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Abstract
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Predictably, gun violence, particularly homicide, is a major study topic for social scientists, particularly criminologists.2 Less predictably, gun (pg.514) crime, accidents, and suicide are also a topic of study among medical and public health professionals. Our focus is the remarkable difference between the way medical and public health writers treat firearms issues and the way social scientists treat those issues. Examination of the literature produced by medical and health writers reveals why their conclusions on firearms diverge so radically from those of criminological scholarship. We focus on that literature's anomalies both for their own sake and because that focus allows us to explore some of the more important policy and legal issues of gun control.
In 1979 the American public health community adopted the "objective to reduce the number of handguns in private ownership," the initial target being a 25% reduction by the year 2000. 3 Based on studies, and propelled by leadership from the Centers for Disease Control and Prevention (CDC), the objective has broadened so that it now includes banning and confiscation of all handguns, restrictive licensing of owners of other firearms, and eventual elimination of firearms from American life, excepting (perhaps) only a small elite of extremely wealthy collectors, hunters, or target shooters. This is the case in many European countries.
In this connection, the term "gun control" needs some clarification. That term could mean no more than noncontroversial measures to prohibit gun misuse or gun possession by high risk groups. In the literature we are analyzing, however, "guns are not... inanimate object[s], but in fact are a social ill," and controlling them implies wholesale confiscation from the general public so as to radically reduce gun availability to ordinary people. 5 This goal parallels the goals of political lobbying groups such as Handgun Control, Inc. and the National Coalition to Ban Handguns. 6 In fact, the public health agenda to drastically reduce availability goes beyond those groups. Handgun Control, Inc. (HCI) seeks only to ban gun ownership for self-defense, but would allow licensed sportsmen to have both handguns and long guns for purely sporting purposes; 7 the Coalition to Stop Gun Violence (pg.516) (CSGV) would allow people to have long guns and limited access to handguns for sporting purposes.8
Perhaps surprisingly, neither medical and health writers nor the journals which publish their writing seem embarrassed by their agenda's close relationship to political lobbying organizations. On the contrary, exhortations to "[s]peak out for gun control" are seen as part of an admirable tradition of political advocacy by doctors and other health professionals in support of political measures designed to improve public health.9 In that spirit, writers in such journals strongly avow the need for active political advocacy, for concerted action with anti-gun groups, and for open support of their political initiatives. 10 Throughout this Article we (pg.517) shall use the phrase "anti-gun health advocacy literature" as a shorthand for medical and public health publications having this focus or agenda.11
Health advocates see no problem reconciling such an openly political agenda with the demands of scholarship. After all, guns are hateful things for which no decent purpose is imaginable, certainly not self-defense.12 Society's need to radically reduce gun availability is an inarguable truth to which there can be no legitimate opposition. Arrayed against the beneficent alliance of health advocates and anti-gun political advocates are only sinister "powerful lobbies that impede constructive exploration of the full range of social options" 13 by nefarious (pg.518) machinations, including racist propaganda cunningly designed to exploit white Americans' irrational fears of crime.14
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This Article incorporates material from the following previously unpublished manuscripts: Don B. Kates, Jr., A Controlled Look at Gun Control, Paper on Firearms and Crime in Connection With the Oral Presentation Before the Select Committee of the Pennsylvania Legislature to Investigate the Use of Automatic and Semi-automatic Firearms (Sept. 20, 1994) (unpublished manuscript, on file with the Tennessee Law Review); Don B. Kates, Jr. et al., Public Health Literature on Firearms: A Critique of Overt Mendacity, Paper Delivered at the Annual Meeting of the American Society of Criminology (1991) (unpublished manuscript, on file with the Tennessee Law Review); Henry E. Schaffer, Serious Flaws in Kellermann et al., (1993) NEJM (Dec. 1993) (unpublished manuscript, on file with the Tennessee Law Review) (criticizing Arthur L. Kellermann et al., Gun Ownership as a Risk Factor for Homicide in the Home, 329 N EW E NG. J. M ED. 1084 (1993)). The authors wish to thank the following for their assistance and advice: James Boen, David Bordua, Philip Cook, David Cowan, Dan Day, Gary Green, Fran Haga, Steve Holland, C. Kates, Gary Kleck, Paul Stoufflet, Edgar Suter, and James D. Wright. Of course, the authors alone are responsible for any errors.
