Wednesday, November 14, 2018

How The NRA Silenced the Science of Gun Violence Prevention

from Medium:

If, as the NRA claims, more guns lead to less crime, why are they opposed to funding studies that could back up their assertion?

Another mass shooting.

Another body count.

Another unending list of questions.

Why does this keep happening? Are we missing warning signs? Can we identify high-risk individuals ahead of time? Are there laws that could prevent or reduce firearm injuries and deaths? If so, what laws are most effective at mitigating the risks?

These are questions that are answerable through the scientific method. Indeed, we might very well know the answers to these questions, or at least have a growing body of evidence to guide us, if leading government scientists and federal agencies were given the funding to study them.

But they’re not: Thanks to a 23-word rider attached to a federal spending bill in 1996 and enacted in 1997, research on gun violence has been frozen for two decades.

The Scandalous History of The Federal Freeze on Gun Violence Research Funding

The freeze on federal funding for gun violence research can be traced back to 1993, when Dr. Arthur Kellerman and colleagues published the results of a CDC-funded study in the prestigious New England Journal of Medicine (NEJM). The study, “Gun ownership as a risk factor for homicide in the home,” found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide. Rather than confer protection, the study concluded that people who keep guns in the home faced a 2.7-fold greater risk of homicide and a 4.8-fold greater risk of suicide.

The NEJM article was the subject of significant media attention, and the National Rifle Association (NRA) responded by trying to shut down the entire center that had funded the study, the CDC’s National Center for Injury Prevention. The center itself survived, but in 1996, Dickey — backed by the NRA — authored an amendment that cut $2.6 million from the CDC’s budget — the exact amount the CDC had invested in research on firearm injuries the previous year.

Passed by a Republican-dominated Congress, the NRA-backed ‘Dickey Amendment’ stated that “[n]one of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” While the amendment doesn’t explicitly ban research on gun violence, the deliberately vague wording — combined with an onslaught of harassment of researchers — had a chilling effect on scientific progress, effectively ending all federal research programs related to gun violence. As Dr. Mark Rosenberg, former director of the CDC’s National Center for Injury Control and Prevention, put it: “The scientific community has been terrorized by the NRA.

“Precisely what was or was not permitted under the clause was unclear,” Dr. Kellerman wrote in a December 2012 article in the Journal of the American Medical Association. “But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up.”

It’s important to note that the freeze on funding doesn’t just impact federal agencies — it applies to federally-funded researchers everywhere. At universities and medical centers nationwide, where research is highly dependent on federal grants, published studies on gun violence dropped off dramatically after the passage of the Dickey Amendment — by about 60% between 1996 and 2010 — while federally funded gun violence research dropped by approximately 96% during the same period. Furthermore, CDC officials say the funding freeze and subsequent lapse in gun violence research caused lasting damage to the field. After funding was cut off, leading researchers moved on to other areas of study that were still supported by the government, and some researchers even discouraged students from specializing in gun violence research because of the lack of funding. Although private violence prevention agencies continued to support research on gun violence, they were unable to produce or analyze nationwide data on gun violence without the work of institutions like the CDC.

The amendment — and the message it sent to scientists — also had the effect of making gun-related research questions controversial even for studies not funded by the government, as scientists feared such research would be held against them if they applied for federal grants in the future. According to a 2017 study published in the Journal of the American Medical Association, gun violence was the least-researched cause of death in the U.S. and the second-least funded cause of death over the past decade.

“As a result of [the Dickey Amendment], many, many people stopped doing gun research, [and] the number of publications on firearm violence decreased dramatically,” Dr. Fred Rivara, a professor of Pediatrics and Epidemiology at the University of Washington at Seattle Children’s Hospital, and a co-author of the 1993 NEJM study, told PRI’s The Takeaway. “It was really chilling in terms of our ability to conduct research on this very important problem.”

Silencing The Science of Gun Violence Prevention

Over the last two decades, Republicans have exploited the Dickey Amendment to argue their case that gun violence is not a public health issue — a view that stands in stark contrast to the position of professional medical and public health organizations, at least 52 of which have independently urged lawmakers to treat gun violence as a pressing public health epidemic. Despite this overwhelming consensus from the scientific community, congressional Republicans actually expanded the scope of the Dickey Amendment to apply to the National Institutes of Health in 2011, after Dr. Douglas Wiebe, an epidemiologist at the University of Pennsylvania’s Perelman School of Medicine, authored a 2009 NIH study that confirmed a significant association between gun possession and gun assault.

