Sunday, July 13, 2008

Doctors are stoopid

The New England Journal of Medicine has an editorial about guns.

Note to the idiot doctors who wrote it. The Second Amendment to the US Constitution is not a "risky epidemiological experiment." It is the cornerstone to a free society. The right to defend yourself--and the right to bear arms to that end--is an ancient right only enjoyed by free men (in the whole species sense) and is not a new or extreme view.

If you (the doctors) don't like treating people with gunshot wounds, GET A NEW FRAKKIN' JOB!!
If there is a widespread loosening of gun regulations, we will learn over the next few years — in a before-and-after experiment — whether the laws we had in place had a significant impact in mitigating death and injury from handguns. In our opinion, there is little reason to expect an optimistic result; research has shown and logic would dictate that fewer restrictions on handguns will result in a substantial increase in injury and death. (Emphasis added)

Really? See John Lott. The research pretty much supports the opposite.
In April, just after the oral arguments in District of Columbia v. Heller, we wrote that "health care professionals, whose responsibility it is to treat the wounded and the dying, have special reason to be concerned." In light of the Court's decision in the case, that concern has been magnified.

Really? Special concern? As above, if you can't stand the heat, get the frak outta the kitchen. How about the concern of an unarmed, law abiding citizen at the mercy of a felonious goblin? Isn't that person's concern a bit more immediate and special?
The Centers for Disease Control and Prevention, in concert with health authorities across the country, keeps careful records on the number of injuries and deaths that result from handgun use. In 2005, the last year with complete data, there were more than 30,000 deaths and 70,000 nonfatal injuries from firearms. About one quarter of the nonfatal injuries and a tenth of the deaths were in children and adolescents. To place these numbers in perspective, 10 times as many Americans die each year from firearms as have died in the Iraq war during the past 5 years. Firearm injuries represent a major public health problem that seems certain to be exacerbated with less handgun regulation.
Oh dear. So many obfuscations, so little time.
Let's take these one at a time.
The Centers for Disease Control and Prevention, in concert with health authorities across the country, keeps careful records on the number of injuries and deaths that result from handgun use.

OK, how do they control for use of the handgun? That is to say, how many of these are at the hands of a criminal engaged in a criminal enterprise? How many are a result of a law-abiding citizen engaged in defending themselves from a criminal? How many are an abused spouse/significant other defending themselves from an aggressive partner? Shouldn't injuries and deaths be treated separately? And as to the injuries outnumbering the deaths, do guns kill or do they just hurt you really, really badly? So much for the careful records.

In 2005, the last year with complete data, there were more than 30,000 deaths and 70,000 nonfatal injuries from firearms.
The number is 30,364. Let's break it down further, shall we?
789 Accidental discharge of firearms (2.6% of total)
17,002 Suicide by gun (56% of total)
12,352 Homicide by gun (40.7% of total)
221 Gun discharges of undetermined intent (0.7% of total)

However, that's not the whole story.
Accidental discharges are in the Accidents category. Total deaths due to Accidents? 117,809.
Guns represent 0.7% of the total Accident deaths.
Motor vehicles represent 38.5% of the total Accident deaths.

Suicides are in the Intentional self-harm (suicide) category.
Guns are 52.1% of the total. The other 47.9% found other ways to off themselves.

Undetermined event firearms discharges are in the "Events of undetermined intent" category.
The guns are 4.7% of the total.

Homicides? Firearms represent 68.1% of the total homicides. About what you'd expect. Unfortunately, we don't know how many were criminals killing an innocent victim and how many were potential victims killing their attackers. We also don't know if any of the perpetrators were multiple offenders (as in one killed many) or if a victim had to defend themselves multiple times in 2005 (attacked by a group or attacked multiple times). To these doctors, apparently, any death by bullet is bad regardless of the circumstances.

The raw numbers, on the other hand, suggest that there are more common ways to shuffle off this mortal coil.

For example, Certain other intestinal infections (other than salmonella, shigellosis, and amebiasis) killed 5,667 in 2005. That's seven times the number that died from accidental firearm discharges. It equals nearly half of the total homicide deaths attributed to firearms.

Falls killed 19,656 folks. Yep. More people died from falling than from firearms homicides in 2005. How about we ban any buildings over one story tall, stairways, escalators, step ladders, trampolines, and ballistic sex acts? No? Onward.

34,136 people died during 2005 from septicemia--that's a blood infection. That's more than the total combined firearms deaths. How did these editorializing doctors miss that?

