Research on Gun Violence Banned? Not Exactly.

Churchill, Thompson submachine gun, 1940

As a physician specializing in emergency medicine, I have a keen interest in areas of research that are related to my practice.  This includes public health and injury prevention.

Much medical research is funded with public dollars.  In fact, most medical research is funded either with public dollars or by industry, meaning the pharmaceutical industry and the manufacturers of medical devices. Among folks in academic medicine, it is considered a truism that publicly funded research is much more likely to be of high quality, whereas industry-funded research is much more likely to be biased, with problems ranging from study design intended to produce certain results, through dubious statistical methods, to spinning results to draw conclusions that aren't really justified.

Many years ago my colleagues in public health came up with the idea that violence is a public health problem.  This led to an interest in all sorts of research into the nature and causes of interpersonal violence.  One area of this research involves violent acts committed with firearms.

Early on some of the researchers adopted a metaphor from the discipline of infection control in which guns are viewed as "vectors" of "disease," rather like the way in which the female anopheles mosquito is a vector for malaria.

And here you can see where some trouble might begin.  You see, there are people - many Americans among them - who like guns.  And so, if you adopt a viewpoint that guns are a vector of disease, you will inevitably find yourself in conflict with those people.  If you want to control malaria, you are likely to decide an effective approach is to wipe out the population of mosquitos that transmit the parasite that causes the disease.  If you view guns as a vector, according to this metaphor, you are likely to think that eliminating guns from human societies may be the solution to the problem.

The reaction from gun rights advocates was predictable.  Maybe violence is a public health problem, they said, but guns are not a vector of disease, and this is an essentially flawed metaphor - a metaphor that biases the research done by the medical scientists working in this field, nearly all of which seems to begin with some sort of hypothesis that guns are bad and that wherever you look at the role of guns in human societies you will find trouble that would go away if we just took guns out of the picture.

At the same time that public health researchers were publishing one study after another that concluded guns are a problem (if not the problem), social scientists (especially criminologists) were doing research that seemed to reach very different conclusions, often finding that guns are used at least as much - maybe much more, according to some - to deter or stop crime than to injure or kill innocents.

It would be easy to conclude that researchers examining the same questions and reaching essentially opposite conclusions probably are all biased, and their opposite conclusions reflect opposite biases.  And that may be the case.  If you are reading this essay, that suggests you are interested in my opinion, so I'll tell you I have read most of this research, and it is pretty clear to me that there is plenty of bias to go around, and it is quite difficult to tell how much the results are influenced by it.  This much, however, I can tell you: the truth is not entirely on one side of this question.

One cannot reach any other conclusion than this: more research would be a good thing, and the less biased that research is by preconceived ideas on the part of researchers, the better.

Where should the funding for that research come from?

Well, public dollars seem a sensible choice, given that gun violence is a public health problem (in the view of medical scientists) or a social problem (in the view of social scientists).  (It is obviously both.)  Besides, what sort of private funding might there be?  You can imagine the potential source of bias if the money came from the firearm manufacturing industry, on one side, or billionaires (such as Michael Bloomberg or George Soros) who ardently support pro-gun-control advocacy groups, on the other.

And that takes us back to 1996, when the National Rifle Association was fed up with the public health research that pretty uniformly concluded guns are bad and we should get rid of them.  The NRA lobbied Congress, with the result that an omnibus appropriations bill prohibited the flow through the CDC of research funding that would "advocate or promote gun control."  (Those are the actual words in the legislation.)  Notice that this is not a prohibition on federal funding for research into the problem of gun violence.  But an article in the New York Times explains how it effectively became that, mostly because the CDC became "squeamish" about funding research in this area.

This puts a little bit different spin on the subject than what we have repeatedly been reading and hearing in the news lately, which is that the NRA succeeded in putting an end to research into this problem.  Two quotations from the Times article offer insight into two quite different perspectives on what the NRA asked the Congress to do:

 “We’ve been stopped from answering the basic questions,” said Mark Rosenberg, former director of the National Center for Injury Control and Prevention, part of the CDC-P, which was for about a decade the leading source of financing for firearms research.

 and

Chris Cox, the NRA’s chief lobbyist, said his group had not tried to squelch genuine scientific inquiries, just politically slanted ones.  “Our concern is not with legitimate medical science,” Mr. Cox said. “Our concern is they were promoting the idea that gun ownership was a disease that needed to be eradicated.”

In 2011 further congressional action extended this restriction on the flow of research dollars so that it affected all other agencies funded through the Department of Health and Human Services.

It seems clear that more research is needed.  It is not clear that congressional action is needed to reverse the actions taken in 1996 and 2011.  I may be extremely naive, but if were in charge of these dollars at the CDC, I would look for opportunities to fund research on gun violence that appeared to lack obvious bias in either direction, and consider the burden of proof to rest upon anyone who objected to convince my congressional overseers that the research was intended "to advocate or promote gun control."

And what sort of research might be funded?  Perhaps you've heard of the National Academy of Sciences.  One of the institutes under its umbrella is the Institute of Medicine (IOM).  The IOM's Division of Behavioral and Social Sciences and Education has a Committee on Law and Justice that published an excellent report addressing this question two years ago: Priorities for Research to Reduce the Threat of Firearm-Related Violence.  (If you follow the link you will see that you can buy a paperback copy of the report, but you can also read it online or download it as a pdf, free of charge.)  If you wonder about bias in this IOM report, I would draw to your attention that two of the reviewers of the report were Paul Blackman, a criminologist and political scientist who is regarded by his detractors as a shill for the NRA, and Arthur Kellermann, a distinguished medical professor and public health researcher whose work is harshly criticized by gun rights advocates.  The IOM does an excellent job of pulling in diverse viewpoints on controversial subjects.

When we see and hear in the news that more than 30,000 people are killed with firearms each year, and many more injured, a small fraction of these in horrific mass shootings that grab the headlines, we all want somebody to do something about it.  The question is what.

And the answer is not whatever seems to you or me to make sense.  I can tell you from my experience of 37 years studying medicine (beginning with medical school) that what makes sense often turns out to be completely wrong when subjected to scientific study.  We need more research.

Thanks to the IOM, we have an agenda.  It is possible to approach this research with an open mind and without bias.  That kind of research has not been prohibited by Congress.  So let's get moving!