Sex, Drugs, and Public Health

The CDC was originally the “Communicable Disease Center.” It focused on microbial diseases like TB, Influenza, Malaria etc. which could spread from one person to another. It is now called the “Centers for Disease Control” and investigates many other society-wide maladies like Cancer, heart attack, and death from injuries.

As with other branches of medicine, we in Public Health make the Diagnosis, search for the Cause of the problem, and decide on a Treatment (in Public Health, that’s Prevention).

In addition to investigating these conditions with their own staff, the CDC also funds research and prevention of disease by many other agencies and universities. The following data reflects a small sample of accomplishments from such efforts, measured between 2000 and 2010:

1. TB: case rate down 30%; Cause – the Mycobacterium; Treatment – drugs, isolation, investigation of contacts
2. H1N1 Pandemic Flu: prevented 30,000 hospitalizations and 1500 deaths; Cause – a virus; Treatment – vaccine, drugs, isolation
3. Cancer: colorectal, breast and cervical down 2.2 to 2.8 % each year; Cause – various; Treatment – screening, early intervention, vaccine
4. Heart Disease: down from 195 cases per 100,000 persons to 126; Cause – the major one is smoking; Treatment – smoking in youth down from 35% to 19.5%.
5. Motor Vehicle Accidents: death rate down from 15 per 100,000 to 11; Cause – inadequate safety devices; Treatment – belts, air bags, better design.

In 1993, the New England Journal of Medicine, America’s most prestigious Medical Journal, published a research paper from the University of Tennessee entitled “Gun Ownership as Risk Factor for Homicide in the Home.” The study showed that homes where guns were kept were significantly more likely to experience a homicide as homes with no guns.

Funding for the study came from the CDC’s Center for Injury Prevention.

Congress, under pressure from the NRA, produced the Dickey amendment to a budget bill, prohibiting the CDC from funding such research. Congress, no doubt parroting NRA catch phrases, accused the CDC of “promoting gun control.” The amendment was named for a congressman from Arkansas.

Over the years, with repeated affirmations of the Dickey amendment (and related budget cuts), CDC funding into firearm injury and death dried up.

As I’m sure you know, the NRA repeatedly envokes the second constitutional amendment to bolster its position. I encourage you to read it. Even though it was written in the vernacular of 225 years ago, it’s only one sentence and is quite clear:

“A well regulated Militia, being necessary to the security of a free State,
the right of the people to keep and bear Arms, shall not be infringed.”

You should probably ask yourself this question: What does a “well regulated militia” mean in 2016?

While you’re at it, ask where the NRA’s money comes from (hint: membership dues is only about 50% of its more than $300 million annual revenue).

In the absence of solid “official” data from the CDC (collected from emergency rooms, physicians, death records etc.) a number of organizations have nevertheless provided us with some sense of this epidemic of injury and death. Numbers vary, due to lack of centralized, fact-checked analysis, but here are some samples:

1. every year in the U.S., between 27,000 and 33,000 people die of Gun Shot Wounds. At least 750 of them are children, and the number may be as high as 2600.
2. Compared with other “developed” countries (Europe, Canada, Australia, New Zealand, Japan, Korea) our GSW homicide rates are 25 times higher, and suicide rates 8 times higher. If people did not have a gun handy (recall the NEJM article discussed above), they’d either use a less lethal tool, or have a little more time to think about it.
3. 60% of all homicides in the U.S. are committed using guns, a much higher percentage than in the U.K., Australia or Canada.
4. Of those 30,000 deaths a year, what percentage involve a mass shooting? Only 2%.
5. Of those 30,000, how many deaths were due to Terrorism between 2005 and 2015? Just 71.

Thus, the vast bulk of GSW deaths never make the national press. Due to this skewed reporting (focusing on mass shootings and those where the shooter was called a “Terrorist” by someone) most of us are unaware of the scope of this epidemic.

If the CDC were allowed to study this issue, it would most likely approach it as it has communicable infectious diseases, cancer, heart disease, and deaths from other injuries. First, it would compile nation-wide data. Next, it would look for patterns in the data which might identify where risk is highest. In certain geographical areas? Are there differences by gender or age in injury and death?

Then we could use that information to formulate a RATIONAL approach (as opposed to the current EMOTIONAL reactions).

Hopefully – very likely, I believe – using such an approach, we’d begin to show improvement in death and injury rates, just as we have with TB, Pandemic Influenza, Cancer, heart disease, and motor vehicle accidents.

This quote has been attributed to the former director of CDC’s Injury Prevention Center: “The scientific community has been terrorized by the NRA.”

An even more interesting quote comes from former congressman Dickey, written jointly with the former CDC director for Injury Prevention in a Washington Post Op-Ed: “We are in strong agreement now that scientific research should be conducted into preventing firearm injuries and that ways to prevent firearm deaths can be found without encroaching on the rights of legitimate gun owners.”

Why not obtain the facts about gun related morbidity and mortality? We wanted it with Pandemic Flu. We want it with Cancer. We have it available from the CDC for dozens of other diseases, including non-gun related injuries. What are we afraid of finding? More to the point, what is the NRA afraid we’ll find out?

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References: CDC, New England Journal of Medicine, American Psychological Association, BBC, CNN, CBS, Forbes, Washington Post, Daily Kos Gun Fail, Brady Center, Business Insider.