Firearm Injuries:

The Gun Battle Over Science

by William Kistner, May 1997
Center for Investigative Reporting

Earlier this year, the Centers for Disease Control and Prevention published a mind-boggling report showing that the U.S. firearm-related homicide rate for children was 16 times higher than the combined rate for children in 25 other industrialized countries. Meanwhile, the U.S. child rate of firearm related suicide was 11 times higher. The report was one of a number of recent CDC funded studies that have fueled a growing perception in the medical community that gun violence has reached epidemic proportions.

But not everyone buys it. "They are politicians and liars masquerading in lab coats," says Dr. Edgar Suter, a San Francisco Bay Area family practice physician who chairs a 500-member non-profit group called Doctors for Integrity and Policy Research. Dr. Suter argues that CDC researchers blatantly support anti-gun activities and ignore the benefits of gun ownership, resulting in "dishonest factoids that advance their preordained biases," he says. Along with the National Rifle Association, Dr. Suter's group has campaigned to get Congress to cut CDC's funding for gun violence research.

Last year, Congress nearly slashed the budget for the CDC's National Center for Injury Prevention and Control (NCIPC), which collects and monitors firearm injury data and funds related research as part of its mission. As a result of new funding mandates, CDC this year has been forced to dramatically reduce its firearm-related injury research, and CDC-funded gunshot injury surveillance programs will come to an end in several states.

All this comes at a time when gunshot injuries are expected to soon outstrip automobile accidents as the number one cause of injury death in the U.S., costing an estimated $20 billion yearly in medical costs and lost productivity. Surprisingly little medical research monitors the kinds of firearm injuries that occur or the types of guns used. While the CDC samples unshot injury data from 91 hospitals around the country, there is no comprehensive national surveillance system to accurately track how many people are wounded by guns each year.

"In civilian firearm injuries and deaths, we're doing worse than any other country," says Dr. Robert Tanz, with the Violent Injury Prevention Center at Children's Memorial Hospital in Chicago. "We're not having a civil war here, but 35,000 to 40,000 people a year die from gunshot wounds." Dr. Tanz would like to see a firearm injury surveillance system in Illinois, but so far those efforts have failed. "The efforts of CDC are important because they apply the science of epidemiology and the principles of public health to injuries from firearms. It's intellectually disturbing to me that people don't want to understand this issue at a basic level," he says.

Tracking gun violence at the state level

Victoria Ozonoff is one of several state gun violence researchers who are losing their CDC funding. As a principal investigator with the Massachusetts' Weapon-Related Injury Surveillance System (WRISS), she helped build one of the nation's first state-wide firearm and weapon injury surveillance programs. With CDC funding, WRISS set up a surveillance program that collects data from hospital emergency rooms, police reports and ballistics records, piecing together the details of shooting deaths and injuries, as well as stabbings. Some of the statistics were surprising: 1994 data show that a majority of state firearm fatalities were suicides and that 87% of those were white males. In contrast, the risk of a black male teenager being shot or stabbed was one in 38 compared to one in 422 for a white male teenager. WRISS even found a hazard among those who use BB guns: more than a hundred Massachusetts children under 15 sought hospital care from pellet gun injuries in 1994 (the overall national pellet gun injury toll is an estimated 28,000 to 38,000 annually).

Access to this type of information is crucial for injury prevention programs and Ozonoff says requests for WRISS data come from all sectors of society, from the state attorney general's office worried about cheap handguns used in crimes to educators designing prevention strategies in schools. Even National Rifle Association supporters have used WRISS data to show that knife assaults are more common than gun assaults. WRISS is able to estimate risk levels for residents across the state. "We're using the data to track firearm injuries in a similar way to a range of other health problems, like cancer and food poisoning," Ozonoff says. She believes the program's $200,000 budget is a bargain for the state. "If we prevent just one spinal cord injury, the program will pay for itself," she says.

The WRISS program recently had some good news to report. The number of gunshot victims in the state dropped by 40% (stabbings dropped 18%) over the past two years, matching a general decline in the overall homicide and violence rates. Boston has recently experienced an extraordinary 22- month period without a firearm homicide of someone age 16 or younger. Improved policing, better education and violence prevention programs are credited with much of the decline. Many believe the key to effective prevention strategies is better information. "Surveillance is the key to tracking and understanding what we're doing," says Dr. Howard Spivak of the New England Medical Center.

Surveillance curtailed?

Despite its accomplishments, the WRISS program is in jeopardy of running out of money this year. Supporters in Massachusetts and several other states are scrambling to find new sources of funding due to recent budget cuts at the CDC, and the chances are slim federal funds will be renewed. Several states, including Oklahoma and Missouri, will not continue their firearm surveillance programs after the CDC funds run out this year.

Sue Mallonee, with the Oklahoma Department of Public Health Injury Prevention, says the state is analyzing the results from its firearm surveillance program. "We hope to use the data to promote prevention and education," she said. Mallonee said there were a number of surprises revealed by the surveillance program, including a substantial number of people who unintentionally shot themselves while carrying guns, and a large number of injuries from pellet guns. But after this year, Oklahoma will have no way to track them.

The Debate over Statistics

Dr. Suter claims this kind of surveillance research is biased since it ignores the defensive uses of guns, resulting in fewer injuries from criminal attacks. "What brand of gun being used in shootings is just a small part of the overall public debate," he says. "What we should be focusing on is the big picture and the mountains of data that show the enormous benefits guns have in our society." Dr. Suter and other firearm self-defense supporters believe there is a substantial under-estimation of number of times Americans use their guns to scare off potential attackers, which they say reduces injuries and medical costs.

