New England Journal of Medicine debates Gun Legislation

[wacki]

The NEJM is probably the best medical journal out there (or at least my gf says so). Now that doesn't mean everything published in NEJM of medicine is gospel, plenty of bad studies make it through, but it does mean that the signal to noise ratio is rather high. Today I decided to read what they had on firearms and came across the following survey:

Support for New Policies to Regulate Firearms — Results of Two National Surveys, Stephen P. Teret, J.D. et al

Which surveyed a 1200 people and concluded:

A majority of the respondents favored safety standards for new handguns. These standards included childproofing (favored by 88 percent of respondents), personalization (devices that permit firing only by an authorized person; 71 percent), magazine safeties (devices that prevent firing after the magazine or clip is removed; 82 percent), and loaded-chamber indicators (devices that show whether the handgun is loaded; 73 percent).

Now since this survey was peer reviewed you are allowed to read the comments that go back and forth. This was got my attention real quick:

To the Editor: The article by Teret et al. concerning the regulation of firearms should be seen in context as the blatant political treatise that it really is, as opposed to the scientific paper it pretends to be. The Journal has a disclosure policy with respect to potential bias arising from research sponsorship. Readers should be informed that the Joyce Foundation that sponsored the study openly and unambiguously solicits funding proposals that will support an obviously political antigun "public health" agenda. In this sense, it is much like the tobacco industry's soliciting of research that will prove tobacco "safe."


Peter H. Proctor, Ph.D., M.D.
4126 S.W. Freeway
Houston, TX 77027

This made me laugh out loud as I thought I was reading The High Road. If you Google for this guy you will find that he's part of the American College of Medical Toxicology which is a nonprofit that does a lot of EPA and environmental (pollution) work. He's not exactly an addle-head. All the other comments were much more detailed and many of them were sourced to half a dozen papers. So most of the comments were well thought out and supported. I wish I could copy and paste the entire article but unfortunately the NEJM isn't open access. It's good to see that the debate is not only alive but rather intense within the few NEJM articles I've read. Whatever end result is, I hope that this display of strong debate pleases the good members of The High Road as much as it pleased me.

Now a couple more just for fun....

I kind of liked this comment (although safety devices certainly provide liability problems if they fail):

To the Editor: Even if one accepts the results of Teret et al. (Sept. 17 issue),1 showing that there is strong public support for strategies to regulate firearms, why are they deemed to support new policies to regulate firearms as consumer products? If the public overwhelmingly endorses measures such as childproofing, personalization (devices that permit firing only by an authorized person), magazine safeties (devices that prevent firing after the magazine or clip is removed), and loaded-chamber indicators (devices that show whether a handgun is loaded), isn't this in fact evidence that governmental regulation is unnecessary? After all, if Americans really want guns with such devices, and are willing to pay for them, why shouldn't the market provide them?

Why the call for action on the part of policy makers? If this study purports to be news, isn't it also news to domestic gun manufacturers? It seems to me that if Teret et al. want to see regulations on firearms enacted, they must first make an argument that the market has failed.

In his accompanying editorial, Dr. Hemenway argues that the success in reducing motor vehicle injuries in the United States "provides insight into methods that could reduce firearm injuries,"2 and indeed, it may. Fatality rates calculated according to the number of miles driven dropped dramatically over the 60-year period preceding the enactment of the National Traffic and Motor Vehicle Safety Act in 1966.3 Furthermore, as Trebilcock has stated, "proponents of the 1966 Act made no serious market failure argument for its enactment; the Senate Commerce Committee, after lengthy hearings, reported that it did not have the foggiest notion as to the truth of the proposition that `safety does not sell.'"3

Finally, just how effective such regulations would be is open to question. According to Trebilcock, "a stream of empirical studies . . . have generally found few if any safety gains from regulation in numerous safety contexts. Those safety gains that were realized have often entailed costs disproportionate to their benefits."3


Frederick Paola, M.D., J.D.
University of South Florida College of Medicine
Tampa, FL 33612-4799

References

1. Teret SP, Webster DW, Vernick JS, et al. Support for new policies to regulate firearms -- results of two national surveys. N Engl J Med 1998;339:813-818. [Free Full Text]
2. Hemenway D. Regulation of firearms. N Engl J Med 1998;339:843-845. [Free Full Text]
3. Trebilcock MJ. Review of: Requiem for regulators: the passing of a counter-culture? The struggle for auto safety. Yale J Regul 1991;8:497-510.

