Darren B. Taichman, MD, PhD, Executive Deputy Editor; Christine Laine, MD, MPH, Editor in Chief; on behalf of the Annals editors *
Requests for Single Reprints: Darren B. Taichman, MD, PhD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0428.
Senior Research Fellow, Crime Prevention Research Center
February 24, 2015
Facts and Beliefs in Medicine
Beliefs abound in the debate on firearms and society, but one would hope facts prevail in the academic literature on firearms and public health. As a charged political issue, this is often not the case, as evidenced in this editorial."The profession's relative silence was disturbing but in part explicable by our inability to study the problem. Political forces had effectively banned the Centers for Disease Control and Prevention (CDC) and other scientific agencies from funding research on gun-related injury and death. The ban worked: A recent systematic review of studies evaluating access to guns and its association with suicide and homicide identified no relevant studies published since 2005"While a widely promoted belief, based on mass media coverage of a white paper published by a un control organization (the former Mayors Against Illegal Guns, now Everytown for Gun Safety) , the literature on firearms has increased markedly in recent years, as reported by John Lott (Crime Prevention Research Center). http://johnrlott.tripod.com/Did_Federal_Fund_Cuts_Really_Stop_Gun_Control_Research_Final.pdf Only a biased analysis of the literature produced the conclusion that the CDC funding limitation blocked firearms research publications. Such rebuttals rarely find their way into the medical literature, but often emerge in econometrics and criminal research journals. Indeed, I have had many Letters to the Editor rejected or outright ignored when attempting to correct beliefs with facts on firearms.Note that non-governmental funding, largely from organizations that advocate gun control, often supports published medical research on firearms, with no conflict of interest disclosed. Many university "Gun Violence" centers rely on funding from such organizations (Joyce Foundation, etc.), typically one step removed from strongly biased donors such as Bloomberg, Soros, etc.As noted in the other editorial referenced in this issue "Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association", a number of medical organizations have joined in advocacy of gun control measure based on other beliefs regarding firearms, without factual merit: "Although evidence to document the effectiveness of the Federal Assault Weapons Ban of 1994 on the reduction of overall firearm-related injuries and deaths is limited, our organizations believe that a common-sense approach compels restrictions for civilian use on the manufacture and sale of large-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity. It seems that such restrictions could only reduce the risk for casualties associated with mass shootings."Note that the limited evidence supporting an Assault-Weapons Ban was a an early report only a year or so into the 10-year ban, and that the final report found no discernible impact of the AWB. http://www.wsj.com/articles/SB10001424127887323468604578245803845796068Similarly, the stance taken on universal background checks is driven by the myth that 40% of gun transfers occur without background checks, based on a study largely conducted before the Brady background checks system was in operation.Why ask for more research funds, yet ignore research that doesn't support desired outcomes and "common-sense" beliefs? The belief that ends justify means has no place in academic medical discourse and peer-reviewed medical literature. Silencing opposition is a shameful means of attempting to achieve ends.
Darren B.Taichman, MD, PhD, Christine Laine, MD, MPH
American College of Physicians
May 27, 2015
Mr. Jessee cites several sources that support his views about restrictions on firearms research and the effectiveness of strategies to reduce the firearm violence. While Figures 2 and 3 in the Crime Prevention Research Center report that Mr. Jessee refers to in his letter do not show a reduction in published articles about firearms following the 1996 and 2011 restrictions on the use of government funding for firearms research, Figure 1 of that report demonstrates an increase from about 3 firearms articles/10,000 medical journal articles in 1985 to 15/10,000 in 1996 when the CDC restrictions were instituted and a subsequent decline to 5/10,000 by 2011. It is important to note several things that support our belief that too little research is done on firearm-related injuries and death given the number of lives affected each year in our country. First, the number of firearms articles is remarkably tiny given the large number of lives damaged by or lost to guns. Second, given the restrictions that were in place, the articles published following the restrictions were likely unfunded or had funding from non-governmental sources that place a priority on reducing firearm-related injury and death. Had funding been available from CDC, NIH, and other governmental sources the amount of research and published articles on firearms would surely have been much larger. Finally, we interact with many public health researchers on a regular basis who are reluctant to study or comment on firearms for fear that doing so would compromise funding for the other conditions they study. Regardless of the impact of the 1996 and 2011 restrictions on numbers of published articles, it seems very clear that we are lacking sufficient high quality research to guide evidence-based policies to reduce firearm-related injury and death. This is true of policies on background checks prior to gun purchases, ownership of assault weapons, safety devices on guns, and a myriad of other policies that could have an important impact on the adverse effects guns have on the health and longevity of too many Americans. Finally, we could not agree more with Mr. Jessee that silencing opposition is a shameful means of attempting to achieve ends.
