Aug 082014
 

When a Psychiatrist Shoots to Kill

A doctor defended himself and others from a violent patient, but he had to break a no-gun policy to do so.

‘More might have died if doctor had not shot gunman” — so read the headline in the Philadelphia Inquirer on July 27. On the previous Thursday, a patient, Richard Plotts, entered the office of his psychiatrist, Lee Silverman, M.D., with his caseworker, Theresa Hunt. Plotts then became very upset and killed Hunt with two shots to her head. While this was happening, Dr. Silverman tried to take cover, drew his handgun, and shot the attacker three times. The doctor suffered slight wounds from bullets that grazed his head and hit his thumb. Staffers then succeeded in subduing the wounded Plotts. He was hospitalized in critical condition and now faces murder charges.

District attorney Jack Whelan said: “If Dr. Silverman did not have the firearm and did not utilize the firearm, he’d be dead today. And other people would be dead.” In fact, the doctor had breached the facility’s “no firearms” policy by carrying a weapon with him to work. The facility released a statement saying that it looked forward to his “return to serving patients at our hospital.”

Plotts had a previous record of violence, including suicide attempts, and he has been involuntarily committed twice to psychiatric care, most recently last year. He was a convicted felon, with two gun-related convictions, and he had served time in prison for bank robbery. His violent behavior had led a local homeless shelter to ban him, and he had caused previous trouble at the hospital. In another article, Plotts’s ex-wife described him as abusive and violent, and she also has said that she remains afraid of him 15 years after their divorce. What was he doing with a firearm? Oh, of course: It was illegal. Convicted felons are prohibited by law from owning a weapon.Theresa Hunt, by all accounts, was a dedicated, caring woman who made it her life’s mission to help those in need of mental-health care and social services. She recognized the risk she faced from unstable patients. She probably died instantly.

In deciding to carry a loaded handgun at his workplace, Dr. Silverman judged that he would be wise to ignore the hospital’s no-guns policy. No one should fault him for this. Perhaps he recognized that it was more important to protect lives than to trust in the false promises of safety offered by “gun-free zones.” Every year mental-health professionals are assaulted by clients, and some are killed. Psychiatrists are the physicians most likely to encounter unpredictably dangerous patients. With the exception of threats and one knock-down, I have been spared so far. But I do know a colleague whose patient shot himself dead in the psychiatrist’s office, and a patient of mine slashed her throat in the waiting room of my clinic. Contrast Dr. Silverman’s experience with that of Kathryn Faughey and Kent Shinbach, two doctors who were unarmed when attacked by a delusional schizophrenic patient in 2008. In that assault, Dr. Faughey was killed and Dr. Shinbech was injured.

The hospital’s announcement that it will welcome Dr. Silverman back once he recovers is amazing compared with the usual treatment of employees who choose self-defense over death and end up being fired for breaching no-gun rules. Dr. Silverman and the staffers exercised a good dose of ordinary, self-preserving common sense — and in doing so they became extraordinary heroes.

Another element of this tragedy, one to which all physicians can relate, is that doctors are taught, first and foremost, the golden rule of medicine: “Do no harm.” It would be a particular grief for a physician to have to harm or kill a patient intentionally. We hope never to have to respond to any patient with anything but care and compassion. But that may not be possible, or right, when a patient is the cause of harm.

Responsible people do right by themselves and, especially, others. Is it possible that we are finally coming to understand that doing right can include using guns, too?

— Robert B. Young, M.D., is a private psychiatrist in Pittsford, N.Y., and a clinical associate professor at the University of Rochester School of Medicine. 

 Posted by at 8:25 pm
Jul 222014
 

Gun Violence Restraining Orders

July 16, 2014

By Robert B. Young, MD

Killers, especially mass murderers, often appear to have some mental illness.  They may not have been treated, or were not successfully treated, or their need for treatment wasn’t recognized.  Overall, people with mental illnesses are no more likely to commit violence than the general population and are far more likely to become victims. 1  However, there are a few major psychiatric problems (for example, paranoid delusions, hallucinations commanding aggression, and major depression with suicidality) that, when acutely symptomatic, do increase the risk of violent behavior.  That risk is heightened when there is previous history of violence or concomitant drug or alcohol abuse.  So it’s very important to try to identify potentially dangerous folks, mentally ill and otherwise, in order to intervene in time to prevent violence.

The best intervention for the mentally ill is good treatment, sometimes by commitment to inpatient care to resolve symptoms of risk or to outpatient care to prevent recurrence.  There are also proposals to remove firearms from individuals at risk.  The inability to accomplish either of these was deadly in the case of James Holmes, the Colorado movie theater killer, whose psychiatrist reported his apparent dangerousness to police but no meaningful action was taken. 2

In most jurisdictions, psychiatrists, other physicians or other mental health authorities can commit people for psychiatric evaluation.  Police will remove firearms from suspects, or from potentially dangerous patients on the request of the treating clinician.   In some states (Connecticut and Indiana) judicial intervention is well established, and other states (California and New Jersey) are considering expanding that. 3  There’s no simple route in most places for the return of those firearms.  Sometimes this can be done on the recommendation of a psychiatrist, but many are reluctant to make these decisions.

