Subject: piml] PIML:  DOCS, GUNS, AND THE CDC (fwd)
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Date: Thu, 3 Oct 96 13:57:07 EDT"
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                       DOCS, GUNS, AND THE CDC
                       -----------------------
                     by Miguel A. Faria, Jr., MD

A major engagement in the war over the right to keep and bear arms
was fought in the House of Representatives this past July. The
House voted to shift $2.6 million away from the National Centers
for Injury Prevention and Control (NCIPC) - a research unit of the
Centers for Disease Control (CDC) - and earmark the funds for other
health research projects. The funding was equivalent to the amount
spent by the NCIPC in its campaign to redefine guns as "first and
foremost, a public health menace."

In a letter to House colleagues, Representative Jay Dickey (R-AR),
who sponsored the amendment to redirect the NCIPC funding,
explained that "NCIPC's director of the division of violence
prevention, has this to say about the political agenda at NCIPC:
'What we have to do is find a socially acceptable form of gun
control.'" In a letter to Senator Arlen Specter (R-PA), who chairs
the Subcommittee on Labor, Health and Human Services, and Education
of the Senate Appropriations Committee, several senators who
support the effort to curtail NCIPC's anti-gun activities noted
NCIPC Director Mark Rosenberg's vision of "a long-term campaign ...
to convince Americans that guns are, first and foremost, a public
health menace."

The redirection of $2.6 million away from NCIPC - a figure that
amounts to less than five percent of the unit's total budget - has
been described as an assault on public health by tools of the "gun
lobby." In reality, it is a modest and overdue effort to deprive
the anti-gun lobby of a taxpayer subsidized propaganda organ. At
stake as well is the scientific integrity of public health
research.

Politicized Medicine

The medical establishment's campaign to "pathologize" firearms is
an outgrowth of an American Medical Association (AMA) crusade
against domestic violence which began in 1991. Numerous concerned
physicians (including this author) eagerly enlisted in what was
perceived as a worthwhile cause. However, the investigation of the
seemingly interrelated topics of domestic violence and street
crime, and the attempt to find workable solutions (as supported by
the available scientific literature), have led many medical
practitioners to a tragic but unshakable conclusion: The entrenched
medical/public health establishment, acting as a willing accomplice
of the gun control lobby, has conducted politicized, results-
oriented, gun control research based on what can only be
characterized as junk science.

This is so, in large part, because gun control is the pasture where
the NCIPC's milk cow is grazing. The Clinton Administration, whose
domestic crime control strategy focuses on midnight basketball and
gun control, was hardly inclined to devote funding to health
research that undermined its preferred policy options. Some might
find it curious that midnight basketball would be linked to gun
control, but the connection is obvious: Both take a therapeutic
approach to crime control. From that perspective, crime is a
disease, and gun control is a public health issue, rather than an
infringement of a constitutionally protected right.

Thus was born the scientifically preposterous - but politically
expedient -concept of guns and bullets as animated, virulent
pathogens which must be contained by limiting gun availability -
with the eradication of private gun ownership as the ultimate cure.
The NCIPC's assignment in this campaign was, and continues to be,
to create a "scientific" basis - however spurious - for this
campaign. Dr. Patrick O'Carroll, a CDC official, was quoted in the
February 3, 1989 Journal of the American Medical Association (JAMA)
as saying, "Bringing about gun control, which itself covers a
variety of activities from registration to confiscation, was not
the specific reason for the [NCIPC]'s creation.... However, the
facts themselves tend to make some form of [firearms] regulation
seem desirable.... The way we're going to do this is to
systematically build a case that owning firearms causes death."
(Emphasis added.)

In their zeal to create a new concept of "disease," officials
conveniently ignore Koch's Postulates of Pathogenicity, the time-
proven and logical series of scientific steps carried out by
medical investigators to prove that a microorganism is directly
responsible for causing a particular disease. Guns and bullets, of
course, have no infectious properties. Their ability to inflict
harm is a matter of individual responsibility and moral conduct.

But there is another dimension neglected by the anti-gun medical
faction -namely, the surfeit of scientific, sociological, legal,
and criminological literature discussing benefits of firearm
possession by law-abiding citizens. Unfortunately, data which
demonstrate the health and safety benefits of gun ownership do not
jibe with NCIPC's prime directive, which has been "to
systematically build a case that owning firearms causes death."

