Science is politics

No, this isn't some post-modernist rant on the inherent non-objectivity of science. On the contrary---this is a much simpler, grittier point, that science actually is the most accurate way of describing reality, and because of this, politics (the job of manipulating and controlling group's social reality) and science will always be roommates.

This comes up because we get complaints---regular complaints about science blogging failing to stick to "science". I gotta say that this complaint always seems to come from those who find reality to be a bit too liberal, but maybe that's just my bias showing.

This intersection (if you'll excuse the expression) is crudely obvious to working scientists writing grants---if you write the "wrong" thing (e.g. studying HIV in sex workers, stem cell research, etc.), your grant is history.

Less crudely, science informs political positions, such as how to deal with global warming (or whether or not it's even a problem).

One such question came up in a comment recently. The question revolved around whether doctors should ask patients about firearms.

It is the policy of my professional organization to inquire about firearm ownership and safety. Is this a valid position, and if so, why?

First, physicians are charged with prevention and treatment of human disease/injury. Prevention encompasses screening for risk factors, and preventative treatments such as vaccination. It also includes counseling regarding important health behaviors, such as seat belt use.

So, we must ask, "are firearms an important, preventable health problem?" Then, "if so, how do we intervene to prevent firearm injury and death?"

The data regarding firearms and preventable injury is unassailable. The CDC and DOJ both track statistics, but as an example, homicide and suicide by firearm are the second and third leading causes of injury-related death in the US in the 15-24 age group. The exact magnitude of the problem can be debated, but its health significance cannot.

The American College of Physicians (in a 1998 position statement) has taken a two-pronged approach: asking patients about gun ownership and safety, and advocating for gun-control legislation. The first should be uncontroversial---who can argue with asking a patient if they own the means to end life rapidly and violently, if they know how to secure it properly, and if they keep it out of the reach of children?

The second point is, needless to say, very controversial, although not so much among physicians, who consistently poll favorably on the issue.

Lets add some science-based medicine to the cauldron. First, is it plausible that doctors' interactions with patients and legislators can reduce gun violence? Sure, it's plausible, but not proven. Is it probable? Can this intervention cause harm? There is slightly more evidence supporting the position that gun violence can be reduced by intervening with patients and on a legal level, but the evidence isn't ironclad. There is no good evidence to suggest that intervening on an individual level is harmful.

Ideologically, and based on my reading of the (very clear) statistics, I agree with the ACP position statement from 1998. Despite lack of conclusive evidence, it is very reasonable to discuss firearm safety with patients, and to let them know that risk of injury and death increases significantly with gun ownership. There is also pretty good evidence to suggest that some gun control laws reduce gun violence in some situations.

There is a push to develop better data. Until then, I'm following a prudent public health course of recommending vaccination, seat belts, safe sex, and firearm safety. If you don't like it, find a doctor who doesn't care.

Tags
Categories

More like this

Every year in the U.S., more than 32,000 people die due to gun-related violence, suicide and accidents. That number includes the deaths of seven children and teens every day. So it’s not surprising that health care providers — those who witness the tragic results of gun violence — are often vocal…
by Kim Krisberg It seems we barely go a week now without news of another violent gun incident. Last week's shooting rampage in Santa Monica, Calif., has resulted in the deaths of five people. And since the Newtown school shooting last December — in the span of less than six months — thousands of…
Guns are the third leading cause of injury-related death in the country. Every year, nearly 12,000 gun homicides happen in the U.S., and for every person killed, two more are injured. Whether Congress will do anything about this violence is a whole other (depressing) article. But there is evidence…
In the midst of another national debate over gun safety regulations, some argue that higher rates of gun ownership will protect people from dangerous strangers with deadly intentions. Physician and public health researcher Michael Siegel set out to study that argument. He ultimately found no…

IMNSHO, anyone but a complete lunatic agrees that there is a need for *some* gun control. The only dispute lies in where to draw the line. Do we allow convicted felons to possess automatic weapons? Do we allow the mentally ill to have high-powered sniper rifles? Does the right to keep and bear arms include tanks? Rocket launchers? Nuclear weapons?

No. There is obviously a need for some form of gun control. Reasonable people can come to reasonable solutions. I would hope my doctor would ask me about firearms, as well as IV drug use, sexual history, and other risk factors.

Before someone starts ranting, nobody is ever going to come take all your guns away. Not in this country. Only the lunatic fringe even dreams of such a drastic step.

Cue libertarian/NRA/Chuck rant in 3... 2... 1...

People don't need to take anyone's guns away. They just successfully co-opt the primary purpose of the second amendment that it effectively becomes meaningless. Still, that is neither here nor there.

Then come the other questions:

Does a doctor ask if a patient rides a motorcycle,

Chooses a profession?

Decides a major in college? (I recently inhaled a decent dose of ammonia by accident yesterday, does that not count?)

Watches x amount of hours of television?

Stresses out about politics?

Carries x number of books/papers to and from the library/office?

Joins the army?

Life's risky, especially a full life. There are an infinite number of things that can hurt someone or pose long term threats to their overall health. I often tell people who are afraid of chemistry sets that anything under their sink can be often used in the same way or worse. Technically, anything can kill you. A guy who works at a garage can have an engine fall on his head.

One could argue many of these things need more data, better data, or more research to make such claims.

You choose to fixate on guns among a host of things that are potentially lethal or injurious. I think this is clear case of personal values and beliefs entering into the equation. Whether it's intended or not, people will always impose their bias on someone else, especially when speaking from a position of authority.

It's not a question of intent to indoctrinate. Quite the opposite, a most compelling case can be made for a natural inclination. If you see the world a certain way, there is a natural tendency to filter. That passes into your perception of evidence and importance. Medicine is frequently (and I'm not speaking from experience admittedly) a question of triage. Is it not? Prioritization. You are more concerned about the heavy smoking than the weight gain often associated with cessation, correct?

This is similar. However, among all the things that harm, kill, and maim, guns may not be legitimate priority. This is where you bear the trump card, all I can give is my opinion, you're the one with the license.

Technically, anything can kill you. [...] You choose to fixate on guns among a host of things that are potentially lethal or injurious.

Well, yes, technically anything can kill you, but some things are better suited to the purpose than others. I'm sure with enough effort you could kill someone will a bowl of lightly blanched asparagus, but that hardly makes it the equivalent of an assault rifle.

Maybe it would serve a purpose to discuss this with your patient, maybe not. Is there a prescription for stupidity though? Accidents happen for mainly 3 reasons: the parents are irresponsible and fail to lock the firearms up, the person has never taken a class on how to operate the firearm or the person has access illegally.

I do have to disagree with LanceR's statement though, "Before someone starts ranting, nobody is ever going to come take all your guns away. Not in this country. Only the lunatic fringe even dreams of such a drastic step".

It actually happened to the Hurricane Katrina victims - police brutality and repossession of firearms in the law abiding citizens.

By NRA supporter (not verified) on 03 Sep 2008 #permalink

It actually happened to the Hurricane Katrina victims - police brutality and repossession of firearms in the law abiding citizens.

Citations? Evidence? Or just "Someone told me"?

This is the problem with the gun control discussion. People drift to the extremes and ignore the wide open middle ground. Everybody but a lunatic agrees with gun control. Calm down, nobody is going to take away your guns.

