WPC  2BPZCourier 10cpi3|wxx6X@8;X@HP IIISi (Legislative)HPLAIITS.PRSx  @H~X@2I 2/4cs(CG Times (Scalable)CG Times Italic (Scalable)3|w"m+O6^;C]ddCCCdCCCCddddddddddCCȲY~~wCN~sk~CCCddCYdYdYCdd88d8ddddJN8ddddYYdYddddddCddddddddd8YYYYYY~Y~Y~Y~YC8C8C8C8ddddddddddYdddddsdYYYYYYYd~Y~Y~Y~YddddddddC8C8C8C8oNd~8~8~8~8~8dvddddJJJkNkNkNkN~8~8~8dddddddYYYd~8dJkN~8dddddCddCCCWxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxNdddCYQQddddddFddddFCChhd44ddzzdddwoodChdF"Ȑdhd岲dCCȐzȲxCddodȐȅdCdYdsȐ]ȐȐȧzȐUwŐdȐYYCCCCѐz~ozoY~NYdYC8YooYdYzsdzdd~YYzozzzzNd88YYYzYzzzzCCdddddddzzzzzzzzzzzzzzzzzzzNNNNNNNdddddddddddddddddddd888888888888YYYYYYYYYYYYYYYYYYYzzzzzzzzzzzzzzzzzzzzCs~CzCddYCx2 Z{X-HP IIISi (Legislative)HPLAIITS.PRSXv\> Ps7;H~XP 8wC;,[7Xw P7XP V"G($,hG P7hP&6uC;,/lXu&_ x$&7XX;hP5sC2,Xs\w xs"m+O6^$(8<><q*"xxxxWWxxxWWkkxxx (   Over the past two decades, criminologists have learned a great deal about firearms and  YH violence.X01Í ÍX5*Í Í* H Y ԍThere has also been massive research on the intentions of the framers of the Second Amendment, and of similar state constitutional protections of the right to keep and bear arms, making it clear that an individual right for sane, nonfelonious adult citizens to own commonlyowned types of guns was expressly what was intended, and that the "militia" reference was to the persons who might be expected to protect the nation in case of an emergency, not any organized body of soldiers. And the Fourteenth Amendment was intended to apply that  Y7 guarantee against infringement by the states. SP Halbrook. That every man be armed: the  Y" evolution of a constitutional right. Albuquerque: Univ. of New Mexico Press, 1984. A right  Y  to bear arms: state and federal bills of rights and constitutional guarantees. Westport, Conn.:  Y Greenwood Press, 1989. S Levinson. The embarrassing Second Amendment. Yale Law J 1989;99:637659. It is understandable that the medical community would not be concerned with constitutional law; it is unclear why MDs and MPHs feel comfortable pretending expertise on the matter in medical journals. Unfortunately, the public health response has largely been to ignore the findings or miscite them in the rhetorical push to have the medical community pretend it has proven the widespread availability of firearms to be a problem, with educational and legislative solutions obvious. While some of the public health production of data have proven interesting, virtually all of the analysis has been pointless, misguided, and dishonest. The criminological findings are, in some ways, disappointing. The most thorough studies  Y by James D. Wright and his colleagues, first at the University of Massachusetts Y ԍ Wright JD, Rossi PH, Daly K. Under the gun: weapons, crime, and violence in America. New York: Aldine, 1983., Y ԍ Wright JD, Rossi PH. Armed and considered dangerous: a survey of felons and their  Y firearms. New York: Aldine de Gruyter, 1986. and then at  Y Tulane, Sheley JF, McGee ZT, Wright JD. Gunrelated violence in and around innercity schools.  Y AJDC 1992;146:677682., Y ԍ Wright JD, Sheley JF, Smith MD. Kids, guns, and killing fields. Society 1992;8489(Nov/Dec). along with the massive literature review and original research by Gary Kleck~ Y ԍ Kleck G. Point blank: guns and violence in America. New York: Aldine de Gruyter, 1991.~ at Florida State University, are all disappointing to a society wishing for simple answers to firearms related violence. Briefly, they have not found firearms availability related to criminal violence, homicide, or suicide. And virtually no gun law has any impact on violent crime, or gun use in violent crime. Kleck found some approaches to punishing unlawful carrying of a firearm somewhat beneficial, and some differences in law or gun availability might affect slightly gun use in suicide but not the overall suicide rate. Guns are frequently used for protection, and using a gun for protection reduces the likelihood the crime will be completed or that the intended victim will be injured. In short, although Wright and Kleck still support some restrictions on firearms, they found no reason to find ownership of guns, or handguns, by ordinary citizens to be a problem, and no reason to believe gun laws would curb the problem. Some of this should be obvious to persons looking at trends in gun or handgun ownership and misuse. Most of the increase in suicide in recent decades occurred with firearm and handgun ownership by households stable;Nm 0*0*0* there was no increase in homicide and suicide following the rise in household ownership of handguns. The recent increase in homicide came at a time when the firearms market was in the doldrums. More significantly, during the 1980s, for most age, ethnic, and gender groups, firearmsrelated deaths declined including deaths among women and domestic homicides, even as there were widespread reports of gun manufacturers targeting women. Most of the recent increase in youth suicide has been less than that in Europe, and most of the increase in homicide has been among persons with traditionally the lowest levels of gun ownership and facing the  Y_ most restrictive gun laws: young, innercity blacks and Hispanics.