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Guns in the Medical Literature -- A Failure of Peer Review


an article reviewing politicized and incompetent research

by Edgar A. Suter MD
Chair, Doctors for Integrity in Research & Public Policy
CIS:73407,3647
Abstract

Errors of fact, design, and interpretation abound in the
medical literature on guns and violence. The peer review
process has failed to prevent publication of the errors of
politicized, results-oriented research. Most of the data on
guns and violence are available in the criminological, legal,
and social sciences literature, yet escapes acknowledgment or
analysis of the medical literature. Lobbyists and other
partisans continue to promulgate the fallacies that cloud the
public debate and impede the development of effective
strategies to reduce violence in our society. This article
examines a representative sample of politicized and
incompetent research.


Introduction

   It is philosophical bias, rather than scientific
objectivity, that characterize the debate on gun control.(1)
Despite a pretense of scientific objectivity and method, the
medical literature is no exception. As an example of the
naked bias, consider the stated no-data-are-needed policy(2)
of the New England Journal of Medicine. Consider the illogic
and prejudice of its editor's recent proposal that if a
little gun control does not work, then, certainly, more gun
control is needed.(3) As this paper will document, errors of
fact, design, and interpretation abound in the medical
literature on guns and violence. Many have credulously
restated the opinions of partisan CDC researchers, but given
short shrift to the refuting data and criticisms. For matters
of "fact," it is not unusual to find third hand citations of
editorials rather than citations of primary data.
   Though it has become quite fashionable to speak of an
"epidemic of violence," analysis of recent homicide and
accident rates for which demographics are available show a
relatively stable to slightly declining trend for every
segment of American society except inner city teenagers and
young adults primarily involved in illicit drug trafficking.
(See Graph 1: "US Homicide Rates 1977-1988" & Graph 2:
"Selected Homicide Rates Comparisons") Federal law makes gun
purchase by teenagers illegal throughout the US. The
teenagers and young adults most at risk for violence live in
urban jurisdictions with the most stringent gun controls. The
areas with the most severe gun restrictions have the worst
violence and areas with the most permissive gun policies have
the least violence. Long term study shows that homicide and
suicide rates wax and wane independent of gun controls and
gun ownership. (See Graph 3: "20th. Century US Homicide and
Suicide Rates") The gun accident rate has fallen steadily for
decades and now hovers at an all time low.(4)(See Graph 4:
"20th. Century US Firearms Accident Rates")  Though guns and
ammunition meet none of Koch's Postulates of Pathogenicity,
certain physician advocates of gun prohibition have played
deceptively with the imagery of "the bullet as pathogen."(5)
Using incompetent research or contrived and emotive imagery
to promote a political agenda only obscures the real problems
and impedes real solutions. The prohibitionists' undeserved
pose of moral superiority is a distraction from objective
analysis and is, therefore, an impediment to rational
solutions.
   Webster et al.(6,7) use powerful images of children in
carefully crafted comparisons to mislead us. Mentioning
"Gunshot wounds are the third most common cause of injury
deaths among children aged 10 to 14 years..." assiduously
avoids noting that only the first leading cause of death
amongst children, motor vehicle accidents , is horrific. (See
Graph 5: "Children's Accidental Deaths")
   How do guns compare with other causes of death? (See Graph
6: "Actual Causes of Death") The 1990 Harvard Medical
Practice Study, a non-psychiatric inpatient sample from New
York state, suggests that doctors' negligence kills annually
three to five times as many Americans as guns, 100,000 to
150,000 per year. With sad irony it has become vogue for
medical politicians to claim that guns, rather than medical
negligence, have become a "public health emergency." (See
Graph 7: "Estimated Annual US Deaths from Doctors'
Negligence")
   Politicization of research cannot coexist with the
scientific objectivity necessary for sound design and
analysis of studies. Errors of fact, design, and
interpretation abound in the medical literature on guns and
violence. The medical literature is a relative newcomer to
the public debate on guns and violence, yet the medical
literature has virtually ignored all of the comprehensive
scholarly evaluations of guns, violence, and gun control,
such as the National Institute of Justice studies,(8,9) the
monumental review by gun control advocate Kleck (that in 1993
won the American Society of Criminology's Hindelang Award as
"the most important contribution to criminology in three
years"),(10) the cross cultural or other analyses by
Kopel(11,12,13) or Kates,(14) Fackler's criticisms of voodoo
wound ballistics,(15,16,17) and refutation(18) of the
American Medical Association's gross distortions(19) on
"assault weapons."
   Those readers familiar only with the medical literature on
guns should review the extensive criticisms of methodology
and conclusions,(20) documentation of false citations,
fabrication of data, and other "overt mendacity" in the
medical literature on guns,(21) "sagecraft,"(22) and thorough
reviews of Centers for Disease Control bias.(23,24) The
medical literature's inbred selectivity demonstrates half-
hearted, if any, effort at objectivity. Rather than balance
the merits and demerits of gun prohibition, it is the purpose
of this paper to expose representative samples of biased and
incompetent research and to spur greater skepticism of
"politically correct" results-oriented polemics. The taxpayer
funding of such politicized research merits debate. For a
discussion of the merits and demerits of gun registration,
licensing, waiting periods, and bans, the reader is guided to
the scholarly reviews cited above.