Pneumonia killed 61,189 people in 2005. That's more than we lost during our entire involvement in Vietnam! In one year! It's also more than twice the total number of the firearm deaths...the TOTAL number! Here's an idea, let's ban pneumonia!

Chronic lower respiratory diseases killed 130,933, malignant neoplasms (cancer) killed 559,312, and Major cardiovascular diseases killed 856,030. Perhaps these are areas the docs should look into as well.

About one quarter of the nonfatal injuries and a tenth of the deaths were in children and adolescents.
So what? The total number of deaths for children and adolescents due to firearms (How do they define adolescents? Adolescence? By physiological standards--the onset of puberty and menarche, etc--or by legal definitions dealing with the age of majority?), if we consider adolescents to be those under the age of 15 (the CDC chart has age-defined groups and there's a break there. I.e., 5-14 and then 15-24. I guess 15 is the medical beginning of adulthood unless they have some magic insight into the chart that eludes me.), is 404 or 1.33% of the total firearms deaths. "Other diseases of respiratory system" killed 458 adolescents--or 1.7% of the "Other...respiratory system"--during the same period.

Interestingly, 792 adolescents in 2005 died as a result of "Assault (homicide) by other and unspecified means and their sequelae". That's almost twice as many as the total number of adolescent firearms deaths and is 13.7% of the total deaths in that category. The highest percentage of adolescent deaths versus total deaths in any of the firearms categories is 9.5% in "Accidental discharge of firearms" followed by 6.8% in "Discharge of firearms, undetermined intent." Note that the actual number of deaths of those two leading firearms categories for adolescents is 90 deaths versus the 792 adolescents killed by other forms of homicide. That's nearly nine times the number. Which brings us to...
To place these numbers in perspective, 10 times as many Americans die each year from firearms as have died in the Iraq war during the past 5 years.

Well, those Americans in the Iraq War are armed with selective fire (capable of automatic or burst fire) weapons and have other similarly armed and trained comrades to watch their backs. Perhaps if we were allowed to carry M-4s, M-249s, have air support on call, and sniper support we could do better in Washington, D.C. and other such "rough" places. This only proves my point that an armed populace is a safe populace. Plus, see how dangerous pneumonia is, above. Let's outlaw sneezing in public and save some people, people!
Firearm injuries represent a major public health problem that seems certain to be exacerbated with less handgun regulation.

Hmmmm. Let's see if there are any public health problems on the chart that constitute a more serious threat--at least as far as total kills for the year as that seems to be the defining characteristic of a "...major public health problem."

Firearms deaths--30,364 (1.2% of total deaths--2,448,017--for 2005)
789 Accidental discharge of firearms (2.6% of total firearms deaths--0.03% of total deaths)
17,002 Suicide by gun (56% of total firearms deaths--0.7% of total deaths)
12,352 Homicide by gun (40.7% of total firearms deaths--0.5% of total deaths)
221 Gun discharges of undetermined intent (0.7% of total firearms deaths--<0.01% of total)

Septicemia--34,136 (1.4% of total annual deaths in 2005)
Malignant Neoplasms--559,312 (22.8% of deaths)
Some of the specific Malignant Neoplasms that contributed to number above--559,312:

Colon, Rectum, Anus--53,252 (2.2% of total annual deaths)
Pancreas--32,760 (1.3% of total deaths)
Trachea, bronchus, lung--159,292 (6.5% of total deaths)
Breast--41,491 (1.7% of total deaths)
Lymphoid, hematopoietic, and related tissue--55,028 (2.2% of total deaths)
All other unspecified malignant neoplasms--62,851 (2.6% of total deaths)

Diabetes mellitus--75,119 (3.1% of total annual deaths)
(Yep, that's correct. Diabetes killed more than twice as many people in 2005 as firearms.)

Alzheimer's--71,599 (2.9% of total annual deaths) Almost as bad as Diabetes!

Major cardiovascular diseases--856,030 (35% of total deaths) More than 1/3 of ALL deaths in 2005!!