1 BOCCACCIO, T HE DECAMERON 686 (Musa & P. Bondanella trans., Mentor-New American Library 1982).
2 See, e.g., SAMUEL WALKER, S ENSE AND NONSENSE ABOUT CRIME AND DRUGS: A P OLICY GUIDE chs. 10 and 13 (1994); GARY KLECK , P OINT BLANK: GUNS AND VIOLENCE IN AMERICA (1991) [hereinafter KLECK , P OINT B LANK]; GERALD D. ROBIN, VIOLENT CRIME AND GUN CONTROL (1991); JAMES D. W RIGHT ET AL., UNDER THE GUN: W EAPONS, CRIME, AND VIOLENCE IN AMERICA (1983) [hereinafter W RIGHT ET AL., UNDER THE GUN]; JAMES D. W RIGHT & P ETER H. ROSSI, ARMED AND CONSIDERED DANGEROUS: A S URVEY OF F ELONS AND T HEIR F IREARMS (1986) [hereinafter W RIGHT & ROSSI, ARMED AND CONSIDERED DANGEROUS]; see also infra note 43.
3 L OIS A. F INGERHUT & JOEL C. KLEINMAN, U.S. DEP' T OF HEALTH AND HUMAN S ERVS., F IREARM M ORTALITY AMONG CHILDREN AND YOUTH, 178 ADVANCE DATA 1 (1989). Significantly, Centers for Disease Control and Prevention (CDC) firearms specialist Lois Fingerhut adds: "The data presented in this report underscore these concerns." Id. at 6. Without substantial exaggeration, they could have added that CDC publications on firearms can be reviewed, as they will be herein, without ever finding analysis of data leading to any other conclusion. See also U.S. DEP' T OF HEALTH , E DUCATION, AND W ELFARE , HEALTHY P EOPLE : T HE S URGEON GENERAL ' S REPORT ON HEALTH P ROMOTION AND DISEASE PREVENTION--BACKGROUND P APERS 18, 64-67, 464-65 (1979)
4 Janice Somerville, Gun Control as Immunization, A M. M ED. NEWS , Jan. 3, 1994, at 9 (profiling health activist Dr. Katherine Christoffel and quoting approving comments by an American Medical Association (AMA) official and the CDC's Mark Rosenberg). "Guns are a virus that must be eradicated.... They are causing an epidemic of death by gunshot, which should be treated like any epidemic--you get rid of the virus.... Get rid of the guns, get rid of the bullets, and you get rid of the deaths." Id.; see also DEBORAH P ROTHROW-S TITH , DEADLY CONSEQUENCES 198 (1991); U.S. DEP'T OF HEALTH AND HUMAN SERVS., SURGEON GENERAL ' S W ORKSHOP ON VIOLENCE AND P UBLIC HEALTH : REPORT 53 (1985) (recommending, among other ideas, a total ban on private possession of handguns); NATIONAL COMMITTEE FOR I NJURY P REVENTION AND CONTROL, 7 I NJURY P REVENTION: M EETING THE CHALLENGE 261-67 (Supp. 1989) (supplemental edition of the American Journal of Preventive Medicine (1989)) [hereinafter INJURY P REVENTION]; Deane Calhoun, From Controversy to Prevention: Building Effective Firearm Policies, I NJ. P REVENTION NETWORK NEWSL., Winter 1989-1990, at 17 (praising the National Coalition to Ban Handgun's change of name to indicate its desire for a broader prohibition reflecting its "belief that guns are not just an inanimate object, but in fact are a social ill"); Marsha F. Goldsmith, Epidemiologists Aim at New Target: Health Risk of Handgun Proliferation, 261 JAMA 675 (1989); Daniel W. Webster et al., Reducing Firearms Injuries, I SSUES IN S CI. T ECH., Spring 1991, at 73, 78.
5 Karl P. Adler et al., Firearm Violence and Public Health: Limiting the Availability of Guns, 271 JAMA 1281 (1994); American Academy of Pediatrics, Firearm Injuries Affecting the Pediatric Population, AAP NEWS , Jan. 1992, at 22 [hereinafter Firearm Injuries Affecting the Pediatric Population] (arguing for a ban on private possession of handguns); American Academy of Pediatrics, Firearms and Adolescents, AAP NEWS , Jan. 1992, at 20; Brady Bill Has Medicine's Support, AM. M ED. NEWS , May 20, 1991, at 25 (Firearms "are one of the main causes of intentional and unintentional injury.... [T]he real cure for the epidemic [of violence by guns] is to eliminate its cause."); Calhoun, supra note 4, at 17; Judith C. Dolins & Katherine K. Christoffel, Reducing Violent Injuries: Priorities for Pediatrician Advocacy, 94 P EDIATRICS 638, 645 (1994) [hereinafter Dolins & Christoffel, Reducing Violent Injuries] (defining gun control as a process of progressively removing weapons from home environments); Harold Henderson, Policy: Guns 'n' Poses, CHI. READER , Dec. 16, 1994, at 8, 24 (quoting Drs. Robert Tanz and Katherine Kaufer Christoffel of Chicago on the need to change public attitudes toward guns as public attitudes toward smoking have been changed); William Raspberry, Sick People With Guns, W ASH. P OST, Oct. 19, 1994, at A23 (quoting Dr. Mark Rosenberg on his, and the CDC's, agenda to create a public perception of firearms as "dirty, deadly--and banned"); Daniel W. Webster & Modena E. H. Wilson, Gun Violence Among Youth and the Pediatrician's Role in Primary Prevention, 94 P EDIATRICS 617, 621 (1994) (stating that "gun manufacturers are polluting our communities").