One simple question for The Chemist: How many of those things have a direct, well-supported impact on injury/death rates that is as dramatic as firearm possession?

Choosing a major? Watching TV? Okay, I'll give you joining the army, but I think we can assume that everyone who joins the army knows that it ain't playtime at the park.

Firearm possession, especially in a family setting, is one of the leading causes of accidental injury and death. Don't gloss over the statistics and forget what we're talking about. Having a firearm in the home drastically increases the chances of someone in the home being accidentally shot. A doctor who does not ask about this is negligent, as would a doctor who failed to tell the patient who watched x hours of television that he needed more exercise, or the motorcycle rider that he should wear a helmet.

among all the things that harm, kill, and maim, guns may not be legitimate priority

Of all the things that harm, kill, and maim, guns are the single most common factor in accidental death. If they are so large a factor, are they not a legitimate priority? What would be a priority?

We live in a country where there are two safety seals on my peanut butter, and none on a box of ammo.

I think the chemist needs to remember that while many things are potentially dangerous, guns are designed intentionally to be dangerous. That's sort of the point of a weapon...

it's more about stats---gun injuries are a major public health problem.

And yes, chemist,when my patients ride motorcycles, i ask them if they use a helmet, and encourage them to.

There is an unstated assumption connecting "gun violence" and "gun ownership" that the latter leads to a risk of the former for the owner. Fact not in evidence, and if my ownership of firearms doesn't increase my risk materially then there really isn't much basis for my physician to bring up the subject with me. (And, no, I really don't know the stats, I'm just commenting on the logic.)

So let's talk follow-through: assuming that the patient does own (or plans to own) firearms. Aside from lecturing on the previous statistical point, do you have a plan B? A referral to a local firearm safety program, for instance? I gather the impression that you're not a Range Safety Officer, so offhand you might be no better qualified to instruct on firearm safety than the RSO is to guide medical decisions.

By D. C. Sessions (not verified) on 03 Sep 2008 #permalink

Obviously, the primary purpose of a gun is to kill someone/something. With or without Tolstoy, common sense says they will. Doctors are rarely counseling the criminals who buy guns with that specific risk in mind. To be fair, we're talking about doctors talking to people who are primarily lawful citizens or average joes. However you talk about accidents, then you say guns are "the single leading factor in accidental death".

That's false. You want cites. Okay. It's a little difficult for me to track down comprehensive stats, but in terms of the number of people killed, swimming pools present a risk above the order of magnitude for accidentalgun related fatalities (note the figures include non-accidental deaths as well). Here I'm assuming the rate of accidental gun death among adults is at lease within the same range as that for children. Perhaps a bad assumption, but data on adult mishaps is harder to come by due to lack of interest. Now where are your cites? A note I append to that request is that I deliberately avoided any deliberately pro-gun websites, I expect the same from you on the anti-gun front.

For the record Lance R, you talk about fringe extremes converging on the argument. Might I propose you are one of them? I'm not that passionate about gun rights, because people in this country would have no clue what to do with them. Yet, it would seem to me you are quite willing to leap down anyone's throat for so much as pointing to a gun. Meanwhile, I groaned at the response to my first comment, because I don't care that much, but I said it and now I have to defend it.

Now obviously, if a health care practitioner has his patient's health in mind, asking about potential hazards in the home is relevant. However, to ask if the patient owns a gun, implies the need to ask if a patient owns a motorcycle or a pool or a bicycle. I've implied (perhaps falsely) that PalMD simply found out about his motorcycle riding patients and doubt he specifically asks his patients what they drive. However, to ask about guns specifically, to the exclusion of other hazards, seems like a biased, politically motivated act.

The other concern is the nature of the questions asked. Questions can be asked in a manner that clearly indicates disapproval, jeopardizing the relationship with the patient. Other questions and information communicated to the patient may not be taking into account specific risk criteria, unnecessarily scaring them. Abortion is in many cases, for better or worse, surgical in nature. Even when not surgical there are certain legitimate risks the patient must be informed about. It doesn't matter how routine the procedure is, my brother had his tonsils removed, and we were informed of the risk of a patient dying under anesthesia.

Still we can all tell when a doctor is outlining legitimate risks involved in what we widely accept as a legitimate decision by the patient, and when a doctor is imposing his/her morality on a patient by crossing a line. The assumption is that such doctors cross the line in dramatic fashion every time. However, there is no rule that says doctors who espouse higher standards of professionalism (but are opposed to abortion) will not unconsciously skew the information given to the patient in a way that will deter her.

"Does a doctor ask if a patient rides a motorcycle. . .

Decides a major in college?

Watches x amount of hours of television?

Stresses out about politics?

Carries x number of books/papers to and from the library/office?

. . .You choose to fixate on guns. . ."

Scond point first: PalMD didn't chose to fixate on guns, it came up as a tangent in a previous discussion, so he addressed it. If he fixated on guns, it would have a bunch more time dedicated to it than one little blog post.

First point second. I've been asked all those questions. The television one oddly precedes the sexual history portion of the questions when I go in for a physical, so I remember it. The carrying of books question I got every time I saw the doctor for any reason when I was in high school and college. Why? I was a lit major, which meant I had a ton of books. And they had "lit major" in my file. The motorcycle question because someone else in my family owned one. Interestingly, I've never been asked the gun question, possibly because I live in a northeastern urban area. So doctors ask all kinds of questions in the course of being your doctor, because they are trying to treat everything, not just whatever ailment brought you into their office. Guns are a sensitive topic for some, in the same way some women get sick of constantly being asked if they are pregnant. Is there a reason? yes. does it get old? absolutely.

By Anonymous (not verified) on 03 Sep 2008 #permalink

I disagree with PalMD that no harm is caused by the two positions taken by the American College of Physicians. The doctor patient relationship is founded upon trust. By advocating for stricter gun control so that people, who exercise their Constitutionally guaranteed rights to keep and bear arms, are fined or jailed, the ACP is destroying that trust. If patients do not trust their doctors, they are far less likely to go to doctors for care and less likely to follow their doctor's advice.

I have never been asked any of those questions by any of my doctors over the years and would consider it none of their business. Meanwhile, the greatest cause of mechanical death in this country and probably all "developed" countries is the automobile. Yet no one screams to get rid of the car and no one screams about better driver training. You have MADD of course but they mostly scream about alcohol in general and are mainly interested in creating a class of alcohol felons in this country since none of their programs actually work to reduce fatalities caused by drunk drivers.

So, do you ask people if they drive and then counsel them NOT to drive since it is so dangerous? Especially for children?

Nowhere did I ever make any statement about people who own guns. Nowhere did I ever condemn guns themselves, or say that they should be taken away. What I did say is that gun ownership increases risk for all persons in a household. That is indisputable. The links are there in PalMD's post. There are simple, cost-effective ways to reduce that risk. The APC feels that they can aid in reducing that risk for their patients. Their actual position states:

Other positions call for strong legislation to ban the sale and possession of assault weapons, support for law enforcement measures to aid in the identification of weapons used in crimes, and restrictions on the sale and possession of handguns.

Does any of that sound unreasonable?

Anyway, the whole point of the post was to discuss whether doctors should discuss firearms with their patients. UberTroll William Wallace got all bent out of shape because his "liberturd" doctor asked about firearms. They studied the effectiveness of brief office counseling, and found that it was very helpful in promoting safer practices.