In a recent Los Angeles Times op-ed, Renée Binder, MD argues that “California Needs a Gun Violence Restraining Order” (and other states, too). 4  Dr. Binder is Director of the Psychiatry and the Law program at the University of California at San Francisco and is president-elect of the American Psychiatric Association.  The APA strongly advocates dealing with mentally ill people compassionately and respectfully, supports their full exercise of civil rights, and stresses the irrelevance of mental illness to the vast majority of violent acts.  The mental health community also recognizes that certain mental illnesses can be a factor in some cases of violence.  Unfortunately, proponents of seizing firearms aren’t often concerned about the rights of gun owners or the mentally ill, which may conflict with their goals.

There are a variety of approaches to firearm seizure.  When police confiscate a suspect’s firearms in Connecticut, a court hearing takes place in 2 weeks to determine whether they should continue to be held for up to one year.  Then a second hearing could be sought by the subject, to show why the confiscation order should end.  If this isn’t sought, the property could continue being held. 3  California prohibits gun possession for 5 years following involuntary psychiatric hospitalization (even if released from no more than 72 hours observation), while a domestic violence restraining order is in effect, and for up to 10 years following conviction of a violent misdemeanor. 4,5  

These issues raise serious concerns:

  • What standards of evidence justify a seizure?  Commitment for psychiatric treatment doesn’t necessarily imply danger with a firearm, let alone for 5 years.  Most of those patients readily recover and many never again require that level of intervention.  In domestic conflicts, there are sometimes false or exaggerated allegations.  Convictions (not just charges) for violent misdemeanors may merit prohibition of gun possession for some time, but 10 years without recourse is longer than necessary or fair in many circumstances.
  • What sort of evidence is required to reverse the seizure?   There’s no way to guarantee that someone will behave safely.  It’s not possible even for psychiatrists to predict the likelihood of violent behavior beyond a day or two.
  • How does the initial seizure of property incorporate any due process, particularly since this contravenes a federal constitutional right?   Yet emergencies do happen, and deaths might be prevented if weapons could be confiscated in time and with good judgment.
  • Police officers deserve great respect but there are always a few who abuse their powers.  How can this be safeguarded?
  • What is reasonable about not permitting the subject to contest these decisions for a year or more?

So here are some thoughts:

  • Clearly criteria must be defined that justify the seizure of individuals’ legally owned firearms, not just any diagnosis of mental illness.  Actual violent threats or acts, preoccupation with violent acts of others or indications of planning such acts, and a history of violent behavior would be more meaningful than someone’s suspicion alone.  Certain psychiatric and substance use problems are suggestive of poor control over dangerous impulses.
  • The presumption of innocence is central to due process in our legal system.  If firearms are seized, the burden of proof should be on the state to justify continuing to deprive owners, not on owners to show that they are no danger.  When commitments of psychiatric patients in New York need to be extended due to similar risks, staff must show why at intervals of from 14 to 60 days.  So such proceedings need to take place early and often, not a year later and only if the subject can initiate and pay for an appeal.  Unless the subject is incarcerated or under psychiatric commitment , how about requiring the state to justify retaining the property every 60 days?
  • When it is decided to return firearms to someone, this must happen promptly within a legally prescribed time period.  It can take far too long to restore property held by law enforcement agencies.  It took 3 years and a lawsuit to get New Orleans to begin returning guns confiscated during Hurricane Katrina, and then many were damaged, unidentifiable or lost. 6   Confiscated property has to be returned in the same condition in which it was taken.  Those responsible for failing to properly care for these valuables, and to return them in a timely fashion, should be penalized.  Owners should be indemnified in cases of lost or damaged property.

There are good reasons to be concerned about leaving weapons with agitated, threatening, intoxicated and/or certain mentally ill people.  As always, the devil is in the details. Core issues about gun seizures are whether the civil rights of potentially risky (and possibly mentally ill) people will be respected and whether needed treatment can be ensured.   Also, it’s past time for all states to contribute complete data about currently prohibited persons to the NICS system.   Had it been up-to-date, Seung-Hui ho’s rampage at Virginia Tech might have been forestalled. 5

Of course, we’ve been discussing firearm risks only, while many more people are killed and injured by accidental poisoning, falls and motor vehicle accidents. 7  What shall we confiscate to prevent those?

 

–  Robert B. Young, MD is a private psychiatrist in Pittsford, NY                                                                  and a Distinguished Fellow of the American Psychiatric Association.

 

 

Footnotes:

1   SAMHSA – “Violence & Mental Illness: The Facts”

2  CNN Justice – 4/5/2013

3  ABC News – 7/6/2014

4  LA Times Op-Ed 5/26/2014  and Hopkins Center for Gun Policy & Research

(and ref. there “Evidence Based Approach for Federal Policy” and “… for State Policy”)

5  NPR – “States Aren’t Submitting Records” 8/16/2012

6  RightofANation.com 1/5/2010 re: NRA “First Freedom” January 2010

7  CDC – “10 Leading Causes of Death & Injury” 2011

 Posted by at 5:13 pm
Jun 162014
 
Robert B. Young, MD

Robert B. Young, MD

By Robert B. Young, MD

President Obama’s troubled nomination of Vivek Murthy, MD to become the nation’s

next Surgeon General raises important questions of policy and politics.  The political is pretty

obvious.  Dr. Murthy is an accomplished physician at the age of 36 with a fascinating personal

history, having been born in Britain to Indian parents.  He is now 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.  Saying 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.” 1,2  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 nomination is 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 3% of murders overall, and “assault”-style rifles in only a fraction of those. 3

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 300 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.