But criminologists are uncertain how many times Americans successfully use a gun to ward off attacks; estimates of defensive gun uses range from less than 100,000 a year to more than two million. Health researchers say gun deaths and injuries are easier to track. "To not evaluate is horrible," says Stephen Teret, director of The Johns Hopkins Center for Gun Policy and Research. "It's like putting air bags in cars and not seeing if it helps to save lives. To not answer these questions is ludicrous." Teret has proposed a national firearm surveillance system that would be modeled on the federal highway fatality reporting system, which is credited with helping reduce automobile accident deaths. He supports funding such a program with a small tax on gun sales, a difficult proposition in today's political climate.

The Politics of Gun Research

In 1992, President George Bush established a new CDC program , the National Center for Injury Prevention and Control. The NCIPC would increase research and monitoring of injuries caused by fire and accidents, which includes firearms related injuries. Since then, the NRA has pressed legislators to abolish funds for the NCIPC, which spent just 5% of its $46 million budget on firearm-related research. In October, 1995, a letter signed by eight Senators, including Bob Dole and Trent Lott, echoed NRA claims that the CDC agency was wasteful, scientifically biased and driven by "preordained political goals and not from the desire for scientific, balanced and unbiased inquiry...This CDC program can be cut with no diminution of service in administering the public interest, and at a savings to the taxpayer."

Several weeks later, CDC's Director Dr. David Satcher wrote a major rebuttal to NRA attacks in The Washington Post, citing government oversight reports and peer-review articles supporting his agency's research center. "If scientists cannot look into such matters without having their characters impugned, research will be inhibited and ultimately the public will suffer," Dr. Satcher wrote.

The NRA continued its campaign against the CDC, putting out a fact sheet last year called "Defunding the CDC's National Center for Injury Prevention and Control." The fact sheet attacked the CDC for an "almost vicious sentiment against personal firearms ownership that is reflected in the lack of objectivity and balance in its work."

Doctors for Integrity in Research and Public Policy also accused CDC officials of "using tax money to pay for political organizing, lobbying and strategizing," promoting an anti-CDC letter writing campaign and testifying before Congress with other gun rights supporters. House Rep. Jay Dickey (R-Ark), a beneficiary of NRA campaign contributions, led the charge to cut CDC funding for firearm research last year. "Does anyone dispute that a person who is struck by a bullet can be seriously hurt or killed," Dickey stated in one press release. "Do we need to spend almost three million of taxpayer money for 'research' to discover this?"

After a heated battle in the House and Senate, the CDC's $2.6 million budget for firearm research was finally restored last summer, but legislators earmarked the money to study traumatic brain injuries instead. Also, the budget bill included specific language that stated no CDC money could be used "to advocate or promote gun control." As a result, CDC's budget for pure firearm injury related research dropped 80% to about $500,000 this year. "We've had to cut back across the board, but we still consider firearm injury surveillance to be a priority," says Dr. Jim Mercy, CDC's special assistant to the Director of Violence Prevention.

Dr. Suter calls the effort "a moral victory" and he vows to continue to monitor the agency. "Congress heard our protestations about the CDC and looked at the research and said it was garbage science. They won't be spending it on anti-gun newsletters and on pro-Sarah Brady meetings anymore." Rep John Porter (R-IL), who heads the House subcommittee that controls CDC funding, supports the CDC surveillance program and has insisted that firearm injury research will continue. But a spokesman for Rep. Porter adds, "We have a limited pot of money. CDC has to make priority decisions."

The controversy over CDC-funded science bothers people like Dr. Jerome Kassirer, editor-in-chief of the New England Journal of Medicine. "It is hard to escape the conclusion that physicians who have urged the elimination of funding for the (CDC's) NCIPC wish to foreclose epidemiologic studies that could be used to undermine pro-gun policies," he wrote in one editorial.

Dr. Suter denies his organization is linked to direct NRA funding, although members have worked closely with NRA researchers. He claims that most medical journals have refused to publish articles supporting his position because of editors' biases against guns. "It's truly an outrage how flawed and dishonest the medical literature is on the subject," says Dr. Suter.

But Dr. Kassirer argues that published CDC firearm injury research is based on the same rigorous peer-review that all significant health studies undergo and that there is scant scientific evidence to refute them. "There is an epidemic of injuries and this is a serious national problem," he says. "CDC funding is essential to provide insight into what kinds of injuries are occurring."

Despite the cutbacks in CDC funding, a few firearm injury surveillance programs are continuing without federal funding. Dr. Stephen Hargarten, with the Department of Emergency Medicine at the Medical College of Wisconsin in Milwaukee, has developed one of the country's most sophisticated firearm injury surveillance programs, funded entirely by state funds and private foundations.

His surveillance program has found that, inexpensive, short-barreled handguns, such as the Raven MP-25, the Davis P-380, and the Lorcin L-380, are some of the most common handguns used in homicides in the Milwaukee area. He too would like to see a national firearms surveillance system to track the estimated 100,000 gunshot injuries treated at U.S. hospitals each year. "The point is, better information is in everybody's best interest," Dr. Hargarten says. "CDC should take the lead, but they don't have the money. People see it as anti-gun when instead they should see it as providing good data."

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