Some of the cardiovascular diseases that contributed to total--856,030:
Acute myocardial infarction (that's a heart attack)--151,004 (6.2% of total 2005 deaths--double that of diabetes)
Other forms, chronic ischemic heart disease--291,118 (11.9% of total deaths)
Heart failure--58,933 (2.4% of total deaths)
All other forms of heart disease--109,579 (4.5% of total deaths)
Cerebrovascular diseases--143,579 (5.9% of total, or nearly 5-times that of firearms)
Atherosclerosis--11,841 (0.5% of total deaths--same as homicide!) Looks like cholesterol is as dangerous as a loaded gun or it was in 2005. That's a gun as used in a homicide.
Aortic aneurysm and dissection--13,843 (0.6% of total deaths)

Pneumonia--61,189 (2.5% of total deaths)Twice as much as firearms, almost 5-times that of homicides.

Emphysema--14,002 (0.6% of total deaths) More than homicides.

Other chronic lower respiratory diseases--112,181 (4.6% of total deaths)

Alcoholic liver disease--12,938 (0.5% of total deaths)
Other chronic liver disease and cirrhosis--14,602 (0.6% of total deaths)
Hey! Here's an idea. Why don't we outlaw/ban alcohol sales to save those unfortunate folks in the last two examples? That'd save TWICE the number murdered by firearms and nearly as many as ALL of the firearm deaths! We could pass an amendment to the Constitution and outlaw ethanol and, oh, waitadamnminute!

Nephritis, nephrotic syndrome, and nephrosis (kidney stuff)--43,901 (1.8% of total deaths)
Renal failure--42,868 (1.7% of total deaths)

Certain conditions originating in the perinatal period--14,549 (0.6% of total deaths)
What does "Certain conditions..." mean? Well, look who's most affected:
Of that 14,549, the number of deaths in the <1 year old category was 14,423. 58 dead in the 1-4 year old category and 26 dead in the 5-14 year old category. So, more newborns died in this perinatal period than total firearms homicides in 2005. Wonder how that ranks on the "major public health problem" scale?

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified--31,999
(1.3% of total deaths) This exceeds the total firearms deaths.

All other diseases (Residual)--217,632 (8.9% of total deaths) Wow, that's behind major cardiovascular diseases (35%) and malignant neoplasms (22.8%) for leader in total deaths. Sounds like a "major public health problem" to me.

Transport accidents--48,441 (2% of total deaths)
Motor vehicle accidents of 48,441 under Transport--45,343 (1.8% of total deaths) Four times the homicide rate, more than total gun deaths. Time to ban motor vehicles.

Nontransport accidents--69,368 (2.8% of total deaths) I looove the breakout below.
Falls--19,656 (0.8% of total deaths) More than suicide by gun or all other (non-suicide) gun deaths combined. We are a clumsy nation!
Accidental discharge of firearms--789 (0.03% of total deaths--Yep, not even a thousand.)
Accidental drowning and submersion--3,582 (0.1% of total deaths)
Accidental exposure to smoke, fire, and flames--3,197 (0.1% of total deaths) Firemen ROCK!!
Accidental poisoning, noxious substances--23,618 (1% of total deaths)
Other and unspecified nontransport accidents--18,526 (0.8% of total deaths) See Falls, above.

So, there may be an area or two of more immediate concern than firearms deaths vis a vis "major public health problems" for the concerned doctors.
It is well documented in the medical literature that regulation of guns benefits the public health.

Really? Where?
For example, a careful study demonstrated that the 1976 restrictive handgun law in the District of Columbia, which was the focus of the Heller case, resulted in an immediate decline of approximately 25% in homicides and suicides by firearms, but there was no such decline in adjacent areas that did not have restrictive laws.

However, here we have the following:
"The chance of being murdered in Washington,DC in 1990 was 3 times greater than the chance of an American soldier being killed in the Gulf War. The average American city with a population of 250,000 or greater has a murder rate of about 20, whereas cities in the 100,000 to 250,000 range have a rate of about 12. About as many Americans were killed (over 54,000) in New York City between 1962 and 2002 as died in the Vietnam War, but the murder rate in 2002 was only about a quarter what it was in 1990, when there were a record 2,245 murders. Mayor Giuliani is credited with the transformation.

And then, "In the 1976-1997 period, the average age of victims fell from 35 to 31 and the average age of murderers fell from 31 to 27. 16% of homicides involved multiple murderers, whereas 4% of homicides involved multiple victims in 1997."

