Monday, April 13, 2009

A Smoldering Issue (Marin IJ)

Nearly two years ago, Seung-Hui Cho, a senior at Virginia Tech University, committed the deadliest act of gun violence in recorded U.S. history. For days afterward, the story was inescapable and dense with horrific images; students in locked classrooms, being picked off by shots fired from 9 mm semiautomatic pistols; people leaping from second-story windows; a professor holding the door to a room shut so that his students could escape, absorbing fatal gunshots in the process; one boy protected from the assailant's bullets by a classmate's dead body; evidence of more than 200 rounds of hollow-point ammunition; still photos of the killer, a young man with drawn lips and hollow eyes and chilling pre-recorded video footage.

In all, Cho felled 32, injured 25 and re-ignited the smoldering issue of gun violence in America.
The press wondered how a person who had previously been declared "mentally defective," could easily obtain semi-automatic weapons. Others obsessed about campus security's slow response. Politicians spun the events to fit their ideologies and bolster their polls. The state of Virginia closed the loophole that had allowed (the mentally unstable) Cho to legally obtain firearms. Later in 2007, Congress beefed up the existing National Instant Criminal Background Check System (NICS), making it somewhat more difficult, nationwide, for the mentally ill to purchase guns. And after that, well, it was quickly back to the status quo.

The status quo in this country is disturbing; eight dead in a mall in Omaha in 2007, nine in a home in Covina in 2008, 13 slain two weeks ago in Binghamton, N.Y., and an annual toll of more than 4 million gunshots, 400,000 gun-related crimes and 11,000 firearm homicides. And consider the booming and mostly unregulated gun show industry, which makes it remarkably easy to purchase firearms, including excessively deadly ones (like the TAC-50 sniper rifle - which has a kill range of nearly two miles).

Gun shows thrive despite evidence that regulating them (as California has done) decreases illegal sales and despite the knowledge that Mexican drug cartels are buying thousands of powerful weapons at U.S. gun shows. In the political arena, it's status quo, too. Many Democrats still blame their 2000 presidential loss on the gun issue and are afraid to re-consider the assault weapon ban (which lapsed in 2004). Congress' Tiahrt amendment, which limits the disclosure and use of gun sales data, still exists, despite widespread opposition by police and law enforcement agencies.

For those who hoped that the Virginia Tech massacre might have made us safer and smarter about gun violence, the situation looks gloomy. "We, sadly, have become accustomed to a high level of gun violence, such as the events that occurred at Columbine and Virginia Tech," says Dr. Garen Wintemute, director of the violence prevention research program at UC Davis Medical Center. "These tragedies have had very little impact on efforts to lessen gun violence in the country. It is clear what we could do; we are just not willing to do it."

Now, you may be wondering why I am writing a medical column about firearms. The simple answer is that I believe gun violence should be considered a public health issue rather than a political one. Wintemute and other experts in the field have long argued that bullets should be viewed as pathogens - like bacteria or tumors. If one views the problem through this lens, targeted restrictions on firearms are preventive medicine, rather than an affront on personal liberty. Forty years ago, at a time when the nation's roadways were unregulated death traps, many voiced concerns that improvements in highway safety were unnecessary impingements on freedom. But, over time, we have come to appreciate that speed limits, traffic safety signs, seat belts and airbags all save lives. In the case of gunshot wounds, the issue of prevention is paramount. It is a simple observation, but no one dies from a bullet that isn't fired. The vast majority of gun deaths happen at the scene - these victims have catastrophic injuries that cannot be treated. Contrast this to some other disease processes, such as heart attacks or blood infections that can often be successfully treated, even in critical cases. Thus, from a public health standpoint, the bullet is a pathogen that, more than just about any other, needs to be prevented rather than treated after the fact.

So, what does gun violence prevention mean? It means keeping guns out of the hands of violent criminals and the severely mentally ill. It should also mean recognizing that a preponderance of scientific evidence demonstrates that owning guns does not make us safer - that you are more likely to kill or be killed with your own gun than you are to peacefully prevent a crime. And it means making bullets less destructive, making enforcement of gun crimes tighter, cracking down on those who sell crime guns, regulating gun shows and stopping the flow of American guns to Mexican drug dealers. This is what we could do, but don't have the will to do.
My (rather conservative) British father-in-law was visiting recently around the time that four Oakland police officers were killed by gunfire. Watching the news coverage, he said to me, "I just don't understand America's obsession with guns." I considered telling him about the Wild West of yesteryear and John Wayne and Clint Eastwood and of the perceived sanctity of the Second Amendment. But, then I thought about it as a father and as a physician and replied simply, "I don't either."