An Ongoing Health Problem

An Ongoing Health Problem


The United States has an ongoing public health problem: death due to guns.  Although deaths due to guns have decreased since the 1990s, they are again slowly rising.  In 2013, the last year for complete published data, there were 33,636 total gun deaths and about 15,000 murders, 11,208 by guns, or about 60%.  Year by year, about 60% of gun deaths are suicides and a few percent are accidents.  In 2013, males accounted for 28,794 gun deaths and females accounted for 4,842.

Mass shootings, although a relatively small part of total gun deaths, keep happening.  In June, 2015, in South Carolina, a deranged, racist, young, white man killed 9 Black people in a Bible study group. In 2012, in Newtown, Connecticut, another deranged, young, white man killed 20 six and seven year old kids and 8 adults, before shooting himself.  In August, 2015, in Colorado, a jury convicted the deranged, young, white man who entered a theater in Aurora, Colorado in 2012, with a machine gun and killed 12 and wounded 70 more before his gun jammed.  Also in August, 2015, a news reporter and her cameraman were murdered on live TV by a disgruntled, black, former newsman who subsequently shot himself.  In September, 2015, in Roseburg, Oregon, a gunman killed nine people at a local community college, then killed himself during a firefight with police.  In December, 2015, a husband and wife who avowed radical Islam killed 18 people at an office Christmas party in San Bernardino, California.  In June, 2016, a young man, apparently a self-radicalized Muslim, killed 50 people with an assault rifle and wounded 53 more in a gay night club in Orlando, Florida.  In September, 2017 a man with a gun converted to automatic fire with a “bump stock” sprayed the crowd at a concert in Las Vegas with thousands of rounds, killing 59 and wounding over 500.  In November a man shot up a church in Texas, killing 26 and wounding 20 more.  In February, 2018, a disaffected 19 year old ex student with an AR 15 shot up a high school, killing 17.  The high school had an armed guard who took cover at the sound of shooting.

Every month there is a new mass shooting.  The perpetrators are usually home-grown, white, Christian males.  The list will continue into the future ad nauseam.  The USA has a population of over 300 million and there are just about this same number of guns, a ratio of about one gun for every man, woman, child and baby in the society.  Although less than half of us own guns, our society is saturated with firearms.  During the Obama Presidency, there was a run on gun and ammunition purchasing for a variety of largely paranoid and mostly racist reasons.  Clearly, crazy people can get guns. The Texas shooter had done a year in prison in the Air Force for cracking his infant’s skull and beating his wife.  And when these mass murders happen, gun purchases also usually rise.  Congress does nothing.  After a mass shooting, right wing politicians always argue that it is “too soon” to discuss the issue of “gun control.”  Then they don’t discuss it at all.

Most of the gun-related deaths in this country are due to hand guns.  Mass shootings tend to be perpetrated with assault weapons with large capacity magazines.  Although the United States does not have the highest rate of gun murders worldwide, it has by far the highest rate among developed countries.  Poverty and unemployment are recognized to be associated with increased gun deaths.

A common theme relating guns to deaths, both here at home and internationally, seems to be gun availability.  States with the highest rates of gun ownership and least restrictive gun ownership laws have the highest rates of gun deaths.

Here are some numbers taken from Am. J. Lifestyle Med. 2011; 5 (6): 502-511 by David  Hemenway, PhD, Professor, Harvard School of Public Health, which reviews 101 articles on this subject.

Violent deaths among 5-14 year olds: USA versus other high income countries:  Gun homicide rate: USA 13.4:1.  Gun suicide rate: USA 8:1.  Total gun deaths: USA 10.6:1. In the fifteen states with the most guns per capita (WY, MT, AK, SD, AR, WV, AL, ID, MS, MD, KY, TN, LA, MO, VT) compared with the six states with the fewest, (HI, NJ, MA, RI, CT, NY) the total populations are 25.5 million in the high gun states and 27.0 million in the low gun states.  The ratio of gun homicides for the 5-14 age group in the high versus low gun states is 2.5:1.  The ratio of non gun homicides is 1:1.  The ratio of gun suicides in high versus low gun states is 12.1:1.  The ratio of accidental gun deaths is 11:1.  There is also good evidence that having a gun in the home is a serious risk factor for intimidation and killing of women who live in that home.  Expanding the data beyond children and women, there isn’t really any statistically credible evidence that there is an overall health or protection risk-benefit ratio to having a gun in any home.  Accordingly, the American Academy of Pediatrics has formally recommended that guns do not belong in households where children are present. And, the death penalty doesn’t help.  States that have the death penalty consistently have higher murder rates than states without it. Look it up.