ߧ Blackman PH. Children and firearms: lies the CDC loves. Paper delivered at annual meeting of the American Society of Criminology, New Orleans, 1992. These data and the failure of gun laws are largely ignored in the rhetorical public health approach to firearms and violence exemplified by the Centers for Disease Control and Prevention (CDC), and its leading spokesmen, Mark Rosenberg and James Mercy, who believe that if they can demonstrate that firearms are involved in morbidity and mortality they are then the epidemiological approach proves that any and all proposals will be effective in solving the  Y endemic problem of violence in America, which they call epidemic.ߧ Blackman PH. Criminology's astrology: the CDC approach to public health research on firearms and violence. Paper delivered at annual meeting of the American Society of Criminology, Baltimore, 1990. One problem with the public health approach is a reliance upon unscientific and deceitful methods. Criticism of public health research on firearms is rebutted not with factual material but with an assertion that the critic is biased. One example: "Coming from an official spokesman for the National Rifle Association [NRA], Blackman's invective is no surprise. Kleck's and Wright's longheld views on the issue of gun control are also well known, and their  Y criticism was predictable."ߧ Sloan JH, Rivara FP, Kellermann A. Correspondence: firearm regulations and rates of  Y suicide. N Engl J Med 1990;323:136137. As it happens, Wright's longheld views were as an advocate of  Y restrictive gun laws whose mind was changed by his research;r ߧ Y ԍ Wright JD. Second thoughts about gun control. Public Interest 1988;91:2339.r and Kleck remains a supporter  Y of restrictive gun laws and has been criticized for that by the NRA. ߧ Blackman PH. Book review: Gary Kleck. Point blank: guns and violence in America.  Y Criminologist 1993;18(3):16. Neither gibe is a  Y scientific response. A more imaginative effort at ad hominem criticism occurred when public health researchers wished to suggest that the theory that, absent a firearm, a potential suicide  Y would simply use a different method, was flawed. ߧ Kellermann AL, Rivara FP, Somes G, Reay DT, Francisco J, et al. Suicide in the home  Y in relation to gun ownership. N Engl J Med 1992;327:467472. They first cited a letter to the New  Y England Journal of Medicine where the substitution theory was enunciated with a citation to  Y a medical journal article ߧ Rich CL, Young JG, Fowler RC, Wahner J, Black NA. Guns and suicide: possible effects  Y of some specific legislation. Am J Psychiatry 1990;147:342346. but the author's affiliation was not given, and then cited a paper by the author, where the substitution theory was not mentioned, but the NRA could arguably be listed as the "publisher." This leads to mention of a related unscientific attitude in public health research, the miscitation of sources. A study which found that a restrictive gun law was followed by a change  Y in the method of suicide but no change in the rate12 was cited11 to support the opposite conclusion. Two surveys one of which asked nothing about firearms accidents, and the other of which asked about accidents but not where they occurred were cited as suggesting "that guns kept in homes are involved in unintentional deaths or injuries at least as often as they are  Y" fired in selfdefense." ߧ Y ԍ Kellermann AL, Reay DT. Correspondence: firearmrelated deaths. N Engl J Med 1986;315:1484. This followed a study which cited two FBI sources for the proposition  Y# that "Less than 2 percent of homicides nationally are considered legally justifiable."ߧ Kellermann AL, Reay DT. Protection or peril?: an analysis of firearmrelated deaths in  Y the home. N Engl J Med 1986;314:15571560. Neither source reported that figure. The FBI did not then report data on the number of homicides police thought might be legally justifiable, and still does not collect data on the number determined by prosecutors or others to be legally justifiable. When a source is attempted to be given for the assertion that gun manufacturers' 1980s targeting of a women's market was followed women's)'0*((aa  Y gunrelated deaths is at an alltime high, a statement popular with the CDC's Mercy,ߧ Y ԍ Cotton P. Gunassociated violence increasingly viewed as public health challenge. JAMA 1992;267:11711174. the source cited is a 1987 work, with data ending in 1982, showing women's gunrelated deaths to  Y have peaked in the 1970s.