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Feb 11, 2013

Weapons of Mass Destruction

Author Affiliations

Author Affiliations: Division of Clinical Decision Making, Informatics, and Telemedicine, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, and Department of Medicine, Stanford University, Stanford, California.

JAMA Intern Med. 2013;173(3):182-183. doi:10.1001/jamainternmed.2013.4026

While our national leaders agonize about the threats in the Middle East from missiles, bombs, and automatic weapons that might fall into terrorist hands, they have remained eerily silent about the unlimited access to weapons of mass destruction in our own backyard. In a sickening recapitulation of terror wrought in schools, movie theaters, and malls, our nation grieves for the large number of innocents murdered in a few minutes by a single American gunman. Yet the gun lobby has successfully muzzled political debate about guns, shut down federal research on gun-related injuries, and promoted legislation that prevents physicians from asking patients about gun-related risks. In the last few years, Supreme Court cases resulted in judgments that affirmed the right to keep guns in the home for protection. Recently, a federal appeals court ruled that our citizens even have a constitutional right to carry loaded guns outside their homes.1 Although legal scholars have questioned the current relevance of the Second Amendment, now that men no longer have to bring their private weapons to join the local militia,2 the Supreme Court has spoken, and for now we must live with its interpretation.

Our sense of security, already seriously shaken by the launching of long-range missiles by rogue countries, by attacks on our citizens abroad, and by brazen terrorist assaults at home, now has us looking over our shoulders when we send our children to school or go to Macy's to buy a shirt. This state of chronic anxiety over safety is new; it is damaging individually and to our national psyche, and we must ameliorate the threats. We must not tolerate a situation in which some irrational, seriously disturbed person with a grudge can quickly blow us to bits along with dozens of others.

Many approaches to prevent this kind of mayhem have been proposed. Some have suggested arming the public: the more guns, they argue, the greater the likelihood that someone will be able to “take down” a shooter. But imagine asking school nurses, librarians, sales clerks, and movie ushers to “pack heat.” Would they kill the shooter or, accidentally, each other? If we judge by recent experiences, this strategy is wanting. In Florida, a “neighborhood watch coordinator” killed an unarmed boy who was acting suspiciously; and near the Empire State Building, police fire injured 9 pedestrians while they were subduing 1 shooter. Would “more guns” lead to fewer gun deaths? Unlikely.

Perhaps, as some have suggested, we could do a better job at prospectively identifying potential shooters based on their psychological profile. Fundamental principles of screening dooms this approach: because men who are described as loners, socially awkward, or some other analogous profile are common, and shooters among them are rare, false-positives would vastly outnumber the true-positives, and thus the number needed to treat (assuming that treatment is preventative) is enormous. Furthermore, some shooters fit no such profile. Prevention based on profiling is simply impractical.

Those who argue that the media, namely television, movies, and video games, glorify guns are undoubtedly correct, and it is reasonable to presume that this extreme focus on weapons encourages some people to violence. Unfortunately, this issue has been debated for decades, and yet no one has been able to convince the entertainment industry to stop romanticizing guns.

We could lessen the anxiety of being at the wrong place at the wrong time by setting up airport-style screening in all public places, as some schools and government buildings have already done. Yet we already grumble about removing our belts and shoes and submitting to invasive and embarrassing body palpation. Moreover, widespread screening is impractical and imperfect and would cast a pall on everyday life.

Assault rifles and handguns with high-capacity ammunition clips are weapons of mass destruction. Though it is true, as the gun lobby asserts, that “people kill people,” the capacity to murder 26 people in the space of a few minutes, as was the case in the recent shooting in Newtown, Connecticut, is enhanced by the ability to get off multiple rounds by merely repeatedly pressing the trigger. How can we discuss causality between the shooter and the extent of deaths and injuries without considering the role of the guns? I am not a gun owner, and I have never understood the allure of owning weapons capable of firing 20 or 30 rounds or more without reloading.3 No self-respecting hunter would use such a weapon, and target practice could easily be accomplished without them. If protection is the rationale, what enemy are the owners of high-capacity guns envisioning? It is hard to recall any event in more than a century in which the police, the National Guard, or the US Army have failed to protect the populace. Is an obsession with “freedom” dependent on owning assault weapons?

Given the large and increasing number of deadly mass shootings and the enormous number of military-style assault weapons available, it stands to reason that we must find ways of reversing the trend, and as physicians, this task should be part of our professional responsibility. We can advocate for restoring the ability of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention to study gun-related injuries and fund these efforts generously.4 Only then can we get answers to some of the unresolved questions about the relationships between private firearms and injuries and deaths.5 We can advocate for a comprehensive analysis of gun ownership by the Institutes of Medicine. We must resist all efforts such as a Florida law that restricts physicians' ability to talk to patients about the risks of guns and routinely inquire about whether they own firearms.6 We can press our national leaders to require registration, background checks, and waiting periods for all gun purchases, not only for some of them.7 And we can push for requirements that make guns safer such as trigger locks that require a code to operate the weapon. We can argue for legislation to restrict the sale of large-capacity magazines and formidable amounts of ammunition. Nothing in the recent Supreme Court rulings prevents such state or national legislation. Even reducing the number of such weapons is not impossible, as illustrated by the 1996 Australian experience, in which a buy-back program substantially reduced the number of firearms in private hands and, to date, has eliminated mass shootings.

But we can do none of this without leadership at the highest levels of government. Opposing the gun lobby's absolutist stance on regulation takes courage, persistence, and fortitude. It can be done, as illustrated by the 1994 passage of the federal assault weapons ban that included a prohibition on the manufacture for civilian use of certain semiautomatic firearms and large-capacity ammunition-feeding devices. So far, President Obama has been vague about his intentions, and though a few politicians have begun to talk about new gun restrictions, the National Rifle Association has yet to exercise its clout over them. The Bush administration allowed the assault weapons ban to expire in 2004; notably, multiple efforts to renew the ban have failed.

While troops were searching fruitlessly in the deserts of Iraq for “weapons of mass destruction,” our politicians have been ignoring major public threats from the increasing number of military-style weapons of mass destruction in the closets, bedside tables, and car trunks in our own cities and towns.

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Article Information

Correspondence: Dr Kassirer, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111 (jpkassirer@gmail.com).

Published Online: December 21, 2012. doi:10.1001/jamainternmed.2013.4026

Conflict of Interest Disclosures: None reported.

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