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Perspective
Firearm Violence
April 1, 2019

Mass Shootings and the Numbing of America

Author Affiliations
  • 1Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2019;179(5):610-611. doi:10.1001/jamainternmed.2019.0578

My daughter celebrated her bat mitzvah on October 27, 2018. It was a day of joyous celebration as she chanted from the Torah and provided her dvar Torah, her commentary on the ethics of the binding and near sacrifice of Isaac by his father Abraham.

At the same time, the Tree of Life Congregation in Pittsburgh, Pennsylvania, was celebrating the beginning of life with a bris, the ritual circumcision that brings a child into the community, and that also dates back to Abraham and Isaac. However, their joy was cut short; the service ended in mayhem as a man opened fire with an AR-15 assault rifle and 3 handguns, killing 11 congregants and wounding 6 others.

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    5 Comments for this article
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    Missing crucial data
    H Silverstein, MD | Preventive Medicine Center
    What % of mass shootings and homicides were committed with illegally obtained weapons?
    CONFLICT OF INTEREST: None Reported
    Biased and Incomplete Information
    Val Finnell, MD, MPH |
    Dr. Fleegler's comments selectively present information regarding firearm homicides in the United States. What he fails to do, among other things, is to look at how many times firearms are used defensively. No serious public health professional should only look at murder rates due to firearms, but also should consider defensive gun uses. The government's own estimate, which has a major methodology problem, is that people defend themselves 235,700 times each year with guns (Firearm Violence, 1993-2011, Bureau of Justice Statistics, May 2013). That's almost 6 times as many defensive gun uses as the 39,773 homicides quoted by Dr. Fleegler. Importantly; this estimate  is on the low end.

    As far as concealed handgun laws, gun homicides were 10% higher in states with restrictive concealed weapons laws, according to a study spanning 1980-2009 (An examination of the effects of concealed weapons laws and assault weapons bans on state-level murder rates, Applied Economics Letters, Vol 21, No. 4).

    Extreme risk protection orders are also problematic. First, there are serious Constitutional concerns about the abridgment of due process rights since the hearing is "ex parte." Second, one recent study showed that red flag laws had no significant effect on murder, suicide, the number of people killed in mass public shootings, robbery, aggravated assault, or burglary. There was also some evidence that rape rates rise (Lott, John R. and Moody, Carlisle E., Do Red Flag Laws Save Lives or Reduce Crime? (December 28, 2018). Available at SSRN: https://ssrn.com/abstract=3316573 or http://dx.doi.org/10.2139/ssrn.3316573).

    I want to counter the commonly heard assertion that mass shootings are somehow unique to the United States. Most recently, we saw a horrific mass shooting in New Zealand that has strict gun control laws that include registration, background checks, and a justification for purchase. None of these laws stopped the Christchurch massacre. Similarly, none of the laws that Dr. Fleegler is proposing would have stopped the Tree of Life shooting. Contrary to popular opinion, the United States does NOT hold the record for mass shootings. The U.S. ranks 11th on deaths due to mass public shootings and 12th on the frequency of mass shootings (See: https://crimeresearch.org/2015/06/comparing-death-rates-from-mass-public-shootings-in-the-us-and-europe/). Countries like France and Switzerland are ahead of the United States and France has very restrictive gun laws.

    Finally, there is no epidemic of school shootings. Overall since 1994, school homicides have not changed much. According to the CDC, between July 1994 and June of 2017, the occurrence of multiple-victim school homicide was 0.008 per 100,000 students. In 2017-2018, that number was 0.0096 per 100,000 (https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a1.htm?s_cid=mm6803a1_w#contribAff). There is no serious public health professional that would call something this rare an epidemic.

    The real problem is that mass shootings virtually all occur in "gun free" zones where people are disarmed and thus easy targets. The solution is not to take rights away from people, but to give them more rights and the freedom to protect themselves.

    Val W. Finnell, MD, MPH
    Colonel, USAF Ret.
    Pittsburgh, PA
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Mass Shootings and Social Capital
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired
    For our nation's health, there are several major health changes that have not been clearly explained as connected to underlying changes within our nation's social fabric. Worsening mass shootings are joined by worsening maternal mortality, child neglect, adolescent obesity, young adult suicide, sedative overdose mortality, homelessness, mid-life depression/disability and decreasing longevity at birth (now 4 years in a row). Between 1984-1999 and 2000-2015, the incidence of mass shootings increased by 234%. (citation below) During the same interval, maternal mortality increased by 239%. Currently, there are nearly 700 women who die annually because they lived in the USA instead of an OECD nation at the time of conception.

    It is likely that the most identifiable underlying cause of these changes in population health for our country can be attributed to the underlying loss of Social Capital, community by community. The related loss of social mobility and social cohesion has had catastrophic effects within our community's neighborhoods. Our nation's strategy for healthcare reform has no capability to mitigate this loss. I offer a contemporary definition for Social Capital as a basis to solve this catastrophic problem.

    ."A community's norms of Trust, Cooperation and Reciprocity that
    .its citizens are more likely to use for resolving the Social Dilemmas
    .they encounter daily within their community's Municipal Life
    .WHEN Caring Relationships broadly permeate
    .the social networks of the community's citizens, especially
    .the enduring Caring Relationships connecting each citizen's Family
    .with their Extended Family and Micro-Neighborhood Networks."

    A strategy similar to the Cooperative Extension Service (since 1914) for the agriculture industry will be required for healthcare reform, county by county. Remember our nation's agriculture industry is the most effective and efficient among the world's developed nations. Aspiring to the same attributes for our nation's health has become impaled by the institutional co-dependency that exists between the payors of healthcare and our providers of complex healthcare. Read the Social Capital definition again.

    Capellan JA, Gomez SP. Change and stability in offender, behaviours, and incident-level characteristics of mass shootings in the United States, 1984-2015. J Investig Offender Profil. 2018;15:51-72

    https://doi.org/10.1002/jip.1491
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Using guns in self defense is distinctly rare in the U.S. compared to the number of i firearm deaths.
    Archie Bleyer, MD | Oregon Health and Science University
    The article cites the Department of Justice special report on gun violence, which is now 8 years old, to contend that there are far more uses of guns in the U. S. for self-defense than there are firearm homicides. On the contrary, the relevant bulleted highlighted conclusion on page 1 of the report states:

    “In 2007-11, less than 1% of victims in all nonfatal violent crimes reported using a firearm to defend themselves during the incident.”

    Not only does the summary contradict the interpretation, but also the gun problem has worsened since 2011.
    CONFLICT OF INTEREST: None Reported
    A View from Australia
    Gavin Frost, MBBS MPH | University of Notre Dame Australia
    I never cease to be saddened by the extent of gun violence, and especially mass shootings, in the USA.
    CONFLICT OF INTEREST: None Reported
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