Faulty and Biased Research

Among the most prominent members of the medical anti-gun faction is
Dr. Arthur Kellermann of the Emory University School of Public
Health. Since at least 1986, Dr. Kellermann and his associates,
whose research has been underwritten by the CDC, have published
several studies purporting to show that individuals who keep guns
in the home are more likely to be victims of homicide than those
who do not. The Kellermann studies have been published in the New
England Journal of Medicine (NEJM) and JAMA amid great fanfare, and
their "findings" have been eagerly recited in the mainstream press.

One of Kellermann and company's most famous "findings," which were
reported in a 1986 NEJM paper, is that an individual who keeps a
gun in his home "is 43 times more likely to kill a family member
than an intruder." Although the study received relatively little
critical scrutiny, its chief finding was quickly canonized by the
press. One of the few qualified observers who carefully examined
the 1986 study was Dr. Edgar A. Suter, chairman of Doctors for
Integrity in Policy Research (DIPR), who refers to the dramatic
risk-benefit ratio as Kellermann's "43 times fallacy."

In a critical review published in the March 1994 Journal of the
Medical Association of Georgia (JMAG), Dr. Suter cited
"methodologic and conceptual errors" in the Kellermann study, such
as prejudicially truncated data (that is, convenient omission of
certain facts) and a reliance on non-sequiturs. He also noted that
in the study, "the correct methodology was described but never used
by the authors."

Moreover, by confining the study to the body count, Kellermann
failed to consider the protective benefits of guns. A proper tally
of those benefits, Suter noted, would include instances that do not
involve the use of lethal force. According to Dr. Suter, "The true
measure of the protective benefits of guns are the lives saved, the
injuries prevented, the medical costs saved, and the property
protected - not the burglar or rapist body count. Since only 0.1% -
 0.2% of defensive gun usage involves the death of the criminal,
any study, such as this, that counts criminal deaths as the only
measure of the protective benefits of guns will expectedly
underestimate the benefits of firearms by a factor of 500 to
1,000."

In a 1993 NEJM article (the research for which was also heavily
funded by the CDC), Dr. Kellermann again attempted to show that
guns in the home are a greater risk to the victims than to the
assailants. Kellermann dealt with critiques offered by Dr. Suter
and other qualified scholars by simply ignoring them and using the
same methodology employed in his 1986 study. However, the results
of the 1993 study were further skewed by Kellermann's selection of
study populations with disproportionately high rates of serious
psycho-social dysfunctions.

For example, 53 percent of the case subjects chosen by Kellermann
had a history of a household member being arrested; 31 percent had
a household history of illicit drug use; 32 percent had a household
member hit or hurt in a family fight; and 17 percent had a family
member hurt so seriously in a domestic altercation that prompt
medical attention was required. Moreover, both the case studies and
control groups in this analysis had a very high incidence of
financial instability. As Dr. Suter points out, all of the factors
listed above "would expectedly be associated with higher rates of
violence and homicide." The results of such a study cannot be
extrapolated to the general population. Furthermore, the 1993 study
once again failed to consider the protective benefits of firearms.
This time, however, Kellermann and associates arrived at the
downgraded but still incorrect "2.7 times fallacy."

Despite what appeared to be premeditated errors in the 1993 study,
its conclusions have permeated the establishment media. Further,
because the data and the flawed conclusions have been published in
"reliable" medical sources, they have been recited in medical
journals and are regarded as credible by physicians, social
workers, professional organizations, law enforcement, and
policymakers.

Predictably, none of the attention lavished on Kellermann's
politically inspired conclusions has been given to studies
conducted by Professor Gary Kleck of Florida State University,
criminologists Don B. Kates and David Kopel, and the scholarly
members of Doctors for Integrity in Policy Research. The studies of
these conscientious investigators document that the benefits of gun
ownership by law-abiding citizens have been greatly underestimated.
In his monumental work Point Blank: Guns and Violence in America,
Professor Kleck found that the defensive uses of firearms by
citizens amount to 2.5 million times per year and dwarf the
offensive gun uses by criminals. Between 25 and 75 lives are saved
by a gun for every life lost to a gun.

Significantly, medical costs saved as a result of gun use by law-
abiding citizens are 15 times greater than costs incurred by
criminal uses of firearms. Guns also prevent injuries to good
people and protect billions of dollars of property every year. Yet,
the AMA/CDC/NCIPC establishment ignores these findings, clings to
the erroneous figures of Dr. Kellermann and other NCIPC
researchers, and uses the suspect conclusions in formulating health
and gun control policies.

