By Sean Gregory and Chris Wilson
March 22, 2018

Columbine. Sandy Hook. Virginia Tech. Las Vegas. The names of America’s mass shootings have become as hauntingly familiar as the responses to them–a now predictable cycle of thoughts and prayers, calls for new gun laws, debate over their need and then, usually, little else. Until the next one.

No other developed country has such a high rate of gun violence. A March 2016 study in the American Journal of Medicine found that Americans are 25 times more likely to die from gun homicide than people in other wealthy countries. There are commonsense steps we can take to reduce that toll, but they require acknowledging certain truths. The right to bear arms is enshrined in the Constitution, and there are approximately 265 million privately owned guns in the U.S., according to researchers from Northeastern and Harvard universities. Any sensible discussion about America’s gun-violence problem must acknowledge that guns aren’t going away. “We have to admit to ourselves that in a country with so many guns, progress is going to be measured incrementally,” says Jeff Swanson, a professor of psychiatry and behavioral sciences at Duke University School of Medicine.

What does that mean in practice? It requires a shift in our collective perspective. While legislators in statehouses and Washington can pass laws that may–or may not–help, the most effective way to tackle our national problem is to stop thinking of gun control as a political battle and instead see gun violence as a public-health issue. “The public-health model says you intervene in as many places as possible,” says Dr. Liza Gold, a clinical professor of psychiatry at Georgetown University School of Medicine. “There are no magic solutions. There are a lot of solutions.”

Here are six steps that we can take to reduce America’s shameful gun-violence problem.

1. Buying a gun should be like buying a car

The reduction in U.S. motor-vehicle deaths over the past 50 years is one of the great triumphs of public-health intervention. Safer cars, stronger seat-belt laws and fewer teenage drivers have helped reduce car fatalities, which dropped from 33.5 deaths per billion miles traveled in 1975 to 11.8 in 2016. Gun deaths have increased steadily since 2009 and are now nearly as lethal as traffic accidents, according to the Centers for Disease Control and Prevention (CDC).

Lawmakers can learn lessons from auto safety. To start, they can put in effect more rigorous requirements for owning firearms. “For the most part, it is much easier to be a legal gun owner in America than it is to be a legal driver,” says David Hemenway, director of the Injury Control Research Center at the Harvard T.H. Chan School of Public Health.

Some measures, like Walmart’s lifting its minimum age for purchasing a gun from 18 to 21, may sound good but likely won’t do much to combat gun violence. According to FBI reports, handguns were responsible for 90% of homicides in 2016. Walmart sells handguns only in Alaska.

A more effective policy would require every buyer, of any age, to obtain a license that includes a registration of all purchases and at least a modest training program. According to the State Firearms Law project, just seven states require a permit to possess a gun of any kind. A 2014 study in the Journal of Urban Health found that Missouri’s 2007 repeal of its permit-to-purchase handgun law was associated with a 25% increase in firearms homicide rates.

2. Pass gun laws that actually reduce gun violence

Not all gun laws are created equal. The military-grade rifles used in many mass shootings may dominate the political debate, but they account for less than 5% of homicides. Meanwhile, research published in JAMA Internal Medicine in early March found that strong firearms laws in a state, such as background checks for all private sales and restrictions on multiple purchases, were associated with lower rates of gun homicides.

Researchers are also finding links between right-to-carry laws–which require governments to issue concealed-carry permits to citizens who meet certain requirements–and spikes in firearms crime. A 2017 National Bureau of Economic Research working paper estimates that 10 years after the adoption of right-to-carry laws, violent crime is 13% to 15% higher than it would have been without those policies.

Another measure that has attracted lawmakers’ attention is extreme-risk protection orders, also known as gun-violence restraining orders. These allow family members or law enforcement to petition a court to temporarily bar an at-risk person from buying firearms. Police may also be permitted to confiscate their guns. Before the shooting in Parkland, Fla., California, Oregon, Washington, Indiana and Connecticut all had some version on the books. Florida adopted one on March 9.

Evidence suggests that these orders save lives. A 2017 study in Law and Contemporary Problems estimated that in Connecticut, every 10 to 20 gun seizures averted a suicide. In California, the San Diego city attorney’s office has issued 20 gun-violence restraining orders since mid-December. In one instance, an employee of a car dealership had praised the Las Vegas gunman and said that if he were fired, he’d return to the dealership with a gun. After the city obtained a gun-violence restraining order, the man surrendered a semiautomatic rifle.

3. Doctors can help reduce gun violence. Let them

Doctors can play a key role in educating families about gun safety, particularly when it comes to keeping guns out of the hands of young children. Studies show that some 3-year-olds are strong enough to shoot a gun. By the time they reach school age, about 75% can fire a weapon. As a result, the American Academy of Pediatrics (AAP) recommends that pediatricians start asking about firearms in the home when children are 3 years old and curious about the world–and objects–around them.

But some states have sought to prevent doctors from talking about guns with patients, even though they present a health risk. A 2011 Florida law threatened physicians with suspending their medical license and fines if they inquired about and discussed a family’s firearms. Doctors sued, claiming that the statute violated their First Amendment rights. A federal appeals court settled the “Docs v. Glocks” case in February, siding with the physicians and overturning the law. Minnesota, Missouri and Montana also limit doctors’ ability to address guns with patients in different ways.