And a Ph.D. from the NRA even showed up:

To the Editor: Antigun public health researchers often compare the large but declining rates of motor vehicle fatalities with the rates of gun-related deaths, ignoring the fact that the relative rates of motor vehicle–related morbidity and medical costs1 are vastly larger than those associated with firearms.2,3 They then go on, as David Hemenway did in his editorial, to credit — generally without documentation — public health measures for the decline, dismissing the role of law enforcement's decades-old crackdown on unlawful driving practices.

Public health researchers are divided on how to address the fact that motor vehicle–related deaths are almost exclusively accidental, whereas firearm-related deaths are overwhelmingly intentional. Some researchers assert as an article of faith that the same initiatives as are aimed at accidents would apply to criminal and suicidal violence.4 Others simply use a bait-and-switch tactic in which they use the large number of gun-related deaths as a basis for declaring an emergency but then acknowledge, as Hemenway did, that proposed gun-control measures "may not substantially reduce gun-related crime, but . . . could decrease the number of deaths and injuries that occur each day as a result of unintentional gunshots." With accidents accounting for just 3 percent of gun-related deaths, the most popular of the regulatory policies endorsed by Teret et al. were aimed at protecting young children, who account for only 5 percent of accidental and 0.2 percent of total firearm-related deaths.

The data, however, undermine the claim that reforms modeled on those designed to reduce motor vehicle injuries are needed for guns. Hemenway notes that in the past 40 years, highway-safety initiatives have resulted in a decrease of over 75 percent in motor vehicle fatalities per mile. Although a precise, similar comparison with respect to guns is not possible, analysis of figures on the stocks of motor vehicles1 and guns5,6 from 1955 to 1995 shows a 68 percent drop in accidental motor vehicle fatalities per 100,000 motor vehicles and an 84 percent drop in gun-related accidental deaths per 100,000 firearms.


Paul H. Blackman, Ph.D.
National Rifle Association of America
Fairfax, VA 22030-7400

References

1. Accident facts, 1997 ed. Itasca, Ill.: National Safety Council, 1997.
2. Max W, Rice DP. Shooting in the dark: estimating the cost of firearm injuries. Health Aff (Millwood) 1993;12:171-185. [Abstract]
3. Cherry D, Annest JL, Mercy JA, Kresnow M, Pollock DA. Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985-1995. Ann Emerg Med 1998;32:51-59. [CrossRef][Medline]
4. Rosenberg ML, O'Carroll PW, Powell KE. Let's be clear: violence is a public health problem. JAMA 1992;267:3071-3072. [CrossRef][Medline]
5. Kleck G. Targeting guns: firearms and their control. New York: Aldine de Gruyter, 1997.
6. Thurman R. Firearm business analysis. Shooting Industry 1998;42(7):32-49.

 

[mekender]

childproofing

since most fatalities involving children happen when an adult fires the gun, that is ineffective

personalization

so if my house gets broken into while im not home, my wife cant use the gun to defend herself?

magazine safeties

so if i get into a situation where my magazine falls out, i cant use that 1 round in the chamber?

loaded-chamber indicators

most fatalities are intnetional, so that wouldnt work very well

why cant the NEJM focus on medical issues? like a study to determine what 9mm round would best stop a BG from raping and killing my wife?

 

[Durruti]

childproofing

since most fatalities involving children happen when an adult fires the gun, that is ineffective

And since most car accidents happen within 20 miles of home, there's no need to wear a seatbelt out of town

Personally, I think storing firearms in a way that makes it difficult for unsupervised children to get a hold of them is a very good idea.

 

[4v50 Gary]

Medical journals should stick to the subject of medicine and leave politics out of its contents. I don't teach how to cure the common cold and they shouldn't teach about societal issues. Heck, shouldn't they concern themselves about HIV, Ebola and the possibility of a new flu outbreak?

 

[Chipperman]

The NEJM is probably the best medical journal out there (or at least my gf says so).