The benefits of guns are the lives saved, the injuries
prevented, the medical costs saved, and the property
protected - not the burglar body count...

the "43 times" fallacy

   Kellermann AL. and Reay DT. "Protection or Peril? An
Analysis of Firearms-Related Deaths in the Home." N Engl J.
Med 1986. 314: 1557-60.

methodological and conceptual errors:
*     prejudicially truncated data
*     non-sequitur logic
*     correct methodology described, but not used, by the
authors
*     repeated the harshly criticized methodology of
Rushforth from a decade earlier
*     deceptively understated the protective benefits of guns
   To suggest that science has proven that defending oneself
or one's family with a gun is dangerous, gun prohibitionists
often claim: "a gun owner is 43 times more likely to kill a
family member than an intruder." This is Kellermann and
Reay's flawed risk-benefit ratio for gun ownership,(25)
heavily criticized for its deceptive approach and its
non-sequitur logic.(10,26,27) Clouding the public debate,
this fallacy is one of the most misused slogans of the anti-
self-defense lobby.

The true measure of the protective benefits of guns are the
lives saved, the injuries prevented, the medical costs saved,
and the property protected - not the burglar or rapist body
count.

   Since only 0.1% to 0.2% of defensive gun usage involves
the death of the criminal,(10) any study, such as this, that
counts criminal deaths as the only measure of the protective
benefits of guns will expectedly underestimate the benefits
of firearms by a factor of  500 to 1,000.
   Interestingly, the authors themselves described ,but did
not use , the correct methodology. They acknowledged that a
true risk-benefit consideration of guns in the home should
(but did not in their "calculations") include "cases in which
burglars or intruders are wounded or frightened away by the
use or display of a firearm (and) cases in which would-be
intruders may have purposely avoided a house known to be
armed...."(25)
   Kellermann and Reay had repeated the harshly criticized
folly of Rushforth(28) from a decade earlier. In 1976 Bruce-
Biggs criticized Rushforth noting that the protective
benefits of guns are the lives saved and the property
protected, not the burglar body count.(29) Kellermann and
Reay would have done well to heed that simple caveat.
Objective analysis, even by their own standards, shows the
"more likely to kill a family member than intruder"
comparison to be deceptively appealing, though only a
specious contrivance.
   Caveats about earlier estimates of 1 million protective
uses of guns each year(10) have led Kleck to perform the
largest scale, national, and methodologically sound study of
the protective uses of guns suggesting between 800,000 and
2.4 million protective uses of guns each year(30) - not quite
as "intangible" as Kassirer claimed(31)  - as many as 75
lives protected by a gun for every life lost to a gun, as
many as 5 lives protected per minute.  Guns not only repel
crime, guns deter crime as is shown by repeated National
Institute of Justice surveys of criminals.(9) These are the
benefits of guns overlooked by scientists whose politics
overshadow their objectivity.
   At his presentation to the October 17, 1993 Handgun
Epidemic Lowering Program conference, Kellermann emotionally
admitted his anti-gun bias, a bias evident in the pattern of
Kellermann's "research."

The "43 times" fallacy becomes the "2.7 times" fallacy...

   Kellermann AL, Rivara FP, Rushforth NB et al. "Gun
ownership as a risk factor for homicide in the home." N Engl
J Med. 1993; 329(15): 1084-91.

methodological and conceptual errors:
*     used only one logistic regression model to describe
multiple socially distinct populations
*     psychosocially, economically, and ethnically
unrepresentative study populations
*     study populations, compared to general population,
over-represented serious social dysfunction and financial
instability, factors that would expectedly increase risks of
homicide
*     unrepresentative nature of dysfunctional study
populations prevents generalizing results to population at
large
*     when properly used, an "odds ratio" only estimates
relative risk of study and control populations -misleading
because the ratio gives no estimate of actual or baseline
risk
*     one week after publication of this article, during his
presentation to a gun prohibition advocacy group, H.E.L.P.
Conference (Chicago, October 18, 1993), the lead author
emotionally admitted his anti-gun bias, and
similar to Kellermann AL. and Reay DT. "Protection or Peril?
An Analysis of Firearms-Related Deaths in the Home." N Engl
J. Med 1986. 314: 1557-60.:
*     ignored criticisms of 1986 methodology, so, for the
second time, repeated the harshly criticized methodology of
Rushforth from 1976
*     non-sequitur logic
*     In 1986, correct methodology described, but never used,
by the lead author
*     failed to consider the protective benefits of guns

