Happiness is a warm gun

Steve Miles, MDCenter for Bioethics, University of Minnesota

“HAPPINESS IS A WARM GUN” BIOETHICS AND GUN POLICY

Producer George Martin showed me the cover of a gun magazine saying “ 'Happiness Is a Warm Gun.’ I just thought it was a fantastic, insane thing to say. A warm gun means you just shot something.” ---John Lennon.b. October 9, 1940 d. December 8, 1980, 10:50 PM– Shot in the back at close range with 4 hollow-point bullets from a Charter Arms Undercover .38 Special at 10:50 PM.

THE LINK BETWEEN MEDICAL ETHICS AND GUN POLICY

Gun Violence: A Public Health Approach

WHAT IS A PUBLIC HEALTH APPROACH TO GUN VIOLENCE?• Research who, when, and where of gun related injuries,

considering the gun user, the gun, and the setting.

• Identify factors associated with greater or lesser risk of injury or death.

• Risk factors are not “causes” (bad railings do not cause a person to fall from a deck).

• A risk factor does not mean that a person will always experience morbidity.

• Prevention decreases risk; it is not always successful.

• Apply lessons from other public health campaigns (e.g. motor vehicles, tobacco, etc.)

• Develop and evaluate morbidity prevention strategies

• Adopt successful prevention strategies. J Pub Hlth Pol 2001; 22:381-402.

1996, NRA successfully lobbies to instruct CDC: "None of the funds made available ... may be used to advocate or promote gun control.”

2013, NRA successfully lobbies to bar Bureau of Alcohol, Tobacco, Firearms and Explosives from using firearms data to make conclusions about gun crimes.

MORE HOUSEHOLDS WITH GUNS:MORE GUN DEATHS.

JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.1286

“The only way to stop a bad guy with a gun is with a good guy with a gun,” NRA Executive Vice President Wayne LaPierre.

• 31,000 deaths per year.

• 75,000 Emergency Room visits per year.

11,078

19,400

606

HomicidesSuicidesAccidents

GUN DEATHS

SUICIDE

11,078

19,400

606

Deaths


39,000 total suicides

Suicide is the seventh top cause of death for men and fifteenth for women in the United States.

SUICIDE BY GUN: OLDER, MALE

Women Men0

5000

10000

15000

20000

25000

Firearm SuffocationPoison Other

Charlton Heston, NRA President

• Suicide is leading cause of death of the buyer during first year after handgun purchase. • N Engl J Med 1999;

341:1583-9.

• Background checks that delay the acquisition of a gun in some studies decrease death by suicide.

SUICIDE AFTER GUN PURCHASE:

1 2 3 4 5 6 7 8 9 100

50

100

150

200

250

300

350

400

Death / 100,000 p-yrs

Baseline Suicide Risk

Months after Purchase

HIGHER RISK OF SUICIDE IN GUN OWNING HOUSEHOLD NOT EXPLAINED BY MORE MENTAL ILLNESS IN THE HOUSEHOLDS.

• People in homes with guns are no more likely to have recent anxiety, mood disorders, substance dependence or abuse, suicidal ideation or suicide planning.

• Having made a suicide attempt over the previous year was the only mental health factor more common among people who lived in a home without firearms.

Injury Prevention. 15(3):183-7, 2009 Jun. Household survey of 9282 adults. Multivariate logistic regression analyses controlled for age, sex, race/ethnicity, educational attainment and poverty.

TEEN SUICIDE: ACCESS AND IMPULSE• Handguns used in most teen suicides. • Teen gun suicide attempts are 80-90% lethal.

• Youth Suicide by Firearms Task Force. http://www.pbs.org/thesilentepidemic/riskfactors/guns.html

• 80% of 14-19 year olds’ suicides take place at home.• A home with a handgun is almost ten times more

likely to have a teen suicide. Most guns owned by parents.

• Suicide & Life-Threatening Behavior. 40(6):609-11, 2010 Dec.

• Children who commit gun suicide have fewer risk factors for suicide, such as expressing suicidal thoughts. Gun suicides appear more impulsive than suicide by other means.

• Suicide and Life Threatening Behavior. 2004; 34:36-43.

