The Tainted Public-Health Model of Gun Control
APRIL 01, 2001 by MIGUEL A. FARIA JR.
Early in the 1990s the American Medical Association (AMA) launched a major campaign against domestic violence, which continues to this day. As a concerned physician, neurosurgeon, and then an active member of organized medicine, I joined in what I considered a worthwhile cause.
It was then that I arrived at the unfortunate but inescapable conclusion that the integrity of science and medicine had been violated—and the public interest was not being served by the entrenched medical/public-health establishment—because of political expediency.1 To my consternation and great disappointment, when it came to the portrayal of firearms and violence, and the gun control “research” promulgated by public-health officials, it was obvious that the medical literature was biased, riddled with serious errors in facts, logic, and methodology, and thus utterly unreliable. Moreover, it had failed to objectively address both sides of this momentous issue, on which important public policy was being debated and formulated. And this was taking place despite the purported safeguards of peer review in the medical journals, the alleged claims of objectivity by medical editors, and the claims of impartiality by government-funded gun researchers in public health, particularly at the Centers for Disease Control and Prevention (CDC).
Over the next five years, particularly as editor of the Journal of the Medical Association of Georgia,2 I found that on the issue of violence, medical journals skirted sound scholarship and took the easy way out of the melee, presenting only one side of the story and suppressing the other. Those with dissenting views or research were excluded. The establishment was bent on presenting guns as a social ill and promoting draconian gun control at any price.
The most prestigious medical journal, the New England Journal of Medicine (NEJM), which claims openness to contrary views, is not immune to bias in this area. In fact, it is one of the most anti-gun publications in medical journalism. The NEJM routinely excludes articles that dissent from its well-known, strident, and inflexible position of gun-control advocacy. Editors have come and gone, but the governing board has made sure that the anti-gun position remains unaltered.
In “Bad Medicine—Doctors and Guns,” Don B. Kates and associates describe a particularly egregious example of editorial bias by the NEJM.3 In 1988, two studies were independently submitted for publication. Both authors were affiliated with the University of Washington School of Public Health. One study, by Dr. John H. Sloan and others, was a selective two-city comparison of homicide rates between Vancouver, British Columbia, and Seattle, Washington. The other paper was a comprehensive comparison study between the United States and Canada by Dr. Brandon Centerwall.
Predictably, the editors chose to publish Sloan’s article with inferior but favorable data claiming erroneously that severe gun-control policies had reduced Canadian homicides. They rejected Centerwall’s superior study showing that such policies had not lowered the rate of homicides in Canada: the Vancouver homicide rate increased 25 percent after implementation of a 1977 Canadian law.4 Moreover, Sloan and associates glossed over the disparate ethnic compositions of Seattle and Vancouver. When the rates of homicides for whites are compared, in both of these cities, it turns out that the rate of homicide in Seattle is actually lower than in Vancouver. The important fact that blacks and Hispanics, who constitute higher proportions of the population in Seattle, have higher rates of homicides in that city was not mentioned.
Centerwall’s paper on the comparative rates of homicides in the United States and Canada was finally published in the American Journal of Epidemiology, but his valuable research, unlike that of Sloan and his group, was not made widely available to the public.5 In contradistinction to his valuable gun-research data, Centerwall’s other research pointing to the effects of TV violence on homicide rates has been made widely available; his data exculpating gun availability from high homicide rates in this country remains a closely guarded secret.6
Gun-Control Lobby Accomplices
Over the years, the entrenched medical/public-health establishment, acting as a willing accomplice of the gun-control lobby has conducted politicized, results-oriented gun (control) research based on what can only be characterized as junk science. This has taken place not only because of ideology and political expediency, but also because of greed—federal money. Public health in general and gun control in particular were important areas where money was allocated by the Clinton administration, along with its repeated attempts at the federalization of the police force, erosion of civil liberties, and the implementation of a national identity card, all centerpieces of former President Clinton’s failed domestic crime-control policy.