   Kellermann and his co-authors have persisted in their
discredited methodology. In a 1993 New England Journal of
Medicine article,(32) Kellermann et al. once again attempted
to prove that guns in the home are a significant risk.
   Both the case studies and control groups in this study
were socially and demographically unrepresentative of the
areas studied or of the nation as a whole. The groups had
exceptionally high incidence of social dysfunction and
instability. For example, 52.7% of case subjects had a
history of a household member being arrested, 24.8% had
alcohol-related problems, 31.3% had a household history of
illicit drug abuse, 31.8% had a household member hit or hurt
in a family fight, 17.3% had a family member hurt so severely
in a family fight that medical attention was required. Both
the case studies and control groups in this study had very
high incidence of financial instability. For example, both
case subject and control heads of household had a median
Hollingshead socioeconomic score of 4 (on a scale of 1 to 5
with 1 being the highest level of socioeconomic status).
These are factors that would expectedly be associated with
higher rates of violence, including homicide. The subjects
and controls did not even reflect the racial profile of the
studied counties; 62% of the subjects were Black compared
with 25% of the overall population of the three studied
counties.
   The unrepresentative nature of the case and control groups
undercut the authors' attempts to generalize from this study
to the nation at large. The results cannot even be
generalized to the counties studied because both the case and
control groups did not even represent the ethnic or
socioeconomic diversity of the counties studied. With so many
complex variables, the authors should have used multiple
logistic regression models, but, with their a priori bias,
used only one logistic regression model.
   Interestingly, according to the authors' own data, guns
were next to last in importance of the "risk factors"
studied. Alcohol, living alone, family violence, and renting
one's home held more risk than guns according to the authors'
calculations, yet the most important risks were barely
mentioned in the publicity or the authors' discussion. (See
Graph#8: - "Kellermann's Homicide Odds Ratios") It appears
that the authors were more concerned about generating a
headline-grabbing "factoid," exaggerating gun risk, than
about accurately or honestly assessing the risks of the
dysfunctional populations studied.


"Proving" a foregone conclusion...
   Kellermann AL, Rivara FP, Somes G, et al. Suicide in the
Home in Relationship to Gun Ownership. N Engl J Med. 1992;
327: 467-72.

methodological and conceptual errors:
*     an "adjustment" to eliminate suicide outside the home
for the stated purpose of exaggerating the focus on guns
*     ignored the vast body of data on suicide method
substitution
*     the authors virtually ignored their own data showing
that factors, such as psychotropic medications, drug abuse,
living alone, and hospitalization for alcoholism, have much
higher correlations with suicide than guns
*     failed to address the important social and ethical
dilemma - how to reduce overall suicide rates
*     ignored the role of failing health in the suicide of
the elderly
   In another effort to prove that guns in the home are a
significant risk, Kellermann and his co-authors purported to
examine certain correlates of suicide.(33) Though the
authors' own data showed higher correlations between suicide
and psychotropic medications, drug abuse, living alone, and
hospitalization for alcoholism, the article focused on guns.
(See Graph#9: - "Kellermann's Suicide Odds Ratios")
   The authors' "adjustment" - their word - that eliminated
the 30% of suicides outside the victim's home intentionally
skewed the data towards their foregone conclusion. The
authors candidly acknowledged their bias - "Our study was
restricted to suicides in the victim's home because a
previous study has indicated that most suicides committed
with guns occur there..." (emphasis added).
   As Kleck's review(10) of the broad expanse of American and
cross-cultural suicide literature shows, even if guns
instantly evaporated from the US, universal access to nearly
equally effective and accessible means of suicide - hanging,
auto exhaust, drowning, and leaping - would likely interfere
with an overall reduction in suicide. Evidence of such
"method substitution" is extensive. Many cultures that have
severe gun restrictions - Japan, China, USSR, Germany,
Luxembourg, Denmark, Belgium, Surinam, Trinidad, Tobago,
Hungary, Rumania, Czechoslovakia, Yugoslavia, Finland, and
Sweden - have total suicide rates far exceeding the USA
suicide rate. Many others - Canada, Iceland, Bulgaria,
Norway, and Australia - exceed the USA suicide rate though
not quite so dramatically.(34)  (See Graph 10: "International
Suicide Rates Comparisons")
   Guns are often portrayed as uniquely lethal as tools of
suicide, yet, amongst tools of suicide, guns are neither
uniquely available, uniquely lethal, nor causal of
suicide.(10) (See Graph 11: "Suicide Method Lethality") The
authors' preoccupation with guns bypasses the real social
dilemma, reducing the total suicide rate. Changing merely the
method of death is an inadequate response to a grave social
problem. Is suicide from hanging or auto exhaust so much more
"politically correct" that research, particularly in these
times of financial austerity, should focus on one
instrumentality rather than on the common roots and
prevention strategies?