If you stick to purely scientific studies, I would agree that it is an excellent journal. They have, however, a long and sordid history of publishing very political and biased "articles".

 

[Standing Wolf]

Kind of like Pravda conducting "research" on capitalism.

 

[ShunZu]

Heck, shouldn't they concern themselves about HIV, Ebola and the possibility of a new flu outbreak?

Nah... They went to school for all those years to learn how to be effective solving the safety problems of the world. Who has time to actually cure any diseases!?

 

[geekWithA.45]

Unfortunately, we used the NEJM as source fodder for our weekly "spot the experimental design flaws" excercise, routinely finding huge, study invalidating flaws that you could drive a truck through.

This has severely eroded my faith not in empirical, scientific methods, but in that those who purport to be scientists actually practice empirical, scientific methods.


It also speaks to how our opponents, including the Joyce Foundation are able to effectively infiltrate and subjugate our institutions.

 

[wacki]

From mekender

why cant the NEJM focus on medical issues? like a study to determine what 9mm round would best stop a BG from raping and killing my wife?

From 4v50 Gary

Medical journals should stick to the subject of medicine and leave politics out of its contents. I don't teach how to cure the common cold and they shouldn't teach about societal issues. Heck, shouldn't they concern themselves about HIV, Ebola and the possibility of a new flu outbreak?

Epidemiology is "the study of factors affecting the health and illness of populations"

That includes exercise, pollution, eating habits, smoking and more. Like it or not gun violence falls under this definition as well. However, many doctors in the 80's and 90's felt exactly the same way you were and the NEJM rejected a lot of studies for that very same reason. Times have changed and like it or not biostatisticians (the people that analyze the efficacy of drugs) are the most qualified people to do this kind of work. You seem to prefer that it not get debated at all. That is fine, but if the efficacy were to be debated which group of professionals would be the most qualified in your opinion?

 

[wacki]

If you stick to purely scientific studies, I would agree that it is an excellent journal. They have, however, a long and sordid history of publishing very political and biased "articles".

If you are talking editorials then every major science journal does that. If you are talking peer-review then we have a totally different discussion.

I normally stick to science, nature and others. I've just recently started reading NEJM and JAMA so I am a bit niave. If there is strong bias in those journals I'd greatly appreciate it if you showed me the pudding.

 

[Kimber1911_06238]

I should do a study for the NEJM. It will be titilating, shocking, and revolutionary. My thesis will be that ACTUAL PARENTING creates a much more intelligent, respectful, and responsible child. It also serves to create a safe environment for the child.

 

[wacki]

Unfortunately, we used the NEJM as source fodder for our weekly "spot the experimental design flaws" excercise, routinely finding huge, study invalidating flaws that you could drive a truck through.

This has severely eroded my faith not in empirical, scientific methods, but in that those who purport to be scientists actually practice empirical, scientific methods.


It also speaks to how our opponents, including the Joyce Foundation are able to effectively infiltrate and subjugate our institutions.

Geek w/ a 45, can you please show me some of these weekly exercises? If your claim is true then there should be a blog that documents this crap.

 

[Zundfolge]

New England Journal of Medicine debates Gun Legislation

So the next issue of The American Rifleman should have an article debating the merits of various Cardio-Thoracic Surgery methods eh?

 

[Jaguar]

Personally, I think storing firearms in a way that makes it difficult for unsupervised children to get a hold of them is a very good idea.

I have children, and when I leave them unsupervised they have access to firearms. Could that be a problem, sure. Could leaving them alone and without means of defending themselves be a problem, you bet. My kids have been shooting all their lives, know how to handle all my guns, and are smart enough and educated enough to know when to use them. I resent it when people who have no faith in their kids tell me my kids should be left defenseless.

Jeff

 

[wacki]

If there is a mod here can we change the title to " New England Journal of Medicine on Gun Legislation Statistics"?

Until someone can come up with a more qualified group to discuss human behavior and it's impact on mortality it would be nice if we could avoid these one line insults against our medical community.