Conclusions: Family physicians’ brief counseling efforts made a significant positive impact in the firearm storage habits of their patients. With a verbal or written recommendation, a significant improvement was observed in firearm storage.

Whether it feels like disapproval from certain doctors is irrelevant. It works, with minimal investment of time.

Do try to argue with my actual statements, not what you think you heard. I support gun rights, with realistic limitations.

FWIW, I've also been asked by my doctor whether I rode a motorcycle, what my profession is, how many books I usually carry around, and how much TV I watch in a week, as well as the standard ones about whether I smoke and how much I drink and how much I exercise in a week. They don't ask about guns, as I am in the UK and they can assume with a certain level of reasonableness that I don't own a gun. Most of these questions even get asked every time I have a checkup.

LanceR is dead right on multiple counts. And doctors ask about the biggest risks in a person's life.

By Luna_the_cat (not verified) on 03 Sep 2008 #permalink

FWIW, i live in a state where everyone hunts and i take care of lots of patients who own guns, many for professional reasons. I don't ask them to abandon their firearms, but i do ask about storage, access, etc.

Meanwhile, the greatest cause of mechanical death in this country and probably all "developed" countries is the automobile. Yet no one screams to get rid of the car and no one screams about better driver training.

Actually, I do, to anyone who will listen.

By advocating for stricter gun control so that people, who exercise their Constitutionally guaranteed rights to keep and bear arms, are fined or jailed, the ACP is destroying that trust.

You're making a big leap there. Stricter gun control need not involve actually banning gun ownership, just as strict vehicle and driver licensing does not involve actually banning cars.

I am not making a leap at all. The ACP has taken the position that American citizens who exercise their rights to keep and bears arms by owning/selling/buying an assault rifle should be fined or jailed.

A person does not have to have a license to drive a car as long as they stay on private property. It is only when driving on public roads that driving becomes a privilege which can be strictly regulated by the state. In contrast it is a right to keep and bear arms.

To The Chemist:

As a medical student I'm currently learning some basic history taking skills. We also use a number of forms that remind us to ask and counsel patients on a number of preventative health issues. Just last night I was looking at one of the forms used at one of our hospitals and in addition to firearms, it includes many, many things such as

-television/video game use
-helmet use
-home safety (smoke detectors, fall risks, etc. etc.)
-motorvehicle safety

all just to name a few. These are all issues that primary care, family medicine, etc. type docs address.

By Mike Russo (not verified) on 03 Sep 2008 #permalink

FWIW, i live in a state where everyone hunts and i take care of lots of patients who own guns, many for professional reasons. I don't ask them to abandon ,their firearms, but i do ask about storage, access, etc.

Now that makes a lot more sense.

There is a lot more to the gun control issue that I have strong opinions about, however the scope of this post is rather narrow. I still stand by my statement that a doctor is liable to impose his personal political feelings on a patient no matter what.

I am not making a leap at all. The ACP has taken the position that American citizens who exercise their rights to keep and bears arms by owning/selling/buying an assault rifle should be fined or jailed.

Do try to argue with the actual position of the APC, instead of the voices in your head. At no time does the APC, or anyone else who supports gun control, want law-abiding citizens to go to jail.

This is what I mean about gun control. Reasonable people can reach reasonable solutions. When unreasonable people begin to paint these absolutists caricatures of other people's positions the real issue gets lost. "OMG! They's gunna take yur gunz away!" Hello? Reality calling.

Felons should not own firearms. Mentally ill people should not own firearms. In a modern society, there should be reasonable restrictions on what firearms are acceptable. This will vary by region, of course. What is acceptable and reasonable in Montana or Nebraska would be outrageous in New York, NY.

Of all the things that harm, kill, and maim, guns are the single most common factor in accidental death. If they are so large a factor, are they not a legitimate priority? What would be a priority?

I'm having a hard time swallowing the idea that "guns are the single most common factor in accidental death" ahead of automobiles.

By D. C. Sessions (not verified) on 03 Sep 2008 #permalink

If you feel that your doctor is "imposing his personal political feelings" on you, then you can find another doctor. It's a free country. Just understand that most doctors will, and all doctors should, ask these questions. If the doctor in question has a personality that conflicts with your own, find another doctor. Heck, ask that doctor for a referral. I'll bet she'll be happy to help if your personalities are that conflicting.

Personality conflicts like this do not invalidate the basic concept. Do read the links and the position papers before you react next time. What PalMD said is exactly what the ACP suggests.

I'm having a hard time swallowing the idea that "guns are the single most common factor in accidental death" ahead of automobiles.

You're right. Second and third. I misread before I misspoke. Not enough coffee this morning.

If guns are the leading cause of accidental death, then we don't have much of a problem with accidental deaths. The proportion of firearms deaths that are accidents is a tiny proportion of the total. Half of gun deaths are suicides, and most of the rest are murders. The classic accident scenario of a child finding a gun and accidentally killing himself or a friend is not at all representative. The typical gun death victim in the US is a depressed, middle aged male. Thus I strongly dispute the claim that having a gun in the house greatly increases the chances of being accidentally shot by it. Correlation is not causality.

By Science Avenger (not verified) on 03 Sep 2008 #permalink

I'm a gun owner, and I don't have a problem with my Doctor asking about my firearms ownership, provided that when I say, "Yes, I own firearms.", further inquiry/advice stays along the lines of, "Do you own a safe? Have you had training?"

Also, doctors who choose to ask about firearms in the home should be ready to answer questions regarding storage and training. If a patient keeps a revolver in the nightstand for home protection, that is bad, but the patient wants to have quick access to the weapon, so what is a good solution for the patient? The doctor should know that there are many quick acting safes out there that allow for secure storage and fast access, and that the price of such a safe is not excessive (I got mine for $150). If a patient asks about training, the doctor should know where to refer them locally for training (local range or firearms instructors).

A doctor who wishes to ask about risks had better be ready to offer positive solutions to a patient so they can better mitigate those risks, solutions other than "Guns are bad, get rid of them." (not that I think PalMD is telling patients that, but you get my point).

As for weapons confiscation after Katrina, see here:
http://www.stateline.org/live/details/story?contentId=198836

Note that after Katrina, a large number of states enacted laws explicitly forbidding law enforcement from confiscating weapons during an emergency.

Regarding Gun Control Laws. There are already over 20,000 state and federal laws on the books, I can't imagine more laws or bans will do anything significant except make it easier for normal men and women to run afoul of the law because they did not know things had changed. Ignorance of the law may not be an excuse, but when the law is so vast and ever-changing, it is unreasonable to expect people to be able to keep track of it all.

Asking about firearm ownership and use is a terrific idea. It's perfectly reasonable for your physician to ask you about your habits regarding seat belts, smoking, drinking, sex, and use of illegal drugs. This gives the physician a safe opening to refer a patient for help at ending dangerous behavior. It's not "fixating" on guns if your doctor asks you about them, any more than it's "fixating" on tobacco if your doctor asks whether you smoke. Your doctor doesn't need to (and should not) debate the Second Amendment with you, but can offer suggestions for your safety and that of your family if you choose to own firearms.

