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Which Is Best for Public Health: More Guns or Fewer Guns?

image of a handgunIn the wake of the Orlando shootings, the usual battle lines are drawn in the usual, predictable way. Urban liberals and many Democrats call for more regulations and enforcement to limit access to firearms (especially assault weapons); hunters and conservatives and many Republicans—and especially the National Rifle Association (NRA)—say such calls are hogwash and won’t solve the problem. Indeed, they often suggest that what we need is more guns, using the “the only way to stop a bad guy with a gun is with a good guy with a gun.”

Is this actually true? To me, it seems patently absurd to suggest that fewer people would have died in that movie theater in Aurora, CO, if more theater-goers were toting firearms, or that fewer children would have died in Sandy Hook, CT,  if there were armed guards in all schools, or Donald Trump’s more recent statement that if more people in that Orlando nightclub had been carrying guns, “you wouldn’t have had the tragedy that you had.”

But since we can’t actually know something that didn’t happen, what if we were to look at this as an empirical question? While it’s hard to design a controlled experiment to see whether more people carrying guns in the streets or to the movies or to school would lead to more or fewer deaths, why not take a scientific approach to determining whether there is such an association and in which direction it points? While my heart resonates with this argument, my head finds a few significant problems:

  1. The powers that be don’t want this sort of information. As President Obama recently and eloquently pointed out, we can look at an analogous public-health issue: fatalities related to motor vehicle accidents. Through careful study leading to evidence-based regulation, such fatalities have dropped precipitously over the last 50 years, which has been rightly hailed by the Centers for Disease Control (CDC) as one of the 10 greatest public health achievements of the 20th century. Obama went on to point out that even though firearm-related deaths are a public health problem, the CDC is specifically prohibited by Congress from studying the problem. While the American Medical Association (AMA) has recently called on Congress to overturn that ban, I am not optimistic about this—not only because of the limited power of the AMA (especially when compared with that of the NRA), but also because…
  2. Even when information is available, we tend to ignore or disbelieve evidence that doesn’t comport with our beliefs. While there hasn’t been enough research on gun violence, there has been some, and it generally supports the notion that having fewer restrictions on gun access is associated with more, not fewer, fatalities—for example, in state-by-state comparisons within the U.S. Further, our tendency to selectively accept or reject the evidence that, respectively, confirms or undermines our prior beliefs is exacerbated by…
  3. Americans’ mistrust of science. This last point is perhaps the most problematic—although as troubling as I find it, I do understand it a bit. First, while science represents a methodology and an approach to thinking about and understanding the world, the way “science” is taught tends to emphasize what we’ve learned from science (often focusing on fact retention) rather than the methodology itself. While the latter is more interesting, it can be intellectually challenging, and one wonders whether our educational system is up to the task. Second, way too many of our  political leaders promote this distrust. Third, some in the scientific community, and many in the news media, contribute to this distrust by overinterpreting or misinterpreting inconclusive or incremental scientific findings—it’s easy to understand how hearing that coffee causes cancer one week and that it prevents cancer the next can make you think scientists don’t know what they’re talking about.

In sum: I’m hoping for effective, evidence-based policies to curb gun violence and reduce firearm-related deaths—but I am of little faith.

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Paul Marantz, M.D., M.P.H.

Paul Marantz, M.D., M.P.H.

Dr. Marantz is a physician-epidemiologist. He is associate dean for Clinical Research Education at Albert Einstein College of Medicine.

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Comments on this entry are closed.

  • StannerC July 20, 2016, 10:49 PM

    Dear Dr. Marantz,
    First let me give you some background on myself. I am a practicing pediatrician in NY state. I grew up in NYC in home without any firearms. Although my father serve in the US Army in the 1960s he has never owned or fired a gun since. My entire education has been in NY state. I write this in order to dispel any thought that I have been influenced by living in more “gun friendly” state. Finally, I am a gun owner but I did not become so until I was in my late 30’s, married, and a father several times over. It became apparent to me with accumulation of age and wisdom that people need to become more self reliant and responsible for their own well-being. People and families have to realize that they are their own “first responder.” In so many other aspects society is trying to get life saving tools into the hands of people who need them as soon as possible. Homes and schools have fire alarms and extinguishers because waiting for the fire department may take too long. People with significant allergies carry epinephrine auto-injectors (now it is recommended to carry two) because waiting for EMS may be too long. Schools, sports arenas, government buildings, etc now have AEDs located throughout their buildings because we now know that getting electricity immediately to someone having a cardiac arrest provides a superior chance of survival over CPR.
    I have had to use my home fire extinguisher once, thankfully have never had to use my son’s EpiPens, and cannot see us using the AED at my office (but we have one). My firearms are similar lifesaving tools. I hope I never need them but if I do I will have one handy for immediate use. I always carry my holstered pistol including during office hours, the exception being when I am barred by law such as attending my children’s school and the courthouse when I have had to testify.
    As for evidence based polices I can point you to economist John Lott’s website, Crime Prevention Research Center (http://crimeresearch.org/), and his book, More Guns, Less Crime. There is also the recent article published in the Harvard Journal of Law & Public Policy, Would Banning Firearms Reduce Murder and Suicide? (http://www.law.harvard.edu/students/orgs/jlpp/Vol30_No2_KatesMauseronline.pdf).
    Finally, you can also peruse a wonderful website, Doctors for Responsible Gun Ownership (https://drgo.us/). It is an interesting pro-self defense, pro-rights site started by physicians to support the “safe and lawful use of firearms.” What is different about these physicians is that they have actual, hands on experience with the safe and practical use of firearms unlike so many doctors and politicians who propose bans and laws regarding without having ever seen, held and fired a gun in person. Have you, Dr. Marantz?

  • Paul Marantz, M.D., M.P.H. Paul Marantz, M.D., M.P.H. August 2, 2016, 11:15 AM

    I appreciate your thoughtful response to my piece. First, let me dispatch the false equivalency you draw between fire extinguishers and EpiPens and AEDs and firearms: you don’t actually believe that carrying a gun to mitigate a perceived threat is even vaguely analogous to having a fire extinguisher available to battle a nascent fire, do you? How often do you think people are killed or injured by poorly aimed or incorrectly used fire extinguishers? (I was able to find this incident in Thailand, but it’s not a fire extinguisher as we know it and having this occur within a closed bank vault seems unlikely to be replicated frequently.) As a physician, I feel certain you deeply understand the profound difference between an individual perceiving signs of impending anaphylaxis in themselves and administering a medication to themselves and someone perceiving a threat from others and therefore firing a weapon at others. Therefore, you not only constructed a straw man for your argument, but your straw man doesn’t have legs.

    As for your purported data to show that more guns lead to more safety: at least this is related to the content of my blog post, although your cherry-picking of available data supports what I describe as problem #2 in the piece. For instance, the “study” you quoted has already been well-documented to not actually be a study, but rather a screed by gun advocates masquerading as science. I freely admit that these sorts of studies are difficult to conduct and interpret, but dispassionate objectivity always must be the hallmark of true scientific inquiry.

    Finally, yes, I have held and fired guns, but that is entirely irrelevant to the argument. Indeed, as I’ve discussed in a previous blog post, experience can often cloud reasoned judgment and lead to incorrect conclusions, much as your letter demonstrates.