 

[Chipperman]

Well, without spending hours looking to support my argument, I'll just post some sources:

http://www.cqs.com/nejmrevs.htm

The prestigious New England Journal of Medicine, which has a conflict-of-interest policy that its editor calls ''the tightest in the business,'' is again having to explain how that policy went askew....
The error might have aroused little interest if the New England Journal was not the world's most esteemed medical publication - and if similar lapses had not happened before....

http://acpeds.org/?CONTEXT=art&cat=12&art=95&BISKIT=2170483

We have grave concerns about the political nature of four articles on partial birth abortion that were published in the May 24, 2007 issue of the New England Journal of Medicine. 1,2,3,4 We are disappointed that the Journal solicited only articles that present one side of this issue, that these articles are the only ones available on-line to the general public, and that their release came so soon after the Supreme Court ruling to ban the procedure, thus demonstrating a biased political posture.

http://findarticles.com/p/articles/mi_m0ISW/is_241-242/ai_107201230

NEJM is only one of many journals that appear to have a bias against natural treatments for common conditions.

 

[strat81]

Until someone can come up with a more qualified group to discuss human behavior and it's impact on mortality it would be nice if we could avoid these one line insults against our medical community.

Given the few quotations cited above, it seems the "article" was more focused on engineering issues (childproofing, 'smart' guns, mag safeties, etc).

Considering that violence and lawful vs unlawful use is the issue, a journal centered on law, criminal justice, or even sociology would be a more prudent outlet for such a piece.

Does the NEJM do articles about stabbings? Gravity knives, switch blades, machetes, bowies... that type of thing?

The blatant anti-gun agenda of the Joyce Foundation is a huge red flag that the article will be biased. I doubt NEJM would publish a study that was funded by Smith & Wesson and the NRA.

As for epidemiology...
http://www.m-w.com/dictionary/epidemiology

a branch of medical science that deals with the incidence, distribution, and control of disease in a population

"Gun violence" is not a disease, no matter what Hillary or Obama say.

 

[buzz_knox]

Personally, I think storing firearms in a way that makes it difficult for unsupervised children to get a hold of them is a very good idea.

Childproofing in this context doesn't mean safe storage, it means making the weapon inoperable by children who happen to find it, as with medicine bottles. So, think along the lines of multiple steps to render a weapon capable of firing, 15 lb trigger pulls, electronic or mechanical keys, etc.

 

[wacki]

As for epidemiology...
http://www.m-w.com/dictionary/epidemiology

Ok, you win on epidemiology. I used wikipedia and medline plus is the better way to go about it.

http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=epidemiology


This is a pretty strong argument that it should be in a different journal for technical reasons. However, the people that regularly contribute to this journal have the most pertinent training and experience on the planet. And the people that read this journal fall into similar categories. This is also a big journal so it garnishes the most discussion. I'd love for someone to point toward any other journal that can compete with the NEJM when it comes to qualifications. Until a more qualified journal can be shown then I see no practical reason why these articles need to go somewhere else. The editors may be biased but that is a different argument and not one I'm equipped to deal with yet.

The blatant anti-gun agenda of the Joyce Foundation is a huge red flag that the article will be biased. I doubt NEJM would publish a study that was funded by Smith & Wesson and the NRA.

That would be an interesting experiment to see. Since the NRA lobbies against research we will probably never know.

Does the NEJM do articles about stabbings? Gravity knives, switch blades, machetes, bowies... that type of thing?

Not specifically no. Then again knive violence doesn't make it into the top 10 causes of death. Firearm violence is in the top 10 and so is falling (especially for old people). Both have numerous articles in the NEJM. I don't see this as a major criticism of top journal. Unless there is the *potential* for a major impact on human welfare or science then a top journal has not only every right but a duty to ignore it.

 

[BobbyQuickdraw]

There is no such thing as childproofing. All you do is make the gun so difficult to fire that a child will give up on it. External locks, internal locks, safes, cables, etc etc. All of these are to make it hard for a child to get to and shoot it.

But when someone kicks down your door at 3 in the morning, all of those "childproof" locks are now "responsible gun owner trying to defend his home" locks. Some one kicks in your door and now instead of taking your gun from where you responsibility kept it, you now retrieve from a stored height of 5 feet (out of range of a child), open the safe, remove the firearm, disengage any and all locks, get the ammo from the next drawer down, load the gun.

In the meantime all your valuables or gone or your family is in danger.