You're also free to refuse to answer. Also, though it may be both unethical and self-defeating to lie to your physician, it's not illegal. You're not forced to give your doctor any information, but withholding it or lying about it makes it that much harder for your physician to provide complete health care and counseling. In the end, it's your choice.

By Julie Stahlhut (not verified) on 03 Sep 2008 #permalink

lance:
"In a modern society, there should be reasonable restrictions on what firearms are acceptable. This will vary by region, of course. What is acceptable and reasonable in Montana or Nebraska would be outrageous in New York, NY."

Rights do not work that way. A person in Montana has no more and no fewer Constitutional rights compared to a person in NY city.

The issue isn't constitutional rights, it's public health. data needs to be developed to see what interventions, including but not limited to legislation, can reduce gun injuries and deaths. If it's as simple as training and securing, great. If it requires laws, the courts and the legislatures will hammer out contitutional solutions.

What I'm emphasizing here is a legitimate health issue that requires immediate intervention, and further study to see what interventions are most effective.

Contra LanceR, accidental gun deaths are a tiny, tiny fraction of the total number of accidental deaths. Gun deaths are split almost evenly between homicide and suicide, with accident a very, very distand third. I'd have to dig a bit to find the exact number of accidental deaths, but I believe it's a couple hundred a year.

Physician error, by the way, is generally believed to kill more than a hundred thousand people a year in the US.

Does anyone actually believe that limiting a felon's access to firearms violates the Constitution? That preventing people from owning tanks is in violation? That possession of a high-powered rifle makes sense in Montana but not in New York is simple. The second amendment does not give unlimited access to guns. With all rights come responsibilities and restrictions.

Ooh, Matt whipped out the Physician Error card! Yeah, that's relevant.

I'm not discussing locking up gun owners. I'm not suggesting taking away anyone's guns. I am saying that we need to enforce the laws we have, and make certain that they fit the needs of our diverse population. Is this really so radical a concept? Or are the pro-gun people just blinded by their hatred of anything that smells like gun control that they don't pay any attention to the actual discussion?

PalMD,

Are you interested in being your patient's doctor or their mother?

For the sake of argument let's assume I am your patient and answer in the affirmative when you step out of line and ask me if I own a fire arm. Where are you going from here?

Are you then going to ask what kind of gun I own? If I own a hand gun are you going to ask me where and how I store it and whether it has a trigger lock? If I own an "assault rifle" are you going to tell me about your professional associations objections to my right to own it?

What are you going to say when I tell you it's none of your fucking business, in those words? Do you suppose that might erode the doctor patient relationship a bit?

You remind me of a doctor I went to, once, because of my insurance network that had a big picture of Jesus in the waiting room and asked me if I was a "believer" and if I "prayed regularly".

He was certain that prayer and faith led to better health and wasn't shy about telling his patients, and had statistics to back it up. I told him he was a fool for believing in a deity and my beliefs were none of his fucking business as I walked out of his office.

Seriously what exactly do you think your job, as a physician, is in regards to your patient's fire arm ownership? Are you going to instruct them on fire arm safety? Are you a trained fire arms instructor? Are you familiar with the many different guns, their operation and safety features? Was that a class you took in med school?

Do you suppose that these adults are not aware of the dangers of fire arms and just found them in the street? Do you suppose that you are more concerned with their safety, with regards to fire arms, than the people that actually purchase them?

The truth is you can impart to them no professional medical information that has anything to do with owning a fire arm other than telling your patients some statistical information about the number of people injured, something that anyone who has made the decision to purchase a fire arm is obviously aware of if not the precise number of injuries.

You and your professional organization association have made the decision to intrude on the privacy of your patients for the sole purpose of pushing a political viewpoint.

The arrogance is astounding. Sadly your profession seems to either attract or breed arrogance.

Citations? Evidence? Or just "Someone told me"?

Of all the things that harm, kill, and maim, guns are the single most common factor in accidental death. If they are so large a factor, are they not a legitimate priority? What would be a priority?

LanceR: The NRA just released a documentary on the live event.

I actually read something last month that claimed doctors are at the top of the list of causing accidental deaths/injuries?

By NRA Supporter (not verified) on 03 Sep 2008 #permalink

Are you interested in being your patient's doctor or their mother?

Strangely enough, these duties often overlap.

For the sake of argument let's assume I am your patient and answer in the affirmative when you step out of line and ask me if I own a fire arm. Where are you going from here?

Are you then going to ask what kind of gun I own? If I own a hand gun are you going to ask me where and how I store it and whether it has a trigger lock? If I own an "assault rifle" are you going to tell me about your professional associations objections to my right to own it?

I would simply ask if you know how to properly use and secure your firearms, and inform you that deaths due to firearms are common (these deaths include homicide and suicide, not just accident...the figures are for "accidental death" which includes all three). I would also inform you that your risk of firearm injury goes down with no gun ownership and with responsible gun ownership.

What are you going to say when I tell you it's none of your fucking business, in those words? Do you suppose that might erode the doctor patient relationship a bit?

You would receive a generic letter from my office giving you 30 days to seek out a new physician (due to personality disorder, but this wouldn't be stated).

You remind me of a doctor I went to, once, because of my insurance network that had a big picture of Jesus in the waiting room and asked me if I was a "believer" and if I "prayed regularly".

Whether or not someone hearts jeezus isn't a public health issue.

Seriously what exactly do you think your job, as a physician, is in regards to your patient's fire arm ownership? Are you going to instruct them on fire arm safety? Are you a trained fire arms instructor? Are you familiar with the many different guns, their operation and safety features? Was that a class you took in med school?

Your temper makes me fear for your ability to safely own a firearm, but it is certainly your right. However, since you are so irrationally enveloped in anger and can no longer read well, my job is to screen for the high risk behavior and encourage behavior modification---most gun owners, if they aren't trained know how to get trained. There is a range right down the street from my office where I'm sure they'd be happy to help them out.

Do you suppose that these adults are not aware of the dangers of fire arms and just found them in the street? Do you suppose that you are more concerned with their safety, with regards to fire arms, than the people that actually purchase them?

Just as people don't know the stats on vaccine-preventable diseases, seatbelts, etc, they are often unaware of the specifics. I have never, in my career, had anyone show offense about being asked about high risk behaviors, including drug use, sexual history (which is far more intimate than gun ownership), and gun ownership.

The truth is you can impart to them no professional medical information that has anything to do with owning a fire arm other than telling your patients some statistical information about the number of people injured, something that anyone who has made the decision to purchase a fire arm is obviously aware of if not the precise number of injuries.

There is nothing obvious about people's level of awareness. Everyone has a pancreas too, and knows that eating to much is bad, but i still tell them so.

You and your professional organization association have made the decision to intrude on the privacy of your patients for the sole purpose of pushing a political viewpoint.

Me and my professional organization made the decision to intrude the moment i stuck my finger up your ass to check your prostate to show you my view point on prostate cancer, which hopefully you won't shoot me for (many of my patients have had to bring firearms to the office and I certainly haven't felt threatened...you...hmmm).

The arrogance is astounding. Sadly your profession seems to either attract or breed arrogance.

The arrogance of some yahoo thinking that doctors should not follow sound public health practices is rather astounding. My arrogance is earned. Yours is bought at the point of a gun.

Idiot.