Where is lawful self-defense "murder"?

   Kellermann AL and Mercy JA. "Men, Women, and Murder:
Gender-specific Differences in Rates of Fatal Violence and
Victimization." J Trauma. 1992; 33:1-5.

methodological and conceptual errors:
*     most women kill in defense of themselves and their
children. In these common circumstances, lawful self-defense
by women against their attackers is not "murder" in any
jurisdiction
*     the authors' discussion focused almost entirely on guns
though the data on knives and other weapons are virtually
identical
*     the authors failed to note that during the study period
the domestic homicide rate nearly halved
*     provided no primary research, instead provides largely
faulty analysis of FBI Uniform Crime Reports data
*     though purporting to assess an aspect of risk, the
authors failed to analyze the protective uses of guns -lives
saved, injuries prevented, medical costs saved, and property
protected - no true risk-benefit analysis
*     ignored data that suggest guns are actually the safest
and most efficacious means of resisting assault, rape, and
even non-violent crime
*     offered no new insights or solutions to the problem of
domestic abuse
   Though recognizing the risk and physical disadvantage of
women, Kellermann and Mercy attempted to draw us to their
conclusion that "...the wisdom of promoting firearms to women
for self-protection should be seriously questioned."(35) No
effort was made by the authors to assess the protective uses
of guns by women, in fact, the authors attempted to portray
legitimate self-defense as "murder." Women are abused 2
million to 4 million times per year.(36) Their children are
similarly abused, even fatally.(37) Almost all the "spouses
and domestic partners" killed by women each year are the very
same men, well known to the police, often with substance
abuse histories, who have been brutalizing their wives,
girlfriends and children.(10,14) Defense with a gun results
in fewer injuries to the defender (17.4%) than resisting with
less powerful means (knives, 40.3%; other weapon, 22%;
physical force, 50.8%; evasion, 34.9%; etc.) and in fewer
injuries than not resisting at all (24.7%).(10) Guns are the
safest and most effective means of protection. This is
particularly important to women, children, the elderly, the
handicapped, the weak, and the infirm, those who are most
vulnerable to vicious male predators. (See Graph 12: "Rates
of Crime Completion by Victim's Method of Protection" & Graph
13: "Rates of Victim Injury by Victim's Method of Protection"
)
   Would it be more "politically correct" if women or
children were killed by their attackers - the common outcome
when women do not defend themselves and their children with
guns? Should women, children, the elderly, the physically
challenged, or anyone rely on riskier or less effective means
of self-protection?  Or... should innocent victims defend
themselves with the safest and most effective means of
defense until such time as prevention strategies become
significantly more effective?
   The article's title notwithstanding, lawful self-defense
is not "murder" in any jurisdiction. It has been estimated
that as many as 20% of homicides are self-defense or
justifiable in the final analysis.(38)  Since the FBI Uniform
Crime Reports records "justifiable homicide" based on the
preliminary determination of the reporting officer, rather
than upon the final determination, the FBI data dramatically
under-reports "justifiable homicide." Knowing one another is
sufficient to meet the FBI's definition of "acquaintance," so
"acquaintance" includes the maniac in one's apartment
building and dueling drug dealers, hardly the type of good
people most would call "friends." These are predators that
Handgun Control Inc. considers "friends and family."
   At unconscionable expense this article recapitulated FBI
Uniform Crime Reports data that was already available "off
the shelf" for $20 from the US Government Printing Office.
The data only bolster what we already knew about women's risk
at home, but Kellermann and Mercy - unjustified by the data -
singled out guns for special treatment. "When women killed
with a gun, their victim was five times more likely to be
their spouse..."(35) Kellermann and Mercy failed to
acknowledge, however, that the FBI data they recounted showed
that when women killed with a knife, their victim was also
five times more likely to be their spouse - and when women
killed with other means, their victim was over four times
more likely to be their spouse.
   The most meaningful conclusion from this study, the
conclusion missed by Kellermann and Mercy, is the tremendous
restraint shown by women, that they kill so few of their
contemptible abusers. Interestingly, during the study period
of this article, 1976-87, the domestic homicide rate fell
from 2.4 to 1.4 per 100,000 (39,40) and the number of teen
and child gun accident fatalities fell from 530 to 280 (41)
-- all this while increasing numbers of guns were in the hands
of US citizens. It is also worth noting that the highly
touted "proliferation of guns" has not been associated with
an increase in rates of gun ownership.(10)
   The male authors' patronizing suggestions about gun
ownership by women are not justified by available data.
Partisan "scientists" who struggle to sculpt their data to
fit their a priori conclusions should be ignored or censured.
Statistical legerdemain cannot hide what the authors failed
to recognize: a woman's or child's life lost because a gun
was absent is at least as valuable as a violent predator's
life lost because a gun was present. Women are justified in
concluding that guns are the most effective and safest tools
of self-defense. Catchy ratios and contrived comparisons
detract from the public debate and are little consolation to
the brutalized victims or their grieving survivors.