 

In 2010 (the last year with full statistics  available), there were approximately   31,000                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

deaths by firearms in the U.S., decreasing along with violent crime in general.  About 19,000 of

those are suicides, accounting for 55% of all suicides, though guns are used in less than 6% of

attempts.  (As a practicing psychiatrist, I take suicide very seriously.  About one million

Americans attempt suicide yearly.  Nearly half a million are treated for self-destructive injuries.

Many attempt repeatedly. We can’t predict who will suicide when, but a self-destructive

impulse can be lethal when a gun is at hand. Responsibility for safe, proper firearm use rests

with the owner.) 

 

About 11,000 shooting deaths were homicides.  Some are justifiable as self-defense, and

about 16% are drug- &/or gang-related, involving folks who will attack each other regardless.

Mass shootings, especially of young people, grab attention for their horrific character.  These

constitute less than 1% of shooting deaths which, despite frantic media coverage, has not

changed over several decades.  Perpetrators consistently target “gun free zones”, places unlikely

to have armed responders (schools, malls, theaters, places of worship, etc.).  Of course, this isn’t

just about deaths.  There were also about 73,000 gun-related injuries.  About 55,000 of these

occur in the course of assaults, with the rest accidental, including “incomplete” suicides.  5,6,7,8

 

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 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.  Even 500,000 times per year is an awful lot of self-protection. 9,10   How many lives don’t

end, how many bodies are uninjured, because guns aid self-protection?  Most respondents

reporting use believed they were life-saving.  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 a half

million (or many more) occurrences, at least .4 to 2.2% (cp. 11,000 homicides) really were

life-saving and that 2.4 to 17% (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).  11  Criminals certainly wish to avoid armed resistance. 12  So having

more responsible armed citizens might well reduce crime, 13 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. 14

 

How are other problems addressed that are similar to firearms misuse, but hold much

greater human cost?  Over 225,000 lives may be lost yearly in U.S. hospitals due to iatrogenic

causes (treatment-caused mistakes), with vastly more non-fatal complications.  These are largely

infections but also include errors made in procedures, medications and other care. 15   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.

 

– Robert B. Young, M.D.

Dr. Young is a psychiatrist in private practice in Pittsford, New York

 

 

References:

 Medscape Medical News, “Surgeon General Nominee Backpedals on Gun Control” 02/04/2014: http://www.medscape.com/viewarticle/820202

Medscape Medical News, “NRA Opposes Surgeon General Nominee” 03/11/2014: http://www.medscape.com/viewarticle/821816

3 FBI: Crime in the United States 2012: http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012/offenses-known-to-law-enforcement/expanded-homicide/expanded_homicide_data_table_8_murder_victims_by_weapon_2008-2012.xls

4  BearingArms.com, “Up to One Million New Yorkers Seize Opportunity to Not Register Their Firearms Ahead of NY SAFE ACT Deadline”, 04/14/2014: http://bearingarms.com/breaking-up-to-one-million-new-yorkers-seize-opportunity-to-not-register-their-firearms-ahead-of-ny-safe-act-deadline/

Centers for Disease Control – National Suicide Statistics: http://www.cdc.gov/violenceprevention/suicide/statistics/index.html

6  FactCheck.org: http://www.factcheck.org/2012/12/gun-rhetoric-vs-gun-facts/

U.S. Bureau of Justice Statistics: http://www.bjs.gov/content/dcf/duc.cfm

8 U.S. National Gang Center: http://www.nationalgangcenter.gov/survey-analysis/measuring-the-extent-of-gang-problems

9  CSN News, “Use of Firearms for Self-Defense”, 07/13/2013: http://www.cnsnews.com/news/article/cdc-study-use-firearms-self-defense-important-crime-deterrent

10 Institute for Medicine/National Academy of Science “Priorities for Research to Reduce the Threat of Firearm-Related Violence”, 2013: http://www.nap.edu/catalog.php?record_id=18319

11 US News, “Using Guns for Defense Leads to Fewer Injuries”, 06/25/2013: http://www.usnews.com/news/articles/2013/06/25/study-using-guns-for-defense-leads-to-fewer-injuries

12  Wright & Rossi, “Armed and Considered Dangerous: A Survey of Felons and Their Firearms” 1986:http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCoQFjAB&url=http%3A%2F%2Fwww.leg.state.co.us%2Fclics%2Fclics2012a%2Fcommsumm.nsf%2Fb4a3962433b52fa787256e5f00670a71%2F10498c3a3264be7887257998006fe0d7%2F%24FILE%2FHseJud0202AttachN.pdf&ei=ADaNU-rLCcLjsASWpYFo&usg=AFQjCNETiQHGYwI3SNtK1L1deLMpMwgX3Q&bvm=bv.68191837,d.cWc

13  There is extensive research on this subject, beginning with John Lott: see his Crime Prevention Research Center.

14 GunFacts.info, “Concealed Carry”: http://www.gunfacts.info/gun-control-myths/concealed-carry/

15 JAMA, “Is US Health Really the Best in the World?”, 07/26/2000: http://www.avaresearch.com/ava-main-website/files/20100401061256.pdf?page=files/20100401061256.pdf

 Posted by at 8:50 pm
Nov 042013
 

The National Association of School Psychologists (NASP) has published what it calls a fact sheet about “gun violence” among youth. DRGO has been informed that the Arizona Association of School Psychologists has submitted this flawed publication to the Arizona legislature in support of enacting firearm policy. DRGO’s Advisory Board member Glen Otero, PhD has analyzed the claims made in the NASP fact sheet and has determined that it’s full of the half-truths and deliberate omissions that the public health anti-gun advocacy literature is famous for.