ߧ Y ԍ Wintemute GJ. Firearms as a cause of death in the United States, 19201982. J Trauma 1987;27:532536. Almost all firearms studies in the public health literature includes citations of materials which do not say what they are purported to have said, or, worse, say something different. The irony of the assertion that Wright's views on "gun control" were "well known" is that, in a previous publication, the same authors had miscited him to support the proposition that  YH "restricting access to handguns could substantially reduce our annual rate of homicide."ߧ Sloan JH, Kellermann AL, Reay DT, Ferris JA, Koepsell T, et al. Handgun regulations,  Y crime, assaults, and homicide: a tale of two cities. N Engl J Med 1988;319:12561262. Mercy's activities also exemplify the problem of public health professionals using rhetoric in place of science. Two examples he likes to make are between the number of firearmrelated deaths which occur in America in a twoyear period with the number which occurred in Vietnam battlefields, and to the number which occurred in the 1980s versus the numbers of AIDSrelated  Y deaths during the 1980s.15 The first, in addition to neglecting the fact that the America's mission was ancillary, and the vast majority of casualties were Vietnamese, ignores the key element of rates per 100,000. America's presence in Vietnam rarely exceeded 600,000, with an annual death rate in excess of 1,000. America's population hovers around 250,000,000. And the AIDS comparison includes years before AIDS was identified and was just beginning its epidemic growth; AIDS now exceeds suicide and homicide as a cause of death in the U.S. The CDC rhetorically notes that firearms, or homicides and suicides exceed natural causes as a cause of death for adolescents and youth adults something to be expected, since, once children escape the killers of infancy and childhood, external causes remain the leading expected cause of death until ailments of middle age come on. In fact, the real change over the past decade has not been that young adults are not killed by natural causes, but that persons aged 2544 increasingly are, by AIDS. Similarly, the CDC rhetorically notes that firearmrelated deaths, for the first time, exceeded motorvehicle deaths in two states, suggesting this was because of an increase in  Ye firearmrelated deaths,zߧ Y ԍ CDC. Firearmrelated deaths Louisiana and Texas, 19701990. MMWR 1992;41:213221.z especially in followup citations. The data in the report indicate that Louisiana accomplished that feat in 1974. More importantly, (a) other data indicate that, nationally, the fall in firearms accidents was greater for that period than the fall in motorvehicle  Y  accident.[ߧ National Safety Council. Accident facts, 1993 edition. Chicago: NSC, 1993.[ And (b) the data comparing accidents with motor vehicles to accidents, suicides, and homicides involving firearms actually showed that, particularly in Texas, both firearms and motor vehicles saw significant decreases, it was merely that the decrease was so much faster for motor vehicles that they fell below firearms. Perhaps more importantly, since some of the rhetoric is obviously just that, is the deliberate skewing of data, either with or without some ostensible other reason. Perhaps the most important single skew is the limitation in the vast majority of public health studies related to firearms where any actual benefits from or harms involved with firearms are measured to mortality data. Mortality data are chosen because they are the available data rather than because they are the right data. The result is to skew matters so that firearms seem more relevant to public health than to criminology. After all, only fractions of a percent of crimes#'0*((aa involve guns; even violent crimes involve firearms only about 13% of the time. But switch from percentages to rankings as a "cause" of death, and firearms rise to greater significance. Similarly, it is possible to pretend firearms are more dangerous to people and to healthcare costs than motor vehicles once morbidity is ignored in favor of mortality. The result, however, is to exclude from consideration the use of firearms in nonfatal ways either in violent crimes, accidents, or for sport or protection. Other skewing of data also occurs. Much of the rhetoric regarding children and X5*Í ÍX1*Í Ífirearmsrelated deaths is achieved by redefining children to include persons up to the age of 19 and  Y1 excluding persons 01.+ Fingerhut LA, Kleinman JC. Firearm mortality among children and youth. NCHS Advance Data No. 178 (Nov. 3, 1989). The obvious reason is the tiny number of firearmrelated deaths among infants, and the high numbers of deaths from natural causes. Later, in reporting trends in gunrelated deaths, the lead author began her study with 1985 because showing an entire  Y decade would show a sharp decline in firearmrelated deaths between 1980 and 1985.+ Fingerhut, LA. Firearm mortality among children, youth, and young adults 134 years of age, trends and current status: United States 19851990. CDC Advance Data 231 (March 23, 1993)., ڂ Fingerhut LA, Kleinman JC, Godfrey E, Rosenberg H. Firearm mortality among children, youth, and young adults 134 years of age, trends and current status: United States 19791988. CDC Monthly Vital Statistics Report 39 (Supplement)(March 14, 1991).  