But how was an agency like the CDC able to get in the gun-control business? Simply by propounding the erroneous notion that gun violence is a public-health issue and that crime is a disease, an epidemic—rather than a major facet of criminology. The public so deluded and the bureaucrats consequently empowered, public-health and CDC officials arrogated to themselves this new area of alleged expertise and espoused the preposterous but politically lucrative concept of guns and bullets as animated, virulent pathogens needing to be stamped out by limiting gun availability and ultimately confiscating guns from law-abiding citizens. Hard to believe in a constitutional republic with a Bill of Rights and a Second Amendment! Let me cite the following statement by CDC official Dr. Patrick O’Carroll as quoted in the Journal of the American Medical Association (JAMA, February 3, 1989): “Bringing about gun control, which itself covers a variety of activities from registration to confiscation was not the specific reason for the [CDC] section’s creation. However, the facts themselves tend to make some form of regulation seem desirable. The way we’re going to do this is to systematically build a case that owning firearms causes death.”
Public-health officials and researchers conveniently neglect the fact that guns and bullets are inanimate objects that do not follow Koch’s Postulates of Pathogenicity (a time-proven, simple, but logical series of scientific steps carried out by medical investigators to definitively prove a microorganism is pathogenic and directly responsible for causing a particular disease); and they fail to recognize the importance of individual responsibility and moral conduct—namely, that behind every shooting there is a person pulling the trigger who should be held accountable.
This portrayal of guns by the public-health establishment parallels the sensationalized reporting of violence and so-called “human interest” stories in the mainstream media; it exploits citizens’ understandable concern about domestic violence and rampant street crime, but does not reflect the accurate, un-biased, and objective information that is needed for the formulation of sound public policy. In most instances, the public-health and medical establishments have become mouthpieces for the government’s gun-control policies.
An example of biased research on which the CDC has squandered taxpayers’ money is the work of prominent gun-control researcher Dr. Arthur Kellermann of Emory University’s School of Public Health. Since at least the mid-1980s, Kellermann (and associates), whose work has been heavily funded by the CDC, has published a series of studies purporting to show that persons who keep guns in the home are more likely to be victims of homicide than those who don’t. Despite the “peer reviewed” imprimatur of his published research, his studies, fraught with errors of facts, logic, and methodology, are published in the NEJM and JAMA with great fanfare (advance notices and press releases, followed by interviews and press conferences)—to the delight of the like-minded, cheerleading, monolithic pro-gun control medical establishment, not to mention the mainstream media.
In a 1986 NEJM paper, Kellermann and associates, for example, claimed their “scientific research” proved that defending oneself or one’s family with a firearm in the home is dangerous and counterproductive, claiming “a gun owner is 43 times more likely to kill a family member than an intruder.” This erroneous assertion is what Dr. Edgar Suter, chairman of Doctors for Integrity in Policy Research (DIPR), has accurately termed Kellermann’s “43 times fallacy” for gun ownership.7
In a critical and now classic review published in the March 1994 Journal of the Medical Association of Georgia (JMAG), Suter not only found evidence of “methodologic and conceptual errors,” such as prejudicially truncated data and non-sequitur logic, but also “overt mendacity,” including the listing of “the correct methodology which was described but never used by the authors.” Moreover, the gun-control researchers “deceptively understated” the protective benefits of guns. Suter wrote: “The true measure of the protective benefits of guns are the lives and medical costs saved, the injuries prevented, and the property protected—not the burglar or rapist body count. Since only 0.1 percent-0.2 percent of defensive uses of guns involve the death of the criminal, any study, such as this, that counts criminal deaths as the only measure of the protective benefits of guns will expectedly underestimate the benefits of firearms by a factor of 500 to 1,000.”8
Greater Risk to Victims?
In 1993, in another peer-reviewed NEJM article (the research again heavily funded by the CDC), Kellermann attempted to show that guns in the home are a greater risk to the residents than to the assailants. Despite valid criticisms by reputable scholars of his previous works (including the 1986 study), Kellermann used the same flawed methodology and non-sequitur approach. He also used study populations with disproportionately high rates of serious psychosocial dysfunction from three selected counties known to be unrepresentative of the general U.S. population.
For example, 53 percent of the case subjects had a household member who had been arrested, 31 percent had a household history of illicit drug use, 32 percent had a household member hit or hurt in a family fight, and 17 percent had a family member hurt so seriously in a domestic altercation that prompt medical attention was required. Moreover, the case studies and control groups in this analysis had a high incidence of financial instability. In fact, gun ownership, the supposedly high-risk factor for homicide, was not one of the most strongly associated factors for being a murder victim. Drinking, illicit drugs, living alone, a history of family violence, and living in a rented home were all greater individual risk factors for being murdered than having a gun in the home. There is no basis for applying the conclusions to the general population.
