By Vik Khanna
Monday, January 16, 2017
Two major medical journals have decided to renew the
academic medical establishment’s assault on gun owners.
The first shot across the bow appeared in the November 8 Journal of the American Medical Association,
where esteemed Stanford University health economist Victor Fuchs published a
paper on the problem of life expectancy in the black community. Near the end of
his lamentation, Fuchs asserts that increasing life expectancy in the black
community “depends more on public health measures such as gun control than on
medical care.” The second shot came with the release of the January issue of JAMA Internal Medicine, which has four
papers and an editorial devoted to firearms violence, with a heavy emphasis on
suicide prevention, which would benefit whites much more than it would the
black community.
It should go without saying that Dr. Fuchs and his fellow
public-health avengers have made critical analytical errors that belie their
actual goal: a creeping vine of restrictions on access to firearms that, in
their most lurid dreams, would eventually make gun ownership illegal.
Unfortunately for them, the inconvenient truth is that the right to bear arms
is in the Bill of Rights. There is no cross-cultural argument that can trump
this right; it exists in the Constitution of no other modern, industrialized
democracy, and no other modern, industrialized democracy resembles ours.
Democratic and demographic differences matter.
But though the law is against them in their aims, these
writers can still do real damage. Their mixing of apples and oranges in order
to arrive at a preordained conclusion — guns are bad, and this “public health
crisis” of “epidemic” gun violence is sufficient cause to reconsider their
place in society — is part of an ominous trend in the way the medical community
thinks about social ills. The words “public-health crisis” and “epidemic” have
become a pretext for restricting perfectly legal individual choices and
behaviors in the marketplace.
When the government deems the actions of individuals a
public-health crisis, mandates can’t be far behind. Insufficient health
insurance was a public-health crisis; Obamacare gave us a mandate. Heart
disease, diabetes, and obesity are public-health crises; Obamacare mandates
coverage of clinical prevention services that almost never
save lives but increase spending. Sugar consumption is a public-health
crisis; the government tries to limit soda sizes and gives us sugar taxes, both
effectively mandates to consume less. Cigarette smoking is a public-health
crisis, so the government mandates reduced consumption through extravagant
taxation, which creates both a thriving black market and a bizarre paradox in
which the health-care industry needs people to continue smoking (to pay the tax
and fund the tobacco settlement) even while it implores them to stop.
Historically, the field of public health focused on
improving the health of populations through strategies that reduced the risk of
harm to individuals without requiring much if any participation by end-users.
This is important when the policy objective (e.g., safe food and water
supplies) or risk elements (e.g., how fast or recklessly is someone else
driving) are difficult for individuals to control.
Well-known and well-documented public-health success
stories include vaccinations, food safety, building codes that require
lead-free paint, food fortification, hospital infection-control protocols, and
clean-air and -water laws. In each of these cases, an agent (most often the
government), acts to affect the
environment so that citizens can go about their lives with relative
security in the public square.
In other words, the theory behind most public-health
successes has hitherto been that big-picture strategies provide passive
protection against harm. The end-user, you or I, needn’t do anything special to
benefit. Active protection requires an action by the end-user. For example,
designing and building safer roads and more crashworthy cars, which better
absorb energy and thus prevent injury or death in an accident, is a passive way
to protect drivers. Requiring a driver or passenger to buckle a seat belt is an
active protection. Punishing a driver who is impaired or distracted and causes
harm is a criminal matter, because we as a society have rightly recognized that
not all harms are preventable and that both negligence and malicious intent
should be punished under the law.
Under the guise of beneficence, public-health elites, who
have fewer and fewer problems they can address via the passive route, have
begun to make a broad range of false allegations when it comes to guns,
employing deceptive but politically motivated and appealing analogies while
ignoring the direction in which the data actually point. Their reluctance to
follow the evidence gives us a third kind of purported protection in which the
code words “public-health crisis” and “epidemic” form the tip of a spear
intruding into the lives of individuals to restrict lawful activities that the
academy simply finds distasteful. They have, in other words, co-opted language
previously reserved for describing problems that require passive protections in
order to agitate for active protections that infringe upon Americans’
constitutional rights.
This insidious shift in public-health strategy dates back
to epidemiology pioneer Abraham Lilienfeld, who teamed with D.A. Henderson to
address the scourge of infectious disease in the middle of the 20th century.
Lilienfeld, whose epidemiology text is still considered a classic, eventually
turned his attention to non-infectious and non-environmental threats to health,
claiming that the one could apply the same methods used in the fight against
infectious disease to problems such as heart disease and cancer. In retrospect,
Lilienfeld was the first to make the apples-to-oranges mistake made by anti-gun
public-health professionals today; cancer, heart disease, and other such
maladies are non-transmissible. Some of their major risk factors are
non-modifiable and unique (family history, age, and gender) and others are
modifiable (exercise, diet, smoking, and alcohol consumption).