Oh, and the whole "Doctors are mass murderers compared to X" myth is discussed here and elsewhere.

And before you think the gaycommielibruljewatheistdoctorcomeztostealmygunsandbodilyfluids, I personally believe in rational, evidence-based gun laws, not all-out banning of all firearms...i like venison too much.

LanceR: You are starting to get as foaming mad as Lance up above. Yes, there are people who feel that limiting access of firearms to felons is wrong, luckily, they are few and far between (and many of them feel that if a felon can be trusted in society, they can be trusted with a gun; I don't agree with that position, but I do understand it).

There are many more who feel that limitations on firearms ownership should be limited to those adjudicated as mentally unsound or convicted of a violent felony. As it stands today, being convicted of ANY felony will potentially lose you your rights (tax evasion is a felony), and with so many non-violent crimes being elevated to the felony level, people are worried that citizens will lose their rights by stumbling over a law they were not aware of, or did not realize had elevated to felony level.

Therefore, any laws regarding firearm ownership, bans, crime tracings, and such need to be evaluated carefully against the rights of citizens, and many times such laws are written in haste in response to a tragedy.

While this is a valid concern for gun owners, it is NOT the point of this post, so why do you keep bringing it up?

To the other Lance:

Your MD should inquire as to risky behavior. While a great many gun owners are responsible and do have training and practice safety and proper storage, many do not, either because they have no clue, or because they think they are doing enough when the truth is that a locked nightstand will slow a curious teenager down by about 60 seconds. Getting offended that your doctor asked is over-reacting and excessive. Now if your doctor starts quoting the talking points from the Brady Campaign, I suggest you tell him "Thank you, but I've done my own research, and I am confident that I have taken the proper precautions and adequate training."

PalMD: I agree with you that asking such questions are within the purview of a GP. However, the NEJM, your professional organization, and other medical groups have taken positions that advocate for laws which are ineffective and confusing and many gun owners find such to be over-bearing and offensive (we are adults, leave us alone until we prove otherwise).

That being said, a GP who chooses to inquire about guns, no matter his or her personal opinion regarding the private ownership of firearms, should limit their advice to secure methods of storage and adequate firearms safety and training. A GP who learns his patient owns guns and who then starts quoting statistics or ranting about accidents is one that will likely find a patient who just stopped trusting him or her. As I said before, advice should focus on, "OK, you've made your choice, I will do what I can to help you learn to mitigate the danger of that choice." Just as you would not tell a motorcycle rider to stop riding, but to instead take a rider safety class and put on a helmet and armor.

Helping someone to learn how to be safer within their own decisions will build trust, telling them that their decision is wrong will insult them and destroy trust.

PaLMD,

I appreciate your point by point reply if not the childish insult at the end.

The subject of your post was that science and politics were the same thing i.e. "Science is Politics".

If you don't understand that there must exist some line between the two in the doctor/patient relationship then you are not respecting the rights of your patients to hold opposing political opinions.

My point was that you were using a very weak therapeutic argument to support pushing your ideological viewpoints onto your patients.

Are you interested in being your patient's doctor or their mother?
Strangely enough, these duties often overlap.

I don't need another mother. I pay my doctor to diagnose illness, prescribe medication and provide medical information. My politics are none of his business nor do I care to be bathed in his.

I would simply ask if you know how to properly use and secure your firearms, and inform you that deaths due to firearms are common (these deaths include homicide and suicide, not just accident...the figures are for "accidental death" which includes all three).

Do you suppose that I am not aware that guns can kill people? Do you suppose that there is any medical value in informing me of this obvious fact? I suggest that you are now engaging in political advocacy and are no longer practicing medicine.

I would also inform you that your risk of firearm injury goes down with no gun ownership and with responsible gun ownership.

Do you also counsel all the people that drive cars that auto related injury "goes down" with no auto ownership and "responsible" auto ownership?

You would receive a generic letter from my office giving you 30 days to seek out a new physician (due to personality disorder, but this wouldn't be stated).

Such a letter would be unnecessary since I would have walked out of your office after telling you that I didn't need to be drenched in your anti-gun politics.

Whether or not someone hearts jeezus isn't a public health issue.

Why the distinction? The good doctor had statistics to back up his religious advocacy. You and I would probably agree that these studies are flawed but that is beside the point, that he could point to statistical evidence to justify his unwelcome advocacy.

You and he are engaged in the same endeavor, pushing your beliefs onto your patients and masking that intrusion as medical advice.

Your temper makes me fear for your ability to safely own a firearm, but it is certainly your right.

Excuse me but I never lost my temper (or called anyone a name for that matter). I told you what I would say to you if you asked me if I owned a gun and then proceeded to tell me why I shouldn't.

However, since you are so irrationally enveloped in anger and can no longer read well?

Again, not angry, just disgusted that you are still pretending that shoving your politics down my throat is good medicine.

...my job is to screen for the high risk behavior and encourage behavior modification...

Well here is the crux of the issue, behavior modification.

Since less that 1/10 of 1% of gun related deaths last year were the result of "assault rifles" why would a "professional organization" that was purely acting on scientific principles and concerned only with my health make banning assault rifles part of its "policy statement"?

I believe that the "behavior" they are trying to modify is the public perception of gun ownership. I also believe that you agree with this political stance and are all too happy to advocate for it under the guise of providing your patients with medical information.

You and your professional organization association have made the decision to intrude on the privacy of your patients for the sole purpose of pushing a political viewpoint. This is much the same as doctors that oppose abortion telling all of their pregnant patients the risks of abortion even when the patient has not mentioned their intention to abort the fetus.

Certainly there are risks to abortion but you and I both know that the real reason these doctors play up those risks, often accompanied by grisly photos of mangled "babies", are based on their religious and political opinion and not their medical opinion.

Me and my professional organization made the decision to intrude the moment i stuck my finger up your ass to check your prostate to show you my view point on prostate cancer,

Ouch, unpleasant imagery there.

Examining my prostate is a medically necessary prophylactic procedure "modifying" my opinion on gun ownership is not.

...which hopefully you won't shoot me for (many of my patients have had to bring firearms to the office and I certainly haven't felt threatened...you...hmmm).

Don't worry I don't expect that we will become so acquainted and I haven't shot anyone yet.

The arrogance of some yahoo thinking that doctors should not follow sound public health practices is rather astounding. My arrogance is earned. Yours is bought at the point of a gun.

You have made yet another unwarranted assumption. I have never owned a fire arm. My displeasure with your arrogance is based on your abusing the doctor/patient relationship to advance your political agenda and has nothing to do with whether I own a gun or not.

Also arrogance cannot be earned, only regretted and disposed of.

So, this guy had a weapon that was illegal to own or possess, and he's facing jail time? Cry me a river. I will go out on a limb here. He will get off with, at most, probation. Since he was licensed, and the real crime is failure to renew the license, I would bet that he gets fined and told to keep his license up to date.

Reasonable people, remember? What is the outer edge of acceptable gun control? Where do we draw that line? Pistols? Rifles? Hand grenades? I'm not being facetious or trying to score points. That is a valid question and I have yet to see even an attempt at answering it.

Everyone will admit there is a need for some gun control, yes? Every right has limitations. What are those limits? What is the least restrictive way to maximize public safety and minimize infringement?