Most important, Kellermann and his associates again failed to consider the protective benefits of firearms.
In this 1993 study, they arrived at the “2.7 times fallacy.” In other words, they downsized their fallacy and claimed a family member is 2.7 times more likely to kill another family member than an intruder. Yet, a fallacy is still a fallacy and, as such, it deserves no place in scientific investigations and peer-reviewed medical publications.
Although the 1993 NEJM study purported to show that the homicide victims were killed with a gun ordinarily kept in the home, the fact is, as Kates and associates showed, 71.1 percent of the victims were killed by assailants who didn’t live in the victims’ household using guns presumably not kept in that home.9
While Kellermann and associates began with 444 cases of homicides in the home, cases were dropped from the study for a variety of reasons, and in the end, only 316 matched pairs were used, representing only 71.2 percent of the original 444 homicide cases. This reduction increased tremendously the chance for sampling bias. Analysis of why 28.8 percent of the cases were dropped would have helped indicate if the study had been compromised by the existence of such biases, but Dr. Kellermann, in an unprecedented move, refused to release his data and make it available for other researchers to analyze.
These errors invalidated the findings of the 1993 Kellermann study, just as they tainted those of 1986. Nevertheless, the errors have crept into and now permeate the lay press, the electronic media, and particularly, the medical journals, where they remain uncorrected and are repeated time and again as gospel. The media and gun-control groups still cling to the “43 times fallacy” and repeatedly invoke the erroneous mantra that “a gun owner is 43 times more likely to kill a family member than an intruder.” And, because the publication of the data (and their purported conclusions) supposedly come from “reliable” sources and objective medical researchers, they are given a lot of weight and credibility by practicing physicians, social scientists (who should know better), social workers, law-enforcement officials, and particularly gun-banning politicians.
What we do know, thanks to the meticulous and sound scholarship of Professor Gary Kleck of Florida State University and DIPR, is that the benefits of gun ownership by law-abiding citizens have been greatly underestimated. In his monumental work, Point Blank: Guns and Violence in America (1991), myriad articles, and his last book, Targeting Guns (1997), Kleck found that the defensive uses of firearms by citizens total 2.5 million per year and dwarf offensive gun uses by criminals. Between 25 and 75 lives are saved by a gun for every life lost to one. Medical costs saved by guns in the hands of law-abiding citizens are 15 times greater than costs incurred by criminal uses of firearms. Guns also prevent injuries to good people and protect billions of dollars of property every year.10
Recent data by John R. Lott Jr. in his book More Guns, Less Crime: Understanding Crime and Gun-Control Laws have also been suppressed by the mainline medical journals and public-health literature. Lott studied the FBI’s massive yearly crime statistics for all 3,054 U.S. counties over 18 years (1977-1994), the largest national survey of gun ownership and state police documentation in illegal gun use. He came to some startling conclusions:
- While neither state waiting periods nor the federal Brady Law is associated with a reduction in crime rates, adopting concealed-carry gun laws cut death rates from public multiple shootings by a whopping 69 percent.
- Allowing people to carry concealed weapons deters violent crime—without any apparent increase in accidental death. If states without right-to-carry laws had adopted them in 1992, about 1,570 murders, 4,177 rapes, and 60,000 aggravated assaults would have been avoided annually.
- Children 14 to 15 years of age are 14.5 times more likely to die from automobile injuries, five times more likely to die from drowning or fire and burns, and three times more likely to die from bicycle accidents than they are to die from gun accidents.
- When concealed-carry laws went into effect in a given county, murders fell by 8 percent, rapes by 5 percent, and aggravated assaults by 7 percent.
- For each additional year concealed-carry laws are in effect, the murder rate declines by 3 percent, robberies by over 2 percent, and rape by 1 percent.11
Another favorite view of the gun-control and public-health establishments is the myth propounded by Dr. Mark Rosenberg, former director of the National Center for Injury Prevention and Control (NCIPC) of the CDC. Rosenberg wrote: “Most of the perpetrators of violence are not criminals by trade or profession. Indeed, in the area of domestic violence, most of the perpetrators are never accused of any crime. The victims and perpetrators are ourselves—ordinary citizens, students, professionals, and even public health workers.”