The modern cult of public health uses manipulation,
conditioning, and contrivance to replace data, logic, and integrity. In the JAMA Internal Medicine papers and
subsequent media coverage, study authors and advocates have blithely conflated
firearm deaths in the U.S. (almost 33,000 in 2013) with automobile deaths
(38,000 in 2015).
This comparison is deceptive in the extreme.
All auto deaths, other than the occasional murderer
driving into a crowd, are by definition accidents, and thus unintentional and
unpredictable. Hence, the academic injury-prevention industry, which cut its
teeth on the issue of automotive safety in the 1970s and 1980s, has typically (and
logically) encouraged better road design and more passive injury-prevention
improvements in car design, such as energy-absorbing materials and air bags.
The industry’s own reasoning is that drivers and passengers may not have
control over what happens to them on the road, so building a safer environment
can save lives. It doesn’t push to restrict the rights of individuals to drive
or to dictate what cars people can buy, because its members cherish those
rights as much as anyone else.
Of the 32,279 firearms deaths in the US in 2014, 586, or
just 1.8 percent, were unintentional discharges. You are nearly six times more
likely to die by accidental drowning and 54 times more likely to die in an
accidental fall than you are to be accidentally killed by a gun. While
accidental firearm deaths are tragic, they are exceedingly rare, and are best
reduced through education about responsible gun ownership and use. The vast
majority of gun deaths — more than 98 percent of them — are intentional,
whether they be suicide or homicide.
Intentionality is the vital but completely ignored
difference in the lie that connects automobile deaths and shooting deaths. To
acknowledge its importance in firearms deaths undoes the argument of the
public-health avengers that guns, per se, are the problem, because intent is
personal. It requires examination of individuals and why they kill themselves
or another person. In all likelihood the circumstantial drivers are as unique
as the individuals involved, making it nearly impossible to craft environmental
solutions that would not be so broad as to intersect with the rights of
law-abiding individuals who pose a threat to no one.
The public-health community never discusses the fact that
the violent-crime rate in the U.S. has dropped
by half since 1990. The total number of fatal and non-fatal firearms events
in the U.S. fell by 69
percent from 1993 to 2011. The firearm-death rate, too, is down over that
time, by nearly 40 percent.
Why aren’t these massive improvements in public safety
celebrated as public-health victories? Well, mostly because the public-health
community had nothing to do with them. You cannot attract new grant money by
pointing out a decline in the problem that you’ve so emotionally labeled as a
public-health crisis and an epidemic. No one can say for sure why the U.S. is
much less violent now than it was 25 years ago, but we can all be thankful that
it is.
There are now more than 300 million guns in circulation
in the U.S., with nearly a million new guns sold each month. The proportion of
households owning a firearm has hovered between 40 percent and 50 percent since
1993; it is now at 47 percent, according to Gallup. But there are 25 million
more households in the U.S. today than there were in 1993. This means that one
of the great public-health achievements of the past 20 years can’t be credited
to anyone in the public-health industry: There are more guns than ever in the
U.S., but as a population, we are also safer than ever. That’s the very
definition of improved public health.
The irony of the academy’s zeal to trample the rights of
Americans is rich. Take Johns Hopkins as an example. Baltimore is one of the
most violent cities in the U.S. In 1988, Maryland passed a ban on the sale of
so-called Saturday-night specials — small, cheap handguns often favored by
criminals — that took effect in 1990. Unfortunately, in 1993, 353 Baltimoreans
were murdered, mostly by guns. Fast-forward to 2016, and more than 100,000
people have fled Charm City. The ban remains intact, but 318 Baltimoreans were
murdered last year anyway, again mostly by guns. Criminals will always find a
way to get a weapon. Always.
So, I’ll ask the question that the academics won’t ask:
What is it about urban America that perpetuates such flagrant disregard for
life? And what strategies does Johns Hopkins have to restore schools, jobs,
churches, social institutions, and, most importantly, self-respect and respect
for life and the rule of law in Baltimore? If they can’t do it there, how can
anyone take seriously their sticking their fingers in the eyes of law-abiding
gun owners elsewhere?
Is this a problem that academics will solve by
restricting the right of people like me to buy any firearm we wish for
recreation or protection or just because we think it’s cool? No. The answer
lies in vigorous prosecution and no-parole sentencing for all violent crime, and in a search for the meaningful expansion of
individual opportunities for the urban poor so they can reclaim their
communities and their lives. That so many public-health academics think
otherwise is telling and profoundly worrisome. Here’s hoping President Trump
and the 115th Congress don’t listen to them.
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