LanceR, I agree entirely with you in spirit. Personally I think the 2nd amendment should be interpreted to apply to weapons which allow the user to target a specific individual. I seriously doubt the FF's thought people should own bombs.

But as bad as the gun nuts arguments are, those from your side are often as bad or worse. Take this gem from PalMD:

"... deaths due to firearms are common (these deaths include homicide and suicide, not just accident...the figures are for 'accidental death' which includes all three)."

I'm sorry, but that is intellectually dishonest. If my doctor said something like that, I'd chew him out and give him a primer on proper statistical analysis and ethics. The vast majority of gun deaths happen because the shooter fires at the victim with malice of forethought, period. Only a dedicated Orwellian could call that an "accident".

The reason those advocating strict gun control policies consistently pull crap like this seems obvious enough: they can't make their case with solid, honest, statistics. I'm neither homicidal, nor suicidal, nor violence-prone, nor mentally ill, nor are any of my houseguests, which means my gun is no more a threat to my well being than is my bathtub, chainsaw, or swimming pool.

The "accident" thing was supposed to be "injury" per my cdc links above. The fact is firearm-related injury and death (accidents, homicides, suicides) are a public health crisis that we don't have a clear stragegy for addressing. Locking people up for longer doesn't seem to help...

but arming people with the NON-SELF-EVIDENT KNOWLEDGE that gun ownership actually increases health risks is important, and letting them know that if you keep a gun, learning to handle it properly probably reduces risk is essential. And it isn't obvious. Trust me on that one or don't.

Madrocketscientist,

I guess I sounded angrier than I intended since everyone keeps telling me how angry my post was. There was no "foam" on my keyboard, honestly.

My remarks were colored by the fact that I had read all of PalMD's post on the subject, including the political advocacy of his professional organization, with which he obviously agrees.

To be honest I would probably just be surprised and give a quick "no" if asked by my physician if I owned a fire arm. It would make me curious and I might pursue the issue further.

I note that I have had the same physician for over fifteen years and have never been asked if I own a gun or a motorcycle for that matter. Nor do I feel that he has been negligent in failing to ask these questions.

Mad you say,

"Your MD should inquire as to risky behavior. While a great many gun owners are responsible and do have training and practice safety and proper storage, many do not, either because they have no clue, or because they think they are doing enough when the truth is that a locked nightstand will slow a curious teenager down by about 60 seconds. Getting offended that your doctor asked is over-reacting and excessive."

While I think you and I are actually very close on this topic I take issue with your above statement. Do you suppose anyone is going to say "Golly Doc, my gun is just lying around. What do you think I should do with it.?"

Is he going to ask if they have a hair dryer dangling from the counter next to their bathtub next?

No one that actually owns a gun is going to say that they are storing it or using it irresponsibly even if they are. To find out the particulars would be a huge invasion of privacy and would require a long series of detailed questions or perhaps an extended questionnaire.

This is not the business of my GP or any other medical professional for that matter.

The practical extent of such questions is likely to be,

Physician: "Do you own a gun?"

Patient: "Yes."

Physician: "Are you trained to use it safely?"

Patient: "Yes."

Physician "Is it safely stored?"

Patient "Yes."

End of discussion.

The truth is such questions are completely perfunctory and are designed to convey a political opinion and not to provide medical advice. In the unlikely event that the patient answers no to any of those questions what is the physician going to say?

Is he really going to launch into a responsible gun ownership lesson? Is he going to hand the patient a pamphlet from the NRA? (I guarantee you PaiMD wouldn't.)

Also PalMD mentioned that he would give the patient the statistics on gun deaths and injuries. What exactly is the point of this information? Do you really believe that PalMD is just quoting medical information to educate his patient so he will be more careful with his "assault rifle"?

Lance, I apologize for my "idiot" comment earlier.

I do still think you are wrong about a few things. Simple interventions regarding public health from a doctor actually work. Many gun owners are not as knowledgable as you are. Even in a hunting state like this one, many people have no clue that gun ownership carries inherent statistical dangers and that practicing gun safety can mitigate these dangers.

Many people do not realize the stats on seat belts, either.

I honestly don't care what kind of firearms my patients own, and I don't have "antigun agitprop" on my office walls. I make simple, appropriate inquiries about public health matters (which you are as unqualified to comment on as I am about maintenance of a hunting rifle). I save my political opinions for outside the office. I certainly would not hand out any NRA lit as the NRA is a gun industry advocacy org, and I would find their agitprop inappropriate. If I lived up north, I might consider having some gun safety pamphlets. Meanwhile, my patients are usually forthcoming, esp. since I don't note the specific answers to the questions, only that I counseled them.

It is a patient's right to do whatever is legal (and from my perspective, whatever is illegal as long as it does not pose an imminent and specific threat).

If I have a young parent with children who lives in a bad neighborhood and buys a pistol, if I don't tell him that he and his family are endangered by this, I'm a bad doctor. If I tell him that no amount of training can make a firearm safer, I'm being ignorant or dishonest. If I tell him that no matter how good you are, you are still at risk, I'm right, but I risk alienating him/her. Like all medicine it's a fine line. If I tell a patient their fat and ugly, I'm cruel and I lose a patient. If I fail to tell them that their increased weight puts them at risk and there are interventions that work, I'm doing my job.

I think you are blinded by gun politics. I have a political opinion, as does my professional organization, but it isn't that strongly evidence-based yet (although it is science-based).

You make a valid point that perhaps politics colors what I say to my patients, but I don't think it's all that valid. I present well-researched facts---gun injuries are an important health problem---protect yourself from them. If you are so worried about jack-booted thugs taking your guns that this offends you,well, I'm finally speechless...

PaiMD,

"Lance, I apologize for my "idiot" comment earlier."

Apology accepted. I often come across more bellicose than I intend so apologies if my remarks were offensive.

You sound like a good doctor and I am not a gun nut, honestly. As I said I have never even owned a gun. If you were my doctor I would probably be aware of some of your political opinions and so long as I felt that you had my best interests at heart I probably wouldn't get too worked up even if you expressed them once in a while.

The fact that you admit that your politics color what you say to your patients shows that at least you are aware of the issues involved and are just trying to be a good physician, if a bit pushy.

But being pushy is probably a pretty good trait for a doctor to have since you aren't a government official but a private practitioner.

If you and I kicked back and discussed politics after work over a couple of beers, after your obligatory warning on the dangers of alcohol use no doubt, it might get heated but as you can see I would probably enjoy that, as I have this exchange.

"And yes, chemist,when my patients ride motorcycles, i ask them if they use a helmet, and encourage them to."

Do you encourage your patients who drive cars to wear a helmet as well?

And on a related front, what is the ratio of total car head injuries/motorcycle head injuries that you saw in emergency?

I'm not telling you it is obvious, I'm telling you it is untrue. Gun ownership does NOT carry inherent statistical dangers. Check out this chart to see what I mean. Accidental deaths are 802, out of millions of gun owners. That's so small it is not worthy of any attention in this discussion. A comparable number of people die from aspirin overdose. If you informed your patients of every risk of similar magnitude, you'd have a 5 hour Q&A.

