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The JAMA Forum
February 2, 2016

4 Simple Reforms to Address Mass Shootings and Other Firearm Violence

Author Affiliations
  • 1University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center, and Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights. His most recent book is Global Health Law (Harvard University Press)

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(5):453-454. doi:10.1001/jama.2015.19497

After the December 2, 2015, terrorist attack in San Bernardino, California, that left 14 people dead and 21 injured, the same, repetitive, “Groundhog Day” narrative played out on gun control as with other salient mass shootings, including a school in Sandy Hook, Connecticut, a Planned Parenthood clinic in Colorado Springs, Colorado, a community college in Roseburg, Oregon, and a church in Charleston, South Carolina ( That narrative has become so predictable that I despair the political community ever finding middle ground.

Lawrence O. Gostin, JD

Georgetown University Law Center

After such tragedies, Democrats urge “sensible” gun control, such as more rigorous background checks. Republicans claim that calls for gun control exploit a tragedy and are futile in preventing mass shootings. They say the answer to mass shootings is more, not fewer, guns, and firearm purchases soar after mass shootings as tens of thousands of people vote with their feet.

But Australia and the United Kingdom have vastly reduced firearm-related deaths through legal reform ( And even though the US Supreme Court has ruled—controversially and ahistorically—that the Second Amendment protects private ownership of firearms (, the Court recently refused to hear a Second Amendment challenge to a Chicago ordinance that banned semiautomatic assault weapons and large-capacity magazines ( And the lower US courts have all upheld reasonable firearm regulations.

From a public health perspective, of course, the solution is tight regulatory control over firearms, including rigorous background checks, safety rules, and the types of firearms permitted. Here are 4 reforms to keep us safer:

Dedicate Federal Funding for Firearms Research

In 1996, Congress inserted language into the Centers for Disease Control and Prevention (CDC) appropriation bill: “… none of the funds made available for injury prevention and control … may be used to advocate or promote gun control” ( Political repercussions resulted in a self-imposed ban on firearms research. Even after President Obama ordered the CDC to study firearm violence (, the agency declined, stating it needed dedicated funding (

There is a political chill in the air. Understanding firearm violence, its causes, and prevention tools, needn’t entail advocacy or lobbying, which the law already forbids. Former Congressman John Boehner (R, Ohio) said, “I’m sorry, but a gun is not a disease. Guns don’t kill people—people do” ( Yes, of course, but researchers study and agencies regulate a host of consumer products. Cars, for example, do not kill, but human behavior, and unsafe vehicles and roads do—so we regulate vehicles and design safer roads.

Require Universal Background Checks and Share Firearms Data

Wide bipartisan agreement exists on 2 ideas, both true but also polar opposites. First, Democrats and Republicans believe firearm control is a political loser, due to the National Rifle Association’s (NRA) political muscle and ardent single-issue voters. Second, 90% of the public consistently supports universal background checks ( Politicians are chilled from doing what Americans want and what public health dictates.

There ought to be consensus over closing glaring gaps in the regulatory framework—loopholes for sales at gun shows, selling guns to individuals on federal no-fly lists, and limits on sharing data among law enforcement agencies.

The sale of a firearm, wherever it takes place, should be predicated on responsible ownership—no record of violence, suspicion of radicalism, or mental illness posing a danger to self or others. The only way health authorities can know a customer’s suitability to buy a weapon is to conduct a thorough background check. And if a potential gun buyer is on the no-fly list, it ought to disqualify him or her from buying a gun. Conservatives say the no-fly list is overly broad; if so, then make it more precise, but don’t allow a potential terrorist to gain access to firearms.

Federal law significantly restricts law enforcement investigation of gun crimes and prosecution of unscrupulous dealers ( This includes prohibiting the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF) from releasing firearm trace data to cities and states, requiring the Federal Bureau of Investigation to destroy all approved gun purchaser records within 24 hours, and prohibiting the ATF from requiring gun dealers to submit their inventories to law enforcement. What conservative ideology would tie the hands of law enforcement?

Ban Assault Weapons and Armor-Piercing Bullets

Assume that citizens have a right to bear arms for sport or self-protection. That does not foreclose regulation of inherently dangerous weapons ill-suited to sport and more likely to cause mayhem than to offer self-protection. Rapid-fire weapons and armor-piercing bullets are weapons of choice in mass shootings.

Even if law-abiding citizens have a right to possess handguns and rifles, high-powered weaponry is beyond any reasonable interpretation of SecondAmendment rights. As Judge Frank H. Easterbrook, of the US Court of Appeals for the Seventh Circuit, wrote (, “assault weapons with large-capacity magazines can fire more shots, faster, and thus can be more dangerous … why else are they the weapons of choice in mass shootings?” The conservative rejoinder is that criminals and terrorists will not be dissuaded by legal rules, but law-abiding citizens will. They cite countries with strict firearms control where such weapons were used in mass shootings, including Norway and France.

No regulation in any sphere can guarantee complete safety, but such measures can significantly reduce injuries and deaths.

Regulate Firearm Safety Design

Unlike other consumer products, safety standards rarely apply to guns ( The NRA opposes safety standards, just as carmakers opposed seat belts and airbags. There are numerous technologies that if widely applied, even mandated, would prevent unauthorized firearm use and accidental discharge—saving lives from suicides, unintentional shootings, and criminals obtaining another person’s weapon.

Safety rules such as mandating trigger and biometric gunlocks, safe storage, and firearm safety training would not affect gun ownership. Injury prevention research teaches us that in addition to measures that promote safer human behavior, such as drivers’ licenses and banning impaired or distracted driving, product design can dramatically reduce injuries. For example, road and vehicle design have made driving much safer in the United States and other developed countries, through such measures as speed bumps, pedestrian crossings, lane markings, and passive restraints.

Beyond all the political hand-wringing about mass shootings, the real American tragedy is inner-city violence and suicides involving firearms. In 2013, the CDC reported 11 208 firearm homicides, 3.5 per 100 000 population, with the vast majority of all firearm deaths from suicides and homicides ( Between 2005 and 2012, mortality rates declined for all leading causes of death, except suicide; as JAMA researchers observed, “For suicide in the United States, the most important modifiable risk factor is access to firearms” (

Of course, gang violence and self-harm would continue if individuals were sufficiently determined. But guns provide the means to inflict much greater damage than knives or fists. Society cannot avoid every social ill through firearms control, but we know how to reduce the daily drumbeat of lost lives in America.

So why are our political leaders unwilling to keep us safer? Can we break through the Groundhog Day political narrative that stops firearms regulation dead in its tracks?

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Article Information

Corresponding Author: Lawrence O. Gostin, JD (

Published online: December 16, 2015, at

Disclaimer: Each entry in The JAMA Forum expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association.

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