Why are the Black and Hispanic homicide rates so high in
Seattle?

   Sloan JH, Kellermann AL, Reay DT, et al. "Handgun
Regulations, Crime, Assaults, and Homicide: A Tale of Two
Cities." N Engl J Med 1988; 319: 1256-62.

methodological and conceptual errors:
*     attempted a simplistic single-cause interpretation of
differences observed in demographically dissimilar cities and
cultures
*     purported to evaluate the efficacy of Canadian gun
control without evaluating the situation before the law
*     the Vancouver homicide rate increased 25% after the
institution of the 1977 Canadian law
*     failed to acknowledge that, except for Blacks and
Hispanics, homicide rates were lower in the US than in Canada
   Sloan, Kellermann, and their co-authors attempted to prove
that Canada's gun laws caused low rates of violence.(42) In
their study of Vancouver, the authors failed to compare
homicide rates before and after the law. As Blackman
noted,(43) they had ignored or overlooked that Vancouver had
26% more homicides after the Canadian gun ban, an observation
that should warrant scientific exploration and generate a
healthy skepticism of the authors' foregone conclusions.
Blackman's critique and analogy were so "on target" as to be
amusing:
   "... The Vancouver-Seattle 'study' is the equivalent of
testing an experimental drug to control hypertension by
finding two ordinary-looking, middle class white men, one 25
years old and the other 40, and without first taking their
vital signs, administering the experimental drug to the 25-
year-old while giving the 40-year-old a placebo, then taking
their blood pressure and, on finding the younger man to have
a lower blood pressure, announcing in a 'special article' a
new medical breakthrough. It would be nice to think that such
a study would neither be funded by the taxpayers nor
published in the (New England Journal of Medicine)."(43)
   Since its publication this article on gun control is among
those most frequently cited, though this small scale (two
cities) study has been thoroughly debunked by three large
scale (national and multi-national) studies.(44,45,46)
Kellermann and Sloan's biased interpretation of their data,
asserting that guns are to blame for crime, assaults, and
homicide, is even refuted by their own statistics.
   Kellermann and Sloan glossed over the disparate ethnic
compositions of Seattle (12.1% Black and Hispanic; 7.4%
Asian) and Vancouver (0.8% Black and Hispanic; 22.1% Asian).
The importance? Despite typically higher prevalence of legal
gun ownership amongst non-Hispanic-Caucasians in the US,(10)
the homicide rate was lower for non-Hispanic-Caucasian
Seattle residents (6.2 per 100,000) than for those in
adjacent Vancouver, Canada (6.4). Only because the Seattle
Black (36.6) and Hispanic (26.9) homicide rates were
astronomic could the authors make their claim. (See Graph 14:
"Ethnic and Racial Groups - Seattle and Vancouver" & Graph
15: "Homicide Rates by Ethnic and Racial Group - Seattle and
Vancouver" )
   Could guns have some special evil influence over Blacks
and Hispanics, but not others? Hardly! The authors failed to
identify the inescapable truth. The roots of inner-city
violence lie in the disruption of the family, the breakdown
of society, desperate and demoralized poverty, promotion of
violence by the media,(47,48) the profit of the drug trade,
the pathology of substance abuse, child abuse, disrespect for
authority, and racism - not in gun ownership.
   For an even-handed and scholarly cross-cultural comparison
of guns, violence, and gun control, the reader is referred to
Kopel's compendium.(11) If one reviews homicide and suicide
data, despite high levels of gun ownership and high levels of
gun control, the US fares well in comparison with many
countries, even those supposedly "non-violent" nations whose
gun controls the US is invited to emulate, such as Japan. How
do US homicide, suicide, and intentional fatality (combined
homicide and suicide) rates compare with other nations? (See
Graph 10: "International Suicide Rates Comparisons"; Graph
16: "International Homicide Rates Comparisons"; and Graph 17:
"International Intentional Fatality (Homicide+Suicide) Rates
Comparisons") Certainly the determinants of the levels of
violence in a society are many and complex.