Similarly, because, while firearms are now involved in about twothirds of homicides  Y nationally, but in only onequarter of those involving children,+ U.S. Dept of Justice Federal Bureau of Investigation. Crime in the United States, 1992 (Uniform Crime Reports). Washington, D.C.: Government Printing Office, 1993. homicide victims under 13  Y were excluded from a study of homicides in the home.+ Kellermann AL, Rivara FP, Rushforth NB, Banton JG, Reay DT, et al. Gun ownership  Y as a risk factor for homicide in the home. N Engl J Med 1993;329:10841091. It would not have taken many children's homicides in homes without firearms in the three counties studied, plus a few false denials of a gun's presence in the homes of controls, for the crude odds ratio for gun ownership to fall below the level of significance. In the same authors' earlier and similar study of suicide, about 30% of suicides were excluded because they occurred outside the home and such suicides  Y were reported by the authors to be less likely to involve guns.11  Those studies were also skewed against firearms by rhetorically ignoring risk factors measured and found to be far greater, but keeping firearms as the focus in the title, in the press,  Y and in educational and policy recommendations.11,24 In the suicide study, firearms as a risk paled compared to tests of illicit drug use, living alone, and domestic violence. In the homicide study, firearms came in fifth of six factors tested for the adjusted odds ratio, behind illicit drug  Y| use and domestic violence.X1*Í ÍX5*Í ÍX5*Í ÍX5*Í Í+*|ߧ Y ԍAn interesting aspect of this for the CDC is that, in speaking to the 1992 annual meeting of the American Society of Criminology, the CDC's Mercy told his audience that firearms research was a high priority for the CDC but that domestic violence research was not.+ Other factors were either not checked at all or were ignored in the calculations. With onethird of the suicide study above the age of 60, no question of physical health was asked. And, while the question of treatment for depression or mental illness was asked, it was not included in the factors for which crude or adjusted odds ratios for suicide were calculated: In fact, the odds ratio, if calculated, would have been about 25 times higher for depression than for firearms ownership. In the homicide study, factors ignored included family upbringing at a time when even the media are noticing, as criminologists long have, the importance of oneparent families as a risk factor, and whether socialization is by peers or family. The entire "case control" approach, justified on the grounds it is useful for studying"K0*((aa  Y events which rarely happenX5*Í ÍX5*Í Í*ߧ Yy ԍThus, were the Kellermann et al. study of homicide's findings accurate,24 gun ownership would raise the annual risk of household homicide to one in 15,000. is misleading as a means to learning about homicide, or suicide. By its very nature, selecting controls similar to persons who die from homicide or suicide means selecting persons largely unrepresentative of society at large or even of the unrepresentative counties chosen. The homicide study, for example, involved persons less affluent and less educated than the counties in general, and the population studied was 62% black while the counties studied were 25% black. It was a study of very high risk individuals compared to high risk individuals, not a study comparing homicide victims to ordinary gun owners. In addition to ignoring the risk of domestic violence, much of the public health research ignores the glaring difference among various ethnic groups, preferring to focus on the firearm,  Y even to the point of deception. A famous comparison of homicide in Seattle and Vancouver17 pretended that firearms explained the difference between the two cities' homicide rates. In fact, with threefourths of each city's population comprised of nonHispanic whites, their homicide rates were virtually identical insignificantly higher in the restricted Canadian city. Vancouver's lack of blacks and Hispanics compared to very high homicide rates among Seattle's ethnic minorities, including a high homicide rate in Seattle's volatile Asian community, while Vancouver's stable Asian community recorded lower homicide rates than their whites. Unscientifically, the authors "are disinclined to calculate a summary odds ratio stratified by  Yb race."