Suicide rates increase every year, which is somewhat intuitive, but note that the rate of death by gun homicide declines significantly as people age. A 20 year old is almost 10 times as likely to be murdered with a gun than is a 60 year old, which makes sense since we hang with people our age, and 20 year olds are far more violent than are 60 year olds. So, one could reduce one's likelihood of being shot with a gun simply by hanging at AARP meetings instead of Eminem concerts.

For many, if not most people, gun ownership carries a statistical danger that rounds to zero. For people who are violent, suicidal, criminal, and/or relatively young, it carries statistical dangers. If you present the issue as if the probability of dying by gun were roughly the same for everyone, you are MISinforming them, every bit as much as you would if you gave the pack-a-week smoker the same talk as the 4-pack-a-day smoker.

Oh, and as if the statistics aren't bad enough, let's not forget that an exceedingly small number of nonsuicidal people are killed with their own guns. Given my personal demographics, whether or not I own a gun is trivial to my risk compared to living in a bad neighborhood filled with less-controlled armed souls. It's my neighbors guns I'm worried about, not mine.

Really, that's a denialist argument. I'll dig up some more cites for you but you really need to read the studies already cited above. "Accidental death" isn't the key...death by firearm is (we can't count "death by idiocy" or "death by the hand of a human, self or other" in the same category as we can't avoid contact with ourselves or other humans).

For example, these stats show comparable death rates from firearms and cars. Cars are an unfortunate necessity of life in most areas, and we mitigate the danger with traffic laws, passive restraints, and air bags.

Guns are a recreational option, and sometime used professionally or for perceived defensive needs. It would be quite simple to avoid exposure to the danger of firearms if you wished to (it is usually the gun you own that kills you).

Of all violent deaths that occurred in 2005 in the 16 states, 48.9% were committed with firearms;

Please also review these stats by age group.

I think there is a lot of good arguing to be done about what is and isn't a good way to address the problem of death and injury by firearm, but to deny that it's a problem is blogging your ears and saying, "lalalalala".

By Anonymous (not verified) on 03 Sep 2008 #permalink

The above is obviously me

PalMD: You've said a few times that a person is statistically more likely to be hurt or killed with their own firearm. I've heard that claim disputed before. What study are you basing this statement off of?

Well, you're sort of shifting the conversation, but i did open the door. I take it you don't dispute the obvious fact that gun injury is a major public health problem. The statement about "own gun" is a generalization based on sound stats, but not ironclad (here is one source of data with citations)

The Risk of Guns in the Home

* Over 35% of American households contain at least one firearm. Police Foundation, 1996
* One out of three handguns is kept loaded and unlocked in the home. Police Foundation, 1996
* Guns kept in the home for self-protection are 22 times more likely to kill someone you know than they are to kill in self-defense. Kellermann, New England Journal of Medicine, 1997
* The risk of homicide in the home is three times greater in households with guns. Kellermann, New England Journal of Medicine, 1993
* The risk of suicide is five times greater in households with guns. Kellermann, New England Journal of Medicine, 1992
* More than 1.2 million elementary-aged, latch-key children have access to guns in their homes. Lee, Journal of the American Medical Association, 1990
* In 60% of fatal accidents involving a firearms, the weapon was located in or near the home. National Association of Children's Hospitals and Related Institutions, 1993
* Currently, an estimated 39% of households have a firearm, while 24% have a handgun. University of Chicago, 1998
* Firearm assaults on family members and other intimate acquaintances are 12 times more lifely to result in death than are assaults using other weapons. Saltzman LE et al., Weapon Involvement and Injury Outcomes in Family and Intimate Assaults, 1997

I could go either way on this debate, but I have to say that the two CDC papers cited in the previous post have a number of inherent problems. The first one is from 1994, and covers 1968-1991. Two significant events happened in that period: the Ford Pinto & Ralph Nader brought public attention to the issue of engineering better safety into cars, and the introduction of crack cocaine and the concomitant explosion of drug related violence in the inner cities. The article predicts results for 2003. I am too lazy to look it up, but how accurate was their projection? Did the trend continue? I am willing to bet that the increase in gun deaths and the decrease in automobile deaths both began to slow down as incremental safety improvements in vehicles became too costly to require (e.g., ABS, side airbags) and the number of violent felons incarcerated increased. (Moreover, as the auto safety initiative happened nearer to the beginning of the sample period, and the increase in drug violence towards the end, the projection curves would be skewed). The second article relied on data from a handful of states, not including California, New York, Texas, Florida or Illinois (e.g., the largest population centers).

I don't have a problem with Dr.s trying to raise public health awareness, but I do have to say it irritates me when my Dr. asks the smoking question (I smoke, but less than one pack a day). I am extremely aware of the dangers of smoking (having lost relatives to lung cancer and being married to a public health scientist), and getting scolded by someone I have met literally for 5 minutes, approx. once a year over the past 5 years (total of maybe 20 minutes), is not exactly persuasive or welcome. If I lived in a smaller town and had a more robust relationship with my MD, I would feel differently, but the type of 5-minutes per patient atmosphere of big city GP practices is probably not the most effective means of communicating public health information. I think it very much depends on the relationship the Doctor wants and is able to have with his/her patients. For example, I talk (or gargle) politics all the time with my dentist, who refuses to be in an insurance network, and is therefore able to perform many of the things that insurance-covered dentists have to delegate to "technicians", allowing him to spend much more time with his patients (and provide a much better quality of care). When he asks me the smoking question, I feel much less like he is reading off a questionnaire, and more like he is genuinely concerned for my well being.

You are aware that the Kellerman studies have been heavily criticized and many claim them invalid (Google Kellerman and Firearms)?

I won't argue that as a society we have developed an extremely loose attitude toward guns, one that I find disturbing. Some people do just get a gun, lock it away in a drawer, and that is all the thought they give it. However, when I talk to people about guns, I encourage them to understand why they want to get a gun (hunting, target shooting, self defense), and once they do, they need to get an appropriate firearm, a safe, to get trained, and to understand how to use and store a gun safely so that it only does what they want it to do. I don't quote statistics to them, especially 10+ year old statistics that are so politically charged and disputed.

of course, that's not the only citations.

Doesn't it just suck when the facts disagree with what you know to be true?

Yeah! Damn reality and it's well-known biases!

Who was it that said "I know what I know. Don't confuse me with facts!"? I forget...

Maybe you could do a study about how effective quoting statistics is to enacting behavior modification, versus offering advice that allows a person to feel more secure within their own decision. Most people don't trust statistics because they know how easily they can be manipulated (Lies, Damn Lies, and Statistics). For every statistic you list, I could probably find a counter statistic if I looked hard enough. I could just go the Stalin route and say that out of 300 million people, 30,000 firearms deaths is statistically not much (0.01% of the population and 1.2% of all deaths).

Saying that something is 22 times more likely to occur is meaningless unless the original probability of occurrence is known as well. If I'm only 0.001% likely to kill a stranger with my gun, but 0.022% likely to kill a family member, then I'm not too worried, as both chances are pretty damn small.

This is why I avoid quoting statistics, they are meaningless unless you understand the context in which they are presented, and you, as a GP, can not adequately do that in the limited time you have with your patients. So if you are quoting statistics, you are pushing your bias onto them, which is not your place. Stick to offering them advice on how to be safer.

What I say to the doctor when he asks off-topic questions: "I really appreciate your concern, but your time is valuable and I don't want to waste it on side issues."