A-ha. Multiple murderers, multiple victims. Now we're getting somewhere.
Hmmm..."Gun control laws are stiffer in Canada, and many claim this accounts for the murder rate being lower in Canada than in the United States. 65% of US homicides were committed with firearms, versus 32% in Canada. However, a large American study indicated that liberalized laws for carrying concealed weapons reduced murder rates in the US by 8.5%. US homicide rates in the year 1900 were an estimated 1 per 100,000 -- at a time when anyone of any age could buy a gun. Statistics-gathering may have been less thorough at that time -- and few people had the money or interest to buy guns. But American gun supply (including handguns) doubled from the 1973-1992 period, during which homicide rates remained unchanged (WALL STREET JOURNAL, 4-Aug-2000, p.A10)."

In addition, although the NEJM study states that,
"METHODS. Homicides and suicides committed from 1968 through 1987 were classified according to place of occurrence (within the District of Columbia or in adjacent metropolitan areas where the law did not apply), cause (homicide or suicide), mechanism of death (firearms or other means), and time of occurrence (before or after the implementation of the law). The number of suicides and homicides was calculated for each month during the study period, and differences between the mean monthly totals before and after the law went into effect were estimated. RESULTS. In Washington, D.C., the adoption of the gun-licensing law coincided with an abrupt decline in homicides by firearms (a reduction of 3.3 per month, or 25 percent) and suicides by firearms (reduction, 0.6 per month, or 23 percent). No similar reductions were observed in the number of homicides or suicides committed by other means, nor were there similar reductions in the adjacent metropolitan areas in Maryland and Virginia. There were also no increases in homicides or suicides by other methods, as would be expected if equally lethal means were substituted for handguns,"
I have some questions about it.

Here we see that the homicide rate for the years in question (1968-1987) fluctuated greatly. (Sorry, too lazy to code the table manually.)

Year Murders Murders per 100,000
1968 195 24.1
1969 287 36.0
1970 221 29.2
1971 275 37.1
1972 245 32.8
1973 268 35.9
1974 277 38.3
1975 235 32.8
1976 188 26.8 (Year the ban, erm, law went into effect.
1977 192 27.8
1978 189 28.0
1979 180 27.4
1980 200 31.5
1981 223 35.1
1982 194 30.7
1983 183 29.4
1984 175 28.1
1985 147 23.5
1986 194 31.0
1987 225 36.2

Why stop at 1987? Hmmmm...

1988 369 59.5
1989 434 71.9
1990 472 77.8
1991 482 80.6 (Year the study was published)
1992 443 75.2
1993 454 78.5
1994 399 70.0
1995 360 65.0
1996 397 73.1
1997 301 56.9
1998 260 49.7

The population steadily declined during the period in question too. (The above figures do not include suicide numbers which the study included as well.

I can give the benefit of the doubt to the study's authors as they published in 1991 and some of the later data may not have been available to them. But the idiots who cited the study as proof of the effectiveness of gun laws should be required to repeat their internships as punishment. Look at how the numbers jump in 1988 and continue to exceed the historical bad ol' days that preceeded the "Law That Saved Everything"TM.

What were the benefits of this law? A peaceful, bucolic society living in harmony? Nope.

From the D.C. police:
"2006 Crime Emergency Data
On Tuesday, July 11, 2006, Chief of Police Charles H. Ramsey announced a Crime Emergency due to an increase in violent crime. The Crime Emergency initiative was officially implemented on July 12, 2006. On Friday, November 3, 2006, Chief Ramsey ended the Crime Emergency and reinstated the specific articles of the labor agreements that were originally suspended on July 11."

Details here, here, and here.

Back to the NEJM editorial:
With the weakening of handgun regulations, we are very concerned about the health of the public, especially young people, whose safety is disproportionately affected by firearms. We have a heightened concern about suicide, in which impulsivity may have an important role; ready access to a gun may significantly increase the risk of completion.

Hmmm, really? You really think so or are you just so politically motivated that you forgot how to read, reason, and really work on the things threatening our youth?
What did the chart say again? Oh, yeah. Does this sound "disproportionate"?

Of the 32,637 souls who took their own lives in 2005, only 272 (0.8% of all suicides) were in the adolescent age group--as per the above, 15-24 isn't counted.

Of those 272 adolescents, 84 (31% of 272, 0.3% of total suicides) died from firearms discharge, 188 (69% of 272, 0.6% of total suicides) by "other and unspecified means."

How about murder? Surely that must be taking a toll on this age group.
Out of 18,124 total homicides--12,352 of which were firearms related--only 1,022 are in the 14 and under age group. Only 230 of those (14 and under) (1.3% of total homicides, 1.9% of total firearms homicides) were killed by firearms.