Senior Research Fellow, Crime Prevention Reserach Center
June 16, 2015
Rate vs Volume of Firearms Literature
Dr. Taichman has provided a thoughtful response to my initial comment, for which I thank him. Indeed, this is one of the few journals that either allow comments, or don't purge dissenting comments. In reviewing his reply, I would note that his description of the content of Figure 1 in the Whitley & Lott 2014 white paper does match that presentation provided in Bloomberg's "Mayors Against Guns" white paper, showing the rate of firearms-related articles per 100,000 medical journal articles did decline between 1996 and 2011, dates coincident with the law restricting CDC funding and Obama's Executive Order skirting the law. The essential point of Whitley & Lott 2014 is that the *volume* of firearms-related publications did not decrease during this period. The relative volume of all medical journal articles simply increased, leading to an apparent decrease in the rate of firearms-related papers (see Figure 2). PUBMED citations increased 55% between 1996 and 2011, but it doesn’t necessarily mean firearms-related papers should parallel that increase. According to the Bureau of Justice Statistics: “Handgun-involved incidents [homicides] increased sharply in the late 1980s and early 1990s before falling to a low in 2008” and ” Firearm-related homicides declined 39%, from 18,253 in 1993 to 11,101 in 2011.” For those contending that guns are a disease, is it not surprising that when the disease ebbs, so does research funding? That said, as Dr. Taichman notes, the maintenance of the firearms-related literature volume appears to have been taken up by private “non-governmental sources that place a priority on reducing firearm-related injury and death.” Many of these sources once self-identified as "Gun Control" advocates, but revised their image to "Gun Safety" advocates, to avoid 2nd Amendment issues. Consider the text of the “ban” itself: “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” With the expressed goal “…to reduce the number of handguns in private ownership, starting with a 25% reduction by the turn of the century,” it’s not hard to see how such funding fell under scrutiny by NRA, other gun-rights advocacy groups, and conservative politicians. Repression of new firearms research and researchers is indeed spoken of by those who had derived funding, or might derive future funding, for firearms research. But a new generation of firearms researchers funded (albeit indirectly) by billionaires Bloomberg and Soros, and Obama’s assembly of foundations with firearms policy as an advocated objective (Joyce, Robert Wood Johnson, etc.) has more than redoubled their ranks. Johns Hopkins School of Public Health Center for Firearms Policy and Research, Harvard Injury Control Research Center, and many other public institutions, are expanding faculty and publishing at an up-ticked rate Their Media/Press staff are working hard to see any ‘online-before-print’ article multiply echoed on mainstream news channels. Payback for “silencing” the CDC’s firearms research funding? Perhaps the pendulum has swung to far, when "Rock Star" academics are sought for news and talk-show interviews before the larger academic community has a first-glimpse and chance to comment on the research
Taichman DB, Laine C, on behalf of the Annals editors. Reducing Firearm-Related Harms: Time for Us to Study and Speak Out. Ann Intern Med. 2015;162:520–521. doi: https://doi.org/10.7326/M15-0428
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Published: Ann Intern Med. 2015;162(7):520-521.
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