Foretelling the future - gun prohibitionists and criminals
share a crystal ball

   Loftin C, McDowall D, Wiersema B, and Cottey TJ. Effects
of Restrictive Licensing of Handguns on Homicide and Suicide
in the District of Columbia. N. Engl J Med 1991; 325:1615-20.

methodological and conceptual errors:
*     the apparent, temporary, and minuscule homicide drop
occurred 2 years before the Washington DC law took effect
*     the "interrupted time series" methodology as used by
Loftin et al. has been invalidated
*     the study used raw numbers rather than population-
corrected rates - not correcting for the 20% population
decrease in Washington, DC during the study period or for the
25% increase in the control population -exaggerating the
authors' misinterpretations
*     the study conveniently stopped as Washington, DC's
overall homicide rate skyrocketed to 8 times the national
average and the Black, male, teen homicide rate skyrocketed
to 22 times the national average
*     used a drastically dissimilar demographic group as
control
*     the authors virtually failed to discuss the role of
complicating factors such as the crack cocaine trade and
criminal justice operations during the study period
   Loftin et al. attempted to show that Washington, DC's 1976
ban on new gun sales decreased murder.(49) Loftin and his co-
authors, using tax money, produced "research" with several
negating flaws that were ignored or overlooked by "peer
review" and the editorial board of the New England Journal of
Medicine -perhaps a corollary of the editor's no-data-are-
needed(2) policy.
   Not only has the "interrupted time series" methodology as
used by Loftin et al. has been invalidated,(50) but the
temporary and minuscule homicide drop began during 1974, 2
years before the gun law - How could the law, even before its
proposal, be responsible for the drop? Since homicidal
maniacs and criminals could not clairvoyantly anticipate the
law, other causalities should have been considered. The
authors, however, side-stepped the question and dismissed
non-gun causalities without any analysis whatsoever.
   The study conveniently stopped as the Washington, DC
homicide rate skyrocketed. If the gun freeze law, which has
not changed, were responsible for the homicide drop, we would
expect the "drop" to continue. If the "guns-cause-murder"
theory is valid and if the gun freeze were effective, as
"grandfathered" guns leave circulation (owner moves, dies,
guns become unserviceable, etc.), the homicide rate should
drop steadily. Quite the opposite is observed. The 1976
Washington, DC homicide rate before the law was 26.9 (derived
from population(51)and homicide(39) statistics) and then
tripled to 80.6 by 1991(52)despite or due to the law;
   Justifiable and excusable homicides, including those by
police officers, were treated the same as murders and were
not excluded from the study. The study used raw numbers
rather than population-corrected rates. This did not correct
for the 20% population decrease in Washington, DC during the
study period or for the 25% increase in the control
population - exaggerating the authors' misinterpretation. The
study used the adjacent suburbs as a control group, an area
with demographics drastically different from the study group.
   The authors examined and allowed only a single cause
interpretation - guns are to blame. They offhandedly
discarded any other possible explanation. They specifically
ignored the role of the crack cocaine trade, FBI stolen
property and Bureau of Alcohol, Tobacco and Firearms illegal
weapon sting operations in progress during the study, and
measures instituted during the study period that improved the
efficiency of the Washington DC court system. They generally
ignored the role of poverty and myriad other factors related
to criminal violence.
   Homicide has declined for every segment of American
society except teenage and young adult inner-city residents.
The Black teenage male homicide rate in Washington, DC is 227
per 100,000,(53) yet less than 7 per 100,000 for rural,
middle-aged white men,(54) the US group for whom gun
ownership has the highest prevalence.(10) If the "guns-cause-
violence" theory is correct why does Virginia, the alleged
"easy purchase" source of all those illegal Washington, DC
guns, not have a murder rate comparable to DC? The "guns-
cause-violence" theory founders. (See Graph 2: "Selected
Homicide Rates Comparisons")
   Even in their responses to criticism,(55) the authors'
intransigent bias is evident. Their position? If a drop in
murder is discovered (or statistically contrived), gun
control must receive the credit, but when attention was drawn
to the failures of gun control and their study design, the
skyrocketing murder rate must be credited to "other causes."
Shall we examine gun control as science or religion? It
appears that the faith of true believers is unshakable
heedless of data and the scientific method.


Aberrant data, illogical analysis, weak analogies, and gross
exaggerations are not a basis for public policy

   Koop CE and Lundberg GD. "Violence in America: A Public
Health Emergency." JAMA. 1992; 267: 3075-76.

methodological and conceptual errors:
*     claimed 1 million US gun homicides per year - a 35-fold
exaggeration
*     lumped gun accidents, homicides, and suicide in a
comparison with automobile accidents alone
*     used data from 2 exceptional states, rather than data
from the 48 states where gun deaths were falling faster than
auto deaths
*     the authors' weak analogy concluded that registration
and licensing of guns would decrease deaths, though offering
no data to show that registration and licensing of
automobiles resulted in such a decrease
*     postulated that controls appropriate to a privilege
(driving) are also appropriate to an inalienable human right
to self-preservation(gun ownership).
*     dismissed - without analysis or authority - the
constitutional and natural rights to gun ownership
*     though the authors promote a public health model of gun
ownership, the "bullet as pathogen" vogue, guns meet none of
Koch's Postulates of Pathogenicity
   An editorial by Koop and Lundberg(56)  promoting the guns
and autos analogy demonstrated deceptions common amongst
prohibitionists - the inflammatory use of aberrant and
sculpted data to reach illogical conclusions in the promotion
of harmful and unconstitutional policy. The authors attempted
to draw a comparison between motor vehicle accidental deaths
with all gun deaths.

