Former CDC Leaders Say the Agency Could Do A Lot More to Research Gun Violence “There is nothing stopping them from addressing this life-and-death national problem.”

For nearly two decades, the Centers for Disease Control and Prevention has devoted scant resources to the study of gun violence, even as fatal shootings constitute a public health issue claiming more than 30,000 lives each year. That lack of research is widely attributed to the Dickey Amendment, language tucked into a 1996 appropriations bill that the CDC, lawmakers, and the press have interpreted as blocking the agency from conducting research on firearms deaths and injuries.

But that conventional wisdom is now under assault from a growing chorus of dissenters, including several former high-ranking agency officials. These experts assert that while the Dickey Amendment placed constraints on the agency, it did not ban the study of gun violence outright. Instead, they say, senior CDC brass made the conscious choice to restrict gun research, rather than risk political retribution.

“It was the leadership of CDC who stopped the agency from doing gun violence research,” Mark Rosenberg, a founder of the CDC’s National Center for Injury Prevention and Control, the division of the agency responsible for its work on the subject, tells The Trace. “Right now, there is nothing stopping them from addressing this life-and-death national problem.”

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How much latitude the CDC has to pursue gun violence research is hardly an academic argument. The CDC is the nation’s leading public health agency, with a yearly budget of more than $11 billion. The failure of the CDC to invest in studies of gun violence has greatly inhibited the ability of social scientists, law enforcement agencies, and policymakers to understand the scope and causes of shootings — while also limiting understanding of interventions that might save lives.

In the immediate aftermath of the Dickey Amendment, which was pushed through with support from the National Rifle Association, senior CDC officials interpreted five words — that federal funding could not be used to “advocate or promote gun control” — as meaning the agency should stop all related research. Agency officials worried that should the CDC continue with gun research, lawmakers might try to punish it by cutting funding for other priorities, such as motor vehicle safety, maternal health, and the control of infectious diseases. Their fear was not without merit. In 1997, the year after the bill was passed, Congress redirected all of the money previously earmarked for gun violence research to the study of traumatic brain injury.

The head of the CDC at the time was David Satcher, the first and only African American to hold the position. He was a vocal advocate for gun violence researchers at the Injury Center, defending their work in front of Congress and in an exhaustive editorial for the Washington Post. He fought to continue studies that were started before the amendment, along with some smaller initiatives. But by 1998, when Satcher left, the agency had almost completely shut down its gun violence research operation. Rosenberg was fired the next year.

If 30,000 people were dying of an infectious disease every year, the CDC would be out there at least saying something.” Linda Degutis Former director, National Center for Injury Prevention and Control

The CDC also stopped issuing funding grants for external gun studies, which left many of the nation’s most well-regarded gun researchers suddenly scrounging for funding from private foundations, or financing out of pocket. The cumulative effect was to dramatically curb gun violence research in the U.S. Today, less than $5 million is spent each year on gun studies. A single HIV or cancer study can cost twice as much.

“I think even if you restored funding today, it would take years or decades to overcome the impact,” says Michael Nance, director of the Pediatric Trauma Center at the Children’s Hospital of Philadelphia.

More than a dozen public health insiders, including current and former CDC senior leaders, said in interviews with The Trace that they are frustrated by the agency’s failure to find ways to engage in substantive gun violence research. These insiders said they believe that the CDC’s interpretation of the Dickey Amendment is overly cautious — and that efforts could be greatly enhanced.

“Even without changing that amendment, the CDC could do a lot more in the area of firearms research,” says Michael Siegel, a public health scientist at Boston University.

Linda Degutis is a former director of the Injury Center who resigned in 2014 in frustration over the agency’s inaction on gun violence prevention. “If 30,000 people were dying of an infectious disease every year, the CDC would be out there at least saying something,” she says. “But 30,000 people are dying from gun violence every year, and so I think it’s a problem that the agency won’t even say that it’s a public health issue.”

Recently, several lawmakers have joined fed-up scientists in calling on the CDC to do more. In March, Democratic Senator Tom Carper of Delaware, a state that is battling a gun violence epidemic, released a letter to CDC Director Tom Frieden, questioning the agency’s reluctance to conduct firearms research.

The CDC has not yet responded to that letter. Frieden, who declined an interview for this story, has faced public criticism for not addressing — or even acknowledging — gun violence as a public health issue.

Current Injury Center Director Debra Houry, in comments relayed through a spokeswoman, says that the only way for the agency to conduct meaningful firearms research is with the express backing of Congress, which it has not received.

The CDC was one of the first agencies to study gun violence as a public health issue. In 1992, Rosenberg and five colleagues launched the agency’s Injury Center, operating out of a converted men’s room with a yearly budget of around $260,000. Without any political impediments, they began to focus on identifying the root causes of firearm deaths and the best methods to prevent them.

One of the first studies that the division funded was “Gun Ownership as a Risk Factor for Homicide in the Home.” Published in the New England Journal of Medicine in 1993, the research found that the mere presence of a gun in a home increased the risk of a firearm-related death by 2.7 percent, and suicide fivefold — a “huge” increase, according to Rosenberg.

The NRA was furious about the findings, which it viewed as biased. The gun organization launched a campaign to shut down the Injury Center, an effort soon joined by two conservative groups led by pro-gun medical professionals, Doctors for Responsible Gun Ownership and Doctors for Integrity and Policy Research. The latter famously called CDC investigators “liars masquerading in lab coats.” The NRA and the conservative doctors’ groups began pressuring members of Congress to stop the CDC’s gun violence research. By 1995, eight senators had signed on to the cause. The next year, 1996, Republican Representative Jay Dickey of Arkansas introduced the amendment bearing his name as a rider to an appropriations bill.