ߧ Centerwall BS. Homicide and the prevalence of handguns: Canada and the United States,  Y 1976 to 1980. Am J Epidem 1991;134:12451260.X5*Í ÍX5*Í ÍX5*Í ÍX5*Í Í* bbߧ Yu ԍThey are similarly disinclined to report other information. They assert that handguns explain the difference in firearmrelated homicide in the two cities, although pictorially, their chart makes the relative difference between the cities' rifle/shotgun homicides look similarly different in size. Requests for the data have been routinely ignored. The significance is that, while handguns are sharply restricted in Canada, rifles and shotguns were relatively unrestricted in both jurisdictions. Interestingly, the authors assumed there were dramatically higher levels of gun ownership in Seattle than in Vancouver largely based on comparing protective handgun ownership in Seattle to sporting handgun ownership in Vancouver, and using a peculiar test which presumes that firearm availability among the general public can be determined by measuring firearm misuse in suicide and homicide. However, a survey by Gary A. Mauser in British Columbia, and Gary Kleck's analysis of two decades of national social surveys suggests that gun ownership levels in the two cities might be similar, and, indeed, that gun ownership might even be higher in the Canadian city. (Private communication) Similar distorted reasoning occurred when the authors turned to suicide in the two  Y cities.` Sloan JH, Rivara FP, Reay DT, Ferris JAJ, Kellermann AL. Firearm regulations and rates  Y of suicide: a comparison of two metropolitan areas. New Engl J Med 1990;322:369373. The authors pretended that suicide rates were generally higher in the gunrestrictive Canadian city overall and for most ethnic and age groups. Finding a difference among 1524 year olds, however and ignoring the fact for part of that age group, the Canadian gun law was then more lenient the gun law should be credited with reducing the suicide rate below that of Seattle. They were essentially saying that a gun law could cause one slice of a pie to be smaller0*((aa without affecting the size of the whole pie. One of the only efforts to test the effects of a gun law similarly deliberately distorted data  Y to reach a conclusion.ߧ Loftin C, McDowall D, Wiersema B, Cottey TJ. Effects of restrictive licensing of  Y handguns on homicide and suicide in the District of Columbia. N Engl J Med 1991;325:16151620. While most scientists will compare cities to cities, these researchers compared the numbers of homicides in a city, which was rapidly losing population, to those in the surrounding suburbs, which were growing. Perhaps worse, the model used disguised the fact any chart on the homicides would have shown, that the rate of homicide fell before the Washington, D.C., gun law went into effect, and then was stable, rose slightly, fell for a brief  YH time, and then skyrocketed.ߧ Government of Washington, D.C., Office of Criminal Justice Plans and Analysis. Homicide Report. April 1992.ā The model used essentially averaged prelaw with postlaw homicides to take advantage of the fact that the homicide rate had been quite high in the early 1970s before falling until the year (1976) the gun law was enacted. When challenged with the assertion that homicide dropped during the two years before the law took effect, between 1974  Y and 1976,ߧ Y ԍ Blackman PH. Correspondence: effects of restrictive handgun laws. N Engl J Med 1992;326:11571158. the authors dishonestly asserted that the critic had said that the drop in homicide  Y began in January 1974, thus suggesting that January 1974 is 24 months before October 1976.ߧ Loftin C, McDowall D, Wiersema B, Cottey TJ. Correspondence: effects of restrictive  Y handgun laws. N Engl J Med 1992;326:1160. The authors had checked no other possible factors to explain what they perceived as a drop in homicide; they assumed it must have been the gun law, even though other factors certainly existed in Washington, D.C., including increased efforts to enforce federal gun laws in the  Yy District in the mid1970s.ߧ Kleck G. Interrupted time series designs: time for a reevaluation. Paper delivered at the annual meeting of the American Society of Criminology, New Orleans, 1992. Some of the problems with public health research on firearms is the making of illogical leaps from data to conclusion. Although there have been massive experiments around the country with a variety of restrictive gun laws, no honest effort has been made to study their  Y actual effects. The Vancouver/Seattle comparisons17,26 simply assumed the gun laws were the primary differences between the two cities, or the two metropolitan areas, an assumption which is unjustified. A more thorough effort did find both lower levels of handgun ownership and handgun involvement in homicides in Canadian provinces than in bordering American states, but no significant differences in homicide rates, except where two cities unlike anything in Canada  Y ԩ New York and Detroit were in the state bordering a Canadian province.25 But that was not a test of law but availability. The general leap from virtually all public health research on firearms is from asserting guns are involved in morbidity and mortality to concluding restrictive gun laws offer a solution, regardless of the content of the law. Thus, with most reports indicating militarylooking guns used in 04% of gunrelated crimes in most jurisdictions where data are available, and in less  Y than 1% of homicides,5,[ ߧ Kleck G. Assault weapons aren't the problem. New York Times, Sept. 1, 1992.