Doctors say such gag laws and restrictions hamper their ability to discuss issues that can affect patient safety; after all, they talk about the dangers of smoking or of not wearing a seat belt in a car. “My role is not to be judgmental,” says Dr. Joseph Wright, chair of the committee on emergency medicine for the AAP. “We are asking about and providing information about what science has demonstrated as the most effective ways to keep children safe in homes with guns.”

4. Invest in smart gun technology

“If we can set it up so you can’t unlock your phone unless you’ve got the right fingerprint,” President Barack Obama asked in January 2013, “why can’t we do the same thing for our guns?” More than five years and too many tragedies later, guns aren’t much smarter now than they were at the time of the Sandy Hook school massacre. In fact, no truly smart guns are on the market in the U.S.

All the pieces appear to be in place. The safety technology is available. Entrepreneurs have introduced products that use biometrics to identify a weapon’s rightful owner while locking it for everyone else. Such smart guns may not prevent mass shootings with firearms purchased legally. But they can prevent crimes or suicides with weapons owned by somebody else. They can also cut down on accidental shootings. According to the CDC, an average of 500 people are shot to death unintentionally every year.

If the benefits seems obvious, why aren’t smart guns available? Some gun owners worry that the technology will fail when they need it most, like during a home invasion. Others fear government overreach. New Jersey passed a law in 2002 requiring that the state’s retailers sell only personalized, or smart, guns within three years of their being available for sale elsewhere in the U.S. The mandate backfired, mobilizing opposition to smart guns from the firearms lobby and stunting investment in the technology. Similarly, when Smith & Wesson, one of the largest handgun manufacturers in the U.S., agreed to develop smart-gun technology in the wake of the Columbine school shooting in 2000, the NRA condemned the company. Gun owners boycotted, and sales plummeted. No major gun manufacturers have invested in the technology since.

In early March, Smith & Wesson’s parent company, American Outdoor Brands Corp., reaffirmed its stance. “We are a manufacturing company, not a technology company,” it wrote in a response to the investment-management firm BlackRock, which had inquired about the gunmaker’s plans to address safety concerns.

Support for smart guns, however, could be building. A 2016 study from Johns Hopkins University found that almost 60% of Americans considering purchasing a new handgun would be willing to make it a smart gun. “The time for smart guns,” says Stephen Teret, founding director of the school’s Center for Gun Policy and Research, “is now.” Such numbers mean that smart guns could be a prime market opportunity. “This isn’t just a great gun-safety mission,” says Gareth Glaser, CEO of LodeStar Firearms, which is developing a smart gun. “It could be a hell of a business.”

5. Eliminate funding restrictions on gun violence research

According to a 2017 study published in the Journal of the American Medical Association, gun violence should have received $1.4 billion in federal research money from 2004 to 2015, on the basis of mortality rates and funding levels for other leading causes of death. Instead, such projects received $22 million–just 1.6% of the projected amount. Gun violence received 5.3% of the federal research funds allocated for motor-vehicle accidents, even though they kill similar numbers of Americans per year.

“We know far less about gun violence as a cause of injury and death than we do about almost every medical problem,” says Dr. Elinore Kaufman, chief resident in surgery at NewYork-Presbyterian/Weill Cornell Medical Center.

There is a reason for this lack of knowledge. In 1996, Congress, with a push from the NRA, passed the Dickey Amendment–named after its author, former Republican Representative Jay Dickey from Arkansas–which mandated that no CDC funds could be spent on research that “may be used to advocate or promote gun control.” Congress also cut $2.6 million from the CDC budget, which was equal to the federal agency’s expenditure on firearm-injury research the prior year. The message to researchers was clear: study the gun problem at your own risk. “The effect of the Dickey Amendment was beyond chilling,” says Dr. Eric Fleegler, a pediatric emergency physician and health services researcher at Boston Children’s Hospital.

The restrictions on research funding have had devastating consequences on what we know–and what we don’t. In early March, the Rand Corp., a nonpartisan think tank, released a sweeping two-year examination of U.S. gun laws. The main takeaway: there’s a dearth of evidence on their impact. Few studies, for example, test the argument that gun restrictions thwart people’s ability to defend themselves. “There are thousands of studies waiting to be performed,” says Fleegler. “But you can’t do them because of the money.” Toward the end of his life, even Dickey, who died in April 2017, said he regretted the amendment that bears his name.

Some states are trying to pick up the slack. California recently opened the nation’s first state-funded firearms-violence research center, on the Sacramento campus of the University of California, Davis. Such investments are urgent as the failure to find answers carries a steep cost. “People are dead today,” says Dr. Garen Wintemute, director of the new center, “as a result.”

6. End legal immunity for gun manufacturers

Federal law offers the gun industry extraordinary protections. In 2005, Congress passed the Protection of Lawful Commerce in Arms Act, which shields gun manufacturers and sellers from civil claims brought by victims of gun violence. NRA CEO Wayne LaPierre hailed the law as the most significant piece of pro-gun legislation in 20 years.

No one benefits from frivolous lawsuits. But holding manufacturers liable for the misuse of their products, experts say, would incentivize them to make firearms safer. “If pillows caused fatalities at that level, those companies would be bankrupt,” says Fleegler of Boston Children’s Hospital. “If there were 500 deaths a year associated with any consumer product, it would be banned, regulated, fixed. But here, nothing.”

with reporting by Alice Park and Aric Jenkins

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