As a graduating internal medicine resident, I have spent three years of sleepless nights learning to prevent deaths from conditions such as sepsis, Clostridium difficile enterocolitis, and meningitis. But I have spent comparatively little time learning how to prevent an equally common cause of death – firearm injury. In 2013, about 33,000 Americans died from gun violence: almost 2/3 by suicide, the remainder by homicide. The escalating suicide rate contributed to the first increase in death rates in the United States in a decade. That same year, roughly 38,000 died from sepsis, 7,600 from C. difficile enterocolitis and 600 from meningitis.
I come by my lack of knowledge honestly – due to lack of funding, firearm injury prevention research is in its infancy in the United States. In 1997, Congress passed the Dickey Amendment, which prohibited funding for research that might “support or promote gun control.” Although Rep. Jay Dickey (R-Ark.), the original bill’s sponsor, now feels the ban was a mistake , it stymies injury prevention efforts to this day. There are few full-time firearm injury researchers and some basic questions remain unanswered. For example, how many guns are there in the United States? How are they stored? How effective is the federal background check system? How many deaths would be prevented if background checks covered all gun purchases, rather than 60% of them?
JAMA Internal Medicine recently issued a call for papers on firearm injuries and gun violence. We hope to stimulate original research and constructive policy proposals that move the needle on firearm injury prevention. See the call for papers here.
The success of motor vehicle accident prevention speaks to how effective firearm injury prevention could be if research were funded at levels commensurate with the havoc gun violence wreaks. Motor vehicle deaths have plummeted precipitously since the 1960s. By contrast, firearm injury deaths have increased; guns killed as many people as motor vehicles in 2014. The drop in motor vehicle deaths is no accident: research led to innovations such as airbags and policies such as stiff penalties for driving under the influence that have saved countless lives. There are many unrealized opportunities for similar reduction in deaths related to gun violence.
Gun violence is comprised of separate, overlapping epidemics. Although more gun-related mass shootings, intimate partner homicides, other homicides, and suicides occur in the United States than in other industrialized nations, each epidemic has its own causes and disproportionately affects different groups of people.
A recent article in the New York Times highlighted just one of these overlooked epidemics, the hundreds of mass shootings that occur each year in communities of concentrated poverty that are predominantly African American. These shootings are poorly understood and usually receive little attention in the news media. The time is right to advance our understanding of how to approach these tragedies and other epidemics of gun violence as medical and public health issues.
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