The cost of gun violence

The appalling toll of the Las Vegas shootings this week has once again focused attention on U.S. gun violence. But mass shootings only account for about one per cent of U.S. gun deaths. Roughly 100 people die a day from shootings in the U.S., with hundreds more injured. Two-thirds of the deaths are suicides, most of the rest are homicides, and a large proportion of those are domestic violence.

Science suppressed and the knowledge gap

A row of different AR-15 style rifles displayed for sale (Alex Brandon/Associated Press) Many researchers believe that even without major changes in gun control policies, firearms injuries and deaths can be reduced through well-designed public health measures. Since the mid-1990s, though, the U.S. Congress has effectively barred funding to their major public health agency, the Centers for Disease Control (CDC), for firearms injury prevention research. Research funding at the National Institutes of Health has been similarly discouraged. As a result there has been little or no good research into things like the best strategies for dealing with firearms and suicide prevention, shootings and PTSD in victims and first responders, and many other important research questions.

The call for action

Dr. Megan Ranney, an associate professor of Medicine at Brown University, and an emergency physician at Rhode Island Hospital, is one of a chorus of voices from the medical community calling for more research into injury prevention and firearms. Earlier this year, she and emergency medicine colleagues put forward an agenda for firearm injury prevention research which they hope will help convince their government that good research will help save lives and prevent tragedies.

This transcript has been edited for length and clarity

Bob McDonald: How has the U.S. government blocked research into firearms violence?

Dr. Megan Ranney: I think it's important to be explicit that the research has not been explicitly blocked. Starting in the mid '90s, Representative Jay Dickey from Arkansas put a rider into a federal spending bill which stipulated that no Centers for Disease Control funds could be used to advocate or promote gun control. At that time, Congress cut the CDC's budget by exactly the most amount that they had been spending on firearm injury research. So although the amendment didn't prohibit research per se - it said only that CDC funds couldn't be used to advocate gun control.

The interpretation, of course, was that if you fund firearm research, we will cut your budget. Now our Centers for Disease Control and Prevention do immensely important public health work on a national scale for diseases ranging from HIV/AIDS to Ebola to Zika virus and they have a mission to protect. So understandably from their perspective, they stopped actively funding firearm injury research. About a decade later similar language was extended to cover the National Institutes of Health and the effect of that was that there was essentially no federally funded firearm injury research from really the mid to late '90s up until very recently.

BM: Was this action on the part of the government to cut the funding. The result of a lobbying effort?

MR: There was some research published in the mid and late '90s examining risk of homicide and suicide deaths in houses which had a gun versus which did not have a gun. On average people who live in houses with guns are more likely to die of homicide or suicide. The NRA [National Rifle Association] in particular interpreted that to mean that researchers were saying that no one should have guns, and really acted to lobby some members of Congress to put this rider in place even though the research was not specifically advocacy-related research.

BM: Well the numbers are certainly staggering. More than 100,000 people are shot per year — 100 deaths every day — in the United States. I mean how serious of a public health issue is this in the U.S.?

MR: It is indeed a staggering problem. The number of deaths per year from firearm injury are approximately equivalent to the number of deaths per year from motor vehicle crashes. Suicides and homicides are responsible for approximately 10 deaths per hundred thousand population. And yet our level of research pales next to the mortality and morbidity burden.

BM: Well terrible events like what just happened in Las Vegas — how significant are mass shootings like that in the picture overall?

MR: The vast majority of firearm injuries and deaths in the United States are suicides — they're responsible for about two-thirds of firearm deaths — and homicides, which are responsible for almost a third of firearm deaths. The role of mass violence — although it is horrific and has a huge impact on communities — deaths from mass violence are less than one per cent of firearm deaths in our nation. The vast majority of firearm injuries and deaths in the United States are suicides — they're responsible for about two-thirds of firearm deaths — and homicides, which are responsible for almost a third of firearm deaths. The role of mass violence — although it is horrific and has a huge impact on communities — deaths from mass violence are less than one per cent of firearm deaths in our nation.

BM: So as horrible as it looks on on television in Las Vegas, still 100 other people died that day.

MR: Exactly, and certainly preventing deaths from mass violence is going to be one of the hardest tasks for us to take on, the other forms of gun violence are potentially much more easily preventable. And I think it's really important to talk about the fact that other forms of gun injury — suicides, homicides, assaults, even unintentional or accidental injuries like toddlers accidentally shooting a family member with a gun that they find — those things are preventable using the public health model. And if we had funding to do decent research, we could prevent it.

BM: A lot of what you're saying seems like common sense. I mean it makes sense to prevent suicidal people from having access to guns. Why do you think we really need this kind of research?

MR: We can talk in very broad strokes about what we think might work but it is critically important to do really high quality, rigorous research on firearm injury so that we can design interventions and strategies that are most likely to be effective. We don't want to do things that are going to harm people.

You know I'm active on Twitter and have been engaging in conversations with a number of people across the political spectrum. And one vet has been having a conversation with me where he said the V.A. has been screening veterans for suicide risk and then threatening them with taking their guns away if they say that they're suicidal. So people aren't admitting they're suicidal and then are going and committing suicide.

That is horrific, if true. I don't know if that's true or not. If screening people for firearm access when they're suicidal really means they're not going to get help, then we have to figure out another solution. Or is that an apocryphal story and is screening actually helping more people than it's hurting? That's just one example of why and where we need to do better research on this topic.