Again: Guns, Surgeons General, and Public Health Policy

From our friends at DRGO

(from thelogicalindian.com)

[Ed: This is the first article I wrote for DRGO, published June 16, 2014. Remarkably, republishing it now is as relevant as it was then, as Dr. Murthy has become not only the 19th but also the 21st Surgeon General of the United States. Fortunately, he hasn’t yet joined in the left’s pogrom against guns and the Second Amendment. A few bits, italicized, are updated; two paragraphs and footnotes have been removed. Those data are dated, thought the points haven’t changed. The original text with footnotes is available in the original, here.]

President Biden’s nomination of Vivek Murthy, MD to become the nation’s next Surgeon General [confirmed March 23] raises important questions of policy and politics.  The political is pretty obvious.  Dr. Murthy is an accomplished physician at the age of 43 with a fascinating personal history, having been born in Britain to Indian parents.  He was at the Brigham and Women’s Hospital teaching for Harvard Medical School following education at Harvard and Yale in medicine and management.  He co-founded “Doctors for Obama” in 2008 to support Barack Obama’s campaign for the Presidency.  With that achieved, the organization was repurposed in 2009 as “Doctors for America”, promoting the Affordable Care Act (on which he consulted as it was drafted).  One is struck by similarities in this choice for Surgeon General to nominations of loyal supporters to plum European ambassadorships.

Dr. Murthy believes, as do many physicians and medical groups, that “gun violence” should be addressed by the government limiting access to guns.  Doctors for America is on record supporting an “assault gun” ban.  Having said earlier that he does “not intend to use the Surgeon General’s office as a bully pulpit for gun control,” he apparently wants people to believe he’ll do as he says, not as he did.  Murthy famously tweeted about “politicians playing politics w/ guns, putting lives at risk b/c they’re scared of NRA. Guns are a health care issue.” What’s scary about an advocacy organization representing its members’ convictions?  And to what extent are guns “a health care issue”?

The main role of a presumably apolitical Surgeon General, beyond heading the U.S. Public Health Service, is to use that bully pulpit to speak to the health needs of the American public.  Previous Surgeons General have been very influential on issues such as tobacco, HIV, violence, nutrition, etc.  How could a man with strongly held beliefs about guns as a health risk not continue promoting those beliefs?  It’s no surprise that his nominations were opposed by gun rights advocates who see violence done with firearms as criminal and educational problems, and gun-related health care issues as consequences of misuse, not of guns themselves.

So is there anything to be said for “health through gun restrictions”?  Certainly, the fewer legal guns, the fewer should get misused.  Would our declining violent crime rates (as gun ownership steadily rises) plummet on banning “assault” (i.e., modern sporting) rifles?  Rifles are used in less than 2% of homicides overall, and “assault”-style rifles in only a fraction of those.

The Supreme Court’s 2008 Heller and 2010 McDonald decisions ended the fantasy of eliminating guns from American society, particularly handguns, by far the most common.  This was never realistic.  There are about 400 million guns now in circulation and estimates of at least 85% rates of civil disobedience to recent confiscatory gun control laws. Depriving people of guns, the most effective tools for self-protection, would only increase victimization of the more vulnerable among us.

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So what is desirable from a public health perspective?  Good public policy (as opposed to agenda-driven policy) takes into account both the risks (harm) and benefits (harm reduction) of issues, and anticipates potential consequences of proposed policies, intended and unintended. These principles rarely seem to concern vociferous gun control partisans.  The most rational basis for forming public policy about “gun violence” is to compare lives that can be saved and people uninjured against the numbers lost and disabled due to shootings.  (This approach ignores the benefits of hunting and the shooting sports.  These are widely enjoyed but don’t ordinarily raise questions of human risk.)

Abundant criminology research since confirmed by unpublished CDC data regarding self-reported defensive use of firearms has estimated that guns are used in self-defense from 500,000 to 3 million times a year in the United States.  The most credible range of 1-2 million times per year is an awful lot of self-protection. How many lives don’t end, how many bodies are uninjured, because guns aid self-protection?  Most respondents reporting use believed they were lifesaving.

Many of these events are not reported to police, so there aren’t official incidence and outcome data. But it is easy to suspect that out of around 2 million occurrences, as many as 2.2% (22-44,000 saved lives cp. 11,000-15,000 homicides) really were lifesaving and as many as 17% (170-340,000 cp. 73,000 injuries) saved someone harm. It’s more difficult to quantify absence of outcomes compared to what happens and is reported, but that has to be considered along with so-called “positive” data.

Thus, it could be quite counter-productive to limit legal gun ownership for reasons of public health and safety.  And how remarkable that guns used defensively are rarely fired, and that people who defend themselves using firearms end up less harmed than those who use other methods (or just give in). Criminals certainly wish to avoid armed resistance. So having more responsible armed citizens may well reduce crime, thanks to individual defensive firearms use and by dampening general criminal motivation.  These legally armed citizens are far less likely than the general population to commit crimes, violent and otherwise.

How are other problems addressed that are similar to firearms misuse, but hold much greater human cost?  400,000 or more American lives may be lost yearly due to iatrogenic causes (treatment mistakes), with vastly more non-fatal complications.  These are largely infections but also include errors made in procedures, medications, and other care. This is tragic in the extreme, that the very places and people trying to save lives actually kill patients.

Why do we let this go on?  Because we recognize that the millions of lives saved thanks to hospitals matter, and we exert ourselves to reduce their damage by improving, not banning, medical care.

Believing that public health demands gun control requires denying guns’ positive uses while lumping all gun users together in one bad-apple barrel.  Of course, this also requires denying the natural right of self-defense and Americans’ Constitutional right to keep and bear arms.  Developing good public health policy requires considering all aspects of an issue, including the harm that misbegotten policy can cause.  That’s a lot more complicated than tweeting sarcastic one-liners.

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Robert B Young, MD

— DRGO Editor Robert B. Young, MD is a psychiatrist practicing in Pittsford, NY, an associate clinical professor at the University of Rochester School of Medicine, and a Distinguished Life Fellow of the American Psychiatric Association.

All DRGO articles by Robert B. Young, MD

Doctors for Responsible Gun Ownership (DRGO) is a project launched in 1994 in response to a coordinated public health campaign against gun rights. DRGO is now a nationwide network of physicians, allied health professionals, scientists, and others who support the safe and lawful use of firearms. DRGO’s members include experts in public health, firearm technology, gun safety education, and tactical medicine.