6 Calhoun, supra note 4, at 17 (noting that the "National Coalition to Ban Handguns" was renamed the "Coalition to Stop Gun Violence").
7 Handgun Control, Inc.'s eventual goal is national gun licensing under which self-defense would not be a ground for gun ownership; only sportsmen would be allowed to own guns. Erik Eckholm, A Little Control, A Lot of Guns, N.Y. T IMES, Aug. 15, 1993, ยง 4, at 4 (quoting Handgun Control, Inc. Chair Sarah Brady). See discussion of HCI, CSGV, and other anti-firearms groups in Don B. Kates, Gun Control: Separating Reality from Symbolism, 20 J. CONTEMP. L. 353, 356-57 (1994).
8 "The position of the National Coalition to Ban Handguns is very clear.... [We support] ban[ning] the manufacture, sale and possession of all handguns, except for police, military, licensed security guards and pistol clubs." Michael K. Beard, Testimony on behalf of the National Coalition to Ban Handguns in Support of 8-132 Before the Committee on the Judiciary 3 (Mar. 22, 1989) (transcript on file with the Tennessee Law Review); see also Sam Fields, Handgun Prohibition and Social Necessity, 23 S T. L OUIS U. L.J. 35, 51 (1979) (an article by a then-official of the National Coalition to Ban Handguns).
9 Webster & Wilson, supra note 5, at 622; see also Stephen Teret, So What?, 4 E PIDEMIOLOGY 93 (1993); William DeJong, Book Review, 21 HEALTH E DUC. Q. 543 (1994) (reviewing L. W ALLACK ET AL., M EDIA ADVOCACY AND P UBLIC HEALTH : P OWER FOR P REVENTION (1993)). Dr. DeJong, who teaches in the Harvard University School of Public Health, advises: "To advance the cause of public health, we need to move... to a new paradigm, one in which health educators focus on galvanizing political action and change." Id. In the same spirit he praises "[w]ork by a gun control advocate [which] shows us how researchers can choose projects that will bring attention to public policy," including the policy goal of prohibiting firearms ownership. Id. at 545; see also Peter Edelman & David Satcher, Violence Prevention As a Public Health Priority, 12 HEALTH AFF. 123, 124 (1994) (emphasizing the urgent need to reduce violence and decrying unwillingness to pursue "any potentially effective interventions").
10 See, e.g., Lester Adelson, The Gun and the Sanctity of Human Life; Or the Bullet as Pathogen, 127 ARCHIVES S URGERY 659, 663-64 (1992); Adler et al., supra note 5, at 1281-82; Calhoun, supra note 4, at 17; Tina L. Cheng & Robert A. Lowe, Taking Aim at Firearm Injuries, 11 AM. J. E MERGENCY M ED. 183, 185 (1993); Katherine K. Christoffel, Toward Reducing Pediatric Injuries from Firearms: Charting a Legislative and Regulatory Course, 88 P EDIATRICS 294 (1991) [hereinafter Christoffel, Reducing Pediatric Injuries from Firearms]; Katherine K. Christoffel & Tom Christoffel, Handguns: Risks Versus Benefits, 47 P EDIATRICS 781, 782 (1986) [hereinafter Christoffel & Christoffel, Handguns]; M. Denise Dowd et al., Pediatric Firearm Injuries, Kansas City, 1992: A Population-Based Study, 94 P EDIATRICS 867, 872 (1994); Jeffrey B. Kahn, Firearm Violence in California: Information and Ideas for Creating Change, 161 W. J. M ED. 565, 569-70 (1994); C. Everett Koop & George D. Lundberg, Violence in America: A Public Health Emergency, 267 JAMA 3075, 3076 (1992); Dolins & Christoffel, Reducing Violent Injuries, supra note 5, at 641, 648-49; Leland Ropp et al., Death in the City: An American Childhood Tragedy, 267 JAMA 2905, 2909-10 (1992); Kenneth Tardiff et al., Homicide in New York City: Cocaine Use and Firearms, 272 JAMA 43, 46 (1994); Webster & Wilson, supra note 5, at 621-22; see also supra note 4; infra note 33.