[ recommendations for bans on socalled "assault weapons" are all but universal in public health literature. Similar support is voiced for the Brady Bill, which would impose a fivebusinessday waiting period with optional police background check before dealer transfers of handguns to persons at least 21 years old in the states which do not already have a background check roughly 30% of the US population. Where such checks occur, about 12% of sales are stopped, rightly or wrongly, to persons who might or might not use the handgun to commit a crime, find another means of obtaining a handgun, obtain a rifle or shotgun, or use another weapon to achieve the same result. With handguns involved in about 10% of violent  Y:& crime,}!ߧ Rand MR. Handgun crime victims. U.S. Dept of Justice, Bureau of Justice Statistics Special Report, July 1990.} the Brady Bill is aimed at a small fraction of a percent of violent crime, none involving adolescents. Doubting the bill would work at all, Kleck's calculations suggest that if#'0*((aa it did, perhaps 50 homicides annually would be affected in a nation with 24,000 such incidents  Y annually.5 Sometimes, the illogical leap goes beyond the assumption that firearmsrelated violence  Y justifies any and all experiments. The New England Journal of Medicine recently suggested that "gun control" experiments which were tested and failed would provide justification for still more  Yx restrictive gun laws.j"ߧ Y ԍ Kassirer JP. Guns in the household. N Engl J Med 1993;329:11171119.j Others believe they have proven harm merely by showing access to a  Ya firearm, even if there is no mortality, morbidity, or other harm from such access.#ߧ Weil DS, Hemenway. Loaded guns in the home: analysis of a national random survey of  Y gun owners. JAMA 1992;267:30333037.,$ߧ Callahan CM, Rivara FP. Urban high school youth and handguns: a schoolbased survey.  Y JAMA 1992;267:30383042. Another believed it had demonstrated a problem requiring legislative and educational correction based not on harm from "latchkey" children's access to firearms as might be demonstrated by showing disproportionate amounts of accidental deaths or gunrelated delinquency from such children nor even from proof of actual access to firearms by those children, but by  Y demonstrating that guns were often present in the homes of "latchkey" children.n%ߧ Y ԍ Lee R, Sacks JJ. Latchkey children and guns at home. JAMA 1990;264:2210.n There may be a problem, although the number of latchkey children appears to be rising as the number of gunrelated accidents with children is falling. But the study did not demonstrate that in any way. Had they, their solutions might or might not have made sense. Part of the problem with public health professionals is an appalling ignorance of firearms, ballistics, and firearms owners. A recommendation that pediatricians teach their patients about the risks of gun ownership is undermined by pediatricians' ignorance of the fact regarding those  Y6 risks&ߧ Webster DW, Wilson MEH, Duggan AK, Pakula LC. Firearm injury prevention  Y counseling: a study of pediatricians' beliefs and practices. Pediatrics 1992;89:902907. and a demonstrated preference for gun owners to learn from gun organizations and non Y owners to learn from law enforcement.'ߧ Webster DW, Wilson MEH, Duggan AK, Pakula LC. Parents' beliefs about preventing  Y gun injuries to children. Pediatrics 1992;89:908914. Recommendations regarding safety features on firearms tend to follow discussions on the numbers of suicides and homicides involving firearms, while accidents represent a small and diminishing percentage of the misuse of guns in  Y America.16,19 And all such recommendations ignore the fact that such devices could be  Y counterproductive if not retrofitted to all guns, (ߧ General Accounting Office. Accidental shootings: many deaths and injuries caused by firearms could be prevented. Report to the chairman, subcommittee on antitrust, monopolies, and business rights, Committee on the Judiciary, United States Senate, 1991.  and that gun owners not only will not have  Y old guns retrofitted but would remove unwanted safeties put on at the factory.6 Similarly, gun owners would not tolerate ammunition ineffective for protection. Less lethal weapons will be developed for law enforcement, and, when effective, will, in all likelihood, be adopted by large  Yg numbers of gun owners without need for legislation or public health advocacy.:*gߧ Y ԍAs has been demonstrated with tear/pepper gas and "stun guns," however, their production will be followed almost immediately for calls for their restriction on the grounds they could also be used by criminals, and the lobbies for any new products are generally poorly organized.:X5*Í ÍX2aÍ ÍX2aÍ ÍX5*Í Í Another problem deals with ignorance or indifference of criminological and other findings  Y" as to what constitutes a risk factor.)