Dr. Otero is a research scientist specializing in bioinformatics and high performance computing. He is a former rifle, pistol and shotgun instructor with Kent Turnipseed and NRA certified rifle instructor. Here is his analysis.

NASP’s Anti-Gun Agenda: Truths and Half-Truths

By Glen Otero, Ph.D.

Doctors for Responsible Gun Ownership (DRGO)

A Project of the Second Amendment Foundation

The Centers for Disease Control and Prevention (CDC) and medical journals like The Journal of the American Medical Association (JAMA) and The New England Journal of Medicine have been heavily criticized for promoting an anti-gun political agenda. (Wheeler, T., Public Health Gun Control: A Brief History, Parts I-III, www.drgo.us/?p=266 , www.drgo.us/?p=285 , and www.drgo.us/?p=314 , accessed June 16, 2013.)  The continual publication of CDC-funded gun violence studies that suffer from serious methodological flaws are responsible for this anti-gun bias. These flaws include:

1) Inventing, selecting and or misrepresenting data to support a priori conclusions

2) Omitting data and lack of citing criminological and sociological research into firearm violence and self-defense

3) Simply ignoring or discounting evidence inconsistent with one’s political prejudices

4) Stating overreaching conclusions and presenting associations and correlations as causation

As a result of their shoddy scientific methods, the journals and CDC are accused of holding ideologically predetermined conclusions and publishing dubious articles that perpetuate the fiction that guns are an infectious disease and that more guns cause more deaths. The idea that guns are an infectious disease like HIV is ridiculous. Despite a wealth of research there is no credible evidence that an increase in guns causes more deaths in the U.S. (National Research Council. (2005). Firearms and Violence: A Critical Review. Committee to Improve Research Information and Data on Firearms. Charles F. Wellford, John V. Pepper, and Carol V. Petrie, editors. Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, page 6).

I will provide some examples of how The National Association of School Psychologists (NASP) Youth Gun Violence Fact Sheet suffers from the very same methodological flaws and unscrupulous misrepresentation of the gun violence knowledge landscape that the CDC and public health literature are guilty of. For instance, in the section of the NASP fact sheet entitled “Firearm Deaths in the United States (CDC, 2012)” the murder and suicide statistics from a single year (2010) are cherry-picked from a slew of potential statistics and provided out of context without any trend data from the last 30 years.

Of the 1,982 youth (age 10-19) murdered in 2010, 84% were killed by a firearm. However, according to the same WISQARS CDC source the rate of murdered youths aged 10-19 has fallen from 4.64/100K to 3.89/100K from 1999-2010. (These and subsequent WISQARS data are taken from the WISQARS Fatal Injury Reports page at www.cdc.gov/injury/wisqars/fatal_injury_reports.html and the WISQARS search page at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_us.html, accessed August 6, 2013.

Of the 1,659 teens (age 15-19) who committed suicide in 2010, 40% were by firearm. However, according to WISQARS the rate of suicide with a firearm in teens 15-19 has fallen from 4.85/100K to 3.03/100K from 1999-2010.

Of the 1,323 males (age 15-19) who committed suicide in 2010, 45% were by firearm. However, according to WISQARS suicide with a firearm in males 15-19 has fallen from 8.4/100K to 5.32/100K from 1999-2010.

Of the 336 females (age 15-19) who committed suicide in 2010, 20% were by firearm. However, according to WISQARS suicide with a firearm in females 15-19 has fallen from 1.11/100K to 0.62/100K from 1999-2010.

In 2010, across all age groups (and including adults), there were 31,672 individuals killed by firearms (with 61% of these deaths being suicide and 26% homicide). According to WISQARS the rate of all individuals killed by firearms has essentially remained the same between 1999 (10.3/100K)-2010 (10.07/100K).

As we can see, the select reporting of statistics from a single year and age group without providing any trend data prevents the reader from putting things into context. The fact is that according to the same CDC data source cited by NASP, the rates of murder and suicide committed with guns in the reported groups have been in decline or remained constant from 1999-2010.

One example of criminological data omission is the non-reporting of firearm related statistics from the Department of Justice (DOJ). According to the DOJ’s Bureau of Justice Statistics (http://www.bjs.gov/index.cfm?ty=tp&tid=31, accessed August 6, 2013), the number of all firearm related homicides declined 39% between 1993 and 2011 and nonfatal firearm crimes declined 69% during the same period (http://www.bjs.gov/content/pub/pdf/fv9311.pdf, accessed August 6, 2013.). In fact, from 1980-2008 the rate of handgun related homicide dipped to its lowest point in 2008. (http://www.bjs.gov/index.cfm?ty=pbdetail&iid=2221, http://www.bjs.gov/content/pub/pdf/htus8008.pdf, accessed August 6, 2013.)