In 2013, following the shooting at Sandy Hook Elementary School, President Obama called on the CDC to resume funding for research into the causes of gun violence. He also asked on Congress to give the CDC $10 million so they could carry out such research, but Congress has not allotted any of those funds in subsequent budgets. While the CDC developed a plan to use this funding on studies addressing firearm injury prevention and control, the agency’s research agenda remains frozen due to congressional inaction. Most recently, in the wake of the 2015 Charleston church shooting, the GOP-controlled Appropriations Committee of the U.S. House of Representatives rejected an amendment that would have lifted the federal funding freeze. Former House Speaker John Boehner defended the lack of government research, saying “a gun is not a disease.”

Notably, we heard the exact same argument back in the middle of the 20th century, when motor vehicle accidents were responsible for killing more than 50,000 Americans a year. The common wisdom, as told by carmakers, was that automobile fatalities were the fault of individual drivers — in other words, ‘cars don’t kill people; drivers kill people.’ This assertion was ultimately shown to be false, but we only discovered the truth after years of rigorous injury prevention and control research conducted by scientists at the CDC. Contrary to the claims of the automobile industry, vehicle design was found to be just as much to blame for high fatality rates as bad drivers. Researchers also discovered that motor vehicle deaths could be significantly reduced with simple safety devices such as air bags and seat belts, as well as road design features such as median barriers. The National Traffic and Motor Vehicle Safety Act of 1966 mandated many of these improvements. It also marked the start of a decades-long federal effort to better understand automobile and highway safety through systematic data collection and analysis. As a result of these studies — and the policies that grew out of them— the motor vehicle fatality rate per mile traveled has fallen 80 percent since 1966.

The insights that emerged from this line of research formed the foundation of the public health approach to injury prevention, an evidence-based model that incorporates 1) ongoing surveillance and monitoring of trends in injury-related morbidity and mortality; 2) identification of risk and protective factors; 3) continuous evaluation and development of prevention strategies; and 4) dissemination of the most efficacious strategies for reducing the incidence and burden of injuries. In addition to motor vehicle safety, this basic model has been applied successfully to reduce the public health burden of intentional and unintentional causes of injury, including poisonings, drownings, child and elder abuse, dating violence, and sexual violence.

We could use the same injury prevention model to study gun violence and reduce its massive public health impact. But unlike car manufacturers, the gun industry — led by the NRA — has been successful in their efforts to suppress scientific inquiry into gun violence and potential approaches to prevention. Moreover, while certain federal agencies like the ATF collect basic data on criminal uses of firearms, prohibitions on data-sharing have stymied scientific research on the subject. For example, as Jennifer Mascia explained in The Trace, the ATF is prohibited from “releasing crime-gun trace data to anyone other than a law enforcement agency or prosecutor — leaving academics and researchers without easy access to valuable data.”

The end result is that many fundamental questions about gun deaths and injuries, such as how many Americans are shot each year, remain unanswered, and we lack the data to establish basic parameters like the magnitude, scope, characteristics, and consequences of firearm violence. That’s important, as public health professionals rely on this type of data to identify risk and protective factors, as well as to develop effective violence prevention strategies. Insufficient research also makes it difficult for policymakers, even in states with strong firearm laws like Massachusetts and California, to know which laws will be effective, since there’s very little data for evaluation. This has meant in practice that “there is no scientific consensus on the best approach to limiting gun violence,” the New York Times reported in a 2011 article, “and the NRA is blocking work that might well lead to such a consensus.”

Even former Congressman Dickey — the Republican who wrote the original provision banning gun violence research — has recanted and urged Congress to repeal the ban, writing in an op-ed that, unlike researchers studying car accidents or infectious disease, “U.S. scientists cannot answer the most basic question: what works to prevent firearm injuries?”

If, as the NRA claims, more guns lead to less crime, why are they opposed to funding studies that could back up their assertion? The very thought is apparently enough to terrify the NRA, which is why they’ve gone to such extreme lengths to suppress this line of research and any policies that might grow out of it.

“If there is no research, it is harder to make suggestions for policy reform,” Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California-Davis, told the Huffington Post. “And if you have a vested interest in stopping policy reform, what better way to do it than to choke off the research? It was brilliant and it worked. And my question is how many people died as a result?”

We didn’t have to ban automobiles to cut motor vehicle fatalities — and we don’t have to ban guns to reduce gun-related deaths. What we do need, however, is a willingness to objectively examine the causes of gun violence — and elected leaders who care enough about American lives to go where the data lead.

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