Guns And Public Health: Epidemic Of Violence Or Pandemic Of Propaganda?

[Copyright © 1994 Tennessee Law Review. Originally published as 61 TENN. L. REV. 513-596 (1994). For educational use only. The printed edition remains canonical. For citational use please obtain a back issue from William S. Hein & Co., 1285 Main Street, Buffalo, New York 14209; 716-882-2600 or 800-828-7571.]

GUNS AND PUBLIC HEALTH: EPIDEMIC OF VIOLENCE OR PANDEMIC OF PROPAGANDA?

DON B. KATES, *
HENRY E. SCHAFFER, PH.D.,**
JOHN K. LATTIMER, M.D.,***
GEORGE B. MURRAY, M.D.,****
AND EDWIN H. CASSEM, M.D.*****

"[Knowledge is neither good nor evil, but takes its character from how it is used.] In like manner, weapons defend the lives of those who wish to live peacefully, and they also, on many occasions kill [murder] men, not because of any wickedness inherent in them but because those who wield them do so in an evil way."1

I. INTRODUCTION
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.

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XVI. CONCLUSION
We believe we have documented an emotional anti-gun agenda in the treatment of firearms issues in the medical and public health literature. While the anti-gun editorials and articles discussed had the superficial form of academic discourse, the basic tenets of science and scholarship have too often been lacking. We call them "anti-gun health advocacy literature" because they are so biased and contain so many errors of fact, logic, and procedure that we can not regard them as having a legitimate claim to be treated as scholarly or scientific literature.

Criminological and sociological analysis provides important, even crucial, information as to the role of firearms in violence and the utility and viability of potential gun control strategies.
Virtually all of this information is ignored or affirmatively suppressed in the health advocacy literature. That literature also shows consistent patterns of making misleading international
comparisons, mistaking the differences between handguns and long guns, and exaggerating the number of children injured or killed, thereby building up the emotional content. Other distortions include presenting gun ownership in such a manner as to ignore or minimize the benefits, and measuring defensive benefits purely in terms of attackers killed, rather than considering attacks deterred or attackers repelled. To the contrary, the criminological and sociological research literature demonstrates the existence of high risk groups for firearms misuse, and of the "career" criminals who commit many of the serious crimes in our society. Yet the anti-gun health advocacy literature consistently overlooks these data and attributes equal propensity to commit violent crime to all people.

The health advocacy literature exists in a vacuum of lock-step orthodoxy almost hermetically sealed from the existence of contrary data or scholarship. (pg.596) Such data and scholarship routinely goes unmentioned and the adverse emotional reaction of the gatekeepers of the health journals assures the elimination of contrary views from their pages. In the rare instances in which works with contrary views are cited at all, they tend to be dismissed with ad hominem comments, but without the presentation of evidence or analysis refuting them. The anti-gun health advocacy literature can be described with the derogatory term "sagecraft," implying that academics have gone beyond the pale. Superficialities of scientific methodology and presentation are used to counterfeit scholarship supporting an anti-gun agenda while the basics of sound research are ignored. This shameful performance implies the willing collaboration of the researchers, the journals, and the CDC as a federal governmental funding agency. While many medical and public health journals have participated in this sagecraft, the New England Journal of Medicine has been one of the most noticeable. It has an editorial policy which is strongly and explicitly anti-gun, has published poorly written anti-gun articles, and has excluded articles which disagree with its editorial policy. These actions forfeit its claim to be a research journal rather than just a political advocacy publication.
This indictment of the anti-gun health advocacy literature is extremely troubling in an era in which research and data are often sought as a basis for debate over guns and formulation of public policy. When emotionally based anti-gun, pseudo-scientific advocacy is presented in the guise of research, ill-founded policy decisions may ensue, wasting public resources and harming many people. The medical and public health journals need to eschew their emotionally based advocacy role in favor of presenting scientific research results.

Finally, some remark must be made on the idea of violence as an epidemic and a public health emergency. For that purpose, we are delighted to adopt recent comments by a preeminent
neutral scholar in criminology, Professor James D. Wright:

And there is a sense in which violence is a public health problem. So let me illustrate the limitations of this line of reasoning with a public-health analogy. After research disclosed that mosquitos were the vector for transmission of yellow fever, the disease was not controlled by sending men in white coats to the swamps to remove the mouth parts from all the insects they could find. The only sensible, efficient way to stop the biting was to attack the environment where the mosquitos bred. Guns are the mouth parts of the violence epidemic. The contemporary urban environment breeds violence no less than swamps breed mosquitos. Attempting to control the problem of violence by trying to disarm the perpetrators is as hopeless as trying to contain yellow fever through mandible control. 368

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* Criminologist and lawyer, San Francisco, California.
** Professor of Genetics and Biomathematics, Department of Genetics, North Carolina State University.
*** Professor Emeritus, Columbia Medical School.
**** Associate Professor of Psychiatry, Harvard Medical School, and Chief of Psychiatric Consultation Service, Massachusetts General Hospital.
***** Associate Professor of Psychiatry, Harvard Medical School, and Chief of Psychiatry, Massachusetts General Hospital.


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 NEW ENG. J. MED. 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, THE DECAMERON 686 (Musa & P. Bondanella trans., Mentor-New American Library 1982).

2 See, e.g., SAMUEL WALKER, SENSE AND NONSENSE ABOUT CRIME AND DRUGS: A POLICY GUIDE chs. 10 and 13 (1994); GARY KLECK, POINT BLANK: GUNS AND VIOLENCE IN AMERICA (1991) [hereinafter KLECK, POINT BLANK]; GERALD D. ROBIN, VIOLENT CRIME AND GUN CONTROL (1991); JAMES D. WRIGHT ET AL., UNDER THE GUN: WEAPONS, CRIME, AND VIOLENCE IN AMERICA (1983) [hereinafter WRIGHT ET AL., UNDER THE GUN]; JAMES D. WRIGHT & PETER H. ROSSI, ARMED AND CONSIDERED DANGEROUS: A SURVEY OF FELONS AND THEIR FIREARMS (1986) [hereinafter WRIGHT & ROSSI, ARMED AND CONSIDERED DANGEROUS]; see also infra note 43.

[Copyright © 1994 Tennessee Law Review. Originally published as 61 TENN. L. REV. 513-596 (1994). For educational use only. The printed edition remains canonical. For citational use please obtain a back issue from William S. Hein & Co., 1285 Main Street, Buffalo, New York 14209; 716-882-2600 or 800-828-7571.]

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