By speedwell (not verified) on 03 Sep 2008 #permalink

For every statistic you list, I could probably find a counter statistic if I looked hard enough.

So go look hard enough. What's stopping you?

See, you're taking a classic denialist tack here, which is to say "Well scientists have been wrong before, so maybe they're wrong now!" That's not a counter-argument, that's plugging your ears and going "PHHLLLLBBBTTT, PHHLLLLBBBTTT , PHHLLLLBBBTTT"

By minimalist (not verified) on 04 Sep 2008 #permalink

no, minimalist, it's "lalalalalalala"

Liar, raspberries are inherently a funnier image. I defy you to prove otherwise.

WITH STATISTICS

By minimalist (not verified) on 04 Sep 2008 #permalink

Well, somebody I once met in a bar (unimpeachable source, right?) said they once read a book that may have been interpreted to say that 85% of people find LALALALALALA to be funnier than a raspberry.

But I could be wrong. <grin>

@LabLemming --
And on a related front, what is the ratio of total car head injuries/motorcycle head injuries that you saw in emergency?

Ask any EMT, anywhere: they have a special name for motorcycle riders who do not wear helmets.

They call them "organ donors."

...Not so for cars. And that alone should tell you something. However, considerably more information is available here: http://www.worldwidewounds.com/2002/october/Bowley/Patterns-Of-Injury-M… -- including

Motorcyclists experience a death rate 35 times greater than the occupants of cars [5]; most of the injuries are to the head and the use of helmets reduces the risk of fatal head injury about one third [7], and the risk of facial injury by two thirds[8].

Have at.

By Luna_the_cat (not verified) on 04 Sep 2008 #permalink

Luna,

Lab lemming's question was, "what is the ratio of total car head injuries/motorcycle head injuries that you saw in emergency?"

The idea being that although motorcyclists "experience a death rate 35 times greater than the occupants of cars" the total number of car occupants is more than 35 times the number of motorcyclists on US roads (and travels many more miles in a car than the average person travels on a motorcycle), therefore an emergency room physician is more likely to encounter a victim of an automobile related head injury.

Thus the question of whether PalMD asks auto occupants if they wear helmets is instructive, because this safety precaution would prevent more injuries annually than properly storing hand guns would.

I can haz data?

No. You can't haz data. Iz no data. I brought you data, but I eated it.

Lance:

In absolute numbers, you are correct, there are far more people injured in cars, as there are far more people in cars than on motorcycles. In terms of individual risk, which is what PalMD wishes to assess in his patients (and what most MDs are interested in), motorcycle riding (and especially without a helmet) are far higher individual risk factors than travel in a car.

Aside from that, all right, here are a few more statistics, although unfortunately the last year in this particular report with full data was 1997 (undoubtedly there are now more recent reports, but I have a strict limit on how much time I can spend arguing with the internets right now).

http://www.nhtsa.dot.gov/people/ncsa/tsf-1998.pdf
The particular sections of interest:
Compare table 7, "Passenger Car Occupants Killed or Injured and Fatality and Injury Rates per Registered Vehicle and Vehicle Miles of Travel, 1975-1998", with Table 10, "Motorcycle Occupants Killed or Injured and Fatality and Injury Rates per Registered Vehicle and Vehicle Miles of Travel, 1975-1998".

For 1997, cars:
registered cars.................................124,672,920
vehicle miles travelled (millions)................1,527,634
car occupants killed.................................22,199
fatality rate per 100,000 registered passenger cars...17.81
fatality rate per 100,000,000 vehicle miles travelled...1.5
car occupants injured.............................2,341,000
injury rate per 100,000 registered passenger cars.....1,877
injury rate per 100,000,000 vehicle miles travelled.....153

For 1997, motorcycles:
registered motorcycles............................3,826,373
vehicle miles travelled (millions)...................10,076
motorcycle occupants (riders) killed..................2,116
fatality rate per 100,000 registered motorcycles......55.30
fatality rate per 100,000,000 vehicle miles travelled..21.0
motorcycle occupants (riders) injured................53,000
injury rate per 100,000 registered....................1,374
injury rate per 100,000,000 vehicle miles travelled.....522

...In other words, absolute numbers of people who show up in the emergency room do not tell the real story of risk.

Also worth considering is that the single most effective measure for reducing risk of injury or death in a car is not, and would not be, helmets: it is seatbelts. And yes, I've had doctors ask about seatbelt use. So once again, the primary risk factor in certain activities is being addressed.

Also, just for interest, for the same year (1997), I found the following US gun death statistics from US Bureau of Justice Statistics (http://www.ojp.usdoj.gov/bjs/glance/tables/frmdth.htm):

Total gun deaths:...32,436
unintentional:.........981
suicide:............17,566
homicide:...........13,522
undetermined:..........367

So gun deaths in the US outnumbered car and motorcycle deaths put together, that year (though not "unintentional" gun deaths, although to be honest I am sure "homicide" is quite unintentional from the point of view of the victim).

Anyway, having contributed my parenthetical $0.03 (allowing for inflation), I need to bow out; I'm on a three week Obligatory Family Visit as of next Monday, and I have heaving amounts of work to finish off before I go.

By Luna_the_cat (not verified) on 04 Sep 2008 #permalink

None of the statistics cited to "prove" guns are the problem are the slightest bit relevant, nor to they refute the points I made, because they assume what they NEED to prove, that the guns were the proximate cause of the problems cited. This is truly amateur hour. That anyone would cite the "22x as likely to kill someone in the house as an intruder" proves this point. This is the sort of thing we professional actuaries and statisticians laugh at. You should be embarrased at how badly your politics are skewing your abilities to think clearly.

The only people here going "lalalalala" are the ones that can't accept the cited facts that gun deaths are far more related to the kinds of people with the guns than the guns themselves. The comparison with cars is appropo in one important sense: whether or not one has an accident is FAR more related to where you live than how often or far you drive. How you feel about it, or how much you intuitively think you know reality is irrelevant.

Anonymous' own data supports my argument. The deaths by gun are HIGHLY correlated with age, plummetting as the victims age, just like with my data. Oh there's denialism going on here alright, but it's by you.

And as I've used more than my share of time here, let me say I am not denying that gun violence is a problem in society: obviously it is. My argument is simply that the problem is not even remotely uniformly distributed across society, but is concentrated in certain demographics, most obviously the young, the male, the suicidal, and the violent. This is supported by ALL of the data. Pretending it isn't, and treating all gun ownership as equally troublesome, does a disservice to your patients, whittling away at your credibility in the same manner that telling kids marijuana will kill them does. And if you've got no credibility, you can't solve the problem.

I think we can all agree that some restriction of gun ownership is solid social policy, and that gun ownership should not be treated cavalierly. I'll leave it at that.

I think we can all agree that some restriction of gun ownership is solid social policy, and that gun ownership should not be treated cavalierly.

-Science Avenger

As I said. Reasonable people, reasonable compromise. At no point did anyone treat "...all gun ownership as equally troublesome". All we have been saying is that 1, talking to people about safe gun storage improves gun storage, and 2, "we need to enforce the laws we have, and make certain that they fit the needs of our diverse population."

When we can get past the knee-jerk "OMG! They're gonna take my guns!" or "OMG! Gunz bad!" we can get to real-world solutions.