11 As used in this Article, the phrase "anti-gun health advocacy literature" does not include the very few articles on firearms topics in medical or health publications which treat the issues neutrally. E.g., Robert L. Ohsfeldt & Michael A. Morrisey, Firearms, Firearms Injury, and Gun Control: A Critical Survey of the Literature, 13 ADVANCES HEALTH E CON. AND HEALTH S ERVS. RES. 65 (1992). Nor does it include articles that take a stance affirmatively supporting freedom of private choice regarding firearms ownership. E.g., Edgar A. Suter, Guns in the Medical Literature--A Failure of Peer Review, 83 J. M ED. ASS' N GA. 133 (1994).
12 P ROTHROW-S TITH , supra note 4, at 198. Inexplicably, the author, who is Dean of the Harvard School of Public Health, indicates that she would allow limited gun ownership for sport, however much she disapproves of it, but not for self-defense. Id. As a University of Chicago health advocate put it, "The only legitimate use of a handgun that I can understand is for target shooting...." Firearms Legislation: Hearings on Oversight of the 1968 Gun Control Act Before The Subcomm. on Crime of the Senate Judiciary Comm., 94th Cong., 1st Sess. 628 (1974-1976) (testimony of Dr. Robert Replogle); see also Adler et al., supra note 5, at 1281-83; James A. Mercy et al., Public Health Policy for Preventing Violence, 12 HEALTH AFF. 7 (1993); Mark L. Rosenberg et al., Guns and Adolescent Suicides, 266 JAMA 3030 (1991); Daniel W. Webster et al., Firearm Injury Prevention Counseling: A Study Of Pediatricians' Beliefs and Practices, 89 P EDIATRICS 902 (1992) [hereinafter Firearm Injury Prevention Counseling]; Daniel W. Webster et al., Parents' Beliefs About Preventing Gun Injuries to Children, 89 P EDIATRICS 908 (1992) [hereinafter Webster et al., Parents' Beliefs].
13 J. Michael McGinnis & William H. Foege, Actual Causes of Death in the United States, 270 JAMA 2207, 2211 (1993); see also Diane H. Schetky, Children and Handguns: A Public Health Concern, 139 AM. J. DISEASES CHILDREN 229, 230 (1985).
Dr. Jerome Kassirer, the current editor of the New England Journal of Medicine, not only deplores the National Rifle Association's (NRA) views on gun prohibition, but criticizes NRA lobbying on the subject as ultra vires to the NRA's historical mission as a group devoted to sports and citizen military preparedness. Jerome P. Kassirer, Book Review, 330 NEW E NG. J. M ED. 373 (1994) (reviewing OSHA G. DAVIDSON, UNDER F IRE : T HE NRA AND THE BATTLE FOR GUN CONTROL (1993)). Compare his own and his predecessors' editorials urging anti-gun laws and health community lobbying for them. Jerome P. Kassirer, Guns in the Household, 329 NEW E NG. J. M ED. 1117 (1993); Arnold S. Relman, More Than Sutures and Transfusions, 297 NEW E NG. J. M ED. 552 (1977) (noting that the New England Journal of Medicine has been "squarely on the side of" anti-gun laws since at least 1968, and citing editorials going back to Franz J. Ingelfinger, Therapeutic Action for A National Ill, 278 NEW E NG. J. M ED. 1399 (1968)). See generally Richard W. Hudgens, Preventing Suicide, 308 N EW E NG. J. M ED. 897 (1983); James A. Mercy & Vernon N. Houk, Firearm Injuries: A Call for Science, 319 N EW E NG. J. M ED. 1283 (1988).
14 Arlene Eisen, Guns: In Whose Hands? A Portrait of Gunowners and Their Culture, 7 I NJ. P REVENTION NETWORK NEWSL., Winter 1989-1990, at 6. Ms. Eisen entitled one subsection "Fear and Racism Among Gun Owners," characterizing--without providing any example or supporting citation--"the veiled racism of NRA literature promoting self-defense." Id. at 9. She noted that "[t]he gun lobby grows fat... on a generalized fear and hostility toward African-American people, especially the association between African-American men and crime in the white public's mind." Id. at 10. See generally Deane Calhoun & Caroline Wang, The NRA: The Myth of Protection, the Marketing of Fear, 7 I NJ. P REVENTION NETWORK NEWSL., Winter 1989-1990, at 3; Dolins & Christoffel, Reducing Violent Injuries, supra note 5, at 638.
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