Another example would be the omission of the United Nations Office on Drugs and Crime (UNODC) statistics on firearm related homicides. From 2003-2010 the UNODC reports that the percentage of homicides by firearm in the U.S. hovered around 67% while the rate of homicide by firearm per 100,000 persons declined nearly 16%. (http://www.unodc.org/unodc/en/data-and-analysis/statistics/crime/global-study-on-homicide-2011.html, http://www.unodc.org/unodc/en/data-and-analysis/homicide.html, accessed August 6, 2013.)

In fact, all violent crime rates are in decline. Data from the FBI’s 2011 Unified Crime Report (UCR) shows that the violent crime and murder and non-negligent manslaughter rates both fell 50% from 1992-2011 (http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2011/crime-in-the-u.s.-2011, http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2011/crime-in-the-u.s.-2011/tables/table-1, accessed August 6, 2013.).The Bureau of Justice Statistics also reports that the homicide rate in 2010 had fallen to rates not seen since the mid-1960s. (http://www.bjs.gov/index.cfm?ty=pbdetail&iid=2221, http://www.bjs.gov/content/pub/pdf/htus8008.pdf, accessed August 6, 2013.)

Furthermore, these statistics suggest that all gun related deaths are equal, which couldn’t be further from the truth. There are accidents, suicides and homicides. It’s been shown that most homicides are not committed by ordinary, law-abiding people, but are instead related to other criminal activity like drug trafficking and gang behavior. Without data from criminological sources to provide context it can seem that all violent crime, including gun violence, is currently increasing, when in fact it is in decline. This omission of critical information does not lend itself to reasonable, well informed policy decisions.

One number never tells the whole story in any field of research, and regardless of conclusions reached, shoddy scientific methods like the selective reporting of statistics, ignoring of contrary data and exclusion of reputable data sources like the FBI UCR and publications by academic criminologists are symptomatic of bias and uncritical thinking. While evident throughout the NASP Youth Gun Violence Fact Sheet, these disturbing practices are not at all confined to gun violence research and in fact are appearing at an alarming rate in many disparate fields of supposed scientific inquiry. Several instances of pseudoscience masquerading as robust science are diligently explored and debunked in Otto, Shawn Lawrence Fool Me Twice: Fighting the Assault on Science in America, Rodale Books, 2011; Mooney, Chris and Kirshenbaum, Sheril Unscientific America: How Scientific Illiteracy Threatens our Future, Basic Books, 2010; Specter, Michael Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives, Penguin Press, 2009; and Grant, John Denying Science: Conspiracy Theories, Media Distortions, and the War Against Reality, Prometheus Books, 2011.

Publications like the NASP Fact Sheet paint a very biased picture of gun related violence that prevents various stakeholders and policy makers from making well-informed decisions. Far from being a fact sheet, the report is actually a half-truths sheet intended to lead the reader to a predetermined conclusion that there is an insidious assault on public health perpetuated by the guns themselves.

What we really need is a knowledge sheet so that the public can be properly informed, educated and empowered to make sound policy decisions. A good start would be the suggested reading list at the end of this article. No scientific organization can claim to make a valid statement about firearms without incorporating what we already know from the mountain of firearm research that already exists.

Selected Bibliography

1) Wright, James D. and Rossi, Peter H. Armed and Considered Dangerous: A Survey of Felons and Their Firearms, Aldine de Gruyter, Hawthorne NY 1986. This 247-page hardbound book was the analysis of extensive data collected from over 2,000 convicted felons in American state prisons. Funded by the National Institute of Justice, this massive and comprehensive study found numerous truths about violent criminals that fly in the face of gun control advocates:

a) Felons prefer large, well-made handguns as tools of their trade, not “Saturday Night Specials” or rifles of any kind. (page 180)

b) The people most likely to be deterred from getting a handgun by gun bans are not criminals, but poor people who have decided they need a gun to protect themselves against the criminals. (page 238)

2) Lizotte, Alan A. “The Costs of Using Gun Control to Reduce Homicide,” Bulletin of the New York Academy of Medicine, vol. 62 no. 5 (June 1986), pp. 539-49. Criminologist Dr. Lizotte, now the dean of the School of Criminal Justice, University at Albany (SUNY), brings before a scientific panel the novel idea that, like any policy, gun control has costs.

3) Kleck, Gary Point Blank: Guns and Violence in America, Aldine de Gruyter, Hawthorne NY 1991. This 512-page book won the 1993 Michael J. Hindelang award of the American Society of Criminology. It offers analysis of the relationships between gun ownership, violent crime, and self-defense. His findings show that the average killer has a long history of criminal conduct, contrary to fashionable public health notions that anyone with a gun is a potential killer. He further found that most successful defensive gun uses are never reported to the police, the so-called “police chief’s fallacy.”

4) Kates, Don B., Schaffer, Henry E., Lattimer, John K., Murray, George B., and Cassem, Edwin W. “Guns and Public Health: Epidemic of Violence or Pandemic of Propaganda?” Tennessee Law Review vol. 62 no. 3 (Spring 1995). A criminologist, a genetics and biomathematics professor, a Columbia Medical School professor, and two Harvard Medical School professors of psychiatry analyze the public health literature on firearms. They find numerous examples of bias, prejudice against gun owners, and just plain ignorance among prominent public health gun researchers.