ߧ Y ԍ Nettler G. Killing one another. Criminal careers, vol. 2. Cincinnati: Anderson Pub Co, 1982. Part of this is owing to the inappropriate methodologies. Case control, for example, requires assuming certain factors to be risk factors ethnicity, age, gender, perhaps income or education which prevents further measurement. Other factors recognized by criminologists have been ignored in most public health studies, including family structure and values, influences of peer groups and the mass media, unemployment, and the like. Sometimes the ignorance leads to pretending a major discovery has been made when the  Y" criminologicallyobvious was happened upon. Kellermann et al.24 recently discovered that"K0*((aa homicides in the home generally involve persons who know one another, rather than strangers, and that intruders are rarely involved. To criminologists, it would be mindboggling that anyone might think otherwise, with burglaryrelated homicides always a small percentage of homicide and, otherwise, it being obvious that people in one's home are persons one knows. Domestic violence is generally recognized but belittled both for homicide and suicide. In one article, women were advised against having a gun for protection, because, when a woman kills with a gun, she is five times more likely to kill a family member or intimate acquaintance  YH than a stranger.*ߧ Kellermann AL, Mercy JA. Men, women, and murder: genderspecific differences in  Y rates of fatal firearms violence and victimization. J Trauma 1992;33:15. (The ratio was approximately the same when women killed with a knife and minimally lower when they killed by some other means.) There was no suggestion that the killings were other than selfdefensive, a view supported by criminological literature: "Moreover, it seems clear that a large proportion of spousal killings perpetrated by wives, but almost none of those perpetrated by husbands, are acts of selfdefense....women kill male partners after years of suffering physical violence, after they have exhausted all available sources  Y of assistance, when they feel trapped, and because they fear for their own lives."+ߧ Wilson MI, Daly M. Who kills whom in spouse killings?: on the exceptional sex ratio of  Y spousal homicide in the United States. Criminology 1992;30:189215. Comparable to the fivetoone ratio, a study of rape found it 3.5 times more likely to be by a  Y nonstranger.,ߧ National Victim Center and the Crime Victims Research and Treatment Center. Rape in America: a report to the nation. Washington, D.C., April 23, 1992. Thus, domestic selfdefense is bemoaned as something women should try to avoid by avoiding firearms ownership. Incredibly, mental illness and depression have been ignored or denied in suicide studies.  Y4 Kellermann et al.11 asked about history of mental illness or depression in a widelypublicized suicide study, but the odds ratio was not calculated. And the CDC's leading spokesmen have  Y denied its relevance to recent increases in suicide, without citation -ߧ Y ԍ Rosenberg ML, Mercy JA. Introduction, 313. In Rosenberg ML, Fenley MA. Violence  Y in America: a public health approach. NY: Oxford, 1991. or, it would seem,  Y justification..ߧ O'Carroll PW, Rosenberg ML, Mercy JA. Suicide, 184196. In Rosenberg ML, Fenley  Y MA, eds. Violence in America: a public health approach. NY: Oxford, 1991. And public health advocates while espousing redesign of guns aimed exclusively at accidents, particularly those involving children generally dismiss firearms safety education as unproved, potentially counterproductive, and meaningless where such a small  Y percentage of firearmsrelated deaths involve accidents.16,/ߧ Y ԍ National Committee for Injury Prevention and Control. Injury prevention: meeting the  Y challenge. NY: Oxford, 1989.X1Í.X1č.X1č.X1[Note Num]č.,X1[Note Num]č.X1Í Num]č.0Ch Kellermann AL, Lee RK, Mercy JA, Banton J. The epidemiologic basis for the prevention  Y of firearm injuries. Ann Rev Pub Health 1991;12:1740.,1Ch Y ԍ AAP Committee on Adolescence. Policy statement: firearms and adolescents. AAP News 1992(January):2021. The proliferation of unscientific antigun advocacy research in public health is likely to continue. For one thing, a Gresham's Law is at work. While criminologists may learn from  YN criminologists,i2Ch Y ԍ Nettler G. Criminology Lessons. Cincinnati: Anderson Pub Co, 1989.i such research is apt to be sneeringly dismissed as contrary to common  Y7 sense.V3Ch Y ԍ Menken M. In reply. Arch Neurol. 