Junk Science of Public Health and Gun Control

Author: 
Miguel A. Faria, Jr., MD
Article Type: 
Correspondence
Issue: 
July/August 2000
Volume Number: 
5
Issue Number: 
4

While the CDC and Arthur Kellermann, M.D. have been siginificantly slowed in their gun prohibitionist agenda (see Medical Sentinel 1997;2(2):46-53 and 1997;2(3):81-86, and the references cited therein), others have picked up the gun control agenda under the pretended theme of "finding solutions to the problem of guns and violence in America."

Guns and Suicide

So where the CDC and NCIPC have been slowed, the various schools of public health sprouting throughout the country via the public-private partnerships of academia and public health, on the one hand, and private foundations (e.g., the Robert Wood Johnson and Joyce Foundations) and the AMA on the other, have picked up the slack.

Among the personalities who have now emerged to take the place of Dr. Kellermann is Dr. Garin J. Wintemute at the University of California, Davis.

In an article in The New England Journal of Medicine (NEJM), Dr. Wintemute and associates blamed suicides on gun availability. I responded to their articles in a letter to the editor, which after passing "review" was accepted for publi-cation, only to be sacked at the last moment because of "space considerations."

I thought it would be of interest to the readers of the Medical Sentinel to publish this thinly veiled attempt at censorship impeding the free exchange of ideas necessary in the intellectual atmosphere of a free society. The following exchange ensued.

----------------

November 19, 1999
Dr. Marcia Angell
Editor, NEJM

Dear Dr. Angell,

Dr. Wintemute, et al's article ("Mortality Among Recent Purchasers of Handguns," N Engl J Med 1999;341(21):1583-9) is not the first to link rates of suicides to availability of handguns in the U.S. What these authors, like their predecessors,(1,2) failed to point out is people readily substitute for handguns (when these are not available), other universally available methods to commit suicide.(3,4)

Japan, Hungary and Denmark boast strict gun control laws and severely restrict the availability of firearms; yet, these countries have much higher rates of suicide than the U.S.(4,5) (Figure 1) In these countries, other methods are used for suicide: Seppuku in Japan, drowning in the Danube in Hungary, inhalation of poisonous gases such as carbon monoxide, or hanging as in Denmark and Germany --- quite effectively --- almost as effectively as with firearms.(4) (Figure 2)

                    Figure 2. Suicide Method Lethality from Kleck, G. Point Blank: Guns and Violence
                    in America
. Hawthorne, NY, Aldine De Gruyter, 1993, Table 6.2.

Guns are not the cause of suicide, but only the vehicle severely depressed Americans tend to use to commit felos de se. As physicians, we should stop blaming firearms, sensationalizing statistics, and making politically motivated predictions, as when Dr. Wintemute erroneously predicted by the year 2004, firearms would surpass motor vehicle accidents as a leading cause of injury death --- a prediction he has reluctantly retracted.(6)

Regarding the risk of homicide with firearms among women, the authors should have pointed out women are being victimized by criminal predators, and purchasing a handgun may have actually been a response to perceived (and as it turned out for many of them real) threats because they were already at risk! It should have been of interest to find out from the study how many of the women who bought a handgun actually survived because of the protection afforded by the firearm. And, herein, lies another major flaw of this study --- the fact the authors failed to consider the protective benefits of firearms, and relied only on a body count.(7-9)

We know from Prof. Gary Kleck of Florida State University the defensive uses of firearms by citizens amount to between 1 to 2.5 million uses per year, dwarfing the offensive gun uses by criminals (statistics which have been substantiated by a 1997 Justice Department study).(10)

We need to honestly admit the real culprit behind rates of suicide is unrecognized or poorly treated depression. It's time we start taking responsibility as professionals for our relative inaction in properly combating depression. Rather than blaming guns, let's carefully analyze the mind of those pulling the trigger.