Dr. Hemenway summarized more data in an editorial in the Los Angeles Times, August 4, 2015.  Briefly, states with higher levels of gun ownership have higher levels of firearm crime; counties with higher levels of gun ownership have higher rates of household burglary; (burglars like to steal guns;) actual use of guns for self-defense is quite rare; using mace, yelling, running away, and calling the police are effective and much more common; using a gun for self-defense does not reduce the likelihood of injury to the victim; and living in a home without a gun does not increase the likelihood that people living in that house will be robbed, injured or killed by criminals.  Instead the likelihood that someone living in a house where a gun is present will be shot accidentally, be murdered, or will commit suicide with that gun increases.  The idea of having a gun “for protection” appears to be a dangerous illusion.

Restrictive gun laws in different states are associated with lower gun-associated death rates.


Gun murder rates in the “developed” world are the highest in the USA, as is the prevalence of gun ownership.  But correlation is not causation.  So let’s examine some contributing factors to this public health problem.

First, the Second Amendment to the Constitution 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.”  The most recent Supreme Court interpretation of this amendment (by a 5-4 vote, McDonald v City of Chicago, 2010) holds that this guarantees all individuals the right to gun ownership.  Some people have also argued in the past, and particularly during the past few years, that the purpose of this amendment is to enable states and individuals to defend themselves against a tyrannical United States government.  But from reading history one should also understand that state militias were instrumental in the revolution against British rule, which was fresh in the minds of the founding fathers when the amendment was adopted in 1791.  My 4X great grandfather, John Baird, fought in a South Carolina militia led by General Sumter.  As far as we know, John had to supply his own musket.  Many, if not most soldiers who fought in the Revolutionary War, were also members of local militias in the various states.  They were fighting to free themselves from a “foreign” tyranny and occupation.  Note also that the amendment begins, “A well regulated Militia, being necessary to the security of a free State…”  This, logically, has been interpreted to mean that the states may need well regulated Militias to control their own populations and that they (the people collectively as a State) should therefore be allowed to keep and bear arms in a well regulated fashion.  Hunting ducks and deer is not mentioned.  At a time in history when hunting actually provided some of the food that people ate, having guns for this purpose was probably assumed by the founding fathers.  The Second Amendment is about something else, as was clearly recognized by all previous interpretations of the Second Amendment until the Roberts Court.1 One should also note that the McDonald v Chicago decision divided along easily recognizable conservative versus liberal leanings of the individual justices.  Each of them made a philosophical decision, then used their legal training to rationalize and justify their prejudgments.

So why, when we no longer need to hunt, do we have so many guns?  Our gun ownership rate is more than ten times the rate in Great Britain and our gun murder rate is thirty times higher.  Guns play a uniquely prominent role in our culture.  Why?

  1. Guns are toys. Many people like to shoot at targets.  Target shooting is amusement, so the concept that guns are toys for many people should be taken seriously.  At some firing ranges the targets are shaped like people.  If you frequently drive on the back roads of America you have surely noticed road signs with lots of bullet holes in them.  The folks that caused this were having a form of fun, however pointless or stupid it may have been.  Robert Spitzer (LA Times, June 12, 2015) made the observation that shooting guns was fun and annoyed many readers who responded in the Letters to the Editor.
  2. Guns are used for hunting, another form of fun for many people. They do not need to hunt to eat anymore.  So they shoot ducks and deer or lions, tigers, and other “big game” for fun and fellowship.  Granted, they may eat some of the game they “bag” but they do not need to.  They have been raised in families that have hunters in them and hunting is one of the things that they enjoy doing together.  Bow hunters do the same thing.  The “Duck Dynasty” folks even parlayed such activity into a successful TV show.  A little more troubling is that some people also specifically enjoy killing animals.  There are “ranches” in Texas where you can pay large sums to shoot a tiger or lion or other exotic animal.  The animals are kept caged, then let out when the hunter has driven close enough to take a shot.  There are similar shooting ranges in Africa.  This “hunting” is done for blood lust, which is fun for some people.
  3. Guns are penis lengtheners. Some people think that guns make them more manly.  Some argue that they carry guns for protection but if you read the anecdotal evidence for guns actually being used to protect the gun owners from assault, the true frequency of such protective use that is not criminal in itself is very hard to determine.  One has particular difficulty determining the number of deaths that would result if those “protecting” themselves did not have a gun. The case of George Zimmerman and Trayvon Martin (Florida, 2012) is illustrative.  Zimmerman was armed and on a self-appointed neighborhood watch at night. He saw Martin walking in his neighborhood.  He interpreted Martin (young black male) as suspicious, called the police, then followed Martin even though the police told him that they were coming and didn’t need for him to do that. Eventually a confrontation took place, Martin knocked Zimmerman down, and Zimmerman, “standing his ground” as Florida law permits, shot Martin to death.  Zimmerman was found not guilty of murder but his case illustrates the problems of anecdotal evidence of guns being used for “self-protection.”  Zimmerman could have stayed in his car and waited for the police.  By the time they arrived Martin would have been home (in the neighborhood where he was walking,) watching TV, and eating his convenience store purchases.  In May, 2016, Zimmerman sold the gun he used to kill Martin for a very large sum.  He said it was part of American History.
  4. Crazy people can get guns. (This raises a whole new set of questions about access to mental health care in this country.)  We have laws that require background checks on people who want to buy a gun in a retail store.  But statistics show that about 40% of guns are sold at gun shows or privately, some by burglars who stole them, and no background checks are conducted.  The Newtown, MA, massacre illustrates a further problem.  The gun used in the massacre was legally purchased by the shooter’s mother.  The shooter himself had access to her guns and no background check was ever conducted on him.  The Charleston, SC shooter bought his gun after a desultory background check failed to disclose his arrest record.  The Texas church shooter’s prison record in the Air Force was not reported to civilian authorities as required by law.  The Florida high school shooter bought his gun legally.  Gun control advocates cite data showing that a gun in a home, as we have seen above, will most likely be used to shoot someone who lives in that home, whether suicide, homicide, or by accident.  Indeed, the Newtown shooter shot his mother first before going to the school.  We will never be able to identify all the potentially homicidal/suicidal people in the society but they will do less damage with knives and baseball bats than with guns.  A couple of years ago, someone in China attacked a school with a knife and slashed 22 students.  They all survived.