4) Kleck, Gary and Gertz, Marc “Armed Resistance to Crime: The Prevalence and Nature of Self-Defense With a Gun,” Journal of Criminal Law and Criminology vol. 86 no. 1 (Fall 1995). These two authors report the results of their large national telephone survey investigating defensive use of firearms. They found that “each year in the U.S. there are about 2.2 to 2.5 million DGUs [defensive gun uses] of all types by civilians against humans, with about 1.5 to 1.9 million of the incidents involving use of handguns.” (page 164)

5) Lott, John R. and Mustard, David B. “Crime, Deterrence, and Right-to-Carry Concealed Handguns,” Journal of Legal Studies vol. XXVI no. 1 (January 1997), University of Chicago Press. These authors studied violent crime trends over 15 years using county-level data from all 3,054 counties in the United States. They found that when state concealed handgun laws went into effect, murders, rapes, and aggravated assaults subsequently decreased.

6) Lott, John R. More Guns, Less Crime: Understanding Crime and Gun Control Laws, University of Chicago Press, Chicago 1998. This landmark book, based on Lott’s research referenced in the 1997 Journal of Legal Studies article, is now in its third edition, with analysis of new data.

7) Wellford, Charles F., Pepper, John V., and Petrie, Carol V., editors. Firearms and Violence: A Critical Review, Committee to Improve Research Information and Data on Firearms, Committee on Law and Justice, Division of Behavioral and Social Sciences and Education, National Research Council, The National Academies Press, Washington, DC (2005). This National Academies of Science committee of leading scholars in criminology reviewed all the existing research on homicide, suicide, and firearms. They found that the existing research studies “do not credibly demonstrate a causal relationship between the ownership of firearms and the causes or prevention of criminal violence or suicide.” Their review was published in this 328-page book.

8) Mauser, Gary A., “Evaluating Canada’s 1995 Firearm Legislation,” Journal on Firearms and Public Policy vol. 17 (Fall 2005), Center for the Study of Firearms and Public Policy of the Second Amendment Foundation, Bellevue, Washington. Professor Mauser (Institute for Urban Canadian Research Studies at Simon Fraser University in Burnaby, British Columbia) examines Canada’s controversial and costly 1995 Firearms Act. This unpopular law vastly exceeded initial dollar cost estimates and has never been definitively shown to have reduced crime. The part of the law requiring registration of long guns (rifles and shotguns) encountered such widespread resistance that it was finally repealed in 2012.

—Doctors for Responsible Gun Ownership Advisory Board member Dr. Glen Otero is a research scientist specializing in bioinformatics and high performance computing. Dr. Otero is a former rifle, pistol and shotgun instructor with Kent Turnipseed and NRA certified rifle instructor.

 

Kids and Antigun Hype

 DRGO News  Comments Off
Oct 222013
 

Like many people, doctors work to keep up with the torrent of new information in their field. One time-tested learning resource for doctors is the medical journal. In addition to general medical journals that cover a wide spectrum of new medical knowledge, most doctors regularly read at least one journal dealing only with their own specialty.

The American Academy of Pediatrics journal Pediatrics is the go-to learning resource for busy pediatricians. They depend on it to help them meet the challenge of caring for sick kids. This month, however, the editors at Pediatrics handed out a big dose of anti-gun hype, hoping their readers will swallow it whole with no fuss. The authors of this anti-gun article hardly even pretend to offer any new scientific knowledge of value. Instead, they follow a well-known technique of medical gun control advocates—KidsNAntigunHype.

KidsNAntigunHype can be defined as an article published in a scientific journal showing no new or helpful findings and designed to shock readers into mentally associating guns with the death of children. The article in the November 2013 issue of Pediatrics is “Gunshot Injuries in Children Served by Emergency Services,” by Craig D. Newgard, Nathan Kuppermann, and ten other authors including Garen Wintemute, a specialist in this type of political writing. The authors conclude “Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among adolescent males.”

In other words, of all the ways children can be injured, gunshot wounds are one of the worst.  Did it really take twelve doctors studying 50,000 injured children (only 1% of them gunshot injuries) to arrive at that breathtaking conclusion? No, but those twelve doctors wanted their name at the top of a hit piece against guns masquerading as a serious scientific paper.

The nothingness of the paper is staggering. Readers looking for guidance will find only a flurry of statistics heavily larded with the turgid technical writing medical authors are so fond of. One can read with great concentration from beginning to end, parsing every word, only to be left with the uneasy feeling that that’s all there is. Because that really is all there is.

The authors even admit that

a) gunshot injuries in children are uncommon

b) gunshot injuries in children occur mostly in the 15 to 19 age group (83% of the sample they studied)

c) they did not determine intent in any of the gunshot injuries. In other words, the authors don’t know how many were crimes committed by gang-bangers.

As we warned earlier this year, we can only expect more KidsNAntigunHype in the future. It will be incumbent on all doctors to recognize it when it appears in their medical journals and to expose it to editors, colleagues, and their patients.

Aug 122013
 

By Timothy Wheeler, MD

Dave Workman over at TheGunMag.com recently uncovered a gun prohibitionists’ playbook prepared last year by Washington, DC public affairs consultants for use in gun control campaigns. One such campaign is a Washington state ballot initiative, I-594, pushed by the gun control group Washington Alliance for Gun Responsibility. The story got national buzz last week, with coverage in The Examiner, The Washington Examiner and the Wall Street Journal’s James Taranto column.

