Map of life expectancy at birth from Global Education Project.

Friday, March 21, 2008


NEJM continues to rack up the Cervantes points by making material of importance to public policy available to you common rabble. This week, Dr. Wintemute discusses your God-given right not only to carry a concealed weapon into the church and shopping mall, but to kill people with it if they look at you sideways. Think I'm exagerating? Not at all. Wintemute tells the tale of a Louisiana homeowner who shot and killed a teenage boy who mistakenly knocked on his door, looking for a party. A jury acquitted the man after three hours deliberation, based on the defense attorney's assertion that "You have the legal right to answer everybody that comes to your door with a gun." In Louisiana, you indeed have the legal right to kill somebody if they refuse to leave your business or dwelling.

In the southeast generally, and in Michigan and North Dakota, legislators have eliminated any duty to try to avoid deadly confrontation by retreating. In other words, all you have to do is murder somebody, and then claim you felt threatened. You're innocent -- and you also are not liable for any injuries to bystanders, in many cases. Thirty-five states require that anybody who isn't disqualified from gun ownership by a criminal record or mental illness must be issued a permit to carry a concealed weapon.

I was at the American Public Health Association meeting in Indianapolis a few years back. Two of my fellow convention goers were in the local Planet Hollywood when a man dropped a cigarette, bent over to pick it up, and his loaded gun fell out of his shirt pocket, hit the floor, and discharged. The bullet went through one woman's wrist and struck the other in the side.

The police announced that no charges would be filed because the man had a permit to carry the gun. That would also be a permit to be an irresponsible idiot, but maybe the good people of Indiana want us to think that's the norm out there. Is that what you all want?

Now, in thinking about public health we frequently confront tensions between reducing death and injury, and what at least initially appears to be the individual liberty interest. Many conservatives, and libertarians who don't necessarily accept the "conservative" label, tend to oppose regulations to improve public health, such as restrictions on smoking, motorcycle helmet laws, and of course gun control, on liberty grounds. (Strange how conservatives are especially zealous about restricting some other categories of personal behavior, such as illicit drug use, but we'll leave that as an aside for now.)

However passionately you may reject the notion of government paternalism, we should at least base the debate on the facts. As Wintemute points out, the relationship between gun ownership and personal safety is clear -- owning and carrying a gun makes an individual far less safe. Having a gun in the house increases your chance of being murdered by something like 100%, and your chance of killing yourself by a far greater amount. Increased gun ownership is associated with increased, not decreased, crime rates, and defensive gun use is far less common than widely believed, so that if you own a gun, you are far less likely to ever use it in self defense than you are to see it used to kill a loved one, by suicide, accident, or impulse.

The National Rifle Association purports to be a grassroots organization of citizens, but it is principally financed by gun manufacturers and it is their interests which it represents. I have written about my friend Festus, the farmer, who uses a rifle to protect his crops from deer and woodchucks, and I would like to see a lot more deer hunting in New England, frankly, because there are too many of the antlered rats and they are terrible pests. I understand very well that in many areas, guns are basic tools for some people and they are a part of the culture. That's fine. So are automobiles, but we license drivers, register vehicles, and ticket or even prosecute people who operate vehicles in an unsafe manner.

It seems to me as obvious as Monday morning that we ought to treat firearms the same way: require people to demonstrate that they understand and are capable of safe possession and operation; require that the devices have safety features; register them so that they can be identified when they are misused and confiscated if the owner proves irresponsible; and require safe use and fine people who don't follow the rules, or revoke their licenses if it comes to that. Objecting to that strikes me as insane.

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