gun lobby against restrictions on firearms ownership by private individuals usually center on two contentions: 1) that the Second Amendment to the U.S. Constitution prohibits restrictions on firearms ownership; and 2) that there is evidence that “responsible gun ownership” deters crime.

When citing the Second Amendment, gun advocates typically omit the first portion of the amendment, “A well regulated militia being necessary to the security of a free state…” and quote only the second portion, “…the right of the people to keep and bear arms shall not be infringed.” It has been well-established in Supreme Court decisions[61,62] and through reviews by legal experts[63,64] that the Second Amendment was intended to protect the rights of states to maintain armed militias and that it does not imply a right of individual citizens to own firearms. Although many U.S. citizens misunderstand the Second Amendment, it cannot be reasonably argued that the Second Amendment prohibits restrictions on firearms ownership by private individuals.

The contention that “responsible gun ownership” deters crime is based largely on anecdotal reports and quasi-scientific studies published outside of the medical literature. One of the most often quoted studies claims that there are 2.5 million incidents of defensive gun use annually in the United States.[65] Another study frequently quoted by gun advocates purports to show that allowing private citizens to carry concealed weapons reduces crime.[66] Serious methodological flaws have been noted in these studies[67,68,69] and their conclusions are not consistent with other studies outside of the medical literature[70,71] or with the large body of data in the medical literature cited above.

The influence of the pro-gun lobby in the United States may in part explain why the response of U.S. legislators to the rash of recent firearms tragedies in this country has been so limited in comparison with the responses to similar events in other countries. In Canada, after the massacre of 14 women at Montreal’s L’Ecole Polytechnique in 1989, the Canadian government, with strong support from the Canadian Association of Emergency Physicians, passed comprehensive gun control legislation, including mandatory registration of all firearms and controls on sales of ammunition.[72] In Australia, after a man with a semiautomatic rifle murdered 35 people in the tourist town of Port Arthur in April of 1996, the Australian government moved quickly to ban semiautomatic weapons, forcing the surrender of 640,000 firearms to authorities.[73] In Britain, after the massacre of 16 schoolchildren and their teacher in a Scottish school, the conservative-led government moved to bar personal possession of handguns altogether outside of hunting and target-shooting clubs.[74] After two Columbine High School students shot and killed 12 other students and a teacher and wounded 23 others before killing themselves in Colorado in April of 1999, the Clinton administration introduced legislation to require background checks before purchases of guns at “gun shows,” closing a loophole in the Brady Act. More than a year later, Congress continues to debate this same measure. As of yet, no new federal gun control legislation has been passed since the Columbine tragedy.

In California in 1999, Governor Gray Davis signed bills outlawing “Saturday night specials” and assault rifles, limiting handgun purchases to one a month, and requiring child safety locks on new firearms,[75] but the Governor also vowed to veto any additional firearms legislation.[76] AB-273, a law to require a safety course and passage of a safe handling test prior to purchase of a handgun, was withdrawn by its author at a time when the bill appeared likely to pass the year 2000 California Legislature because of a threat of a veto by the Governor.[77]

San Francisco Bay Area PSR’s Position on Firearms Violence Prevention

Firearm violence is at epidemic levels in California and the United States. Rates of firearm injuries and fatalities are much higher in our state and in our country than in all other democratic, industrialized nations. We believe that it is both desirable and possible to reduce rates of firearms fatalities and injuries in California and the United States to rates at or below those in the other democratic, industrialized societies of the world. We believe that firearms violence is a public health problem, and that the medical community is therefore both obligated and well suited to take a leading role in efforts to reduce firearms violence. The roots of firearms violence are complex. We support all measures that are reasonably calculated, based either on sound medical research or on application of established principles of disease and injury prevention, to reduce rates of firearms injuries and deaths. We believe that it has been well established in the medical literature that increasing availability of firearms is associated with higher rates of firearms violence, and that that enactment and enforcement of restrictions on firearms availability leads to reduced firearms violence. We believe that the single, most effective and most necessary step to reduce firearms violence in our society is to adopt restrictions on firearms ownership in our country similar to the restrictions in other democratic nations. While we believe that reducing firearms availability is key to reducing firearms violence, we also believe that firearms violence needs to be considered in the broader social context. We believe that physicians should continue to strive to understand the roots of violence in general, and to work toward its eradication.