RESPONSIBILITY is the strongest safety device of all.

 

[BobbyQuickdraw]

As for firearm violence as a top reason of accidental death, it is 7th.

The top 6 are:
Suffocation
Fire
Drowning
Poisoning
Falls
Car Accident

Accidental firearm deaths range from 800 to 1500. Car Accident fatalities are 43,000+ per year.

Also see this (Medically Related causes is 8th on the list):

Doctors: (A) There are 700,000 physicians in the U.S. (B) Accidental deaths caused by physicians total 120,000 per year. (C) Accidental death percentage per physician is 0.171.

Guns: (A) There are 80 million gun owners in the U.S. (B) There are 1,500 accidental gun deaths per year, all age groups. (C) The percentage of accidental deaths per gun owner is 0.0000188.

 

[brickeyee]

“And since most car accidents happen within 20 miles of home, there's no need to wear a seatbelt out of town”

This statistic keeps showing up with no data indicating what portion of car trips are within 20 miles of home.
It might be interesting if it was a disproportionate number of accidents (say 20% of trips are within 20 miles but they are 90% of all accidents) but without more data it is just BS.

How many trips do YOU take that start and end at home and take you less than 20 miles from home?
Mine are damn near 100% unless we actually go on a driving trip somewhere.

“This has severely eroded my faith not in empirical, scientific methods, but in that those who purport to be scientists actually practice empirical, scientific methods.”

You have made a horrible mistake about medical doctors.
They are NOT scientists.

Some do hold advanced degrees that might qualify them as scientists, but the majority has a 4 year professional school degree in medicine.
NIH has a boat load of PhD scientists, as do many of the pharmaceutical companies.

 

[wacki]

Chipperman,

The American College of Pediatricians (ACEDS) link may be correct that their editorials were one sided (i didn't check) but the editorials that they linked to mostly took the position that Congress does not have the expertise to practice medicine and that they are crossing that line in many areas. The articles said that if government intervenes it should be an organization like the FDA or some other organization made up of people with proper medical training. They were upset that there was not exemptions for medical emergencies.

Looking at their positions on parenting, gays etc it looks like ACEDS is a pretty far right wing organization. I don't think this is a display of bias in the NEJM as I highly doubt 25% or even 0.01% of doctors want Ted Kennedy or Pelosi telling them what is best for the patients in every single situation.

The article on drugs is a bit eye opening and somehow not terribly shocking since they get a ton of advertising revenue from drug companies. I haven't checked all of the sources but the few I have certainly checked out well enough.

I'll get to the third article later. Have a bit of eyestrain and it's getting tough to read.

 

[wacki]

Accidental firearm deaths range from 800 to 1500. Car Accident fatalities are 43,000+ per year.

Also see this (Medically Related causes is 8th on the list):

Doctors: (A) There are 700,000 physicians in the U.S. (B) Accidental deaths caused by physicians total 120,000 per year. (C) Accidental death percentage per physician is 0.171.

Guns: (A) There are 80 million gun owners in the U.S. (B) There are 1,500 accidental gun deaths per year, all age groups. (C) The percentage of accidental deaths per gun owner is 0.0000188.

This is awesome

 

[Pat McCoy]

Number of deaths for leading causes of death

Heart disease: 652,486

Cancer: 553,888

Stroke (cerebrovascular diseases): 150,074

Chronic lower respiratory diseases: 121,987

Accidents (unintentional injuries): 112,012

Diabetes: 73,138

Alzheimer's disease: 65,965

Influenza/Pneumonia: 59,664

Nephritis, nephrotic syndrome, and nephrosis: 42,480

Septicemia: 33,373

Source: Deaths: Final Data for 2004, Table 12

Firearms are not listed in the above top 10 causes of death in 2004, but if you take the total of firearms accidents and firearms suicides from the table, the total is still under 33,373 (about 27000). This data is from CDC website.

NEJM, as well as other, often have articles that may be peer reviewed, but are statistical messes. If an article uses both whole numbers and percentages, but not both types for all samples you need to be very wary of the suposed outcome. Stating one side of an arguement in percentages, and the other side in whole numbers is one of the old tricks to make numbers look like they support certain reasoning. NEJM is guilty of this in many instances.