aberrant and sculpted data

   "One million US inhabitants die prematurely each year as
the result of intentional homicide or suicide" is a 35-fold
exaggeration(57)Whether carelessness or prevarication, such a
gross distortion evokes, at best, questions regarding
competence in this field.
   It is doubtful that the authors would lump deaths from
surgery, knife attacks, and hara kiri  to contrive some
inference about knives, but to claim that Louisiana and Texas
firearms deaths exceed motor vehicle accidents,(58)it was
necessary to total firearm accidents, homicides, and
suicides.  Koop and Lundberg, as promoters of the fashionable
"public health model" of gun violence, should know that the
root causes and, hence, prevention strategies are very
different for accidents, homicides, and suicides. Also, it is
not that firearms deaths rose, but that, in just those two
states, they fell less rapidly than accidental auto deaths.58
   In the forty-eight other states the converse is noted,
firearms accidents (and most other accidents) fell 50% faster
than motor vehicle accidents - between 1980 and 1990, a 33%
rate drop nationally for guns compared to a 21% drop for
motor vehicles.(59) Should we base public policy on
contrivances and exceptions?

illogical conclusions

   Koop and Lundberg referenced a Morbidity and Mortality
Weekly Report(58) that claimed seven reasons for the fall in
motor vehicle accidents - better cars, better roads, passive
safety devices, children's car seats, aggressive drunk
driving enforcement, lower speed limits, and motorcycle
helmets - but did not claim licensing or registration of cars
was responsible for the fall.  It is by a fervent act of
faith, rather than one of science or logic, that Koop and
Lundberg proposed their scheme.
   The selectivity of the analogy is further apparent when we
recognize that licensing and registration of automobiles is
necessary only on public roads. No license or registration is
required to own and operate a motor vehicle of any kind on
private property. The advocates of the automobile model of
gun ownership would be forced by their own logic to accept
use of any kind of firearm on private property without
license or registration. Since any state's automobile and
driver license is valid in every state, further extension of
the analogy suggests that the licensing of guns and gun
owners would allow citizens to "own and operate" firearms in
every US jurisdiction. A national concealed firearms license
valid throughout this nation would be a significant
enhancement of self-protection, a deterrent to violent crime,
and a compromise quite enticing to many gun owners.

harmful and unconstitutional nostrums

   Crime and homicide rates are highest in jurisdictions,
such as Washington, DC, New York City, Chicago, and
California, where the most restrictive gun licensing,
registration, and prohibition schemes exist. Why are homicide
rates lowest in states with loose gun control (North Dakota
1.1, Maine 1.2, South Dakota 1.7, Idaho 1.8, Iowa 2.0,
Montana 2.6) and highest in states and the district with
draconian gun controls and bans (District of Columbia 80.6,
New York 14.2, California 12.7, Illinois 11.3, Maryland
11.7)?(49) (See Graph 18: "Representative State Homicide
Rates")
   Precisely where victims are unarmed and defenseless is
where predators are most bold. Gun prohibitionists argue a
"need" for national controls, yet similar national
prohibitions have not stemmed the flow of heroin, cocaine,
and bales of marijuana across our national borders. What
mystical incantation will cause homicidal drug criminals to
respect new gun laws when they flaunt current gun laws and
ignore the most basic law of human morality, "thou shalt not
murder"? The proponents of adding to the 20,000 gun laws on
the books have yet to explain how "passing a law" will disarm
violent, sociopathic predators who already ignore laws
against murder and drug trafficking.