Southgate — A crowd of 300 students, parents and staff members gathered Thursday night for a vigil honoring an eighth-grader who shot himself to death.Police said he took the gun from a family member's home.The firearm, a .40 caliber Glock handgun, was legally registered.

WHEN GUNS LEAVE HOUSEHOLDS: FEWER PEOPLE, ESPECIALLY TEENS, SUICIDE.

• When there were one or more guns in the home, the risk of suicide among women increased five times.

• For each 10% decline in the percentage of households containing children and firearms, firearm suicide by children <19 dropped 8.3%.

• Inj Prev. 2006 June; 12(3): 178–182. Multivariate population study, US.

• See also: J Trauma 2007;62:1029-35.

NB: Studies suggest that handguns are a greater risk than long guns and that guns stored unlocked are a greater risk than guns stored locked.

BOTTOM LINE: SUICIDE• Suicide is the most common lethal

event with a gun.• The biggest risk factor for suicide by

gun is having one available in the house.

HOMICIDE

11,078

19,400

606

Deaths


Homicide weapon0

2000

4000

6000

8000

10000

12000

14000

16000

18000

OtherBlunt ObjKnifeOther gunHandgun

Homicide trends and weapon used.

Bureau of Justice http://bjs.gov/content/pub/pdf/htius.pdf

Soc Sci & Med 2007 64;656 – 64., Multivariate analysis for rates of aggravated assault, robbery, unemployment, urbanization, alcohol consumption, and resource deprivation (e.g., poverty), genders and all age groups.

States with higher levels of household gun ownership had higher rates of firearm and overall homicide. There is no association between gun prevalence and non-firearm homicide.

ASSOCIATION BETWEEN HOUSEHOLD GUN-OWNERSHIP AND HOMICIDE RATES.

GUNS AND INTIMATE MURDER


• Gun owners 8 times more likely to threaten their partners with a gun than non-gun owners.

• threatening to shoot them

• threatening to shoot a pet or person the victim cares about,

• cleaning, holding or loading a gun during an argument, and

• shooting a gun during an argument.• J Am Med Women Assn, 2005; 60:62-8. 8,000+ men in a certified batterer

intervention program in MA, 1999-2003. See also Evaluation Review. 2006; 30:283-95.


• A gun in the home makes it three times more likely a person will be murdered by a family member or intimate partner.

• Gun intimate assaults are 12 times more likely to result in death than non-firearm associated assaults.

• http://www.silentwitness.net/sub/violences.htm


11,078

19,400

606

Deaths


1,100

BOTTOM LINE: HOMICIDE• Homicide is the second most common lethal

event with a gun.• Guns in the house is highly correlated with

the risk they will be used for homicide.• Guns in the house are the most powerful

predictor of domestic intimate violence becoming a homicide.

GUN ACCIDENTS

11,078

19,400

606

Deaths


14,675 wounded but survive (1/5 under 19 years old). NCIPC

GUN ACCIDENTS• Fatal gun accidents are 1% of all lethal home accidents (poisonings 43%,

falls 34%, burns 9%).

• BUT: 14,675 wounded but survive (1/5 under 19 years old). NCIPC

• BUT: Preventable

• Accidental lethal shootings 8 times more common in the four states with the most guns compared to the four states with the fewest guns

• Acc Anal Prev 2001;33: 477-84.

• Adults with a gun in the home have a 4 fold higher risk of dying of an accidental gunshot.

• Acc Anal Prev 35(2003)711-716

CHILDREN

11,078

19,400

606

Deaths


180 190

160

130

190

190

350

160

Children (<14 Years) Deaths per year

RELATIVE RISK OF GUN HOMICIDE, SUICIDE AND LETHAL ACCIDENT FOR 5 TO 14 YEAR OLDS IN HIGH AND LOW GUN STATES

J Trauma 2002; 52:267-75.

Homicide Suicide Accident0

2

4

6

8

10

12

14

16

18

3.3

6.7

16.3

1 1 1

High GunLow GunNon Gun

High Gun States areLA, AL, MS, ARK, WV

Low Gun States areHI, MA, RI, NY, DEL

1

Ratio of High Gun Sts to Low Gun Sts for Non-Gun deaths

RELATIVE RISK OF GUN DEATHS FOR CHILDREN

• For 5 to 14 year olds, the U.S. unintentional gun death rate is 11 times higher than the combined rates of 22 other high-income developed countries.