Miguel A. Faria, Jr., MD
Editor-in-Chief, Medical Sentinel of the Association of American Physicians and Surgeons (AAPS)

References

1. Kellermann AL, Rivara FP, Somes G, et al. Suicide in the home in relationship to gun ownership. N Engl J Med 1992;327:467-72.
2. Sloan JH, et al. Firearm regulations and rates of suicide: A comparison of two metropolitan areas. N Engl J Med 1990:322:369.
3. World Health Organization, World Health Statistics 1989. Geneva, Switzerland: World Health Organization, 1989.
4. Kleck G. Point Blank: Guns and Violence in America. Hawthorne, NY, Aldine De Gruyter, 1993.
5. Suter EA Guns in the medical literature - a failure of peer review. J Med Assoc Ga 1994;83(3):137-148.
6. Wintemute GJ. The future of firearm violence prevention. JAMA 1999;282(5).
7. Lott JR, Jr. More Guns, Less Crime - Understanding Crime and Gun Control Laws. Chicago, IL, University of Chicago Press, 1997.
8. Kleck G. Targeting Guns - Firearms and Their Control. New York, NY, Aldine De Gruyter, 1997.
9. Kates DB, Schaffer HE, Lattimer JK, Murray GB, Cassem EH. Bad Medicine: Doctors and Guns in Guns - Who Should Have Them? (Ed., Kopel DB), New York, NY, Prometheus Books, 1995, pp.233-308.
10. U.S. Department of Justice study (conducted in 1993 and published in 1997) cited in Guns and Safety. Medical Sentinel 1998;3(1):7.

------------------

February 2, 2000
Dear Dr. Faria,

Your letter to the editor regarding the Wintemute article of November 19 has been accepted for publication in edited form in a forthcoming issue of the Journal and sent to the authors for their comments...

Gregory D. Curfman, MD
Deputy Editor, NEJM

 -----------------

March 7, 2000
Dear Dr. Faria,

I regret that we will not be able to publish your letter to the editor in response to the article to Wintemute et al. Because of other space priorities, we are unable to print the letter. I am sorry that we must change our decision...

Gregory D. Curfman, MD
Deputy Editor, NEJM

----------------

March 14, 2000
Marcia Angell, MD
Editor, NEJM

Dear Dr. Angell,

When you ascended to the post of Interim Editor of The New England Journal of Medicine (NEJM) following the resignation of Dr. Jerome Kassirer, I applauded your promotion because, among other things, you had also courageously breached the wall of junk science being built around the issue of silicone implant litigation. Moreover, under Dr. Kassirer, when it came to the topic of public health and gun control, and to a lesser degree, Medical Savings Accounts (MSAs) and private medical care, NEJM took a decidedly liberal perspective, whereby only one point of view was promoted.

The other side was ignored or, let us say it, censored. More recently, the mainstream press has been critical of NEJM because it had violated its own policies on conflict of interest ethics. When on November 22, 1999, I sent a letter to the editor (addressed, incidentally, to you), responding to Dr. Wintemute et al's article, "Mortality Among the Recent Purchases of Handguns" in N Engl J Med 1999;341(21):1583-9, and after passing editorial review, was accepted for publication, I was particularly delighted and grateful for its acceptance in your esteemed journal (Correspondence #99-3859). I was delighted because as a Hispanic (and the NEJM has promoted diversity), it seems that NEJM was also now promoting diversity of intellectual views.

Unfortunately, my hopes came tumbling down. Yesterday, I received a letter from Gregory D. Curfman, M.D., Deputy Editor, NEJM. He stated: "I regret that we will not be able to publish your letter to the editor in response to the article by Wintemute et al. Because of other space priorities, we are unable to print the letter. I am sorry that we must change our decision."

...Given the content of my letter, I must assume that like the refrain says, "The more things change, the more they stay the same." Intellectual freedom and social progress can only thrive in an atmosphere where there is a free and open exchange of ideas and information --- not censorship. I hope you can use your moral authority to reverse this decision. I remain hopeful that you can decidedly end this resurgence of lack of professionalism and ethics --- and return of censorship...

Miguel A. Faria, Jr., MD
Editor-in-Chief, Medical Sentinel of the Association of American Physicians and Surgeons (AAPS)

------------------

March 27, 2000
Dear Dr. Faria,

Thank you for your letter to Dr. Angell dated March 14. Regarding the correspondence on the Wintemute article, when we finally assembled it all, it was clear that we did not have sufficient space to explore all of the topics raised by that article. The central issue of your letter, that "guns are not the cause of suicide," is an interesting point, but one that we could not commit the space to assess in depth. [Emphasis added.] Thank you again for your interest in The New England Journal of Medicine.

Gregory D. Curfman, MD
Deputy Editor, NEJM

Correspondence originally published in the Medical Sentinel 2000;5(4);113-117. Copyright©2000 Association of American Physicians and Surgeons (AAPS).

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