1993;50:346347.V Competent medical and public health researchers might prefer to go into fields where honesty and competency is highly regarded, leaving the fame and fortune of gun research to the biased and incompetent. Peer review then works to enforce Gresham's Law, as standards  Y steadily decline. Katherine K. Christoffel really is the peer of Arthur Kellermann.B*vCh Yk! ԍChristoffel recently refused admission to a conference she was holding because its purpose was to "use a public health model to work toward changing society's attitude toward guns so that it becomes socially unacceptable for private citizens to have handguns," and the registrant "does not share these beliefs, and, therefore, does not meet the criteria for attendance at the meeting." (Letter to Edgar Suter, MD, September 28, 1993) CDC grant recipient Kellermann and CDC representatives Rosenberg and Mercy were welcomed at the conference.B It normally takes but one peer reviewer to blackball an article; thus, even if some antigun reviewers would0*((aa accept research viewed as progun, it would likely be blackballed by another, who would reject any article conflicting with preconceived ideas. One peer reviewer blackballed an article suggesting some legislative remedy would not keep guns out of the hands of children, arguing that it was not enough to say what would not work; the article would have to say what would work to be worthy of publication. That approach is not similarly applied to experiments to see  Y if a particular drug will aid in the treatment of a disease. (Private communication*vCh Y ԍOccasionally a scholar whose research is perceived as progun will be asked to peerreview antigun research, presumably when its flaws are so obvious to the editor that even the lower standards for gun research are not met, and as a way to demonstrate fairness in the selection of peer reviewers. And occasionally research perceived as progun has been published because the editor ignored efforts of peer reviewers to blackball research for reaching the "wrong"  Y conclusion.25) The news media can be counted on to exacerbate the situation by dutifully ignoring all of the caveats which are perfunctorily included in antigun public health research, as well as corrections of the most egregious of errors. When a study found that, among suicidal  Y adolescents, firearms in the home doubled the likelihood of suicide,4Ch Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence  Y and accessibility of firearms in the homes of adolescent suicides: a casecontrol study. JAMA  Y 1991;256:29892995. two times became 75  Y times for the CDC,x5Ch Y ԍ Rosenberg ML, Mercy JA, Houk VN. Guns and adolescent suicides. JAMA 1991;266:3030.x and the requirement that the adolescents be suicidal was ignored by the  Y popular press.W6Ch Reeves R. Give gun control a chance. Baltimore Sun, September 25, 1992.W And, while Kellermann and Reay14 noted that a study was preliminary and not necessarily accurate with regard to anyplace but the metropolitan area covered, it is constantly cited as if it were definitive although the more cautious, while still treating it as definitive, will voice it more as "one study found...." The situation is not likely to improve anytime soon. So long as available data are accepted instead of the data actually needed for scientific study, and so long as higher praise comes for more highly biased studies, there is little incentive to scientific research. Neither the medical profession nor public health professionals should be expected to insist upon competency and honesty in firearms research. Most of them are too busy doing their jobs and keeping up with relevant literature to be bogged down in shoddy research which is simply ignored or dismissed as unworthy of being read. A certain irony exists in the fact that medical personnel are among the leading lights of  Y antigun advocacy, since gun, and handgun, ownership tend to rise with affluence.5 And, while some workers in innercity hospitals wish their patients were disarmed by law, others see more and more reason to arm themselves. And one of the reasons some restrictive gun laws are not enforced with enthusiasm by police, prosecutors, and the courts, is that violators all too often turn out to be persons who have never been a threat to society, who have no prior arrest records, and may just be nurses who have to travel to or through unsafe neighborhoods on their  Y  way to work.7Ch Blackman PH. Carrying handguns for persons protection: issues of research and public policy. Paper delivered at the annual meetings of the American Society of Criminology, San Diego, 1985. Recommendations for the nursing community would be: (1) Demand better research of public health professionals, incorporating the lessons learned from criminology. (2) Evaluate 0*((aa the feasibility of increasing reporting from emergency rooms on details regarding firearmrelated morbidity and mortality without hampering treatment to patients. (3) Work with the NRA to get schools in each nurse's area to adopt the NRA "Eddie Eagle" firearm safety program. (4) Nurses interested in developing their own personal safety strategy should be advised to inquire about the availability in their areas of NRA's courses on the subject, by telephoning: 18008611166. l%REFERENCES