A Sinister Objective

Behind the faulty research and the dissemination of this biased
information lies a sinister objective. This objective was discussed
by respected criminologist Don B. Kates in a 1995 Tennessee Law
Review article entitled "Guns and Public Health." After examining
the activities of NCIPC and its allies, Kates concluded:

Based on studies, and propelled by leadership from the Centers for
Disease Control and Prevention (CDC), the objective [of defining
guns as a public health risk] has broadened so that it now includes
banning and confiscation of all handguns, restrictive licensing of
owners of other firearms and eventual elimination of all firearms
from American life, excepting (perhaps) only a small elite of
extremely wealthy collectors, hunters or target shooters. This is
the case in many European countries.

According to Kates, "In this connection, the term 'gun control'
needs some clarification. That term could mean no more than
noncontroversial measures to prohibit gun misuse or gun possession
by high risk groups. In the literature we are analyzing, however,
'guns are not   inanimate objects, but in fact are a social ill,'
and controlling them implies wholesale confiscation from the
general public so as to radically reduce gun availability to
ordinary people."

As a neurosurgeon who has spent countless hours treating victims of
gunshot wounds, this writer has witnessed the deplorable
consequences of armed violence. But we must have the moral courage
to pursue the truth and find viable solutions through the use of
unbiased, sound, scholarly research. Regrettably, the CDC,
particularly the NCIPC, and a distressingly large portion of the
medical establishment have pursued a grossly politicized agenda and
have, in essence, become a powerful arm of the gun control lobby -
at measurable expense to the traditional mission of protecting
public health.

One particularly damning example of the CDC's blatant support for
the gun-banning lobby is found in the Spring 1995 issue of the
Injury Prevention Network Newsletter. An article entitled "What
Advocates Can Do" includes the following statement: "Make your
support for federal, state, and local gun laws known to your
representative. This may include: opposing repeal of the assault
weapons ban, restricting ammunition availability by caliber and
quality, maintaining restrictions on issuance of concealed weapons
permits...." This same newsletter discloses that it was "supported
in part by Grant #R49/CCR903697-06 from the Centers for Disease
Control and Prevention." In other words, by the taxpayers -
including gun owners.

Public Challenge

In a letter to Senator Arlen Specter, Dr. William Waters of Doctors
for Integrity in Policy Research protested the "overt political
activism of the NCIPC staff and their federally-funded
researchers.... [T]here seems to be a tacit assumption - perhaps
even foundational concept - among many public health researchers
that firearm prohibition/control provides a ready solution to many
of society's ills. We believe that this view is expressed in the
NCIPC's approach to the problem of violence, since the research
performed is fantastically narrow in scope, excludes most of what
is known about violence in human societies from consideration or
study, and is often performed using abysmally poor methodology."
When supporters of NCIPC's findings and funding are challenged, Dr.
Waters observed, they take refuge in tautology: "There seems to be
a tendency on the part of those defending the NCIPC to simply
reiterate figures depicting the problem of firearms violence/injury
as justification for the agency's existence."

Concerned about the political corruption of public health research
and possible violations of the public trust, DIPR representatives
sought to educate key members of Congress and the Senate; others
took the case directly to the public via local and syndicated radio
and television shows, including National Empowerment Television
(NET). A critical breakthrough occurred when Dr. Timothy Wheeler,
president of the California-based Doctors for Responsible Gun
Ownership, appeared on the CBS program This Morning to debate Dr.
Jerome Kassirer, editor-in-chief of NEJM. Dr. Kassirer had defended
the supposed objectivity of the CDC-supported gun studies in a
previous NEJM editorial.

Dr. Kassirer's defense of the CDC provided an opportunity for Dr.
Wheeler to display, on camera, a copy of the anti-gun issue of the
Injury Prevention Network Newsletter cited above. The cover of that
issue, which bore the title "Women, Guns and Domestic Violence,"
displayed an illustration of a menacing handgun blasting away at
the defenseless female symbol. Wheeler was also able to share some
of the "neutral" recommendations offered within that tax-funded
newsletter. Here is a sampling from the publication:

"Put gun control on the agenda of your civic or professional
organization. Release a statement to the media or explain in your
organization's newsletter why gun control is a women's (or nurses'
or pediatricians') issue. Ask TV and print media to name the gun
manufacturer in every story it runs involving gun violence.
Organize a picket at gun manufacturing sites, perhaps with posters
showing pictures of victims of gun violence.... Work for campaign
finance reform to weaken the gun lobby's political clout. Boycott
publications that accept advertising from the gun lobby or
manufacturers.... Get media attention for your events. Encourage
your local police department to adopt a policy prohibiting officers
from recommending that citizens buy guns for protection."

