Timothy McFarren and Sandra Koch: Firearms: A public health crisis
March 31, 2018
Gun deaths have become a public health crisis. With an average of more than 90 deaths each day, deaths from guns are now approaching the death rate from opioid overdose.
The rate of gun deaths is 25 times higher than the average for other high-income countries. More than half of these deaths are from suicide and 1/3 are from homicide. Having a firearm in the home is associated with an increase in the risk of injury or death. People with a history of domestic violence and with a firearm in the house are five times more likely to shoot and kill their partner than a home without a firearm. More than half of women murdered in 2011 were killed by family members or intimate partners. There's clear evidence to support these sad truths.
The Second Amendment states, "A well-regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed." For the first time in the history of America, the Supreme Court in 2008 (District of Columbia vs. Heller) allowed for an individual's right to bear arms unrelated to a militia. However, this ruling upheld states' rights to place specific limits on ownership by the mentally ill and felons. In addition, it upheld limits placed on concealed weapons and sensitive locations such as schools. It recognized the right of government to impose "conditions and qualifications on the commercial sale of arms" and the ability to prohibit "dangerous and unusual weapons." The court has since declined to hear challenges to state laws relating to control over firearms.
We have laws that prohibit individuals convicted of domestic violence, drug users, the mentally ill, felons, unlawful residents, and fugitives from purchasing weapons. These people are listed on the FBI's National Instant Criminal Background Check System (NICS). Unfortunately, the NICS database is poorly maintained, can be inaccurate and doesn't include dangerous persons (such as those with a history of threatening violence) or those on the watch list for terrorism. An audit of the handling of firearm purchase denials through the NICS revealed improper updates in 630 out of 631 cases in 2016. Is this the system we want to rely on?
Why does federal law protect gun manufacturers and sellers by limiting legal action, research and the sharing of data? In general, victims harmed by unlawfully possessed firearms are unable to sue makers or sellers for negligence. The Bureau of Alcohol, Tobacco, Firearms and Explosives is prevented by federal law from releasing gun-tracing data from crime scenes. This obstructs access to this vital data by law enforcement making it more difficult to solve or prevent a crime.
Federal law, through the Dicky Amendment, banned the CDC (Center for Disease Control and Prevention) from using injury funds to advocate or promote gun control. The result was a 96 percent reduction in funding for gun violence research by the CDC. This is unfortunate because evidence based laws aligning with the Second Amendment should be the solution to this crisis.
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Here's what we can do:
Enforce our current Laws: Our federal law should require universal background checks and work to make the NICS data comprehensive and accurate. To effectively limit prohibited persons from buying guns there should be a minimum waiting period. This system should be regularly assessed with high quality audits and with incentives for timely reporting.
Protect children with safe storage and smart firearms: Firearm storage should be regulated. Safe storage includes unloaded guns, trigger locks and secure cabinets. Trigger locks should be required in high risk environments, such as firearms children can access. The use of smart guns, which can only be fired by authorized users, would allow technology to make homes safer for families.
Ban hazardous weapons: Hazardous weapons are frequently used in mass shooting such as in Las Vegas earlier this year. Nevada's emergency responders have given detailed descriptions of the devastating injuries they cause. The Supreme Court has expressly stated government has the right to ban these firearms. The government should immediately ban especially hazardous weapons such as assault or military-style firearms, rapid-fire modifications (i.e. bump stocks), high-capacity magazines, and armor-piercing or exploding bullets. What are we waiting for?
Crime fighting: We all have an undeniable interest in preventing, identifying and prosecuting crime. To prevent, detect and prosecute crimes, law enforcement needs good data. Our law enforcement must be allowed to access data, including high-volume firearm purchases and the ability to trace bullets and firearms used for criminal purposes. As with all data collection, privacy should be respected.
Research gun safety: Removing the obstacles to firearm research would improve the data collection and allow for evidence based firearm legislation. To have this happen on a national level would be most effective. Current data demonstrates high gun prevalence correlates with high gun violence. The states with the highest percentage of gun ownership have the highest gun related deaths and vice-versa.
Don't let dangerous individuals purchase firearms: People disposed to violence, subject to due process, shouldn't have access to firearms. Our laws should include all potentially dangerous people including those on the no-fly list. We should set a minimum age of 21 for firearm purchases because youth are at high risk for impulsive behavior.
Given the public health crisis created by high levels of firearm deaths, we should call for the convening of an expert non-partisan panel. We should declare this a public health emergency, as we have done with opioids, and put gun violence in the public eye, thereby triggering enforcement of current law, appropriate new legislation and funding/freedom for research. Well-regulated laws and practices consistent with the Second Amendment have been demonstrated to reduce firearm deaths in other countries. After the terribly sad mass shootings we've recently lived through in our own Las Vegas and in churches and schools around our country, we all know something needs to be done to address gun violence. Our children, families, and loved ones deserve no less. Gun violence is a public health crisis!
Timothy McFarren, MD, and Sandra Koch, MD, are practicing Ob-Gyns in Carson City. They share a strong interest in the health and welfare of their community and state.
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