• J Trauma 2011;70:238-43.

• In 2011, 2,886 children 0-19 were treated in an emergency room for an unintentional gunshot injury. NCIPC

• For 0 to 4 year olds, gun deaths are 17 times more common in high gun states than low gun states.

• For 5 to 14 year olds, gun deaths are 14 more common in high gun states than low gun states.

• Acc Anal Prevent 2001;33: 477-84

GUN LOCKS:Toddler shot in St. Paul as kids play with handgun

PRICELESS

Less than half of home guns are

secured.

CHEAP

UNDERUSED

BOTTOM LINE: CHILD DEATHS BY GUNS

• Guns in the home are the most powerful predictor of lethal gun accidents, suicides, and homicides of children.

GUNS PREVENT VICTIMIZATION

Kokapo— rara avis

• 222 of the 4799 (which in turn was 20% of the total sample respondingreported having at least one Defensive Gun Use (DGU) in the past 5 years.

• After correcting for oversampling in some regions, this drops to 66 personal DGUs in the preceding year, indicating that 1.326 percent of adults nationwide had experienced at least one DGU.

• When multiplied by 1.478, the number of DGUs reported per DGU claimant and by the adult population, an estimate of 2.55 million DGUs per year was arrived at.

MAJOR PAPER CITED BY ANTI GUN CONTROL PREVENTS CRIMES.

Kleck, Gertz. J Crim Law Criminology 1995;86.150-87.

Our survey was “free of the taint of being

conducted by, and on behalf of,

employees of the federal government,

and it was completely anonymous.”

FROM 2.55 MILLION DEFENSIVE GUN USES PER YEAR TO….

• 277 news reports where the intended victim disarmed criminal.

• 25 where an armed rape attack victim got the upper hand.

• 65 where an armed carjack victim prevailed.

• 11 out of 4,699 where a criminal took a gun away from a defender.

Cato Institute. Tough Targets. 2012. 8 years of news clippings.


BOTTOM LINE: GUNS FOR SELF PROTECTION FROM HARM.• An armed citizen is vastly more likely

to commit homicide or to suffer harm to him/her-self or those in his/her household than he/she is to benefit from gun protection.

THE DOCTOR’S OFFICE

AMERICAN ACADEMY OF PEDIATRICS (PARAPHRASED)

• Pediatricians should counsel parents about the dangers of allowing children and adolescents to have access to guns inside and outside the home.

• Pediatricians should ask about the presence and availability of firearms …and urge parents who possess guns to prevent access to these guns by children.

• Health professionals should counsel parents of all adolescents to remove guns from the home or restrict access to them. This advice should be reiterated and reinforced for patients with mood disorders, substance abuse problems (including alcohol), or a history of suicide attempts.

“The Affordable Care Act does not prohibit or otherwise regulate communication between doctors and patients, including about firearms.”

• –White House

“Doctors are being ordered, instructed to talk to patients and get information from them about gun ownership, where they are in their house, who has access to them, where the ammunition is kept. Doctors are now "permitted” to do this. It makes 'em deputies, agents of the state.”

STRONGER GUN LAWS: FEWER GUN DEATHS

Strength of laws

Fire

arm

dea

ths

• No permit to purchase or license to posses, no fingerprinting.

• No requirement to report thefts.

• No ban on assault rifles, large clips.

• No disarming of prohibited handgun possessors.

• No state dealer license.

• Dealers not required to retain records for guns /ammo sales.

• No mandatory theft reporting,

• No ID microstamps on semi-auto handguns.

• No bar on bulk sales of handguns.

• No background checks on gunshows or interpersonal sales.

• No mandated sale of locks with all handguns.

MINNESOTA LAWSGun Dealers Gun Owners

http://data.huffingtonpost.com/2013/03/gun-deaths

SLIDES AVAILABLE ON REQUEST.Steven Miles, [email protected]

Happiness is a warm gun

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