JAMA Editors Say Gun Deaths Are "Public Health Crisis"

The editors cited limits on research by CDC and called on physicians to be more proactive in screening for the presence of guns in homes of those at high risk for suicide.

Twelve editors of JAMA and its affiliated journals today published a joint editorial, “Death by Gun Violence—A Public Health Crisis,” that chastised Congress for limits on gun research and called on physicians to do more to halt the carnage, through simple steps like asking patients about guns in the home.1

“Guns kill people,” the editors wrote, 1 week after a well-armed gunman killed 58 people attending an outdoor music festival before shooting himself in a Las Vegas hotel room.

“More background checks; more hotel, school, and venue security; more restrictions on the number and types of guns that individuals can own; and the development of ‘smart guns’ may help decrease firearm violence,” the editors continued. “But the key to reducing firearm deaths in the United States is to understand and reduce exposure to the cause, just like in any epidemic, and in this case, that is guns.”

The editorial, which appeared online simultaneously across all journals in the JAMA network, was accompanied by a JAMA viewpoint, “The Las Vegas Shootings—Underscoring Key Features of the Firearm Epidemic.”2 Authors of the article drew on the events of the October 1, 2017, when a 64-year-old man brought 23 weapons to a 32nd floor suite at the Mandalay Bay hotel. The authors,

including an official with the Norwegian Centre for Violence and Traumatic Stress Studies in Oslo, Norway, also drew on experiences from the 2011 mass shooting in that country that caused 69 deaths.

Beyond the fatalities, other issues demand attention, the authors wrote, including the enormous toll of firearm injuries and the subsequent rates of psychological distress. These authors examine the role of corporate interests “whose incentive is to manufacture and sell firearms,” which they say have had the effect of “privileging individual gun ownership over collective safety.”

The JAMA editors cited 2015 statistics that firearms caused 36,252 deaths, more than those caused by traffic accidents, adding, “Often forgotten is that 60.7% of the gun deaths in 2015 in the United States were suicides.” Suicide attempts with guns are almost always successful, they write, while ingestions of pills or wrist cutting fail 90% of the time.

Prevention matters in an epidemic, the JAMA editors note. But when it comes to guns, prevention is constrained by a 2-decade limit that Congress has imposed on scientific research; the ban states that CDC cannot fund projects that “advocate or promote gun control.” Scientists have heard the message loud and clear, and gun deaths are not treated the same way as data collection that has helped bring down smoking rates or track the rise of opioid abuse. Instead, these are treated as police records, even if the deaths are caused by police.

But physicians and healthcare professionals can take steps now. Asking about guns in the home is important, “especially with high-risk patients,” they write, and discuss removing and storing guns elsewhere. “Physicians can conduct appropriate screening and early intervention for suicide, the most common cause of gun death,” the editors said.

The JAMA editors cited polls that the public wants steps to curtail violence, and offered to provide policymakers “with accurate, timely information to guide interventions that will reduce injuries and deaths from guns.”

References

1. Bauchner H, Rivara FP, Bonow RO, et al. Death by gun violence—a public health crisis [published October 9, 2017]. JAMA network. doi:10.1001/jama.2017.16446.

2. Schultz JM, Thoresen S, Galea S. The Las Vegas shootings—underscoring key features of the firearm epidemic [published online October 9, 2017]. JAMA. doi:10.1001/jama.2017.16420.