That statement is contradicted by government data. The fact is that the typical murderer has had a prior criminal history of at least six years with four felony arrests before he finally commits murder. The FBI statistics reveal that 75 percent of all violent crimes for any locality are committed by 6 percent of hardened criminals and repeat offenders. Less than 2 percent of crimes committed with firearms are carried out by licensed law-abiding citizens.12
Violent crimes continue to be a problem in the inner cities owing to gangs involved in the drug trade and hardened criminals. Crimes in rural areas for both blacks and whites, despite the preponderance of guns, remain low. Evidence supports the view that availability of guns per se does not cause crime. Prohibitionist government policies and gun control (rather than crime control) exacerbate the problem by making it more difficult for law-abiding citizens to defend themselves, their families, and their property. Prohibition in the 1920s and passage of the Gun Control Act of 1968 brought about an increase, not a decrease, in both the rates of homicides and suicides.
A Sinister Objective
As a physician and medical historian, I have always been a staunch supporter of public health in its traditional role of fighting pestilential diseases and promoting health by educating the public on hygiene, sanitation, and preventable diseases;13 but I deeply resent the workings of that unrecognizable part of public health that has emerged in the last three decades with its politicized agenda, proclivity toward suppression of views with which it disagrees, and the promulgation of preordained research that is frequently tainted and result-oriented; it can only be characterized as being based on junk science.
In 1996, the U.S. House of Representatives voted to shift $2.6 million away from the NCIPC and earmark it for other health research projects. The redirected money was the amount formerly allocated to the discredited “gun (control) research.” Moreover, the House forbade the CDC from allocating further money for that research in the future. Kellermann’s gun research was for the first time defunded. Unfortunately, other gun prohibitionist researchers, like Drs. Sloan, Garen J. Wintemute, Colin Loftin, and Frederick P. Rivara, continue to publish their slanted research in the complying mainstream medical journals. They are encouraged in their work by the sponsoring schools of public health sprouting all over the country and funded by the American Medical Association (sometimes through public-private partnerships) or by the large, private statist foundations such as the Joyce Foundation.
Thus the task of separating science from politics is far from over. Much more needs to be done to return public health to its traditional role of stamping out infectious diseases and epidemics—and reeling it back from meddling in politics.
- Miguel A. Faria, Jr., “The Perversion of Science and Medicine,” Part I and II: “On the Nature of Science” and “Soviet Science and Gun Control,” Medical Sentinel, Spring 1997, pp. 46-48 and 49-53; and “The Perversion of Science and Medicine,” Parts III and IV: “Public Health and Gun Control Research” and “The Battle Continues,” Medical Sentinel, Summer 1997, pp. 81-82 and 83-86, www.haciendapub.com.
- See the account in my Medical Warrior: Fighting Corporate Socialized Medicine (Macon, Ga.: Hacienda Publishing, 1997), pp. 107-20.
- Don B. Kates et al., “Bad Medicine: Doctors and Guns,” in David Kopel, ed., Guns—Who Should Have Them? (Amherst, New York: Prometheus Books, 1995).
- John H. Sloan, et al., “Handgun Regulations, Crime, Assaults, and Homicides: A Tale of Two Cities,” New England Journal of Medicine 319 (1988), pp. 1256-62.
- Brandon S. Centerwall, “Homicide and the Prevalence of Handguns: Canada and the United States, 1976 to 1980,” American Journal of Epidemiology 134 (1991), pp. 1245-60.
- Brandon S. Centerwall, “Exposure to Television as a Risk Factor for Violence,” American Journal of Epidemiology 129 (1989), pp. 643-52. (See also Miguel A. Faria, Jr., “TV Violence Increases Homicides,” www.NewsMax.com, August 17, 2000.)
- Edgar Suter, “Guns in the Medical Literature—A Failure of Peer Review,” Journal of the Medical Association of Georgia 83(3) 1994, pp. 136-37.
- Kates et al.
- Faria, “The Perversion of Science and Medicine” (Part II), pp. 52-53.
- John R. Lott Jr., More Guns, Less Crime: Understanding Crime and Gun-Control Laws, 2d ed. (Chicago: University of Chicago Press, 2000).
- Miguel A. Faria, Jr., “Women, Guns, and the Medical Literature: A Raging Debate,” Women and Guns (Second Amendment Foundation), October 1994, pp. 14-17 and 52-53.
- See my book Vandals at the Gates of Medicine (Macon, Ga.: Hacienda Publishing, 1995).