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Gun Violence, Research, and Advocacy

Anand Swaminathan, MD FAAEM and Megan Ranney, MD
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08:15

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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EMRAP 2019 04 April Written Summary 439 KB - PDF

Gun Violence, Research, and Advocacy

Anand Swaminathan MD and Megan Ranney MD

 

Take Home Points

  • We are uniquely positioned to examine and discuss gun violence.
  • Restrictions on funding for gun violence research have hampered the development of non-partisan solutions.
  • The public health issue of gun violence has become politicized.

 

  • In November 2018, the NRA told doctors to “stay in our laneregarding the discussion of gun violence. The backlash was astounding and included nurses, PAs, NPs and our colleagues in other specialties. Then the EM community was rocked by the loss of one of our own when Dr. Tamara O’Neal was shot and killed outside Mercy Hospital in Chicago along with a police officer Samuel Jimenez and a pharmacist Dayna Less. We see patients frequently who have experienced gun violence and we need to understand the depth of the problem.
  • Ranney is an emergency medicine doctor, gun violence researcher, advocate and founder of the AFFIRM group. [Ed. note: AFFIRM stands for American Foundation for Firearm Injury Reduction in Medicine]
  • Why should emergency providers care about this issue? No one knows about this issue more than we do. Any gunshot victim who survives to the hospital will be seen by one of us. 200 people are injured and another 100 killed by a gun every day across the United States. We don’t just treat victims of gunshot wounds. Many of us have personal connections to the issue. So many of us have lost loved ones to firearm suicide or homicide. Studies suggest 98% of Americans have been personally affected by gun violence.
  • How can we be involved? This is a public health problem. We don’t just treat problems, we speak up about existing problems and help create solutions. What if we saw HIV cross our doors and didn’t talk about it or do anything? Or car crash deaths, Zika or antibiotic resistance? There is a science of disease prevention that is non-partisan. We can do more than apply science. We can share our stories.
  • The difference about gun violence is that this issue has been politicized. In the last twenty years, we have been told we can’t or shouldn’t talk about gun deaths. Over the last five years, many of us have changed that paradigm. We have come together, gun owners and non-gun owners alike, to insist that this is a public health issue and we can and should address it.
  • Why do we not have the necessary research on the subject of gun violence to affect meaningful change or determine policy? In the 1990s, a representative from Arkansas, Jay Dickey, authored an amendment that prevented the CDC from using any money to advocate for gun control. It The CDC is not allowed to use money for advocacy regardless. The money it was spending on firearm injury prevention was funding research. Congress took away the money the CDC was spending on firearm injury prevention. Since then, the CDC has received zero dollars to research this issue. Money was also cut from the NIH. Over the last 22 years, federal funding for firearm injury prevention is less than 2% of what would be predicted. Without funding, it is nearly impossible to do high-quality research.
  • Our research is at the same level as 1986. What if we said the same thing about sepsis or cancer or airway management? It is crazy. Without good research, we won’t find good non-partisan effective solutions. There have been some good efforts over the last few years such as work done by Garen Wintemute MD at UC Davis, Rebecca Cunningham MD and Patrick Carter MD at University of Michigan and Marian Betz MD at University of Colorado. It simply isn’t enough. Because of the lack of research, this disease has become a problem of political soundbites rather than the science of prevention.
  • It is time for us to do better. We need research funding. This is the reason Ranney co-founded AFFIRM; to provide private nimble innovative funding that can find non-partisan solutions to this epidemic. We need the two sides to talk. We see this epidemic every day. Many of us own guns and many of us don’t. At the end of the day we are all clinicians and we need to work together and speak up about the human toll. We need to stand up and describe this as a healthcare issue. It has a real human effect. It has long-lasting ramifications for patients, communities and families.
  • https://affirmresearch.org/

 

Recent Related Material

ROP - PCMA Archive 2016 February Bonus Lecture - Gun Violence And Firearms Safety: The Physicians Role

EM:RAP 2015 April - Gun Violence

ROP - PCMA Archive 2013 November - Abstract 28 - Curbing Gun Violence: Lessons From Public Health Successes

 

Ben R. -

Hey,
This was a great segment that brings attention to an important issue--namely, lack of federal funding to research a cause of significant morbidity and mortality in our country.

I wanted to draw attention to one statement that you made, Anand, around 5:40. Gun violence may seem like it's at an all time high (ie. prominent media coverage) but, from what I can tell, it's lower than when many of us grew up in the 70s/80s/90s. Especially with hot-button issues, it's important that we don't over-state the problem, lest those with opposing views characterize gun safety/research advocates as out-of-touch with reality.

Thanks again for the segment,
ben

Sources:
https://www.washingtonpost.com/news/wonk/wp/2015/12/17/guns-are-now-killing-as-many-people-as-cars-in-the-u-s/?utm_term=.7c461e9cf89e
https://www.pewresearch.org/fact-tank/2015/10/21/gun-homicides-steady-after-decline-in-90s-suicide-rate-edges-up/

Megan R. -

Thanks for this response, Ben. You're totally right that levels decreased in the late 90s/early 2000s. The mortality rate now has however been going up steadily since ~2010. According to the most recent available data, it is currently at approximately 12/100,000 - lower than in the midst of the 80s drug wars, but higher than other points in American history.

Anyhow, thank you for listening and for your very thoughtful comment :) - Megan R.

Lane S. -

Colleagues:

Like others listening to EMRAP, I’m in favor of more high quality research on gun violence - the operative words being high and quality. I’m skeptical that some of the researchers and vocal advocates in academia are equipped to perform this research in an unbiased manner. For example, exaggerations such as gun violence being at an all-time high in the US makes me think that far too many clinicians are willing to put the policy “cart” before the research “horse” when dealing with this particular topic.

The ACP position statement that sparked this most recent debate is another example of putting policy and ideology before evidence. In it, you will find a number of positions such as bans on semiautomatic rifles and high-capacity magazines , as well as comments on concealed carry that are poorly supported by existing evidence.

For those interested in a good summary of the existing evidence on firearms policy and research, the Rand Corporation keeps excellent tabs on the quality of the existing evidence in this space.

So yes, I say increase the level of funding in this area. However, I hope that some of that funding will be directed outside of academia and toward private research institutions such as Rand. Multiple sets of eyes from different perspectives are likely to give us the most useful information on this topic.

Anand S., M.D. -

Lane - I definitely confused this issue with my comment about violence being at an all time high. Luckily, Dr. Ranney corrected me (see above comment from her).
Thanks for your thoughts, have forwarded to Dr. Ranney as well.

Megan R. -

What the good Dr. Swaminathan said. And thanks for your support of increasing funding. Take a look at our work at www.affirmresearch.org - a non-partisan external program. I totally agree with RAND's great work, as well.

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