The guide, titled “Preventing Gun Violence Through Effective Messaging” is notable for admitting in print what gun owners have long known—gun prohibitionists have no shame when it comes to pushing their cause. The cynical public affairs consultants advise gun control activists to take full advantage of mass shooting tragedies such as the Virginia Tech shootings, or high-profile incidents like the Trayvon Martin shooting to push for gun control. Here are some choice bits of what the authors call “effective messaging”:

·       “The truth is, the most powerful time to communicate is when concern and emotions [after a shooting tragedy] are running at their peak. While we always want to be respectful of the situation, a self-imposed period of silence is never necessary.”  In other words, don’t wait for families to grieve or the facts to come out before pointing fingers and pumping up the public’s emotions.

·       “Don’t assume the facts—and don’t wait for them.” After all, who needs facts like police reports or court evidence when you want to harness the power of negative emotions while they’re running high?

·       Don’t use the term “Stand Your Ground Law.” Instead call such laws “Shoot First” or “Kill at Will” laws.  This is not only a crass attempt to stir bad feeling toward these laws, but perpetuates the lie that they empower victims to become legal aggressors. Stand Your Ground laws simply codify longstanding case law that a person doesn’t have to retreat from a violent criminal attack in a place where he has a right to be. He certainly may retreat, but is not required to by law. This is not a new concept, but gun prohibitionists have latched onto it in an attempt to delude the public and weaken gun rights by calling for repeal of Stand Your Ground laws.

Safire’s Political Dictionary describes the ancient rabble-rousing political technique of waving a bloody shirt. He details how the technique was used in ancient Rome and on through the turmoil of pre-civil war America. It is a dubious method based on cynical exploitation of man’s less noble nature. It hides facts and reason, and it encourages anger and prejudice. But judging from this gun control playbook, gun grabbing activists and politicians apparently love it.

Jul 232013
 

By Timothy Wheeler, MD

With all the ill-will, misunderstanding, and downright meanness swirling around the outcome of the George Zimmerman trial I was glad to see this article in the Los Angeles Times today. The Times even managed to put aside its longstanding bias against gun owners—almost, anyway—to take a look at one of the NRA’s new public faces, Colion Noir. A hip young African-American attorney from Houston, Noir doesn’t fit the L.A. Times stereotype of American gun owners—“old, fat, white guys,” as Noir himself puts it.  Neither does perennial gun rights champion the Rev. Kenn Blanchard, who in the article defends Noir from predictable charges of “selling out to the white pro-gun establishment.”

Inadvertently displaying her own bigotry, Los Angeles Times writer Molly Hennessy-Fiske mused “perhaps Noir’s rise says more about the NRA’s acceptance of minorities than the group’s ability to woo them.”  I’ll bet this would be news to NRA Board of Directors member and NBA All-Star Karl Malone. As a Jewish woman dedicated to the right of self defense, former NRA president Sandra Froman would likely be surprised, too. I’ve been an NRA member since the 1970s, and I don’t recall seeing any checkbox for race, religion, or gender on the membership form. The NRA’s “acceptance of minorities” comes as a surprise to most mainstream media types, but not to the members themselves.

There are historical reasons that the American tradition of gun ownership is strongest among the descendants of the northern Europeans who settled much of America. But an enduring and transcendent benefit of being an American—whether your descendants came to these shores 12 generations ago as mine did or 3 generations ago as my wife’s did—is that the blessings of liberty belong to us all.  It’s been a long road since colonial America.  But here we all are in the 21st century, living in the greatest nation on earth. And prominent among those blessings is our natural right of self-defense, whether we live in South Central Los Angeles or Beverly Hills.

Jun 272013
 

By Timothy Wheeler, MD

A group of Wisconsin doctors is asking the American Medical Association to adopt a policy to advocate protecting the controversial practice of doctors interrogating their patients about guns in their homes. Here’s an excerpt from the story from Medscape (log-in required for the original story):

CHICAGO — Two proposals up for debate before American Medical Association (AMA) delegates seek to remove barriers to doctor–patient conversations in the exam room. One is a resolution proposed by the American College of Physicians Wisconsin Delegation asking the AMA to support an end to government interference in what doctors can discuss with patients. In Florida, for instance, the Firearm Owners’ Privacy Act, enacted in 2011, forbids doctors from asking patients whether there’s a gun in the house; the penalty for contravening the Act is a fine or loss of license. Barbara Hummel, MD, an alternate delegate from Wisconsin, told Medscape Medical News that allowing “the government to start telling physicians what they can discuss with patients — well, that’s crazy. We’re not against guns; that’s not the issue. We want to be able to provide some safety. We want to be able to talk to patients about whether they have guns in the house,” she added.

We’re not against guns? Really? Dr. Hummel needs to review some of the official policy of the organization she’s representing, the American College of Physicians (ACP).  The ACP earlier this year published with great fanfare a policy that, among other things, urges mental health screenings before gun purchases and banning “automatic and semiautomatic assault weapons”. Sorry, Dr. Hummel, people who visit their doctors know the difference between teaching gun safety and unethical meddling in their private affairs. And by the way, Dr. Hummel, what did you learn in medical school about “gun safety”? Did you take an NRA gun safety class? Did you get some gun safety training through Wisconsin Force, your state’s firearm association?