Federally subsidized CDC researchers also became directly involved
in anti-gun rights agitation. For example, NCIPC-funded researchers
and staff served as faculty at the Handgun Epidemic Lowering Plan
(HELP) "strategy conferences," held in Chicago in 1993 and 1995.
Those meetings assembled "like- minded individuals who represent
organizations [that seek to] use a public health model to work
toward changing society's attitude so that it becomes socially
unacceptable for private citizens to have guns."

Dr. Katherine Christoffel, one of the founders of these
conferences, is known for her anti-firearms activism. Dr.
Christoffel has stated, "Guns are a virus that must be eradicated.
We need to immunize ourselves against them." Taking the
pathological perspective on guns to its most ridiculous extreme,
Christoffel has declared: "Get rid of the cigarettes, get rid of
the secondhand smoke, and you get rid of lung disease. It's the
same with guns. Get rid of the guns, get rid of the bullets, and
you get rid of deaths."

Another conference on firearms violence held in 1992 at the
University of Iowa was underwritten in part by CDC/NCIPC funds
which had previously been allocated to the study of rural injuries
and farm occupational hazards. Significantly, the only non-academic
faculty member invited to the 1992 conference was Sarah Brady of
Handgun Control, Inc. A similar event, "National Violence
Prevention Conference - Bridging Science and Program," was held at
the University of Iowa in 1995; the CDC/NCIPC co-hosted the event
with the University of Iowa Injury Prevention Research Center, and
NCIPC Director Mark L. Rosenberg offered the event's inaugural
speech.

Peer Jury

The growing evidence of anti-gun partisanship at the NCIPC provoked
the interest of freshman Congressman Bob Barr (R-GA). In a letter
to CDC Director David Satcher, Barr requested an investigation of
"whether certain taxpayer-funded grant money is being used to
advocate opposition or endorsement of federal legislation, and,
among other things, urges picketing activities.... I consider these
activities, involving federal taxpayer dollars, to be not only
questionable but illegal. I find it highly offensive that federally
appropriated monies are being used for lobbying...."

On March 6, 1996, three physicians - Drs. Waters and Wheeler and
this author - and noted criminologist Don B. Kates were given an
opportunity to testify before the House Appropriations Subcommittee
on Labor, Health and Human Services, and Education. Testimony
focused on the CDC/NCIPC's use of suspect data, skewed study
populations, dubious research models, and result- oriented
research. The panel was also informed that NCIPC researchers
violated accepted scientific practice by refusing to release and
make available to other researchers their original data for further
critical analysis - an indispensable part of genuine peer review.

Testimony was also offered concerning the inappropriate diversion
of taxpayer monies to research for dissemination of partisan
newsletters, as well as the participation of NCIPC staff and
researchers in partisan anti-gun gatherings. In addition, there was
an examination of the redundant nature of much of the injury
prevention research performed by the CDC/NCIPC. For example, the
Department of Transportation does research into automobile-related
injuries; the Labor Department's Occupational Safety and Health
Administration keeps track of workplace injuries; the Justice
Department keeps records on domestic violence; and, of course,
Health and Human Services maintains the National Institutes of
Health, which is involved in violence prevention, mental health,
drug and alcohol abuse, and numerous other subjects. Curiously, the
politicized anti-gun campaign may be the only non-redundant
research effort underway at CDC/NCIPC.

The amendment offered by Representative Jay Dickey, which would de-
fund NCIPC's anti-gun initiative, may not survive the conference
committee process. Furthermore, the constitutionally appropriate
course of action would be to eliminate all funding for the NCIPC,
thereby saving taxpayers nearly $50 million annually and, most
importantly, effecting a major step towards de-politicizing medical
research.

Dr. Faria, editor in chief of The Medical Sentinel of the American
Association of Physicians and Surgeons, is a consultant
neurosurgeon and author of Vandals at the Gates of Medicine (1995).

The New American * September 30, 1996
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