What remedies should we consider? None will cure the problem but they may ameliorate it.

Banning the private ownership of assault weapons and high-capacity magazines seems reasonable.  These semi-automatic weapons with high-capacity magazines are made to kill large numbers of people as quickly as possible.  They are for war.  The shock wave accompanying their high velocity bullets shred anything in their path. They are not used to shoot ducks and deer.  The theater shooter in Aurora, Colorado had purchased several thousand rounds of ammunition and the shooter in Connecticut had several hundred.  Why should hunters need that amount of ammunition?  Part of the mystique of hunting is the ability to bring down game with a single shot. Those who think that the Second Amendment was written so that they, as individuals, can protect themselves from our federal government are wrong as a matter of history and as a matter of practicality.  Reread the histories of the Symbianese Liberation Army, the Branch Davidians, and Ruby Ridge and reflect on how successful these deranged people were at fighting the government.  The history of the Confederate States is also relevant.  They put up a huge fight defending their right to enslave Negroes but they lost.  At least 600,000 people died in this insurrection against the federal government.  Many in the former CSA have still not given up.

Hand gun ownership should also be much more severely restricted.  Most gun deaths are caused by handguns.  Wanting a handgun and really needing it are two very different things. There are simply too many people who own guns and don’t really know how to use them effectively for self-protection without committing crimes themselves.  Representatives of the National Rifle Association have argued, for example, that all teachers in the public schools should be armed, that the people at Bible study in Charleston should have been armed, or even more, that everybody in society should be armed.  I have discussed this with my son, Daniel, who holds a second degree Black Belt in Karate and who has taught classes in schools to instruct teen-age girls in self defense against assault.  Daniel points out that people who are not well-trained and very experienced in fighting, with or without guns, will always hesitate when attacked. That hesitation gives the attacker the ability to shoot first or strike the first blow.  The armed teacher will likely be the first casualty.  Should we also have them wear bullet-proof vests?  And one should think about the wisdom of having people open defensive fire in a crowded hall or schoolroom or darkened movie theater.  It is hard to hit what you’re aiming at with a pistol, especially when you are frightened and confused or it is dark. Even well-trained shooters are not very accurate with hand guns.  A New York Times article from May 8, 2008,  reported that  New York police, shooting at people, hit their targets 34% of the time.  In Los Angeles, the rate was 31%, and these are well trained police.  It would also seem obvious that one should be required to register handguns and obtain permits to own them.  Permits should only be issued upon completion of an approved course in gun use and safety.  We do that if you want to drive a car.  Universal background checks on prospective gun buyers are associated with decreased gun deaths.

Our epidemic of gun deaths could also be ameliorated by severely regulating sales of ammunition.  Requiring background checks and permits to buy ammunition are also associated with a reduction in gun deaths.  If you have a gun at home for “protection,” you should be able to buy one clip full of bullets.  If you expend these bullets protecting yourself from a robber, you should be allowed to replenish them.  If you shoot yourself or family members, you should not.  If you want to go to a firing range and practice shooting, you should be allowed to buy the bullets at the range and use them there.  Similarly, if you have rifles for hunting, you should be able to buy perhaps a dozen bullets for any given hunting trip.  Make every shot count.  Again, to practice shooting, you would buy and use bullets at the firing range.  If you want to take your guns out into the desert and shoot up hulks of wrecked, rusting cars for fun, you should have your head examined.  You may, of course, use your  supply of hunting bullets to shoot at abandoned cars but you will again have to make every shot count. This should be easy because the abandoned cars are not moving.  And to buy bullets for hunting, you should have a valid hunting license.