So, no, it's not that big a deal when measured against things like:

Drowning--810 deaths (14 and under)(22.6% of all drowning deaths)

Major Cardiovascular Diseases--1087 deaths (14 and under)(0.1% of total Major CV disease deaths)

Malignant Neoplasms--1,452 deaths (14 and under)(0.3% of total malignant neoplastic deaths)

Motor Vehicle Accidents--2,210 deaths (14 and under)(4.9% of all MVA deaths)

Perinatal conditions--14,507 deaths (14 and under)(99.7% of all perinatal deaths)

Perhaps the docs should be advocating for swimming lessons, airbags, and get to work in the lab rather than focusing on a red herring--to wit, that fewer guns equal fewer gun deaths.
"There is no language in the Constitution that would limit regulation.

"Shall not be infringed." That seems to limit regulation. It may not completely proscribe regulation, but it damn sure limits regulation to something less than the outright banning of arms. (Which, for all intents and purposes is what the 1976 law in D.C. did.)
Indeed, the preamble to the Second Amendment includes the phrase "well-regulated" in reference to the use of firearms by militias.

Nothing more dangerous in this world than a doctor with a little knowledge. The phrase "well-regulated" is well-addressed in the majority's opinion by Justice Scalia's in Heller. (My entry on the day the opinion was released.)
Justice Scalia on the meaning of "well-regulated" (554 U.S. 23 (2008)):
"Finally, the adjective “well-regulated” implies nothing more than the imposition of proper discipline and training. See Johnson 1619 (“Regulate”: “To adjust by rule or method”); Rawle 121–122; cf. Va. Declaration of Rights §13 (1776), in 7 Thorpe 3812, 3814 (referring to “a well-regulated militia, composed of the body of the people, trained to arms”)."
And regarding militias, the very same page of the decision (above the "well-regulated" portion):
"Although we agree with petitioners’ interpretive assumption that “militia” means the same thing in Article I and the Second Amendment, we believe that petitioners identify the wrong thing, namely, the organized militia. Unlike armies and navies, which Congress is given the power to create (“to raise . . . Armies”; “to provide . . . a Navy,” Art. I, §8, cls. 12–13), the militia is assumed by Article I already to be in existence. Congress is given the power to “provide for calling forth the militia,” §8, cl. 15; and the power not to create, but to “organiz[e]” it—and not to organize “a” militia, which is what one would expect if the militia were to be a federal creation, but to organize “the” militia, connoting a body already in existence, ibid., cl. 16. This is fully consistent with the ordinary definition of the militia as all able-bodied men."

Back to the stoopid doctors.
Given the diversity of geography and population in the United States, lawmakers throughout the country need the freedom and flexibility to apply gun regulations that are appropriate to their jurisdictions. The Court's decision in District of Columbia v. Heller may greatly reduce the latitude that legislators have had in setting firearm regulations for their localities.
There is no latitude. Here is Justice Scalia again (554 U.S. 19 (2008)):
"c. Meaning of the Operative Clause. Putting all of these textual elements together, we find that they guarantee the individual right to possess and carry weapons in case of confrontation. This meaning is strongly confirmed by the historical background of the Second Amendment.
We look to this because it has always been widely understood that the Second Amendment, like the First and Fourth Amendments, codified a pre-existing right. The very text of the Second Amendment implicitly recognizes the pre-existence of the right and declares only that it
“shall not be infringed.” As we said in United States v. Cruikshank, 92 U. S. 542, 553 (1876), “[t]his is not a right granted by the Constitution. Neither is it in any manner dependent upon that instrument for its existence. The Second amendment declares that it shall not be infringed . . . .”(Emphasis original)

and then (554 U.S. 21 (2008)):
"In the tumultuous decades of the 1760’s and 1770’s, the Crown began to disarm the inhabitants of the most rebellious areas. That provoked polemical reactions by Americans invoking their rights as Englishmen to keep arms. A New York article of April 1769 said that “[i]t is a natural right which the people have reserved to themselves, confirmed by the Bill of Rights, to keep arms for their own defence.” (cite omitted). They understood the right to enable individuals to defend themselves. As the most important early American edition of Blackstone’s Commentaries (by the law professor and former Antifederalist St. George Tucker) made clear in the notes to the description of the arms right, Americans understood the “right of self-preservation” as permitting a citizen to “repe[l] force by force” when “the intervention of society in his behalf, may be too late to prevent an injury.” 1 Blackstone’s Commentaries 145–146, n. 42 (1803) (Emphasis added)

'Nuff said.