The AMA, once a powerhouse lobby for doctors, no longer represents American doctors. It has become its own highly lucrative business, independent of income from dues paid by its few remaining members. Typical of organized medicine, it is dominated by career technocrats advancing their pet causes. And gun control is at the top of the list. This AMA policy initiative, sponsored by the American College of Physicians, is just one more effort by two medical organizations dedicated to taking your guns away.

 

 Posted by at 10:36 pm
Jun 062013
 

By Dr. Timothy Wheeler, M.D.DRGO

The years 2011 and 2012 saw a rash of horrible high profile murders whose suspected perpetrators bore the striking common trait of serious mental illness.  In all cases—the Aurora, Colorado movie theater mass shootings, the Newtown, Connecticut school shootings, and the shooting of Arizona congresswoman Gabrielle Giffords—the suspects were known in advance by their families or associates to be seriously disturbed.  Aurora shooting suspect James Holmes had even seen a psychiatrist, who properly reported her concerns about his instability to police.  But in all three cases our legal system failed to prevent the multiple murders of men, women, and children and the disastrous injury of a U.S. congresswoman.

In response to the shootings President Obama in January issued a list of executive actions (incorrectly described by some in the media as executive orders) officially directed at the problem of mass shootings by madmen.  In reality many of the actions are items long on the policy wish list of gun prohibitionists, and they have little if anything to do with mass shootings.  But several of the listed actions call for the legitimate goal of trying to prevent dangerously mentally ill people from obtaining firearms.

This week the U.S. Department of Health and Human Services (HHS) is calling for public comments as part of their plan to revise federal law to improve reporting of people with the so-called “mental health prohibitor” of gun ownership.  As the HHS Proposed Rule document notes, federal law already prohibits those persons from possessing or receiving a firearm who:

1)  have been involuntarily committed to a mental institution

2)  have been found incompetent to stand trial or not guilty by reason of insanity

3)  otherwise have been determined, through a formal adjudication process, to have a severe mental condition that results in the individuals presenting a danger to themselves or others or being incapable of managing their own affairs.

Most people agree that those inclined to criminal violence should not have guns.  Violent felons and people with homicidal or suicidal delusions are the categories at whom current laws are directed.  The federal National Instant Criminal Background Check System (NICS) aims to detect both categories of prohibited persons at the point of sale prior to transfer of the firearm.  But the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes a privacy rule that provides severe penalties for many types of disclosure of personal health information.  In some cases this includes records of mental illness required by NICS reporting.

The HHS Proposed Rule under consideration intends to “creat[e] an express permission in the HIPAA rules for reporting the relevant information to the NICS by those HIPAA covered entities responsible for involuntary commitments or the formal adjudications that would subject individuals to the mental health prohibitor, or that are otherwise designated by the States to report to the NICS.”  The intent is to overcome obstacles to NICS reporting posed by the problematic HIPAA law.

The HIPAA privacy rule was enacted with the good intention of protecting Americans from disclosure of private information contained in their medical records.  But the threat of serious penalties for stepping outside the boundaries of the law has spread fear throughout the medical community.  Doctors, medical record administrators, and hospital officials have been systematically intimidated by the law’s threat of civil and criminal penalties.  Penalties for various categories of HIPAA violations include a $50,000 fine for each violation and imprisonment for more serious violations.  HIPAA’s vast reach includes a long list of doctors, nurses, hospital administrators, and state and local health officials.  When the law was enacted medical groups and hospitals held training classes for doctors and nurses in how to comply with the complex law.

HIPAA’s unintended but entirely predictable effect was to complicate and limit appropriate communication of medical information to parties who had a valid interest in knowing it.  Doctors and nurses began to withhold information about medical emergencies from patients’ families, who were understandably outraged at being kept in the dark.  But given a choice between a family’s complaint and criminal prosecution, busy medical professionals chose the lesser of two evils.

Mental health records are the most sensitive kind of personal health information.  The keepers of these records jealously guard them as a matter of professional obligation.  The threat posed to them by HIPAA only reinforces their tendency toward protecting it from disclosure.  But the need for proper identification of dangerously mentally ill prospective gun owners is a legitimate public concern, and the political pressure to make it a reality must result in action.  Toward that end, the HHS proposed rule to modify HIPAA is a worthy objective.

Precautions must be taken in any such modification.  No disclosure to NICS of any medical information should be allowed unless it clearly establishes a prospective gun purchaser to be prohibited as described by law.  The opportunity for administrative overreach in denying NICS approval is great, given the tendency of some executive branch officials to deny gun ownership to as many people as possible.

According to the National Institute of Mental Health tens of millions of Americans suffer from mental illness each year, although many go without treatment.  Therefore mental health records in particular should be carefully secured against political attempts to stigmatize and disqualify a prospective gun owner with a psychiatric diagnosis that does not constitute a mental health prohibitor.

When possible, administrative remedies should be written into the rules to allow recovery of legal fees and other costs for persons whose constitutional right to own a firearm is infringed as a result of bureaucratic mistakes or undue delay.

All of this ignores the reality that any determined individual can obtain a firearm and use it to commit a crime, NICS and HIPAA and every other law notwithstanding.  But within the confines of imperfect law, it is reasonable to strive for amending HIPAA’s privacy requirements to allow the communication of mental health information to NICS when it establishes a prospective gun purchaser to be prohibited as described by law.

Timothy Wheeler, MD is director of Doctors for Responsible Gun Ownership, a project of the Second Amendment Foundation.