We now know from experience that the more armed people there are, the more disagreements will lead to gunfights and the more people, criminal and law-abiding alike, will die.  This is particularly true when people are allowed to carry guns into bars as some states permit.  One can easily imagine a scene where the usual law-abiding folks are in a bar watching a football game on TV.  The liquor flows and a controversial call occurs in the second half or about three drinks into the game.  An argument ensues and escalates; deities are invoked; unnatural and incestuous sex acts are charged; interspecies parentage is asserted; guns are produced; other armed fans take notice, pick a side, and all hell breaks loose.  People are wounded or die; liquor is spilled; and the disputed call on TV results in offsetting penalties.  Similar developments may be anticipated at drunken fraternity parties when the open carry law goes into effect on the campuses of the University of Texas in 2016.  Occasionally an armed guard may stop an assault in a public place but the number of lives saved may be cancelled out by the number lost elsewhere in arguments that escalate to shooting because one or more of the participants is armed.

If we may return to the British for a moment, an article in the May 22, 2015 Washington Post reported that a new activity is catching on in London pubs.  They are having life drawing “classes.” Attendees pay about $8, the management hires a nude model, or one of the attendees volunteers, and the group drinks and sketches. This is what Socialist societies with low murder rates do for fun.  So far no fights have broken out.  They are confined to the other rooms of the pub where the usual crowd is watching soccer on TV.  Sometimes a bloody nose results.  In Britain, most people do not own guns and those who do don’t carry them into bars.  This seems sensible to me but I am a liberal.

To return to the United States, simply repealing the Second Amendment because it is out-of-date is probably not possible. But the right to keep and bear arms is not one of the Creator-endowed rights asserted in the Declaration of Independence.  Indeed the Constitution was written, ordained and established by “We the People…” not God, in the eighteenth century.  It has to serve a continuously evolving society.  When one of its provisions causes an ongoing public health problem today, then it does not “insure domestic Tranquility or promote the general Welfare,” as the Preamble says it should. The Constitution can and has been reinterpreted and provisions can and have been repealed.  Slavery is now illegal and women can vote.  Let us approach this problem rationally and not testicularly or religiously.  We regulate automobiles, liquor, tobacco, and lots of drugs.  None of these are designed specifically to kill but their use carries inherent dangers that we all recognize.  Guns are designed specifically to kill.  How can we not rigorously regulate their possession and use? The first clause of the Second Amendment says we should.

A last thought.  People who gonadally or religiously view their guns will not be persuaded by any of the facts I have cited or arguments I have written.  This is the nature of ideas taken on faith.  In spite of dispositive evidence, there are still people who do not believe that President Obama was born in Hawaii, that evolution explains speciation, or that global warming due to human activity is happening.   These people are immune to facts and reason.  They illustrate an observation made by Jonathan Swift: “It is useless to attempt to reason a man out of a thing he was not reasoned into.”  The pronouncements of Wayne La Pierre of the NRA have been explained by Upton Sinclair: “It is difficult to get a man to understand something when his salary depends on his not understanding it.”  Robin Williams added: “God gave man a brain and a penis and only enough blood to run one at a time.”  Such people with misdirected circulation simply must be outvoted.  Your congressmen and women need encouragement to act responsibly.  This is an ongoing public health problem that we ignore at our peril.

  1. Note added in proof. In October, 1881, in Tombstone, Arizona, a famous gunfight took place: the so-called “Gunfight at the OK Corral.”  The town council in April, 1881 had passed an ordinance that required visitors carrying knives and guns to deposit them either at the livery stable or saloon upon entering town.  This was specifically in order to keep rambunctious drunks from shooting up the town and/or killing each other.  The Clantons and McLaurys, scofflaws who respected no authority but their own, refused to give up their arms.  The Earp brothers, led by town Marshall, Virgil Earp, assistant Marshall, Morgan Earp, brother Wyatt Earp, and Doc Holliday (without portfolio) went to disarm them.  A gunfight broke out, whose details were confused then and still are today.  The Earps and Holliday won.  Of relevance to the above discussion is: at no point did the Clantons or McLaurys ever cite the Second Amendment as a defense for refusing to give up their weapons upon entering Tombstone.  Nor was this amendment ever discussed in any of the extensive coverage of the gunfight in the local press or in the many movies that Hollywood has made about the event.  No one ever questioned the town of Tombstone’s right to pass and enforce an ordinance regulating the keeping and bearing of arms.  They still haven’t.

Stephen Baird, MD