The new prohibition - enforceability and constitutionality

   The deceptions in the medical literature are not
restricted to scientific issues. The insurmountable practical
and constitutional impediments to gun bans are either
offhandedly or deceptively(60) discounted. Neither practical
matters, such as the massive expense and civil rights
violations necessary to enforce gun bans,(61) nor historical
matters, such as the racist and oppressive roots of gun
control,(62-66) are discussed by medical politicians who
advocate gun bans.
   Besides unenforceability, the Right to Keep and Bear Arms
is an insurmountable impediment to gun bans. Gun
prohibitionists mistakenly predicate that controls
appropriate to a privilege, driving, are appropriate to an
inherent, irrevocable, and constitutionally protected right.
While certain state and federal gun controls may be
constitutional, gun prohibitions are clearly
unconstitutional. Gun controls may not be so onerous as to
regulate the right into meaningless, virtual nonexistence.
   Failure to recognize that the National Guard is a
component of the US Army and not equivalent to the Second
Amendment's "militia"(67) has allowed prohibition advocates
to misconstrue the protections guaranteed to individual
citizens by the Second Amendment. Considerable legal
scholarship also finds protection of gun civil rights in
"unenumerated rights" protected by the Ninth Amendment,(68)
the natural right to self-protection,(69) and in the
"privileges, immunities, equal protection" and "due process"
guarantees of the Fourteenth Amendment.(70,71)
   Despite plausible misinterpretations by physicians(72) and
Handgun Control Inc.(73) and other prohibitionist(74)
attorneys about the function and definition of "militia,"
   "The militia of the United States consists of all able-
bodied males at least 17 years of age... and under 45 years of
age."(75)
   Notwithstanding prohibitionists' convoluted distortions
about "the people," and constitutional case precedents, the
US Supreme Court has explicitly protected an individual right
to keep and bear arms,(76-79) especially and explicitly
protecting military-style weapons, "part of the ordinary
military equipment...."(79) To claim that "the people" who have
the Right to Keep and Bear Arms are actually the States and
not the same "the people" who have First, Fourth, Ninth, and
Tenth Amendment protections requires some rather unlikely
assumptions. Did the authors of the Bill of Rights use the
term "the people" in the First Amendment to refer to
individuals, then, 28 words later, use the term "the people"
in the Second Amendment to refer to the States, then, 44
words later, use the term "the people" in the Fourth
Amendment and four and five articles later, in the Ninth and
Tenth Amendments, to refer to the individual?
   The US Supreme Court has rejected such convoluted logic.
In US v. Verdugo-Urquidez,(80) a Fourth Amendment case
holding that the warrant requirement is inapplicable to the
search of a home in a foreign country, the Supreme Court
noted that "the people" who have the right to free speech, to
peaceably assemble, and to be secure in their papers and
effects are one and the same "the people" who have the right
to keep and bear arms.
   The US Supreme Court has yet to use the Fourteenth
Amendment to incorporate many Bill of Rights protections
against the states, the Second Amendment protections among
them.(70,71) Using a "states' rights" prohibitionist argument
that the Bill of Rights fails to protect the right to keep
and bear arms from infringement by states,(73,74) however,
uses logic that, if similarly applied, would fail to protect
freedom of speech, freedom of religion, freedom of the press,
freedom from unreasonable searches and seizures, the right to
trial by a jury of peers, and other rights from state
infringement. Prohibitionists take hypocritical refuge in a
guns only interpretation of collective states' rights. The
supportive authorities referenced above are quite convincing
of the inherent and irrevocable right to self-protection
against criminals, crazies, and tyrants. The right to keep
and bear arms and ammunition is essential to that self-
protection and has little, if anything, to do with duck
hunting or other subjective "legitimate sporting uses" of
guns.
   These important civil rights matters will be discussed in
detail in a forthcoming article.


Conclusions

   Utopia is not one of the available solutions to violence
in our society. Only incremental improvements are attainable
through repeal of victim disarmament laws and through
implementation of effectual, affordable measures. Objective
assessment of the risks and benefits of various proposals
will assist development of rational and effectual public
policy. Hysterical, ineffectual, unconstitutional, and merely
symbolic measures only squander time, money, and energy that
are better devoted to effectual solutions and realistic
goals.
   The author hopes that sufficient data and analysis have
been provided so that the reader questions common, but
erroneous, assumptions about guns and gun bans and to
generate deserved skepticism of the medical literature on
guns and violence.
   The responsible use and safe storage of any kind of
firearm causes no social ill and leaves no victims. In fact,
guns offer positive social benefit in protecting good
citizens from vicious predators. The overwhelming
preponderance of data we have examined shows that between 25
to 75 lives may be saved by a gun for every life lost to a
gun. Guns also prevent injuries to good people, prevent
medical costs from such injuries, and protect billions of
dollars of property every year. In view of the overwhelming
benefits, it is ludicrous to punitively tax gun or ammunition
ownership. They save far more lives than they cost.
   The peer review process has failed in the medical
literature. In the field of guns, crime, and violence, the
medical literature - and medical politicians - have much to
learn conceptually and methodologically from the
criminological, legal, and social science literature. Gross
politicization of research will only increase the present
disrespect in which medical journals and peer-review are held
by physicians.(81) To further honest public debate, organized
medicine and CDC researchers should adopt scientific
objectivity and integrity and improve the peer review
process. Since it has demonstrated it is unable to police
itself, stringent oversight must be placed over the CDC's
grant award process. Taxpayers must demand meaningful
oversight of scientific integrity and competence.
   If devotees of the "true faith" of gun prohibition and
pacifists who deny we have a right to self defense wish to
eschew the safest and most effective tools of self-
protection, they are welcome to do so. In this imperfect
world their harmful philosophy must not be imposed upon an
entire society. In essence, society should adopt a "Pro-
Choice" approach to self-defense and gun ownership.


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