Notably, the Dickey Amendment did not immediately lead to a total stoppage of gun violence research by the CDC, as Satcher kept a few existing initiatives alive. But when Satcher left the CDC in 1998, Rosenberg says, his departure marked the end of substantive gun research at the agency. The new director, Jeffrey Koplan, had little interest in continuing the agency’s work on gun violence prevention, Rosenberg says.

It’s important to remember that there is no law preventing gun violence research. CDC leaders have decided that they don’t want to do gun violence research because it’s too much of a hot potato.” Mark Rosenberg Founder, National Center for Injury Prevention and Control

In 1999, Rosenberg says Koplan called him into his office and fired him. “He didn’t give me a reason, he just said, ‘You’ve got to go,’” Rosenberg says. Koplan declined an interview for this piece, but Rosenberg says he feels sure that he was dismissed based on his support of gun violence research. With Satcher gone, the CDC had begun to crack down on its researchers at the Injury Center, he says, forbidding them to speak with the press. ​(The policy, which continues today, was a point of contention after the Sandy Hook shooting in 2012 when the agency, Degutis says, instructed researchers not to speak to reporters or publicly frame gun violence as a public health issue.)​ For Rosenberg, his termination was an unmistakable signal that firearms research at the CDC would no longer be tolerated.

“I think it sends a very strong message to people that if you work in this area, you might risk your whole career,” he says.

For many years, Rosenberg says he, too, believed that the Dickey Amendment was responsible for gutting gun violence research at the CDC. But then he developed an unlikely friendship with Dickey, who told The Trace in December he now regrets his amendment.

“He pointed out to me, ‘Wait a minute, Mark, Congress and the NRA didn’t stop CDC from doing gun violence research. CDC stopped itself from doing this research,’” Rosenberg says.

Indeed, the language of the Dickey Amendment does not explicitly prohibit the agency from conducting research on gun violence, but only from advocating gun control. Rosenberg believes that distinction presents the CDC with an opening.

“It’s important to remember that there is no law preventing gun violence research,” he says. “CDC leaders have decided that they don’t want to do gun violence research because it’s too much of a hot potato.”

The CDC says that critics of the agency’s policies on gun research fail to comprehend its budget constraints. Houry, the current Injury Center director, says the Dickey Amendment left the agency with “very limited discretionary funding ” for gun violence research. Last year, the agency said it didn’t spend any money on firearm injury prevention research.

Houry says gun violence is still studied to some extent. For example, she says, the agency collects information on gun violence through sources like WISQARS, its general injury database. That database categorizes deaths, including those caused by guns, like accidental shootings and suicides. The CDC makes that information available to researchers, but does not conduct further analysis.

“If a gun is the cause, that’s recorded,” explained producer Todd Zwillich in a public radio report on the Dickey Amendment. “It’s not like they ignore it entirely. But gun deaths and gun injuries as a public health issue are still basically anathema to CDC researchers and anyone who gets CDC funding, which is potentially millions of dollars.”

Garen Wintemute, a gun violence researcher at the University of California at Davis, says data collection is useful, but doesn’t amount to research.

Related Gun Policy The CDC Just Released a 'Gun Violence' Study But the agency did it while avoiding actually studying guns' role in the violence it was researching — a line it is still at pains not to cross.

Last year, researchers were cheered by a CDC study on gun violence in Wilmington, Delaware, a city that experiences one of the highest murder rates in the country. It had been so long since the agency had offered any independent research on gun violence that many public health experts viewed the report as a positive sign that attitudes were changing within the CDC.

“It was a class act, a solid piece of work,” Wintemute says. But it failed to examine how gun ownership or availability might contribute to the area’s high crime rates, an indication, Wintemute says, that the agency remains reluctant to tackle guns head-on.

The Wilmington study was also not funded with money allocated for gun violence research. The study was the product of the CDC’s “Epi-Aids” program, which assists state and local governments with public health problems through the agency’s Epidemic Intelligence Service division.

“It’s not like the study was initiated by the CDC,” Degutis, told The Trace in December. “It was a response to a request from the city.”

In his 2017 budget request, President Obama requested $10 million specifically for gun violence research at the CDC — which works out to roughly 0.1 percent of the agency’s total funding allotment. Rosenberg believes that rather than waiting for a Republican-controlled Congress to grant Obama’s request, the CDC could immediately divert that sum from other programs to jumpstart new studies.

“They could do that in the blink of an eye,” he says.

Satcher, the CDC director who sought to shield gun research from cuts, says he understands Rosenberg’s viewpoint — but also knows firsthand how political realities can shape agency policy.

“I think it could be feasible, but the question is, how would it affect their budget?” he asks. “How would Congress punish the CDC for that? It would be easy for me to criticize the CDC, and I’m tempted to do that. But I also know the kind of risks they’re facing.”

The researchers and former CDC officials interviewed for this story stress that the agency does vital work, confronting public health dangers all over the world, from opioid addiction, to the Zika virus. They say Congress could easily solve the agency’s dilemma by once again earmarking funds for gun violence research.

But even as they recognize that the CDC is caught in a political fight not of its making, the researchers say the agency should and could do more. “People at CDC are not frightened people,” Rosenberg says. “They go in at the midst of an Ebola epidemic and risk their lives to save people.”

Satcher, the former CDC director, is distressed by the agency’s predicament. With so many other important priorities, and the threat of political retribution, top officials have come to see gun violence research as something they can’t fight for.

“The director of the CDC doesn’t feel comfortable even talking about gun violence, let alone trying to find a way to reinitiate the research,” he says. “It is very unfortunate.”

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